Functional tasks exercise versus resistance exercise to improve daily function in older women: a feasibility study

Does Regular Physical Activity Improve Personal Income? Empirical Evidence from China

A lack of adequate exercise threatens human health, weakening human capital accumulation. The relationship between exercise and income has become the focus of attention in health economics. In terms of reducing body weight and improving physical fitness, diet and physical exercise are intertwined and become effective ways to shape a healthy state. Based on individual-level survey data from China, this study quantified the economic returns of habitual exercise behavior by using an endogenous switching regression model (ESRM) to eliminate selection bias. The study shows that (1) participants in the group with regular exercise behavior increased their income by 3.79% compared with those not exercising regularly; (2) for the group with no regular exercise behavior, regular exercise increased their income by 13.36% compared with those not exercising regularly. Additionally, empirical evidence shows that both drinking and smoking can significantly increase individual income, despite unhealthy habits. These results suggest that the habit of regular physical activity plays a vital role in increasing individual income and improving overall national health, and the effect of individual behavior on income is affected by national culture. The outcomes are empirical evidence for the Chinese government to promote Healthy China Action and support developing countries worldwide to enable habitual exercise, stimulating a policy of exercise behavior.

Effects of Protein-Rich Nutritional Composition Supplementation on Sarcopenia Indices and Physical Activity during Resistance Exercise Training in Older Women with Knee Osteoarthritis

Older adults with knee osteoarthritis (KOA) are at high risk of sarcopenia. Protein-rich nutritional composition supplementation (PS) combined with resistance exercise training (RET) improves muscle gains and facilitates physical activity in older adults. However, whether PS augments the effects of RET on muscle mass and PA in patients with KOA remains unclear. Therefore, this study identified the effects of PS on sarcopenic indices and PA in older women with KOA subjected to an RET program. Eligible older women aged 60–85 years and diagnosed as having KOA were randomly assigned to either the experimental group (EG) or the control group (CG). Both groups performed RET twice a week for 12 weeks. The EG received additional PS during this period. Outcome measures included appendicular lean mass index, walking speed, physical activity, and scores on the Western Ontario and McMaster Universities Osteoarthritis Index—WOMAC). All measures were tested at baseline and after intervention. With participant characteristics and baseline scores as covariates, analysis of variance was performed to identify between-group differences in changes in all outcome measures after intervention. Statistical significance was defined as p < 0.05. Compared with the CG, the EG achieved greater changes in appendicular lean mass index (adjusted mean difference (aMD) = 0.19 kg/m², p < 0.01), physical activity (aMD = 30.0 MET-hour/week, p < 0.001), walking speed (aMD = 0.09 m/s, p < 0.05), and WOMAC global function (aMD = −8.21, p < 0.001) after intervention. In conclusion, PS exerted augmentative effects on sarcopenic indices, physical activity, and perceived global WOMAC score in older women with KOA through 12 weeks of RET.

Adherence Is More Than Just Being Present: Example of a Lay-Led Home-Based Programme with Physical Exercise, Nutritional Improvement and Social Support, in Prefrail and Frail Community-Dwelling Older Adults

BACKGROUND

Little is known about the implementation of lifestyle interventions in frail, community-dwelling people. This study highlights different domains of adherence to explain an effectively delivered home-based intervention.

METHODS

Eighty prefrail and frail persons (≥65 years) participated in a physical training, nutritional, and social support intervention over 24 weeks. A detailed log book was kept for comprehensive documentation in order to assess adherence and further organizational, exercise, and nutritional parameters.

RESULTS

Participants reached an adherence rate (performed home visits/number of planned visits) of 84.0/80.5% from week 1-12/13-24. Out of those, 59% carried out ≥75% of the offered visits. Older age was associated with a higher adherence rate. A mean of 1.5 (0.6) visits/week (2 were planned) were realized lasting for a mean of 1.5 (0.9) hours (154% of the planned duration). Per visit, 1.2 (0.6) circuits of strength training were performed (60.5% of the planned value) and 0.5 (0.3) nutritional interventions (47%). After twelve months, 4.2% still carried out the home visits regularly and 25.0% occasionally.

CONCLUSION

Adherence is much more than "being there". Adherence rate and category are limited parameters to describe the implementation of a complex lifestyle intervention, therefore a comprehensive documentation is needed.

Functional Voice Assessment and Therapy Methods Supported by Telepractice, VoiceEvalU8, and Estill Voice Training

Functional assessment and therapy methods are necessary for a client-centered approach that addresses the client's vocal needs across all environments. The purpose of this article is to present the approach with the intent to encourage discussion and implementation among educators, clinicians, researchers, and students. The functional approach is defined and its importance is described within the context of the World Health Organization's International Classification of Functioning, Disability, and Health with support provided by synchronous and asynchronous telepractice, the VoiceEvalU8 app, server, and web portal, and a framework that defines voice qualities (e.g., resonance, twang, loud, and others) by the anatomy and physiology of the voice production system (i.e., Estill Figures for Voice). Case scenarios are presented to highlight application of the functional voice approach.

Comparação de cinesioterapia em solo e em água em idosos

Introdução. O envelhecimento está associado com perda da capacidade funcional. Como conseqüência, há diminuição da independência e aumento de risco de quedas. Objetivo. Avaliar a melhora do desempenho funcional no idoso, comparando dois protocolos: em solo (S) e em água (A). Método. Um estudo prospectivo de 12 semanas, randomizado e cego foi realizado no departamento de fisioterapia da Universidade Metodista de São Paulo (UMESP). Os dados foram obtidos pela versão brasileira do questionário OARS (Older Americans Resources and Services Program), Brazilian Multidimensional Functional Assessment Questionnaire (BOMFAQ). Resultados. A pontuação média do OARS demonstrou passou de 70,6±1 para 72,1±1 (p=0,37) no grupo S e de 71,5±0,8 para 72,9±0,8 (p=0,16) no grupo A. Uma atividade em S (andar no plano) e uma atividade em A (deitar e levantar da cama) apresentaram melhora significativa de 4,7±1,2 para 5,6±0,7 com p=0,03 de 4,7±1,2 para 5,6±0,7 com p=0,02, respectivamente. Conclusão. Um programa de atividade física baseada em exercícios em solo e em água aumenta significantemente a capacidade de andar no plano e de deitar e levantar da cama.

Effects of linear periodization versus daily undulating periodization on neuromuscular performance and activities of daily living in an elderly population

BACKGROUND

Periodization is a systematic training calendar designed to provide variations in performance targeting, while maximizing results and reducing the potential for overtraining. When provided across multiple weeks, termed a mesocycle, it may also incorporate active recovery periods using specified drills designed to translate neuromuscular gains into targeted functional abilities. There are a number of models that can be used when applying periodization to resistance training (RT). Among the most common are the linear (LP) and daily fixed non-linear (NLP) models. It is currently unknown whether an optimal periodization strategy exists that will maximize benefits for older adults; therefore, we compared the impact of these two periodization models on neuromuscular and functional measures in a group of older persons living independently in the community.

METHODS

Thirty-six older adults, 58-80 years of age, were randomly assigned to either a LP (n = 16; 69.3 ± 4.6 y) or NLP (n = 14; 68.9 ± 6.7 y) group. The LP group performed 12 weeks of training comprised of separate 4-week strength and power training cycles, each followed by a 2-week recovery period incorporating translational exercises. The NLP group performed the strength, power, and translational training on three separate days during the week. Neuromuscular testing included seated chest press and leg press strength and power tests, while physical function testing included the gallon jug shelf test, laundry transfer test, floor stand-up, chair-to-stand test, and 8 foot timed up-and-go.

RESULTS

3 (time) × 2 (sex) × 2 (group) repeated measures ANOVA revealed both periodization strategies were equally effective at inducing neuromuscular and functional improvements and that men generally produced more strength and power than women.

CONCLUSIONS

Both LP and NLP can be used to improve strength, power, and functional performance in healthy untrained older adults when strength, power and functional training cycles are involved. Therefore, personal preference and variety should be considered when deciding which approach to use, provided high-speed power and translational recovery components are included.

Multicomponent Training Program with High-Speed Movement Execution of Ankle Muscles Reduces Risk of Falls in Older Adults

The purpose of this study was to investigate the effects of multicomponent training program, designed to improve the torque around the ankle joint performing high-speed movement execution, on healthy older adults. Participants were balanced by torque around the ankle joint and randomly allocated to either exercise (n = 12, 69.7 ± 4.8 years, 74.6 ± 16.8 kg, 1.63 ± 0.10 m) or control group (CG) (n = 14, 70.86 ± 6.48 years; 73.5 ± 13.4 kg, 1.56 ± 0.05 m). The exercise group (EG) performed a multicomponent training of resistance, agility, and coordination exercises, focusing on the plantar flexor muscles during 12 weeks (3 days per week). Outcome measures were torque (plantar flexion and extension), reactive capacity (Step test), and functional mobility (gait and timed up and go [TUG] test). The training program was induced to increase peak torque of extensor muscles around the ankle joint to EG (Δ = 50%; d = 1.59) compared to the CG. Such improvement was converted to reactive capacity improvements considering the decrease in the execution time of the Swing phase and in the Total time of the Step test (Δ = 19%; d = 0.93, Δ = 14%; d = 1.02, respectively). Gains in functional mobility were verified by the increase of the walking speed (Δ = 15%; d = 1.37) and by the smaller time of execution of TUG test (Δ = 17%; d = 1.73) in the EG. Therefore, the multicomponent training was effective to reduce or to reverse muscular age-related declines, which are associated with functional capacity and reduction of fall risk in older adults.

The effectiveness of functional task exercise and physical therapy as prevention of functional decline in community dwelling older people with complex health problems

Background

A physically active lifestyle in older people contributes to the preservation of good health. We assessed the influence of physiotherapy on daily functioning among community dwelling older people (75+) with complex health problems identified with screening, versus usual care. We also compared functional task exercise (FTE), with problems prioritized by older people, trained in the home environment, versus usual preventive physical therapy (PPT).

Methods

Design: FTE and PPT were compared in a randomized controlled trial (RCT). Both interventions were compared with daily functioning in an observational study: control group.

Setting/Participants: Community-dwelling persons aged ≥75 years with daily activity limitations enlisted in 83 general practices (n = 155).

Interventions: Both intervention groups (FTE, n = 76 and PPT, n = 79) received individual, 30 min treatments. The control group (n = 228) did not get any experimental intervention offered.

Measurements: Groningen Activities of Daily Living Restriction Scale (GARS).

Statistical analyses: Linear Mixed Model analysis, correcting for age, sex, baseline scores and clustering by physiotherapist were used to compare the different groups.

Results

At baseline, 74% percent of the intervention trial group was female vs 79% in the control group. Median ages were 83.9 and 84.7 respectively.

The median baseline GARS-score for the control group was 41.0 (25 and 75 percentile): 35.0; 48.0) and 40.0 (25 and 75 percentile: 32.3; 46.0) for the intervention group (FTE + PPT). The mean change over time was 3.3 (2.5; 4.1) for the control group. Mean difference in change over time between the intervention (FTE + PPT) and the control group was − 2.5 (− 4.3; − 0.6) (p = .009).

Between FTE and PPT the difference in change was − 0.4 (95% CI: -2.3; 3.0, p = 0.795).

Conclusion

An exercise intervention led by physiotherapists may slow down decline in self-reported daily functioning in older persons with daily activity limitations, identified by pro-active case finding.

Trial registration

Netherlands trial register (NTR2407). Registered 6th of July 2010.

Electronic supplementary material

The online version of this article (10.1186/s12877-018-0859-3) contains supplementary material, which is available to authorized users.

Effects of elastic band exercise on lean mass and physical capacity in older women with sarcopenic obesity: A randomized controlled trial

Sarcopenia is associated with loss of muscle mass as well as an increased risk of physical disability in elderly people. This study was aimed to investigate the effect of elastic band resistance training (ERT) on muscle mass and physical function in older women with sarcopenic obesity. A randomized controlled trial with an intention-to-treat analysis was conducted. A total of 56 women (mean ± SD age 67.3 ± 5.1 years) were randomly assigned to the experimental group receiving 12 weeks of ERT and to the control group receiving no exercise intervention. Lean mass (measured using a dual-energy X-ray absorptiometer), physical capacity (assessed using the global physical capacity score), and a 36-item short form questionnaire were conducted at the baseline examination (T₀), as well as the 3-month (T₁) and 9-month followups (T₂). At T₁ and T₂, the between-group difference was measured in total skeletal mass relative to T₀, with mean differences of 0.70 kg (95% CI 0.12-1.28; P < 0.05) and 0.72 kg (95% CI 0.21-1.23; P < 0.01), respectively. Similar results were found in muscle quality, physical capacity, and physical function outcomes. The ERT exerted a significant beneficial effect on muscle mass, muscle quality, and physical function in older women with sarcopenic obesity.

Task-Specific Training for Adults With Chronic Knee Pain: A Case Series

Study Design Case series. Background Recent evidence suggests that traditional impairment-based rehabilitation approaches for patients with knee pain may not result in improved function or reduced disability. This case series describes a novel task-specific training approach to exercise therapy for patients with chronic knee pain and reports changes in measures of clinical outcome (pain and physical function) following participation in the training program. Case Description Seven patients with chronic knee pain aged 40 years or older were included. Each reported at least "moderate" difficulty with sit-to-stand transfers, floor transfers, and/or stair negotiation at baseline. Experienced physical therapists provided between 8 and 16 treatment sessions focusing on improving performance of difficult or painful tasks. Outcomes A majority of patients demonstrated clinically important improvements in both patient-rated outcomes (Knee injury and Osteoarthritis Outcome Score, numeric pain-rating scale, modified Arthritis Self-Efficacy Scale) and performance-based outcomes (30-second chair-rise test, timed stair-climb test, floor transfer test, Performance Assessment of Self-Care Skills). Discussion A task-specific training approach for patients with chronic knee pain was described and yielded considerable improvement in pain and function for most of the individuals in this case series. Larger studies are needed to determine how task-specific training compares with more traditional impairment-based exercise approaches for chronic knee pain. Level of Evidence Therapy, level 5. J Orthop Sports Phys Ther 2017;47(8):548-556. doi:10.2519/jospt.2017.7349.

Promoting ADL independence in vulnerable, community-dwelling older adults: a pilot RCT comparing 3-Step Workout for Life versus resistance exercise

Background

Resistance exercise is effective to increase muscle strength for older adults; however, its effect on the outcome of activities of daily living is often limited. The purpose of this study was to examine whether 3-Step Workout for Life (which combines resistance exercise, functional exercise, and activities of daily living exercise) would be more beneficial than resistance exercise alone.

Methods

A single-blind randomized controlled trial was conducted. Fifty-two inactive, community-dwelling older adults (mean age =73 years) with muscle weakness and difficulty in activities of daily living were randomized to receive 3-Step Workout for Life or resistance exercise only. Participants in the 3-Step Workout for Life Group performed functional movements and selected activities of daily living at home in addition to resistance exercise. Participants in the Resistance Exercise Only Group performed resistance exercise only. Both groups were comparable in exercise intensity (moderate), duration (50–60 minutes each time for 10 weeks), and frequency (three times a week). Assessment of Motor and Process Skills, a standard performance test on activities of daily living, was administered at baseline, postintervention, and 6 months after intervention completion.

Results

At postintervention, the 3-Step Workout for Life Group showed improvement on the outcome measure (mean change from baseline =0.29, P=0.02), but the improvement was not greater than the Resistance Exercise Only Group (group mean difference =0.24, P=0.13). However, the Resistance Exercise Only Group showed a significant decline (mean change from baseline =−0.25, P=0.01) 6 months after the intervention completion. Meanwhile, the superior effect of 3-Step Workout for Life was observed (group mean difference =0.37, P<0.01).

Conclusion

Compared to resistance exercise alone, 3-Step Workout for Life improves the performance of activities of daily living and attenuates the disablement process in older adults.

Relation of physical activity level with quality of life, sleep and depression in patients with knee osteoarthritis

OBJECTIVE:

In the present study, we aimed to investigate the effects of physical activity level on the quality of life, depression, sleep quality and functional capacity in elderly patients with knee osteoarthritis (OA).

METHODS:

Fifty-five patients over 65 years of age (age range: 65–84 years) with knee osteoarthritis were enrolled in the study. Patients were divided into two groups including Insufficient Activity Group (IAG) and Physically Active Group (PAG) according to their responses to the International Physical Activity Questionnaire. Radiological OA grading was performed using Kellgren-Lawrence classification system. Patients were evaluated using Short-Form 36 (SF-36) questionnaire, Beck Depression Inventory (BDI), Pittsburgh Sleep Quality Index (PSQI) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).

RESULTS:

Mean age, body mass indices, mean pain scores and gender distribution were comparable between the two groups. WOMAC physical function scores were lower in the Physically Active Group (p=0.01). Mean PSQI scores did not differ statistically significantly between the two groups (p=0.242). Mean BDI score of PAG was significantly lower compared to that of IAG (p=0.015). Mean SF-36 physical function (p=0.044), physical role (p=0.008) and physical component (p=0.016) scores of the Physically Active Group were significantly higher vs Insufficient Activity Group.

CONCLUSION:

Maintaining a high physical activity level reduces the possibility of depression and improves the quality of life and functional capacity in geriatric patients with knee osteoarthritis.

Relationship between functional movement screen scores, core strength, posture, and body mass index in school children in Moldova

The assessment of functionality should include parameters that consider postural control, limb asymmetries, range of motion limitations, proprioceptive deficits, and pain. An increasingly popular battery of tests, the Functional Movement Screen (FMS), is purported to assess the above named parameters. The purpose of our study was twofold: (a) to report differences in total FMS scores in children, provide preliminary normative reference values of each of the 7 individual FMS scores for both genders and report on asymmetries and (b) to evaluate the relationship between total FMS scores, age, body mass index (BMI), core strength/stability, and postural angles to explore the possibility of using the FMS in the assessment of children's functional fitness. Descriptive data on 77 children aged 8-11 years were collected. The children performed core strength/stability exercises. Photographs were taken from a lateral view for later calculation of postural angles. The children performed the FMS while being videotaped for later review. The average total FMS score (of 21) was 14.9 (+1.9), and BMI was 16.4 (+2.2). Static posture is not related to results of the FMS. Core strength was positively correlated to the total FMS score (r = 0.31; p = 0.006). Over 60% demonstrated at least 1 asymmetry. The individual test scores indicate that none of the test items is too difficult for the children. Based on the screen's correlation to core strength, and the fact that it identifies areas of asymmetry, we suggest to further investigate its possible use in the assessment of children's functional fitness.

Intensive Gait Training for Older Adults with Symptomatic Knee Osteoarthritis

OBJECTIVE

The objective of this study was to determine whether individualized gait training is more effective than usual care for reducing mobility disability and pain in individuals with symptomatic knee osteoarthritis.

DESIGN

Adults aged 60 yrs or older with symptomatic knee osteoarthritis and mobility limitations were randomized to physical therapist-directed gait training on an instrumented treadmill, with biofeedback individualized to optimize knee movements, biweekly for 3 mos or usual care (control). Mobility disability was defined using Late Life Function and Disability Index Basic Lower Limb Function score (primary); mobility limitations, using timed 400-m walk, chair-stand, and stair-climb tests; and symptoms, using the Knee Injury/Osteoarthritis Outcome Score at baseline, as well as at 3, 6, and 12 mos. The analyses used longitudinal mixed models.

RESULTS

There were no significant intergroup differences between the 35 gait-training (74.3% women; age, 69.7 ± 8.2 yrs) and 21 control (57.1% women; age, 68.9 ± 6.5 yrs) participants at baseline. At 3 mos, the gait-training participants had greater improvement in mobility disability (4.3 ± 1.7; P = 0.0162) and symptoms (8.6 ± 4.1; P = 0.0420). However, there were no intergroup differences detected for pain, 400-m walk, chair-stand, or stair-climb times at 3 mos or for any outcomes at 6 or 12 mos.

CONCLUSIONS

Compared with usual care, individualized gait training resulted in immediate improvements in mobility disability knee symptoms in adults with symptomatic knee osteoarthritis, but these effects were not sustained.

Handgrip strength, functionality and plasma levels of IL-6 in elderly women

AbstractIntroduction Aging is associated with a chronic low-grade inflammatory process characterized by an increased production of inflammatory mediators. These elevated levels are predictors for muscle function (sarcopenia) and deterioration of physical performance in the elderly.Objective To investigate the correlation between sarcopenia, functional capacity, and interleukin-6 levels.Materials and methods This cross-sectional study assessed a convenience sample of elderly individuals (n = 130) using a handgrip dynamometer (JAMAR™), and the functional capacity test was performed by sitting and standing. Interleukin-6 levels were determined using high sensitivity ELISA kits. Spearman correlation coefficient was used to assess the correlation between these variables, at a significance level (α) of 0.05.Results There was significant inverse correlation between strength and function (rS = -0.273, p = 0.002) such that elderly individuals with lower peak force took longer to perform the sit-to-stand test, in contrast with the relationship between plasma interleukin-6 levels and strength (rS = -0.043, p = 0.624) or functionality (rS = -0.060, p = 0.501).Conclusion The outcome measures analyzed could predict the decline in muscle strength and functional capacity, and may be indicative of sarcopenia in elderly individuals. There was no correlation between the interleukin-6 levels and the grip strength and functional capacity of the sample investigated.

Analysis of Core Stability Exercise Effect on the Physical and Psychological Function of Elderly Women Vulnerable to Falls during Obstacle Negotiation

[Purpose] The aim of the present study was to investigate the effects of core stability exercise (CSE) on the physical and psychological functions of elderly women while negotiating general obstacles. [Subjects and Methods] After allocating 10 elderly women each to the core stability training group and the control group, we carried out Performance-Oriented Mobility Assessment (POMA) and measured crossing velocity (CV), maximum vertical heel clearance (MVHC), and knee flexion angle for assessing physical performances. We evaluated depression and fear of falling for assessing psychological functions. [Results] Relative to the control group, the core stability training group showed statistically significant overall changes after the training session: an increase in POMA scores, faster CV, lower MVHC, and a decrease in knee flexion angle. Furthermore, depression and fear of falling decreased significantly. [Conclusion] CSE can have a positive effect on the improvement of physical and psychological performances of older women who are vulnerable to falls as they negotiate everyday obstacles.

Individual correlates of autonomy in activities of daily living of institutionalized elderly individuals: an exploratory study in a holistic perspective

This study aimed at identifying the individual correlates of autonomy in activities of daily living (ADL) of 40 institutionalized elderly individuals. Results showed that balance skill and perception of physical functioning were significantly associated with ADL. Interventions on the physical functioning, both perceived and real, might have positive influence on the autonomy of institutionalized elderly individuals.

Assessment of Daily Activity Performance: Exploring the Option of Shortening the Test

The Assessment of Daily Activity Performance (ADAP) test has been developed to measure the physical capacity of older adults to carry out instrumental activities of daily living (ADL). The present study explores the option to create a less time-consuming short version of the ADAP that can be completed in the individual’s home environment and that imposes less of a physical burden. Data from 141 independently living women aged 70 and older were analyzed using principal components analysis (PCA). PCA identified two factors, on which 10 of the original 21 items had loaded sufficiently to be eligible for inclusion in a short version. The ADAP short version is considerably shorter than the original test and provides a good representation of the constructs being measured. More research is necessary to develop a short version of the ADAP that is easily applicable in the home environment of older adults.

Effect of occupation- and activity-based interventions on instrumental activities of daily living performance among community-dwelling older adults: a systematic review

This systematic review examines the effectiveness of occupation- and activity-based interventions on community-dwelling older adults' performance of instrumental activities of daily living (IADLs). It was conducted as part of the American Occupational Therapy Association's Evidence-Based Practice Project. Forty studies met the inclusion criteria and were critically appraised and synthesized. Within occupation-based and client-centered interventions, the evidence that multicomponent interventions improve and maintain IADL performance in community-dwelling older adults is strong. The results also indicate that client-centered, occupation-based interventions can be effective in improving and maintaining IADL performance. The evidence is moderate for functional task exercise programs and limited for simulated IADL interventions to improve IADL performance. In the area of performance skills, the evidence related to physical activity and cognitive skills training is mixed, and the evidence that vision rehabilitation interventions improve IADL performance in older adults with low vision is moderate. Implications for practice, education, and research are also discussed.

Optimizing the benefits of exercise on physical function in older adults

As the number of older adults continues to rise worldwide, the prevention of physical disability among seniors is an increasingly important public health priority. Physical exercise is among the best known methods of preventing disability, but accumulating evidence indicates that considerable variability exists in the responsiveness of older adults to standard training regimens. Accordingly, a need exists to develop tailored interventions to optimize the beneficial effects of exercise on the physical function of older adults at risk for becoming disabled. The present review summarizes the available literature related to the use of adjuvant or alternative strategies intended to enhance the efficacy of exercise in improving the physical function of older adults. Within this work, we also discuss potential future research directions in this area.

Upper extremity muscle volumes and functional strength after resistance training in older adults

Aging leads to a decline in strength and an associated loss of independence. The authors examined changes in muscle volume, maximum isometric joint moment, functional strength, and 1-repetition maximum (1RM) after resistance training (RT) in the upper extremity of older adults. They evaluated isometric joint moment and muscle volume as predictors of functional strength. Sixteen healthy older adults (average age 75 ± 4.3 yr) were randomized to a 6-wk upper extremity RT program or control group. The RT group increased 1RM significantly (p < .01 for all exercises). Compared with controls, randomization to RT led to greater functional pulling strength (p = .003), isometric shoulder-adduction moment (p = .041), elbow-flexor volume (p = .017), and shoulder-adductor volume (p = .009). Shoulder-muscle volumes and isometric moments were good predictors of functional strength. The authors conclude that shoulder strength is an important factor for performing functional reaching and pulling tasks and a key target for upper extremity RT interventions.

A randomized controlled trial to determine the effect of a model of restorative home care on physical function and social support among older people

OBJECTIVE

To determine the impact of a restorative model of home care on social support and physical function among community-dwelling older people.

DESIGN

Cluster-randomized controlled trial.

SETTING

Home care in an urban area.

PARTICIPANTS

Participants (N=205) were randomly assigned to an intervention group (n=108; mean age, 79.1y; 71.3% women; 81.5% New Zealand European [NZE]; 50.8% residing in areas of the highest levels of social deprivation) or a usual care group (n=97; mean age, 76.9y; 60.8% women; 73.2% NZE; 53.5% in the highest levels of social deprivation).

INTERVENTION

Participants randomly assigned to the intervention group completed a goal facilitation tool with a needs assessor to determine their needs and to establish the aims for the episode of care. Services were structured according to the principles of restorative home care (independence focused with individually tailored activity programs). Usual care participants received a standard needs assessment that informed the delivery of home care services.

MAIN OUTCOME MEASURES

Short Physical Performance Battery (SPPB), Dukes Social Support Index (DSSI).

RESULTS

There was greater change over time in physical function (measured by SPPB: F=8.30, P=.003) but no associated increase in social support (as determined by DSSI: F=2.58, P=.09).

CONCLUSIONS

Significant improvements in physical function were observed after a period of restorative home care services. The absence of an associated change in social support may have been the result of a combination of factors, including the threshold of physical function required for community ambulation, the low rate of allied health service provision, and the time required to reestablish social ties. The findings contribute to a greater understanding of factors necessary to refocus home-based services to emphasize improvements in physical function and independence.

The implementation of the functional task exercise programme for elderly people living at home

Background

The Functional Task Exercise programme is an evidence-based exercise programme for elderly people living at home. It enhances physical capacity with sustainable effects. FTE is provided by physiotherapists and remedial therapists. Although the intervention was found to be effective in a Randomised Controlled Trial, we may not assume that therapists will automatically supply the programme or that elderly people will automatically join the programme. This study protocol focuses on identifying determinants of implementation, developing implementation strategies and studying the effects of the implementation in daily practice.

Methods/Design

Phase 1: The systematic identification of determinants of the implementation of FTE among therapists and the elderly. A questionnaire study was conducted in a random sample of 100 therapists, and interviews took place with 23 therapists and 8 elderly people (aged 66 to 80 years). The determinants were broken down into four categories: the characteristics of the environment, the organisation, the therapists, and the training programme.

Phase 2: Developing and applying strategies adapted to the determinants identified. Fifteen physiotherapists will be trained to provide FTE and to recruit elderly people living at home. The therapists will then deliver the 12-week programme to two groups of elderly, each consisting of six to twelve people aged 70 years or older.

Phase 3: Study of implementation and the impact. To study the actual use of FTE: 1) therapists record information about the selection of participants and how they apply the key features of FTE, 2) the participating elderly will keep an exercise logbook, 3) telephone interviews will take place with the therapists and the elderly and there will be on-site visits. The effects on the elderly people will be studied using: 1) the Patient-Specific Questionnaire, the Timed Up and Go test and a two performance tests. All tests will be performed at the start of the FTE programme, half way through, and at the end of the programme.

Discussion

The number of older people will increase in many countries in the years to come and so the project outcomes will be of interest to policy-makers, insurance companies, health-care professionals and implementation researchers.

Exercise for improving balance in older people

BACKGROUND

In older adults, diminished balance is associated with reduced physical functioning and an increased risk of falling. This is an update of a Cochrane review first published in 2007.

OBJECTIVES

To examine the effects of exercise interventions on balance in older people, aged 60 and over, living in the community or in institutional care.

SEARCH METHODS

We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, CENTRAL (The Cochrane Library 2011, Issue 1), MEDLINE and EMBASE (to February 2011).

SELECTION CRITERIA

Randomised controlled studies testing the effects of exercise interventions on balance in older people. The primary outcomes of the review were clinical measures of balance.

DATA COLLECTION AND ANALYSIS

Pairs of review authors independently assessed risk of bias and extracted data from studies. Data were pooled where appropriate.

MAIN RESULTS

This update included 94 studies (62 new) with 9,917 participants. Most participants were women living in their own home.Most trials were judged at unclear risk of selection bias, generally reflecting inadequate reporting of the randomisation methods, but at high risk of performance bias relating to lack of participant blinding, which is largely unavoidable for these trials. Most studies only reported outcome up to the end of the exercise programme.There were eight categories of exercise programmes. These are listed below together with primary measures of balance for which there was some evidence of a statistically significant effect at the end of the exercise programme. Some trials tested more than one type of exercise. Crucially, the evidence for each outcome was generally from only a few of the trials for each exercise category. 1. Gait, balance, co-ordination and functional tasks (19 studies of which 10 provided primary outcome data): Timed Up & Go test (mean difference (MD) -0.82 s; 95% CI -1.56 to -0.08 s, 114 participants, 4 studies); walking speed (standardised mean difference (SMD) 0.43; 95% CI 0.11 to 0.75, 156 participants, 4 studies), and the Berg Balance Scale (MD 3.48 points; 95% CI 2.01 to 4.95 points, 145 participants, 4 studies).2. Strengthening exercise (including resistance or power training) (21 studies of which 11 provided primary outcome data): Timed Up & Go Test (MD -4.30 s; 95% CI -7.60 to -1.00 s, 71 participants, 3 studies); standing on one leg for as long as possible with eyes closed (MD 1.64 s; 95% CI 0.97 to 2.31 s, 120 participants, 3 studies); and walking speed (SMD 0.25; 95% CI 0.05 to 0.46, 375 participants, 8 studies).3. 3D (3 dimensional) exercise (including Tai Chi, qi gong, dance, yoga) (15 studies of which seven provided primary outcome data): Timed Up & Go Test (MD -1.30 s; 95% CI -2.40 to -0.20 s, 44 participants, 1 study); standing on one leg for as long as possible with eyes open (MD 9.60 s; 95% CI 6.64 to 12.56 s, 47 participants, 1 study), and with eyes closed (MD 2.21 s; 95% CI 0.69 to 3.73 s, 48 participants, 1 study); and the Berg Balance Scale (MD 1.06 points; 95% CI 0.37 to 1.76 points, 150 participants, 2 studies).4. General physical activity (walking) (seven studies of which five provided primary outcome data). 5. General physical activity (cycling) (one study which provided data for walking speed). 6. Computerised balance training using visual feedback (two studies, neither of which provided primary outcome data). 7. Vibration platform used as intervention (three studies of which one provided primary outcome data).8. Multiple exercise types (combinations of the above) (43 studies of which 29 provided data for one or more primary outcomes): Timed Up & Go Test (MD -1.63 s; 95% CI -2.28 to -0.98 s, 635 participants, 12 studies); standing on one leg for as long as possible with eyes open (MD 5.03 s; 95% CI 1.19 to 8.87 s, 545 participants, 9 studies), and with eyes closed ((MD 1.60 s; 95% CI -0.01 to 3.20 s, 176 participants, 2 studies); walking speed (SMD 0.04; 95% CI -0.10 to 0.17, 818 participants, 15 studies); and the Berg Balance Scale ((MD 1.84 points; 95% CI 0.71 to 2.97 points, 80 participants, 2 studies).Few adverse events were reported but most studies did not monitor or report adverse events.In general, the more effective programmes ran three times a week for three months and involved dynamic exercise in standing.

AUTHORS' CONCLUSIONS

There is weak evidence that some types of exercise (gait, balance, co-ordination and functional tasks; strengthening exercise; 3D exercise and multiple exercise types) are moderately effective, immediately post intervention, in improving clinical balance outcomes in older people. Such interventions are probably safe. There is either no or insufficient evidence to draw any conclusions for general physical activity (walking or cycling) and exercise involving computerised balance programmes or vibration plates. Further high methodological quality research using core outcome measures and adequate surveillance is required.

Knee extensor strength is associated with Mini-Mental State Examination scores in elderly men

The present study examined whether the strength capability of knee extensor muscles is associated with global cognitive function, assessed by Mini-Mental State Examination (MMSE), in non-disabled elderly men. Isometric torques during maximal voluntary knee extension, plantar flexion, and elbow flexion and MMSE scores were determined in 39 non-disabled men aged 61-79 years and used for the cross-sectional analysis examining the associations among the measured variables. Moreover, 27 of the subjects participated in a training program consisted of body mass-based exercises (sitting down onto and standing up from a chair, hip joint extension and flexion, calf raises, side leg raises, and trunk flexion and extension) 6 days a week for 3 months. Isometric torques and MMSE scores were determined after the intervention. Among the data before intervention, only knee extension torque (KET) and KET relative to body mass (KET/BM) significantly correlated to the MMSE scores: r = 0.579 (P < 0.0001) for KET and r = 0.520 (P < 0.001) for KET/BM. After the intervention, KET and KET/BM increased significantly, but MMSE score did not. However, the absolute change in MMSE scores was significantly associated with that in KET (r = 0.381, P < 0.05) and KET/BM (r = 0.422, P < 0.05). These findings indicate that the strength capability of knee extensors is associated with global cognitive function in non-disabled elderly men, and provide a new perspective to a general concept that exercises strengthening knee extensor muscles should be included in resistance training programs for elderly individuals.

Increased muscle strength improves managing in activities of daily living in fall-prone community-dwelling older women

BACKGROUND AND AIMS

The aim of this longitudinal study was to describe whether an increase in knee extension strength is associated with improvements in managing in activities of daily living (ADL) and in self-perceived physical condition in fall-prone community-dwelling older women.

METHODS

Subjects (n=417) aged ≥ 65 years belonged either to intervention or control groups in a 12-month randomized controlled fall prevention trial. Isometric muscle strength of knee extension was measured with an adjustable dynamometer chair. Managing in activities of daily living was measured with structured questions about abilities to climb stairs, walk at least 400 meters, toilet, bath, go to the sauna, do light or heavy housework, and carry heavy loads. A question of self-perceived physical condition was also asked.

RESULTS

Positive associations were found between increased knee extension strength and an increase in walking at least 400 meters (p<0.001), carrying heavy loads (p=0.004), and climbing stairs (p=0.007), and in self perceived physical condition (p=0.005) over a 12- month follow-up. In addition, low age, non-use of a walking aid, low number of prescribed medications, and good functional balance at baseline were associated with an increase in performance of these ADL functions.

CONCLUSIONS

An increase in knee extension strength during the 12-month follow-up was associated with improvement in some ADL functions and improvement in self-perceived physical condition during the same period in fall-prone community-dwelling women.

Feasibility and preliminary effectiveness of ice therapy in patients with an acute tear in the gastrocnemius muscle: a pilot randomized controlled trial

OBJECTIVE

To investigate the feasibility of a randomized controlled trial and the preliminary effectiveness of ice therapy in the acute phase of a gastrocnemius tear for the quality of functional recovery.

DESIGN

A pilot version of an intended prospective randomized controlled clinical trial was conducted.

PARTICIPANTS

A total of 19 patients with an acute tear in the gastrocnemius muscle were randomly allocated to either active or control treatment.

INTERVENTION

The intervention consisted of the repeated application of crushed ice.

MAIN MEASURES

Primary outcome measures were functional capacity and reconvalescence time. Secondary outcome measures were pain and work absenteeism. The number of patients we could include within the 6-hour time window and dropping out from the pilot study were regarded as indicators of the feasibility of ice therapy.

RESULTS

A total of 16 patients were excluded from the study because diagnosis was not made within 6 hours after onset of the complaint. The 19 patients included completed the treatment. For functional capacity, reconvalescence time, work absenteeism and pain relief, no significant differences between the intervention and control group were found.

CONCLUSIONS

The execution of a randomized controlled trial on ice therapy for acute gastrocnemius tear is feasible though quite an enterprise. First, it is recommended to improve the recruitment processes. Second, power analysis demands inclusion of 396 participants. Preliminary effectiveness in our limited-sized trial indicates that the use of ice is not beneficial for people who receive ice therapy.

Preoperative therapeutic exercise in frail elderly scheduled for total hip replacement: a randomized pilot trial

OBJECTIVE

To evaluate the feasibility and preliminary effectiveness of therapeutic exercise before total hip replacement in frail elderly.

DESIGN

A single-blind, randomized clinical pilot trial.

SETTING

Outpatient physiotherapy department.

SUBJECTS

Frail elderly with hip osteoarthritis awaiting total hip replacement.

INTERVENTIONS

A short (3-6 weeks) tailor-made, therapeutic exercise programme was compared with usual care.

MAIN MEASURES

Feasibility was assessed through patient satisfaction, adherence, occurrence of adverse events and the number of eligible non-volunteers. Preliminary preoperative effectiveness was assessed with performance and self-reported measures of pain, functioning, physical activity and quality of life. Postoperatively we measured functional recovery and length of hospital stay.

RESULTS

Sixty-two eligible patients were approached of whom 21 (mean age 76 years) agreed to participate. Exercisers (n = 10), rated the intervention as very good 8.9 (8-10) (10-point rating scale). No serious adverse events occurred. Forty-one (66%) eligible patients did not participate, mainly because of logistic considerations, resulting in selection bias. The intervention group (trainings sessions participated 91%) showed relevant preoperative improvements on the chair-rise time (delta -2.9 seconds; 95% confidence interval (CI) -6.2 to 0.4) and timed-up-and-go (delta -4.4 seconds; 95% CI -9.3 to 0.5). Postoperatively, no significant differences were seen.

CONCLUSIONS

A short, tailor-made, exercise programme is well tolerated and appreciated in elderly patients awaiting total hip replacement. However, a larger randomized clinical trial in the same setting is not warranted, because of the high number of eligible non-volunteers.

Progressive resistance strength training for improving physical function in older adults

BACKGROUND

Muscle weakness in old age is associated with physical function decline. Progressive resistance strength training (PRT) exercises are designed to increase strength.

OBJECTIVES

To assess the effects of PRT on older people and identify adverse events.

SEARCH STRATEGY

We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialized Register (to March 2007), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2007, Issue 2), MEDLINE (1966 to May 01, 2008), EMBASE (1980 to February 06 2007), CINAHL (1982 to July 01 2007) and two other electronic databases. We also searched reference lists of articles, reviewed conference abstracts and contacted authors.

SELECTION CRITERIA

Randomised controlled trials reporting physical outcomes of PRT for older people were included.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected trials, assessed trial quality and extracted data. Data were pooled where appropriate.

MAIN RESULTS

One hundred and twenty one trials with 6700 participants were included. In most trials, PRT was performed two to three times per week and at a high intensity. PRT resulted in a small but significant improvement in physical ability (33 trials, 2172 participants; SMD 0.14, 95% CI 0.05 to 0.22). Functional limitation measures also showed improvements: e.g. there was a modest improvement in gait speed (24 trials, 1179 participants, MD 0.08 m/s, 95% CI 0.04 to 0.12); and a moderate to large effect for getting out of a chair (11 trials, 384 participants, SMD -0.94, 95% CI -1.49 to -0.38). PRT had a large positive effect on muscle strength (73 trials, 3059 participants, SMD 0.84, 95% CI 0.67 to 1.00). Participants with osteoarthritis reported a reduction in pain following PRT(6 trials, 503 participants, SMD -0.30, 95% CI -0.48 to -0.13). There was no evidence from 10 other trials (587 participants) that PRT had an effect on bodily pain. Adverse events were poorly recorded but adverse events related to musculoskeletal complaints, such as joint pain and muscle soreness, were reported in many of the studies that prospectively defined and monitored these events. Serious adverse events were rare, and no serious events were reported to be directly related to the exercise programme.

AUTHORS' CONCLUSIONS

This review provides evidence that PRT is an effective intervention for improving physical functioning in older people, including improving strength and the performance of some simple and complex activities. However, some caution is needed with transferring these exercises for use with clinical populations because adverse events are not adequately reported.

Efficacy of progressive resistance training on balance performance in older adults : a systematic review of randomized controlled trials

The serious health, social and economic consequences of falls are well documented. Lower extremity muscle weakness and power as well as balance impairment are major independent intrinsic contributors to falls and amenable to intervention. Progressive resistance training (PRT) is widely accepted as an appropriate modality for treating sarcopenia and has been reported to improve balance. However, other studies affirm no significant effect of PRT on balance. To date, there is no clear, definitive statement or synthesis of studies that has examined the effect of PRT on balance. Therefore, our objective was to systematically review the literature to probe the merit of PRT as a single intervention on balance performance in older adults. We conducted a comprehensive search of major electronic databases to October 2006, with citation searches and bibliographic searches of journal articles and literature/systematic reviews. Two independent reviewers screened for eligibility and assessed the quality of the studies using the Physiotherapy Evidence Database scale for validity assessment. Randomized controlled trials of PRT only, with any balance outcome in participants with a mean age of >/=60 years (individual minimum age >50 years) were included. Trials that contained more than one intervention, providing the PRT and control groups matched the inclusion criteria, were also included. Because of the heterogeneity of interventions and balance outcomes, a meta-analysis was not performed. However, corrected effect sizes with confidence intervals were determined for each study outcome. Twenty-nine studies were compatible with the inclusion/exclusion criteria and were eligible for review. Participants (n = 2174) included healthy, community-dwelling, mobility-limited, frail cohorts and those with chronic comorbidities. Balance outcomes conducted were extensive and were broadly categorized by the authors as: static, dynamic, functional and computerized dynamic posturography. Some studies used more than one balance outcome. The number of balance tests in all totalled 68. Fourteen studies (15 tests representing 22% of all balance tests) reported improvements, significantly greater than controls, in balance performance following PRT. Improvements were not linked to a particular type of balance performance. The inconsistent effect of PRT on balance may be explained by heterogeneity of cohort and balance tests, variability in methodology of the balance test and sample size, inadequate dose of PRT and/or compliance to training, or lack of statistical power. Standardization of balance testing methodology and better reporting of procedures may ensure greater comparability of results in future studies. It is also possible that PRT alone is not a robust intervention for balance control. This is the first systematic synthesis of the literature to examine the effectiveness of PRT alone on balance performance in older adults. The limited evidence presented in currently published data has not consistently shown that the use of PRT in isolation improves balance in this population. However, further research should explore optimal resistance training regimens that: focus on the muscles most pertinent to balance control, best target neuromuscular adaptations that protect against postural challenges and elucidate mechanism(s) by which PRT may affect balance control.

Exercise for improving balance in older people

BACKGROUND

Diminished ability to maintain balance may be associated with an increased risk of falling. In older adults, falls commonly lead to injury, loss of independence, associated illness and early death. Although some exercise interventions with balance and muscle strengthening components have been shown to reduce falls it is not known which elements, or combination of elements, of exercise interventions are most effective for improving balance in older people.

OBJECTIVES

To present the best evidence for effectiveness of exercise interventions designed to improve balance in older people living in the community or in institutional care.

SEARCH STRATEGY

We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (Feb 2006), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2006, Issue 1), MEDLINE (1966 to February 2006), EMBASE (1980 to February 2006), other databases and reference lists of articles. No language restrictions were applied.

SELECTION CRITERIA

Randomised controlled trials and quasi-randomised trials testing exercise interventions designed to improve balance in older people were included. We excluded trials of interventions targeting individuals with specific conditions in order not to broaden the scope of this review too widely. Trials were included where participants were randomised to receive the following: a single exercise intervention or a multiple exercise intervention and a control group (usual activities or attention or recreational activity). Trials comparing two or more exercise interventions and a control group were also included.

DATA COLLECTION AND ANALYSIS

Three pairs of members of the review team independently assessed trial quality and extracted data. For each trial, relative risk and 95% confidence intervals were calculated for dichotomous outcomes, and mean differences and 95% confidence intervals calculated for continuous outcomes. Where appropriate, results of comparable groups of trials were pooled and 95% confidence intervals calculated.

MAIN RESULTS

For the 34 included studies there were 2883 participants at entry. Statistically significant improvements in balance ability were observed for exercise interventions compared to usual activity. Interventions involving gait; balance; co-ordination and functional exercises; muscle strengthening; and multiple exercise types appear to have the greatest impact on indirect measures of balance. There was trend towards an improvement in balance with cycling on a static cycle. However, there was limited evidence that effects were long-lasting.

AUTHORS' CONCLUSIONS

Exercise appears to have statistically significant beneficial effects on balance ability in the short term but the strength of evidence contained within these trials is limited. Many of these mainly small studies demonstrated a range of methodological weaknesses. The failure across the included studies to apply a core set of standardised outcome measures to determine balance ability restricts the capacity to compare or pool different trials from which firm conclusions regarding efficacy can be made. Further standardisation in timing of outcome assessment is also required as is longer term follow-up of outcomes to determine any lasting effects.

Physical training in rehabilitation programs before and after total hip and knee arthroplasty

OBJECTIVE

A review of the literature to investigate physical training in rehabilitation programs before and after hip and knee arthroplasty.

METHODS

We performed a literature search of the MedLINE and Cochrane databases since 1966 to 2006 using 8 keywords for articles of literature reviews or randomized controlled trials investigating physical training before and after hip and knee arthroplasty.

RESULTS AND DISCUSSION

The search resulted in 14 articles: 2 reviews of the literature and 7 articles of studies concerning total hip arthroplasty and 5 knee arthroplasty. Results were difficult to analyze because of the low number of patients included, a high number of dropouts, no matched control populations, different physical training protocols, and the use of functional scores or inadequate parameters. We found no randomized controlled trial concerning physical training after knee arthroplasty.

CONCLUSION

Physical training does not seem benefit patients before hip or knee arthroplasty. However, the training may have benefit immediately after, and particularly well after, total hip arthroplasty.

Definitions of sedentary in physical-activity-intervention trials: a summary of the literature

This review describes the definitions of sedentary used to screen community-dwelling adults in physical-activity-intervention trials published from 2000 to 2005. Results of 42 trials showed that definitions of sedentary varied from <20 to <150 min/week of physical activity, and few reported the type (work, household, or leisure) or intensity of activity that was used to screen participants. The range of "sedentary" samples makes it difficult to compare trial results or generalize findings. Published reports of exercise trials would be more useful to practitioners and researchers if they included an explicit description of the cut point used to define sedentary adults in the sample, in terms of maximum minutes or days per week of activity and the wording of the screening measure in terms of type and intensity of activity.

Power training for older adults

Resistance training is widely advocated for older adults to alleviate the muscle and strength loss that occurs with aging. While primary and secondary prevention of disability are often mentioned as benefits of strength training, the evidence for this is limited and inconclusive. Researchers have started to examine another form of resistance training that may prove to be more beneficial than strength training in terms of the reduction of age-related disability. Power training is being investigated because several studies have shown a stronger relationship between power and function than between strength and function. Early studies on power training suggest that neuromuscular power can be increased to a greater extent with high velocity or explosive training than strength training alone. In addition, there may be more positive effects on performance tasks measured in the laboratory, although evidence on disability reduction was very limited. Adverse events were reported in several studies, although the risk for injuries appears to be higher for testing than for training itself. Future well-designed studies on the risks and benefits of power training should provide more evidence on this promising form of resistance training for older adults of varying health and functional status.

The effect of functional tasks exercise and resistance exercise on health-related quality of life and physical activity. A randomised controlled trial

BACKGROUND

Data regarding the effect of exercise programmes on older adults' health-related quality of life (HRQOL) and habitual physical activity are inconsistent.

OBJECTIVE

To determine whether a functional tasks exercise programme (enhances functional capacity) and a resistance exercise programme (increases muscle strength) have a different effect on the HRQOL and physical activity of community-dwelling older women.

METHODS

Ninety-eight women were randomised to a functional tasks exercise programme (function group), a resistance exercise programme (resistance group), or normal activity group (control group). Participants attended exercise classes three times a week for 12 weeks. The SF-36 Health Survey questionnaire and self-reported physical activity were obtained at baseline, directly after completion of the intervention (3 months), and 6 months later (9 months).

RESULTS

At 3 months, no difference in mean change in HRQOL and physical activity scores was seen between the groups, except for an increased SF-36 physical functioning score for the resistance group compared with the control group (p = 0.019) and the function group (p = 0.046). Between 3 and 9 months, the self-reported physical functioning score of the function group decreased to below baseline (p = 0.026), and physical activity (p = 0.040) decreased in the resistance group compared with the function group.

CONCLUSIONS

Exercise has a limited effect on the HRQOL and self-reported physical activity of community-living older women. Our results suggest that in these subjects HRQOL measures may be affected by ceiling effects and response shift. Studies should include performance-based measures in addition to self-report HRQOL measures, to obtain a better understanding of the effect of exercise interventions in older adults.

Reliability and validity of the Assessment of Daily Activity Performance (ADAP) in community-dwelling older women

BACKGROUND AND AIMS

The Assessment of Daily Activity Performance (ADAP) test was developed, and modeled after the Continuous-scale Physical Functional Performance (CS-PFP) test, to provide a quantitative assessment of older adults' physical functional performance. The aim of this study was to determine the intra-examiner reliability and construct validity of the ADAP in a community-living older population, and to identify the importance of tester experience.

METHODS

Forty-three community-dwelling, older women (mean age 75 yr +/-4.3) were randomized to the test-retest reliability study (n=19) or validation study (n=24). The intra-examiner reliability of an experienced (tester 1) and an inexperienced tester (tester 2) was assessed by comparing test and retest scores of 19 participants. Construct validity was assessed by comparing the ADAP scores of 24 participants with self-perceived function by the SF-36 Health Survey, muscle function tests, and the Timed Up and Go test (TUG).

RESULTS

Tester 1 had good consistency and reliability scores (mean difference between test and retest scores (DIF), -1.05+/-1.99; 95% confidence interval (CI), -2.58 to 0.48; Cronbach's alpha (alpha) range, 0.83 to 0.98; intraclass correlation (ICC) range, 0.75 to 0.96; Limits of Agreement (LoA), -2.58 to 4.95). Tester 2 had lower reliability scores (DIF, -2.45+/-4.36; 95% CI, -5.56 to 0.67; alpha range, 0.53 to 0.94; ICC range, 0.36 to 0.90; LoA, -6.09 to 10.99), with a systematic difference between test and retest scores for the ADAP domain lower-body strength (-3.81; 95% CI, -6.09 to -1.54), ADAP correlated with SF-36 Physical Functioning scale (r=0.67), TUG test (r=-0.91) and with isometric knee extensor strength (r=0.80).

CONCLUSIONS

The ADAP test is a reliable and valid instrument. Our results suggest that testers should practise using the test, to improve reliability, before applying it to clinical settings.