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Kim MK, Kim CY, Baek CY, Kim SW, Je HD, Jeong JH, Kim HD. The effects of various stair-climbing exercises on functional mobility and trunk muscle activation in community-dwelling older adults: A pilot randomized controlled trial. Medicine (Baltimore) 2024; 103:e38446. [PMID: 38847683 PMCID: PMC11155611 DOI: 10.1097/md.0000000000038446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 05/10/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND Stair-climbing (SC) is an essential daily life skill, and stair-climbing exercise (SCE) serves as a valuable method for promoting physical activity in older adults. This study aimed to compare the impact of SCEs with heel contact (HC) and heel off (HO) during SC on functional mobility and trunk muscle (TM) activation amplitudes in community-dwelling older adults. METHODS In the pilot randomized controlled trial, participants were randomly allocated to either the HC group (n = 17; mean age 75.9 ± 6.3 years) or the HO group (n = 17; mean age 76.5 ± 4.6 years). The HC participants performed SCE with the heel of the ankle in contact with the ground, while the HO participants performed SCE with the heel of the ankle off the ground during SC. Both groups participated in progressive SCE for one hour per day, three days per week, over four consecutive weeks (totaling 12 sessions) at the community center. We measured timed stair-climbing (TSC), timed up and go (TUG), and electromyography (EMG) amplitudes of the TMs including rectus abdominis (RA), external oblique (EO), transverse abdominus and internal oblique abdominals (TrA-IO), and erector spinae (ES) during SC before and after the intervention. RESULTS Both groups showed a significant improvement in TSC and TUG after the intervention (P < .01, respectively), with no significant difference between the groups. There was no significant difference in the EMG activity of the TMs between the groups after the intervention. The amplitude of TMs significantly decreased after the intervention in both groups (P < .01, respectively). CONCLUSION Both SCE methods could improve balance and SC ability in older adults while reducing the recruitment of TMs during SC. Both SCE strategies are effective in improving functional mobility and promoting appropriate posture control during SC in older adults.
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Affiliation(s)
- Min-Kang Kim
- Department of Health Science, The Graduate School, Korea University, Seoul, Republic of Korea
| | - Chang-Yong Kim
- Department of Pharmaceutical and Bio-Pharmaceutical Industry, Pharma and Bio Pharma Industry Team, Korea Health Industry Development Institute, Cheongju, Republic of Korea
| | - Chang-Yoon Baek
- Department of Health Science, The Graduate School, Korea University, Seoul, Republic of Korea
- Department of Rehabilitation Medicine, National Health Insurance Ilsan Hospital, Ilsandong-gu, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Suhng-Wook Kim
- Department of Health and Safety Convergence Science, Graduate School, Korea University, Seoul, Republic of Korea
| | - Hyun Dong Je
- Department of Pharmacology, College of Pharmacy, Catholic University of Daegu, Daegu, Republic of Korea
| | - Ji Hoon Jeong
- Department of Pharmacology, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Hyeong-Dong Kim
- Department of Health Science, The Graduate School, Korea University, Seoul, Republic of Korea
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Meulemans L, Van Roie E, Seghers J, Delecluse C. Older adults' lower-limb muscle power production throughout a full flight of stairs: Reliability and comparison between different stair models. PLoS One 2024; 19:e0296074. [PMID: 38359000 PMCID: PMC10868844 DOI: 10.1371/journal.pone.0296074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 12/05/2023] [Indexed: 02/17/2024] Open
Abstract
Lower-limb muscle power should be closely monitored to prevent age-related functional ability declines. Stair-climbing (SC) power is a functionally relevant measurement of lower-limb muscle power. Body-fixed sensors can measure power production throughout the different steps of a flight of stairs to assess different aspects of performance. This study investigated: 1) power production throughout a full flight of stairs; 2) if staircases with less or more steps can provide similar information; and 3) test-retest reliability of SC power. 116 community-dwelling older adults (57 women) ascended three staircases as fast as possible: 12, 6 and 3 steps. Mean vertical power production per step was collected and analyzed using a commercial body-fixed sensor and software. Three phases were found in SC power production: 1) an acceleration phase, i.e., the power produced in step 1 (P1); 2) a phase where the highest performance (Pmax) is reached and; 3) a fatiguing phase with power loss (Ploss; only measurable on 12-step staircase). Mean power (Pmean) over the different steps was also evaluated. P1 did not differ between staircases (all p>0.05), whereas Pmax and Pmean were higher with increasing number of steps (p = 0.073 -p<0.001). P1, Pmax and Pmean were strongly correlated between staircases (r = 0.71-0.95, p<0.05). and showed good to excellent reliability (ICC = 0.66-0.95, p<0.05). Ploss showed poor reliability. To conclude, measurements of SC power production (P1, Pmax and Pmean) with a single sensor on the lower back are reliable across different staircases. A small, transportable, 3-step staircase can be used for measuring power production in clinical practices with no access to regular staircases. However, absolute values are dependent on the number of steps, indicating that measurements to track performance changes over time should always be done using an identical stair model.
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Affiliation(s)
- Lien Meulemans
- Department of Movement Sciences, Physical Activity, Sports & Health Research Group, KU Leuven, Leuven, Belgium
| | - Evelien Van Roie
- Department of Movement Sciences, Physical Activity, Sports & Health Research Group, KU Leuven, Leuven, Belgium
| | - Jan Seghers
- Department of Movement Sciences, Physical Activity, Sports & Health Research Group, KU Leuven, Leuven, Belgium
| | - Christophe Delecluse
- Department of Movement Sciences, Physical Activity, Sports & Health Research Group, KU Leuven, Leuven, Belgium
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3
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Chang BC, Agrawal SK. Change in Muscle Synergies During Stairmill Ascent With External Forces on the Pelvis. IEEE Robot Autom Lett 2022. [DOI: 10.1109/lra.2022.3181740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Biing-Chwen Chang
- Robotics and Rehabilitation Laboratory, Department of Mechanical Engineering, Columbia University, New York, NY, USA
| | - Sunil K. Agrawal
- Department of Mechanical Engineering, Department of Rehabilitation and Regenerative Medicine, Columbia University, New York, NY, USA
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Brodowski H, Andres N, Gumny M, Eicher C, Steinhagen-Thiessen E, Tannen A, Kiselev J. Reliability of stair-climbing speed in two cohorts of older adults. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2021. [DOI: 10.12968/ijtr.2020.0137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims The ability to climb stairs is an important prerequisite for activities of daily living and social participation in older adults, and is therefore an important part of rehabilitation. However, there is no consensus on how to measure stair-climbing ability. The aim of this study was to investigate the test–retest reliability of the measurement of stair-climbing speed (steps per second) as a parameter for functional ability in older adults. Methods A total of 57 participants who were in hospital and 56 participants who were community-dwelling and did not have any limitations in activities in daily living, all aged 60 years and over, ascended and descended a set of 13 stairs twice. The halfway point of the staircase was marked in order to split the time required for both the ascending and the descending actions. Additional measurements consisted of the Functional Reach Test, the Timed Up and Go Test, walking ability using the GAITRite walkway system and the isometric strength of four muscle groups of the lower extremities using a handheld dynamometer. Results Test–retest reliability of the first and second half of the stair-climbing for both ascending and descending showed excellent results for the group of hospitalised participants (intraclass correlation coefficient, [ICC] 0.87, 95% confidence interval [CI] 0.79–0.93 to 0.94, 95% CI 0.9 – 0.97 for comparison of first vs second half of stair climbing; ICC 0.9, 95% CI 0.83-0.94 to ICC 0.95, 95% CI 0.92–0.97 for comparing first vs second measurement)) and moderate to excellent results for the group of community-dwelling participants with no limitations (ICC 0.58, 95% CI 0.37–0.73 to ICC 0.76, 95% 95% CI 0.63-0.85 for comparison of first vs second half of stair climbing; ICC 0.82, 95% CI 0.71-0.89 to 0.92, 95% CI 0.87–0.95 for comparing first vs second measurement). As expected, hospitalised participants took significantly longer descending than ascending stairs (t(56)=6.98, P<0.001, d=0.93). A general and significant trend of increasing speed while descending could be observed in both groups (performing paired sample t-tests). Conclusions The results indicate that stair-climbing speed is not constant and that different patterns exist in older adults who have no limitations and in those who are hospitalised. The use of stair-climbing speed as an assessment tool should include both stair ascent and descent, because differences in these speeds seem to be indicators of stair-climbing ability.
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Affiliation(s)
- Hanna Brodowski
- Institute of Health Sciences, Academic Physiotherapy, Pain and Exercise Research Luebeck University of Luebeck, Luebeck, Germany
- Geriatrics Research Group, Charité – Universitätsmedizin Berlin, Corporate Member of Function Reacheie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Natascha Andres
- Geriatrics Research Group, Charité – Universitätsmedizin Berlin, Corporate Member of Function Reacheie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Margareta Gumny
- Geriatrics Research Group, Charité – Universitätsmedizin Berlin, Corporate Member of Function Reacheie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Cornelia Eicher
- Geriatrics Research Group, Charité – Universitätsmedizin Berlin, Corporate Member of Function Reacheie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Elisabeth Steinhagen-Thiessen
- Geriatrics Research Group, Charité – Universitätsmedizin Berlin, Corporate Member of Function Reacheie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Divison of Lipid Metabolism of the Department of Endocrinology and Metabolic Medicine, Charité – Universitätsmedizin Berlin, Corporate Member of Function Reacheie Universität Berlin Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Antje Tannen
- Institute of Health and Nursing Science, Charité – Universitätsmedizin Berlin, Corporate Member of Function Reacheie Universität Berlin Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Joern Kiselev
- Geriatrics Research Group, Charité – Universitätsmedizin Berlin, Corporate Member of Function Reacheie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Department of Anesthesiology and Intensive Care Medicine, Campus, Charité Mitte, Corporate Member of Function Reacheie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
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5
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Allen JR, Satiroglu R, Fico B, Tanaka H, Vardarli E, Luci JJ, Coyle EF. Inertial Load Power Cycling Training Increases Muscle Mass and Aerobic Power in Older Adults. Med Sci Sports Exerc 2021; 53:1188-1193. [PMID: 33433149 DOI: 10.1249/mss.0000000000002588] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE Reductions in skeletal muscle mass, beginning after the third decade of life, reduce maximal neuromuscular power (Pmax). Maximal aerobic power generation is also reduced. The primary purpose of this study was to investigate the effectiveness of maximal power cycling (PC) training using an inertial load ergometer on skeletal muscle mass and cardiovascular function in untrained 50- to 68-yr-old participants. METHODS The study used a pre- or postoutcome exercise intervention testing untrained 50- to 68-yr-old adults (n = 39, M = 15, mean ± SE = 58.5 ± 0.8, range = 50-68 yr). Over the course of 8 wk, participants performed 15 min of training 3 times per week. Each session involved repeated (15-30 times) 4-s sprints of PC. Measurements were thigh muscle volume, total body lean mass, Pmax, peak oxygen consumption, cardio-ankle vascular index, performance on functional tests of living (FTLChair and FTLRamp), and intermuscular fat volume. RESULTS Training for 8 wk increased thigh muscle volume (3.7% ± 0.9%, P < 0.001) and total body lean mass (1.5% ± 0.4%, P < 0.01) while increasing total body mass (TBM) (1.4% ± 0.3%, P < 0.01). Physical performance measures increased significantly (all P < 0.05) with improvements in Pmax (12.0% ± 1.5%); peak oxygen consumption (9.8% ± 1.8%), and FTL (8.5% ± 1.3% to 17.2% ± 2%). Cardio-ankle vascular index was significantly decreased -2.3% ± 1.1% (P < 0.05), indicating reduced arterial stiffness. CONCLUSIONS These results demonstrate that 8 wk of PC training at true maximal power was effective at increasing muscle mass and maximal power, as well as maximal cardiovascular capacity and functional tasks in untrained 50- to 68-yr-olds.
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Affiliation(s)
- Jakob R Allen
- Human Performance Laboratory, Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX
| | - Remzi Satiroglu
- Human Performance Laboratory, Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX
| | - Brandon Fico
- Cardiovascular Aging Research Laboratory, Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX
| | - Hirofumi Tanaka
- Cardiovascular Aging Research Laboratory, Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX
| | - Emre Vardarli
- Human Performance Laboratory, Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX
| | - Jeffrey J Luci
- Department of Neuroscience and Biomedical Engineering, and the Biomedical Imaging Center, The University of Texas at Austin, Austin, TX
| | - Edward F Coyle
- Human Performance Laboratory, Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX
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Bakker EA, Zoccali C, Dekker FW, Eijsvogels TMH, Jager KJ. Assessing physical activity and function in patients with chronic kidney disease: a narrative review. Clin Kidney J 2020; 14:768-779. [PMID: 33777360 PMCID: PMC7986327 DOI: 10.1093/ckj/sfaa156] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 07/08/2020] [Indexed: 01/08/2023] Open
Abstract
Physical activity potentially improves health outcomes in patients with chronic kidney disease (CKD) and recipients of kidney transplants. Although studies have demonstrated the beneficial effects of physical activity and exercise for primary and secondary prevention of non-communicable diseases, evidence for kidney patients is limited. To enlarge this evidence, valid assessment of physical activity and exercise is essential. Furthermore, CKD is associated with a decline in physical function, which may result in severe disabilities and dependencies. Assessment of physical function may help clinicians to monitor disease progression and frailty in patients receiving dialysis. The attention on physical function and physical activity has grown and new devices have been developed and (commercially) launched on the market. Therefore the aims of this review were to summarize different measures of physical function and physical activity, provide an update on measurement instruments and discuss options for easy-to-use measurement instruments for day-to-day use by CKD patients. This review demonstrates that large variation exists in the different strategies to assess physical function and activity in clinical practice and research settings. To choose the best available method, accuracy, content, preferable outcome, necessary expertise, resources and time are important issues to consider.
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Affiliation(s)
- Esmée A Bakker
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Carmine Zoccali
- Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension of Reggio Calabria, National Council of Research, Institute of Clinical Physiology, Reggio Calabria, Italy
| | - Friedo W Dekker
- Centre for Innovation in Medical Education and Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Thijs M H Eijsvogels
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Kitty J Jager
- ERA-EDTA Registry, Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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7
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Park C, Son H, Yeo B. The effects of lower extremity cross-training on gait and balance in stroke patients: a double-blinded randomized controlled trial. Eur J Phys Rehabil Med 2020; 57:4-12. [PMID: 32891079 DOI: 10.23736/s1973-9087.20.06183-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Cross-training is an indirect intervention to promote muscle activity on the affected side by applying resistance exercise to stronger parts of the body. Indirect interventions are useful for treating patients who have difficulty with direct interventions. Previous studies have focused on measuring increased muscle strength and muscle activity in healthy individuals. AIM This study aimed to investigate the effects of cross-training on gait and balance in hemiplegic patients when applied to the affected and unaffected lower extremities. DESIGN Double-blinded randomised controlled trial. SETTING In-patients attending the rehabilitation treatment room of a single center. POPULATION Fifty-two stroke patients were randomly allocated to a control group (N.=19), affected side cross-training group (N.=15), and unaffected side cross-training group (N.=18). METHODS Patients were administered general neurological physiotherapy for 30 mins, twice daily, 5 days/week for 4 weeks. The two intervention groups underwent 30 mins of cross-training instead of general neurological physiotherapy once daily, 3 days/week for 4 weeks (postintervention). For data analysis, one-way ANOVA for between-group comparisons and paired t-tests were performed for within-group comparisons between pre- and postintervention groups (significance level of 0.05). RESULTS In the Timed Up and Go Test (TUG), comparing pre- and postintervention, the control group showed no significant change (P>0.05), while the affected side and unaffected side cross-training groups showed significant improvements in function (P<0.05). In the 10-meter Walk Test, the control group showed no significant change (P>0.05), while the affected side and unaffected side cross-training groups showed significant increases in speed (P<0.05). In balance testing, the limits of stability showed a significantly increase in all three groups (P<0.05). There were no pre- or postintervention differences in gait or balance between the groups (P>0.05). CONCLUSIONS Gait and balance improved in hemiplegic stroke patients who participated in cross-training, regardless of the intervention applied to the affected or unaffected side. CLINICAL REHABILITATION IMPACT In clinical settings, for patients who experience difficulties with direct interventions on the affected side, we propose indirect interventions to improve gait and balance.
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Affiliation(s)
- Chanhyun Park
- Department of Physical Therapy, Team of Rehabilitation, Keunsol Medical Hospital, Busan, South Korea
| | - Hohee Son
- Department of Physical Therapy, College of Health Science, Catholic University of Pusan, Busan, South Korea -
| | - Bokgi Yeo
- Department of Physical Therapy, Team of Rehabilitation, Keunsol Medical Hospital, Busan, South Korea
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Weighted Vest Training in Community-Dwelling Older Adults: A Randomized, Controlled Pilot Study. PHYSICAL ACTIVITY AND HEALTH 2019. [DOI: 10.5334/paah.43] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Bui KL, Maia N, Saey D, Dechman G, Maltais F, Camp PG, Mathur S. Reliability of quadriceps muscle power and explosive force, and relationship to physical function in people with chronic obstructive pulmonary disease: an observational prospective multicenter study. Physiother Theory Pract 2019; 37:945-953. [PMID: 31537146 DOI: 10.1080/09593985.2019.1669233] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background: Muscle power declines with age and is a stronger determinant of physical function than strength. Muscle power using computerized dynamometry has not been investigated in COPD.Objectives: To determine: 1) test-retest reliability of quadriceps power using a standardized protocol with computerized dynamometry; and 2) associations between quadriceps strength and power, and functional capacity.Design/Setting: Prospective observational study in four Canadian research labs.Participants: People with mild to very severe COPD.Methods: Tests were conducted on two days. Quadriceps muscle maximal strength was evaluated during a static maneuver using maximal voluntary isometric contractions (MVIC). Rate of torque development (RTD) during MVIC was used to assess explosive force. Muscle power was measured using a dynamic, isotonic protocol from which peak and average power and peak velocity were derived. Functional capacity was assessed with the Short Physical Performance Battery (SPPB). Reliability was assessed using intraclass correlation coefficients (ICC), standard error of measurements (SEM), and Bland Altman plots. Spearman and Pearson correlation coefficients were used for associations.Results: 65 patients (age 69 ± 8 years; FEV1 48 ± 21% of predicted) were included. ICC was 0.77 for RTD and 0.87-0.98 for isotonic power measures (95%CI 0.63-0.99, p < .001); SEM < 10% for average/peak power and peak velocity, and > 30% for RTD. SPPB had moderate correlation with average power, but not with MVIC or RTD.Conclusion: The standardized isotonic protocol with computerized dynamometry was reliable in assessing quadriceps power in COPD. Our data highlights that average power correlates best with functional capacity, indicating higher relevance than static measures when investigating determinants of function.
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Affiliation(s)
- Kim-Ly Bui
- Centre de Recherche, Institut universitaire de cardiologie et pneumologie de Québec, Université Laval, Québec, Canada
| | - Nathalia Maia
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Didier Saey
- Centre de Recherche, Institut universitaire de cardiologie et pneumologie de Québec, Université Laval, Québec, Canada
| | - Gail Dechman
- School of Physiotherapy, Dalhousie University, Halifax, Canada
| | - François Maltais
- Centre de Recherche, Institut universitaire de cardiologie et pneumologie de Québec, Université Laval, Québec, Canada
| | - Pat G Camp
- Centre for Heart and Lung Innovation, University of British Columbia and St. Paul's Hospital, Vancouver, Canada.,Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Sunita Mathur
- Department of Physical Therapy, University of Toronto, Toronto, Canada
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Normandin E, Yow D, Crotts C, Kiel J, Beavers KM, Nicklas BJ. Feasibility of Weighted Vest Use during a Dietary Weight Loss Intervention and Effects on Body Composition and Physical Function in Older Adults. J Frailty Aging 2019; 7:198-203. [PMID: 30095153 DOI: 10.14283/jfa.2018.17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND While intentional weight loss in older adults with obesity yields clinically important health benefits there is a need to minimize the negative effects of weight loss on concomitant loss of muscle mass and strength. Data show wearing weighted vests during exercise improves lean mass and lower extremity strength, however the efficacy of wearing a weighted vest during a period of weight loss to mitigate muscle and strength loss is not known. OBJECTIVES This study examined the feasibility of daily weighted vest use during a dietary weight loss intervention, and examined effects of vest use on body composition and physical function in well-functioning older adults with obesity. DESIGN Randomized, controlled pilot study. SETTING Wake Forest Baptist Medical Center in Winston-Salem, NC. PARTICIPANTS 37 older (age=65-79 yrs), obese (BMI=30-40 kg/ m2) sedentary men and women. INTERVENTIONS 22-week behavioral diet intervention (targeting 10% weight loss, 1100-1300 kcals/day) with (Diet+Vest; n=20) or without (Diet; n=17) weighted vest use (goal of 10 hours/ day with weight added weekly according to individual loss of body mass). MEASUREMENTS Body composition by dual-energy x-ray absorptiometry and measures of physical function, mobility, and muscle strength/power. RESULTS Average weighted vest use was 6.7±2.2 hours/day and the vest-wear goal of 10 hrs/day was achieved for 67±22% of total intervention days. Five participants reported adverse events from wearing the vest (all back pain or soreness). Both groups lost a similar amount of weight (Diet= -11.2±4.4 kg; Diet+Vest = -11.0±6.3 kg; p<0.001), with no differences between groups (p=0.25). Fat mass, lean mass, and % body fat decreased significantly (p<0.0001), with no differences between groups. Compared to Diet+Vest, the Diet intervention resulted in greater decreases in leg power (p<0.02), with no other between group differences in physical function. CONCLUSION This pilot study showed that vest use during dietary weight loss is feasible and safe in well-functioning older adults with obesity. Larger studies are needed to definitively determine whether external replacement of lost weight during caloric restriction may preserve lower extremity muscle strength and power.
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Affiliation(s)
- E Normandin
- Barbara J. Nicklas, Ph.D. Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA, Phone: (336) 713-8569, Fax: (336) 713-8588, e-mail:
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11
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Mair JL, De Vito G, Boreham CA. Low Volume, Home-Based Weighted Step Exercise Training Can Improve Lower Limb Muscle Power and Functional Ability in Community-Dwelling Older Women. J Clin Med 2019; 8:jcm8010041. [PMID: 30621121 PMCID: PMC6352105 DOI: 10.3390/jcm8010041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 12/21/2018] [Accepted: 01/02/2019] [Indexed: 12/24/2022] Open
Abstract
Stepping exercise can be used as a scalable form of high intensity exercise to enhance important aspects of physical fitness in older populations. The addition of supplementary weights increases the resistive element of stepping, with the potential for training improvements in muscular strength, power, and functional abilities alongside other fitness outcomes. The aim of this study was to evaluate the effects of a low-volume, home-based weighted step exercise programme on muscular strength, power, and functional ability in previously inactive community-dwelling older women. Eleven participants, aged between 65⁻74 years, independently completed a six-week individualised and progressive step exercise training programme wearing a weighted vest. Knee extensor strength, lower limb power output, and physical function using a battery of functional tests were measured at baseline, following a 6-week control period, and again following the 6-week training programme. Following training, lower limb power output improved by 10⁻11% (p < 0.05) and was accompanied by a corresponding 9% (p < 0.01) improvement in stair climb time and 10% (p < 0.01) improvement in normalised stair climbing power, highlighting the beneficial effects of weighted stepping for transferable improvements in functional fitness. The magnitude of observed training improvements suggest that weighted step training has the potential to prolong independence and prevent age-related health conditions such as sarcopenia.
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Affiliation(s)
- Jacqueline L Mair
- School of Applied Sciences, Edinburgh Napier University, Sighthill Campus, Edinburgh EH11 4BN, Scotland.
| | - Giuseppe De Vito
- Institute for Sport and Health, University College Dublin, Bellfield, Dublin 4, Ireland.
| | - Colin A Boreham
- Institute for Sport and Health, University College Dublin, Bellfield, Dublin 4, Ireland.
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12
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Robbins GT, Yih E, Chou R, Gundersen AI, Schnieder JC, Bean JF, Zafonte RD. Geriatric rehabilitation. HANDBOOK OF CLINICAL NEUROLOGY 2019; 167:531-543. [PMID: 31753153 DOI: 10.1016/b978-0-12-804766-8.00029-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Rehabilitation of elderly persons is accompanied by unique challenges, as the physiologic changes with aging may be compounded by a multitude of psychologic, social, and genetic factors. In this chapter we present an overview of the impairments that develop with aging. We discuss factors to consider when evaluating a patient with functional complaints and opportunities for treatment. We provide an overview of common injuries encountered in the elderly, prognostication, and general strategies employed for rehabilitation. New treatment options and areas of ongoing research are also discussed.
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Affiliation(s)
- Gregory T Robbins
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States; Massachusetts General Hospital, Boston, MA, United States; Brigham and Women's Hospital, Boston, MA, United States; Boston Veterans Administration, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Erika Yih
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States; Massachusetts General Hospital, Boston, MA, United States; Brigham and Women's Hospital, Boston, MA, United States; Boston Veterans Administration, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Raymond Chou
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States; Massachusetts General Hospital, Boston, MA, United States; Brigham and Women's Hospital, Boston, MA, United States; Boston Veterans Administration, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Alex I Gundersen
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States; Massachusetts General Hospital, Boston, MA, United States; Brigham and Women's Hospital, Boston, MA, United States; Boston Veterans Administration, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Jeffrey C Schnieder
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States; Massachusetts General Hospital, Boston, MA, United States; Brigham and Women's Hospital, Boston, MA, United States; Boston Veterans Administration, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Jonathan F Bean
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States; Massachusetts General Hospital, Boston, MA, United States; Brigham and Women's Hospital, Boston, MA, United States; Boston Veterans Administration, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Ross D Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States; Massachusetts General Hospital, Boston, MA, United States; Brigham and Women's Hospital, Boston, MA, United States; Boston Veterans Administration, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
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Füzéki E, Banzer W. Physical Activity Recommendations for Health and Beyond in Currently Inactive Populations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15051042. [PMID: 29789470 PMCID: PMC5982081 DOI: 10.3390/ijerph15051042] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 05/21/2018] [Accepted: 05/21/2018] [Indexed: 12/14/2022]
Abstract
Widespread persistent inactivity makes continued efforts in physical activity promotion a persistent challenge. The precise content of physical activity recommendations is not broadly known, and there are concerns that the general messaging of the guidelines, including the recommendations to perform at least 150 min of at least moderate intensity physical activity per week might seem unattainable for and even actually discourage currently inactive people. Here we show that there are a myriad of ways of being physically active, and provide (in part) out-of-the-box examples of evidence based, pragmatic, easily accessible physical activity regimes below 150 min and/or with lower than moderate intensity that yield meaningful health benefits for currently inactive people.
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Affiliation(s)
- Eszter Füzéki
- Department of Sports Medicine, Goethe University Frankfurt, 60487 Frankfurt, Germany.
| | - Winfried Banzer
- Department of Sports Medicine, Goethe University Frankfurt, 60487 Frankfurt, Germany.
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14
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Floreani M, Rejc E, Taboga P, Ganzini A, Pišot R, Šimunič B, Biolo G, Reggiani C, Passaro A, Narici M, Rittweger J, di Prampero PE, Lazzer S. Effects of 14 days of bed rest and following physical training on metabolic cost, mechanical work, and efficiency during walking in older and young healthy males. PLoS One 2018. [PMID: 29529070 PMCID: PMC5847238 DOI: 10.1371/journal.pone.0194291] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
In this study, we investigated: i) the effects of bed rest and a subsequent physical training program on metabolic cost (Cw), mechanical work and efficiency during walking in older and young men; ii) the mechanisms underlying the higher Cw observed in older than young men.Twenty-three healthy male subjects (N = 16 older adults, age 59.6±3.4 years; N = 7 young, age: 23.1±2.9 years) participated in this study. The subjects underwent 14 days of bed rest followed by two weeks of physical training (6 sessions). Cw, mechanical work, efficiency, and co-contraction time of proximal muscles (vastus lateralis and biceps femoris) and distal muscles (gastrocnemius medialis and tibialis anterior) were measured during walking at 0.83, 1.11, 1.39, 1.67 m·s-1 before bed rest (pre-BR), after bed rest (post-BR) and after physical training (post-PT).No effects of bed rest and physical training were observed on the analysed parameters in either group. Older men showed higher Cw and lower efficiency at each speed (average +25.1 and -20.5%, P<0.001, respectively) compared to young. Co-contraction time of proximal and distal muscles were higher in older than in young men across the different walking speeds (average +30.0 and +110.3%, P<0.05, respectively).The lack of bed rest and physical training effects on the parameters analyzed in this study may be explained by the healthy status of both young and older men, which could have mitigated the effects of these interventions on walking motor function. On the other hand, the fact that older adults showed greater Cw, overall higher co-contraction time of antagonist lower limb muscles, and lower efficiency compared to the young cohort throughout a wide range of walking speed may suggest that older adults sacrificed economy of walking to improve stability.
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Affiliation(s)
- Mirco Floreani
- Department of Medical Area, University of Udine, Udine, Italy
- School of Sport Sciences, University of Udine, Udine, Italy
| | - Enrico Rejc
- Department of Medical Area, University of Udine, Udine, Italy
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States of America
| | - Paolo Taboga
- Department of Medical Area, University of Udine, Udine, Italy
- Department of Kinesiology and Health Science, California State University, Sacramento, CA, United States of America
| | - Alessandro Ganzini
- Department of Medical Area, University of Udine, Udine, Italy
- School of Sport Sciences, University of Udine, Udine, Italy
| | - Rado Pišot
- Institute for Kinesiology Research, Science and Research Centre Koper, Koper, Slovenia
| | - Bostjan Šimunič
- Institute for Kinesiology Research, Science and Research Centre Koper, Koper, Slovenia
| | - Gianni Biolo
- Department of Medical, Surgical and Health Sciences, Division of Internal Medicine, University of Trieste, Trieste, Italy
| | - Carlo Reggiani
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Angelina Passaro
- Department of Medical Sciences, Section of Internal and Cardiorespiratory Medicine, University of Ferrara, Ferrara, Italy
| | - Marco Narici
- MRC/ARUK Centre for Musculoskeletal Ageing Research, University of Nottingham, Derby Royal Hospital, Derby, United Kingdom
| | - Joern Rittweger
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
- Department of Pediatrics and Adolescent Medicine, University of Cologne, Cologne, Germany
| | - Pietro Enrico di Prampero
- Department of Medical Area, University of Udine, Udine, Italy
- School of Sport Sciences, University of Udine, Udine, Italy
| | - Stefano Lazzer
- Department of Medical Area, University of Udine, Udine, Italy
- School of Sport Sciences, University of Udine, Udine, Italy
- * E-mail:
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15
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Rejc E, Floreani M, Taboga P, Botter A, Toniolo L, Cancellara L, Narici M, Šimunič B, Pišot R, Biolo G, Passaro A, Rittweger J, Reggiani C, Lazzer S. Loss of maximal explosive power of lower limbs after 2 weeks of disuse and incomplete recovery after retraining in older adults. J Physiol 2018; 596:647-665. [PMID: 29266264 DOI: 10.1113/jp274772] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 12/11/2017] [Indexed: 01/01/2023] Open
Abstract
KEY POINTS Disuse in older adults can critically decrease lower limb muscle power, leading to compromised mobility and overall quality of life. We studied how muscle power and its determinants (muscle mass, single muscle fibre properties and motor control) adapted to 2 weeks of disuse and subsequent 2 weeks of physical training in young and older people. Disuse decreased lower limb muscle power in both groups; however, different adaptations in single muscle fibre properties and co-contraction of leg muscles were observed between young and older individuals. Six physical training sessions performed after disuse promoted the recovery of muscle mass and power. However, they were not sufficient to restore muscle power to pre-disuse values in older individuals, suggesting that further countermeasures are required to counteract the disuse-induced loss of muscle power in older adults. ABSTRACT Disuse-induced loss of muscle power can be detrimental in older individuals, seriously impairing functional capacity. In this study, we examined the changes in maximal explosive power (MEP) of lower limbs induced by a 14-day disuse (bed-rest, BR) and a subsequent 14-day retraining, to assess whether the impact of disuse was greater in older than in young men, and to analyse the causes of such adaptations. Sixteen older adults (Old: 55-65 years) and seven Young (18-30 years) individuals participated in this study. In a subgroup of eight Old subjects, countermeasures based on cognitive training and protein supplementation were applied. MEP was measured with an explosive ergometer, muscle mass was determined by magnetic resonance, motor control was studied by EMG, and single muscle fibres were analysed in vastus lateralis biopsy samples. MEP was ∼33% lower in Old than in Young individuals, and remained significantly lower (-19%) when normalized by muscle volume. BR significantly affected MEP in Old (-15%) but not in Young. Retraining tended to increase MEP; however, this intervention was not sufficient to restore pre-BR values in Old. Ankle co-contraction increased after BR in Old only, and remained elevated after retraining (+30%). Significant atrophy occurred in slow fibres in Old, and in fast fibres in Young. After retraining, the recovery of muscle fibre thickness was partial. The proposed countermeasures were not sufficient to affect muscle mass and power. The greater impact of disuse and smaller retraining-induced recovery observed in Old highlight the importance of designing suitable rehabilitation protocols for older individuals.
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Affiliation(s)
- Enrico Rejc
- Department of Medicine, University of Udine, Udine, Italy.,Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA
| | - Mirco Floreani
- Department of Medicine, University of Udine, Udine, Italy.,School of Sport Sciences, University of Udine, Udine, Italy
| | - Paolo Taboga
- Department of Medicine, University of Udine, Udine, Italy.,Department of Kinesiology and Health Science, California State University, Sacramento, CA, USA
| | - Alberto Botter
- Department of Medicine, University of Udine, Udine, Italy.,School of Sport Sciences, University of Udine, Udine, Italy
| | - Luana Toniolo
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Lina Cancellara
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Marco Narici
- Department of Biomedical Sciences, University of Padova, Padova, Italy.,MRC/ARUK Centre for Musculoskeletal Ageing Research, University of Nottingham, Derby Royal Hospital, Derby, UK
| | - Boštjan Šimunič
- Institute for Kinesiology Research, Science and Research Center of Koper, Koper, Slovenia
| | - Rado Pišot
- Institute for Kinesiology Research, Science and Research Center of Koper, Koper, Slovenia
| | - Gianni Biolo
- Department of Medical Sciences, Surgical and Health Sciences, Clinica Medica AOUTS, University of Trieste, Italy
| | - Angelina Passaro
- Department of Medical Sciences, Section of Internal and Cardiorespiratory Medicine, University of Ferrara, Ferrara, Italy
| | - Joern Rittweger
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Carlo Reggiani
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Stefano Lazzer
- Department of Medicine, University of Udine, Udine, Italy.,School of Sport Sciences, University of Udine, Udine, Italy
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16
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Francis P, Lyons M, Piasecki M, Mc Phee J, Hind K, Jakeman P. Measurement of muscle health in aging. Biogerontology 2017; 18:901-911. [PMID: 28378095 PMCID: PMC5684284 DOI: 10.1007/s10522-017-9697-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 03/25/2017] [Indexed: 12/14/2022]
Abstract
Muscle health is a critical component in the struggle against physical frailty and the efforts to maintain metabolic health until the limit of chronological age. Consensus opinion is to evaluate muscle health in terms of muscle mass, strength and functional capability. There has been considerable variability in the components of muscle health which have been investigated in addition to variability in the tools of assessment and protocol for measurement. This is in stark contrast to the validated measurement of bone health across the adult life span. The purpose of this review was to identify indices of muscle mass, strength and functional capability most responsive to change with ageing and where possible to provide an estimate of the rate of change. We suggest lean tissue mass (LTM) or skeletal muscle (SM) is best evaluated from the thigh region due to its greater responsiveness to ageing compared to the whole body. The anterior compartment of the thigh region undergoes a preferential age-related decline in SM and force generating capacity. Therefore, we suggest that knee extensor torque is measured to represent the force generating capacity of the thigh and subsequently, to express muscle quality (strength per unit tissue). Finally, we suggest measures of functional capability which allow participants perform to a greater maximum are most appropriate to track age-related difference in functional capacity across the adult lifespan. This is due to their ability encompass a broad spectrum of abilities. This review suggests indices of muscular health for which reference ranges can be generated across the lifespan.
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Affiliation(s)
- Peter Francis
- Musculoskeletal Health Research Group, School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, LS13HE, UK.
- Human Science Research Unit, Center for Intervention in Inflammation, Infection and Immunity, University of Limerick, Limerick, Ireland.
| | - Mark Lyons
- Human Science Research Unit, Center for Intervention in Inflammation, Infection and Immunity, University of Limerick, Limerick, Ireland
| | - Mathew Piasecki
- School of Healthcare Science, Manchester Metropolitan University, Manchester, UK
| | - Jamie Mc Phee
- School of Healthcare Science, Manchester Metropolitan University, Manchester, UK
| | - Karen Hind
- Carnegie Research Institute, Leeds Beckett University, Leeds, UK
| | - Philip Jakeman
- Human Science Research Unit, Center for Intervention in Inflammation, Infection and Immunity, University of Limerick, Limerick, Ireland
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17
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Skeletal Muscle Power Measurement in Older People: A Systematic Review of Testing Protocols and Adverse Events. J Gerontol A Biol Sci Med Sci 2017; 73:914-924. [DOI: 10.1093/gerona/glx216] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 10/26/2017] [Indexed: 12/25/2022] Open
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18
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Hicks GE, Sions JM, Velasco TO. Hip Symptoms, Physical Performance, and Health Status in Older Adults With Chronic Low Back Pain: A Preliminary Investigation. Arch Phys Med Rehabil 2017; 99:1273-1278. [PMID: 29111171 DOI: 10.1016/j.apmr.2017.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 09/21/2017] [Accepted: 10/04/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To determine (1) whether there are differences in the prevalence of clinical hip symptoms between older adults with and without chronic low back pain (CLBP); and (2) whether coexisting hip symptoms are associated with worse physical performance and poorer health-related quality of life (HRQOL). DESIGN Case-control study. SETTING Individuals participated in a standardized evaluation in a clinical laboratory. PARTICIPANTS Clinical hip symptoms, which are proposed predictors of radiographic hip osteoarthritis according to American College of Rheumatology guidelines, were evaluated in a volunteer sample of community-dwelling older adults with CLBP (n=54; aged 60-85y) and in age- and sex-matched healthy controls (n=54). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Physical performance was measured by the repeated chair rise test and stair-climbing test. HRQOL was measured by the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). RESULTS Hip joint pain, morning stiffness, and pain with hip internal rotation were more common among older adults with CLBP (P<.05). Participants with CLBP and coexisting hip symptoms had worse physical performance than individuals without CLBP or hip symptoms (P<.0001). Additionally, the presence of coexisting hip symptoms was associated with worse HRQOL, particularly in the domains of social functioning, mental health, and role limitations attributable to emotional problems as measured by the SF-36 (P<.01). CONCLUSIONS Given our limited understanding of CLBP among older adults, there is a definitive need to systematically explore coexisting pain conditions that may contribute to worse outcomes. Based on these data, future longitudinal studies should explore whether coexisting hip symptoms are associated with a worse prognosis in older adults with CLBP.
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Affiliation(s)
- Gregory E Hicks
- Department of Physical Therapy, University of Delaware, Newark, DE.
| | - J Megan Sions
- Department of Physical Therapy, University of Delaware, Newark, DE
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19
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Hicks GE, Sions JM, Coyle PC, Pohlig RT. Altered spatiotemporal characteristics of gait in older adults with chronic low back pain. Gait Posture 2017; 55:172-176. [PMID: 28458149 PMCID: PMC5493311 DOI: 10.1016/j.gaitpost.2017.04.027] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 04/12/2017] [Accepted: 04/21/2017] [Indexed: 02/02/2023]
Abstract
Previous studies in older adults have identified that chronic low back pain (CLBP) is associated with slower gait speed. Given that slower gait speed is a predictor of greater morbidity and mortality among older adults, it is important to understand the underlying spatiotemporal characteristics of gait among older adults with CLBP. The purposes of this study were to determine (1) if there are differences in spatiotemporal parameters of gait between older adults with and without CLBP during self-selected and fast walking and (2) whether any of these gait characteristics are correlated with performance of a challenging walking task, e.g. stair negotiation. Spatiotemporal characteristics of gait were evaluated using a computerized walkway in 54 community-dwelling older adults with CLBP and 54 age- and sex-matched healthy controls. Older adults with CLBP walked slower than their pain-free peers during self-selected and fast walking. After controlling for body mass index and gait speed, step width was significantly greater in the CLBP group during the fast walking condition. Within the CLBP group, step width and double limb support time are significantly correlated with stair ascent/descent times. From a clinical perspective, these gait characteristics, which may be indicative of balance performance, may need to be addressed to improve overall gait speed, as well as stair-climbing performance. Future longitudinal studies confirming our findings are needed, as well as investigations focused on developing interventions to improve gait speed and decrease subsequent risk of mobility decline.
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Affiliation(s)
- Gregory E Hicks
- Department of Physical Therapy, University of Delaware, Newark, DE
| | - J. Megan Sions
- Department of Physical Therapy, University of Delaware, Newark, DE
| | - Peter C. Coyle
- Department of Physical Therapy, University of Delaware, Newark, DE
| | - Ryan T. Pohlig
- Biostatistics Core Facility, University of Delaware, Newark, DE
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20
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Portegijs E, Rantakokko M, Viljanen A, Rantanen T, Iwarsson S. Perceived and objective entrance-related environmental barriers and daily out-of-home mobility in community-dwelling older people. Arch Gerontol Geriatr 2017; 69:69-76. [DOI: 10.1016/j.archger.2016.11.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 08/05/2016] [Accepted: 11/15/2016] [Indexed: 11/17/2022]
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21
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Effects of an Eight-Week Stepladder Exercise Protocol on Lower Limb Muscular Strength of Apparently Healthy Young Adults. HUMAN MOVEMENT 2017. [DOI: 10.1515/humo-2017-0026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractPurpose. Backward descent of stairs is associated with improved muscle strength and reduced joint stress, but the effect of backward ascent of stairs on lower limb muscle strength has not been reported. This study compared the effects of forward and backward stair climbing on lower limb muscle strength in apparently healthy young adults. Methods. The total of 31 young volunteers were allocated to either forward or backward stair climbing group (n = 16 and 15, respectively). Dynamic quadriceps and hamstring muscle strength was assessed in addition to thigh girth at baseline and at weeks 4 and 8 with the use of the repetitive maximum method and tape measure, respectively. Results. Between baseline and week 8, muscular strength in both groups (quadriceps: 14.4 ± 3.6 to 16.4 ± 3.4 kg; 14.0 ± 2.9 to 15.3 ± 2.7 kg; hamstring: 12.2 ± 3.2 to 13.4 ± 3.2; 11.7 ± 2.5 to 12.9 ± 2.7 kg) increased significantly (p < 0.05) while the increase in thigh girth was not significant (p > 0.05). The groups were comparable in all three measures post intervention. Conclusions. Forward and backward stair climbing protocols are effective for improving the dynamic strength of the hamstring and quadriceps muscles of apparently healthy young adults. Thus, either protocol could be used for the improvement of lower limbs dynamic muscle strength.
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Ageing, Muscle Power and Physical Function: A Systematic Review and Implications for Pragmatic Training Interventions. Sports Med 2016; 46:1311-32. [DOI: 10.1007/s40279-016-0489-x] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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23
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Garatachea N, Pareja-Galeano H, Sanchis-Gomar F, Santos-Lozano A, Fiuza-Luces C, Morán M, Emanuele E, Joyner MJ, Lucia A. Exercise attenuates the major hallmarks of aging. Rejuvenation Res 2016; 18:57-89. [PMID: 25431878 DOI: 10.1089/rej.2014.1623] [Citation(s) in RCA: 243] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Regular exercise has multi-system anti-aging effects. Here we summarize how exercise impacts the major hallmarks of aging. We propose that, besides searching for novel pharmaceutical targets of the aging process, more research efforts should be devoted to gaining insights into the molecular mediators of the benefits of exercise and to implement effective exercise interventions for elderly people.
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Affiliation(s)
- Nuria Garatachea
- 1 Faculty of Health and Sport Science, University of Zaragoza , Huesca, Spain
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24
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Abstract
BACKGROUND Functional fitness is the ability of an older adult to perform activities of daily living. Stair-climb power is a well-documented marker of functional fitness among older adults. Gait velocity and parameters of gait are related to functional fitness but have been understudied to date. PURPOSE The purpose of this observational study was to determine differences in parameters of gait between high- and low-functioning older adults. METHODS Twenty high-functioning older adults, mean age (SD)=71.6 (5.6), volunteered for the cross-sectional observational study. Functional fitness was determined by a stair-climb performance test. Parameters of gait included velocity, step length, swing and stance phase, double support time, ground reaction forces, impulse, and propulsion during habitual walking. Analysis of variance was performed to determine differences in the dependent variables between groups. RESULTS Individuals with high levels of functional fitness walked 13.1% faster than the lower-functioning group (P=.01). No significant differences (P>.05) were detected for any other measure; however, all gait parameters were more favorable in the higher-functioning group. CONCLUSION Functional fitness is imperative for older adults as declines could hinder mobility. Thus, earlier detection of declines in gait parameters may reduce the risk of falling. The results suggest that gait velocity was slower among older adults with lower levels of functional fitness.
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Affiliation(s)
- Sally Paulson
- 1Department of Exercise Science, Shippensburg University, Shippensburg, Pennsylvania. 2Department of Health, Human Performance, and Recreation, University of Arkansas, Fayetteville, Arkansas
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STROLLO S, CASEROTTI P, WARD R, GLYNN N, GOODPASTER B, STROTMEYER E. A review of the relationship between leg power and selected chronic disease in older adults. J Nutr Health Aging 2015; 19:240-8. [PMID: 25651453 PMCID: PMC4840887 DOI: 10.1007/s12603-014-0528-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE This review investigates the relationship between leg muscle power and the chronic conditions of osteoarthritis, diabetes mellitus, and cardiovascular disease among older adults. Current literature assessing the impact of chronic disease on leg power has not yet been comprehensively characterized. Importantly, individuals with these conditions have shown improved leg power with training. METHODS A search was performed using PubMed to identify original studies published in English from January 1998 to August 2013. Leg power studies, among older adults ≥ 50 years of age, which assessed associations with osteoarthritis, diabetes mellitus, and/or cardiovascular disease were selected. Studies concerning post-surgery rehabilitation, case studies, and articles that did not measure primary results were excluded. RESULTS Sixteen studies met inclusion criteria, addressing osteoarthritis (n=5), diabetes mellitus (n=5), and cardiovascular disease (n=6). Studies generally supported associations of lower leg power among older adults with chronic disease, although small sample sizes, cross-sectional data, homogenous populations, varied disease definitions, and inconsistent leg power methods limited conclusions. CONCLUSIONS Studies suggest that osteoarthritis, diabetes mellitus, and cardiovascular disease are associated with lower leg power compared to older adults without these conditions. These studies are limited, however, by the heterogeneity in study populations and a lack of standardized measurements of leg power. Future larger studies of more diverse older adults with well-defined chronic disease using standard measures of leg power and interventions to improve leg power in these older adults with chronic disease are needed.
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Affiliation(s)
- S.E. STROLLO
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - P. CASEROTTI
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - R.E. WARD
- Health and Disability Research Institute, Boston University, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - N.W. GLYNN
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - B.H. GOODPASTER
- Sanford Burnham Medical Research Institute, Orlando, FL, USA
| | - E.S. STROTMEYER
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
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Exercises including weight vests and a patient education program for women with osteopenia: a feasibility study of the OsteoACTIVE rehabilitation program. J Orthop Sports Phys Ther 2015; 45:97-105, C1-4. [PMID: 25579693 DOI: 10.2519/jospt.2015.4842] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Prospective case series with 1-year follow-up. OBJECTIVES The primary aim was to describe the OsteoACTIVE rehabilitation program and evaluate its feasibility in terms of progression, adherence, and adverse events in patients with low bone mineral density (BMD) and a healed forearm fracture. The secondary aim was to assess changes in measures of function and quality of life. BACKGROUND Previous studies have shown benefits of weight-bearing activities, resistance exercises, and balance and coordination training for women with low BMD and older adults. However, no studies, to our knowledge, have described or examined a rehabilitation program combining the use of weight vests and patient education in patients with low BMD. METHODS Forty-two postmenopausal women with osteopenia and a healed forearm fracture attended the OsteoACTIVE program for 6 months (3 sessions of 60 minutes per week). Feasibility was assessed by documenting training progression (load and exercises), program adherence (aiming for greater than 80%), and adverse events (joint pain, muscle soreness, and falls). Secondary measures included quadriceps strength, BMD, dynamic balance, walking ability, and self-report functional outcome measures. All outcome measures were recorded preintervention (baseline), postintervention, and at 1-year follow-up. RESULTS Thirty-five women (83%) completed the 6-month program and 31 women (74%) attended all the follow-up measurement sessions. All participants progressed during the rehabilitation program for both load and type of exercises. Furthermore, 87% of the participants met the a priori goal of 80% adherence, and no participants reported adverse events. Improvements in quadriceps strength and BMD of the femoral trochanter were noted at the end of the 6-month training period (P<.05). At 1-year follow-up, there were significant improvements in quadriceps strength and dynamic balance compared to baseline (P<.05). CONCLUSION The OsteoACTIVE rehabilitation program was feasible and achieved progression of training level, had high adherence, and had no adverse events. Positive improvements were established in lower extremity function and femoral trochanter BMD. Clinical trial registered at ClinicalTrials.gov (NCT01357278). LEVEL OF EVIDENCE Therapy, level 4.
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Gray M, Paulson S. Developing a measure of muscular power during a functional task for older adults. BMC Geriatr 2014; 14:145. [PMID: 25551186 PMCID: PMC4290456 DOI: 10.1186/1471-2318-14-145] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 11/27/2014] [Indexed: 11/22/2022] Open
Abstract
Background Muscular power is an important aspect of many activities of daily living and declines at a faster rate than other fitness parameters (i.e. muscular strength and endurance). Assessing muscular power among older adults is problematic as many of the popular tests are contraindicated among older adults and field tests to assess muscular power among older adults have not been validated among older adults. Therefore, the aim of the present investigation was to determine the validity and reliability of a field test to measure of muscular power during a functional movement among community-dwelling older adults (≥ 65 years). Methods Twenty community-dwelling older adults (71.6 ± 5.6) volunteered to have their muscular power assessed during repeated sit-to-stand (STS) tasks. Each participant performed 10 STS with 60 s rest between trials. Muscular power was assessed during this functional movement with the Tendo as well as change in center of mass (COM) over time using cinematography. Results Relative power measured by Tendo was 5.34 ± 1.67 W/kg and values for COM were 5.39 ± 1.73 W/kg (p = .86). Cronbach’s alpha for Tendo muscular power for repeated trials was .98. Conclusions Tendo is a simple field method of determining muscular power among older adults and validation is essential. Results from this investigation support Tendo as a valid and reliable method for determining muscular power during a STS task among older adults. Clinicians may use this tool to evaluate and assess progress in older adults’ power and physical functioning.
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Affiliation(s)
- Michelle Gray
- Department of Health, Human Performance, and Recreation, Human Performance Laboratory, Office for Studies on Aging, University of Arkansas, HPER 309, Fayetteville, AR 72701, USA.
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Kendrick D, Kumar A, Carpenter H, Zijlstra GAR, Skelton DA, Cook JR, Stevens Z, Belcher CM, Haworth D, Gawler SJ, Gage H, Masud T, Bowling A, Pearl M, Morris RW, Iliffe S, Delbaere K. Exercise for reducing fear of falling in older people living in the community. Cochrane Database Syst Rev 2014; 2014:CD009848. [PMID: 25432016 PMCID: PMC7388865 DOI: 10.1002/14651858.cd009848.pub2] [Citation(s) in RCA: 139] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Fear of falling is common in older people and associated with serious physical and psychosocial consequences. Exercise (planned, structured, repetitive and purposive physical activity aimed at improving physical fitness) may reduce fear of falling by improving strength, gait, balance and mood, and reducing the occurrence of falls. OBJECTIVES To assess the effects (benefits, harms and costs) of exercise interventions for reducing fear of falling in older people living in the community. SEARCH METHODS We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (July 2013), the Central Register of Controlled Trials (CENTRAL 2013, Issue 7), MEDLINE (1946 to July Week 3 2013), EMBASE (1980 to 2013 Week 30), CINAHL (1982 to July 2013), PsycINFO (1967 to August 2013), AMED (1985 to August 2013), the World Health Organization International Clinical Trials Registry Platform (accessed 7 August 2013) and Current Controlled Trials (accessed 7 August 2013). We applied no language restrictions. We handsearched reference lists and consulted experts. SELECTION CRITERIA We included randomised and quasi-randomised trials that recruited community-dwelling people (where the majority were aged 65 and over) and were not restricted to specific medical conditions (e.g. stroke, hip fracture). We included trials that evaluated exercise interventions compared with no intervention or a non-exercise intervention (e.g. social visits), and that measured fear of falling. Exercise interventions were varied; for example, they could be 'prescriptions' or recommendations, group-based or individual, supervised or unsupervised. DATA COLLECTION AND ANALYSIS Pairs of review authors independently assessed studies for inclusion, assessed the risk of bias in the studies and extracted data. We combined effect sizes across studies using the fixed-effect model, with the random-effect model used where significant statistical heterogeneity was present. We estimated risk ratios (RR) for dichotomous outcomes and incidence rate ratios (IRR) for rate outcomes. We estimated mean differences (MD) where studies used the same continuous measures and standardised mean differences (SMD) where different measures or different formats of the same measure were used. Where possible, we performed various, usually prespecified, sensitivity and subgroup analyses. MAIN RESULTS We included 30 studies, which evaluated 3D exercise (Tai Chi and yoga), balance training or strength and resistance training. Two of these were cluster-randomised trials, two were cross-over trials and one was quasi-randomised. The studies included a total of 2878 participants with a mean age ranging from 68 to 85 years. Most studies included more women than men, with four studies recruiting women only. Twelve studies recruited participants at increased risk of falls; three of these recruited participants who also had fear of falling.Poor reporting of the allocation methods in the trials made it difficult to assess the risk of selection bias in most studies. All of the studies were at high risk of performance and detection biases as there was no blinding of participants and outcome assessors and the outcomes were self reported. Twelve studies were at high risk of attrition bias. Using GRADE criteria, we judged the quality of evidence to be 'low' for fear of falling immediately post intervention and 'very low' for fear of falling at short or long-term follow-up and all other outcomes.Exercise interventions were associated with a small to moderate reduction in fear of falling immediately post intervention (SMD 0.37 favouring exercise, 95% confidence interval (CI) 0.18 to 0.56; 24 studies; 1692 participants, low quality evidence). Pooled effect sizes did not differ significantly between the different scales used to measure fear of falling. Although none of the sensitivity analyses changed the direction of effect, the greatest reduction in the size of the effect was on removal of an extreme outlier study with 73 participants (SMD 0.24 favouring exercise, 95% CI 0.12 to 0.36). None of our subgroup analyses provided robust evidence of differences in effect in terms of either the study primary aim (reduction of fear of falling or other aim), the study population (recruitment on the basis of increased falls risk or not), the characteristics of the study exercise intervention or the study control intervention (no treatment or alternative intervention). However, there was some weak evidence of a smaller effect, which included no reduction, of exercise when compared with an alternative control.There was very low quality evidence that exercise interventions may be associated with a small reduction in fear of falling up to six months post intervention (SMD 0.17, 95% CI -0.05 to 0.38; four studies, 356 participants) and more than six months post intervention (SMD 0.20, 95% CI -0.01 to 0.41; three studies, 386 participants).Very low quality evidence suggests exercise interventions in these studies that also reported on fear of falling reduced the risk of falling measured either as participants incurring at least one fall during follow-up or the number of falls during follow-up. Very low quality evidence from four studies indicated that exercise interventions did not appear to reduce symptoms of depression or increase physical activity. The only study reporting the effects of exercise interventions on anxiety found no difference between groups. No studies reported the effects of exercise interventions on activity avoidance or costs. It is important to remember that our included studies do not represent the totality of the evidence of the effect of exercise interventions on falls, depression, anxiety or physical activity as our review only includes studies that reported fear of falling. AUTHORS' CONCLUSIONS Exercise interventions in community-dwelling older people probably reduce fear of falling to a limited extent immediately after the intervention, without increasing the risk or frequency of falls. There is insufficient evidence to determine whether exercise interventions reduce fear of falling beyond the end of the intervention or their effect on other outcomes. Although further evidence from well-designed randomised trials is required, priority should be given to establishing a core set of outcomes that includes fear of falling for all trials examining the effects of exercise interventions in older people living in the community.
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Affiliation(s)
- Denise Kendrick
- The University of NottinghamDivision of Primary Care, School of MedicineFloor 13, Tower BuildingUniversity ParkNottinghamUKNG7 2RD
| | - Arun Kumar
- University of NottinghamSchool of Medicine, Division of Primary CareQueen's Medical Centre (B‐Floor)Derby RoadNottinghamUKNG2 6SN
| | - Hannah Carpenter
- University of NottinghamSchool of Medicine, Division of Primary CareQueen's Medical Centre (B‐Floor)Derby RoadNottinghamUKNG2 6SN
| | - G A Rixt Zijlstra
- Maastricht UniversityDepartment of Health Services Research and CAPHRI School for Public Health and Primary CareP O Box 616MaastrichtNetherlands6200 MD
| | - Dawn A Skelton
- Glasgow Caledonian UniversitySchool of Health & Life Sciences, Institute of Applied Health ResearchCowcaddens RdGlasgowUKG4 0BA
| | - Juliette R Cook
- University of NottinghamSchool of Medicine, Division of Primary CareQueen's Medical Centre (B‐Floor)Derby RoadNottinghamUKNG2 6SN
| | - Zoe Stevens
- University College LondonResearch Department of Primary Care and Population HealthFaculty of Biomedical SciencesRoyal Free Campus, Rowland Hill StreetLondonUKNW3 2PF
| | - Carolyn M Belcher
- University of NottinghamSchool of Medicine, Division of Primary CareQueen's Medical Centre (B‐Floor)Derby RoadNottinghamUKNG2 6SN
| | - Deborah Haworth
- University College LondonResearch Department of Primary Care and Population HealthFaculty of Biomedical SciencesRoyal Free Campus, Rowland Hill StreetLondonUKNW3 2PF
| | - Sheena J Gawler
- University College LondonResearch Department of Primary Care and Population HealthFaculty of Biomedical SciencesRoyal Free Campus, Rowland Hill StreetLondonUKNW3 2PF
| | - Heather Gage
- University of SurreySchool of EconomicsGuildfordSurreyUKGU2 7XH
| | - Tahir Masud
- Nottingham University Hospitals NHS TrustQueens Medical Centre CampusNottinghamUKNG7 2UH
| | - Ann Bowling
- University of SouthamptonFaculty of Health SciencesBuilding 45Highfield CampusSouthamptonUKSO17 1BJ
| | | | - Richard W Morris
- University of BristolSchool of Social and Community MedicineCanynge Hall39 Whatley RoadBristolUKBS8 2PS
- Royal Free Campus, UCL Medical SchoolResearch Department of Primary Care and Population HealthLondonUK
| | - Steve Iliffe
- University College LondonResearch Department of Primary Care and Population HealthFaculty of Biomedical SciencesRoyal Free Campus, Rowland Hill StreetLondonUKNW3 2PF
| | - Kim Delbaere
- University of New South WalesNeuroscience Research AustraliaBarker StreetRandwick, SydneyNew South WalesAustralia2223
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Mair JL, Laudani L, Vannozzi G, De Vito G, Boreham C, Macaluso A. Neuromechanics of repeated stepping with external loading in young and older women. Eur J Appl Physiol 2014; 114:983-94. [PMID: 24504651 DOI: 10.1007/s00421-014-2826-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 01/18/2014] [Indexed: 11/28/2022]
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Váczi M, Tékus E, Kaj M, Kőszegi T, Ambrus M, Tollár J, Atlasz T, Szabadfi K, Karsai I. Changes in metabolic and muscle damage indicators following a single bout of jump training on stair versus at level. ACTA ACUST UNITED AC 2014; 100:445-56. [PMID: 24013940 DOI: 10.1556/aphysiol.100.2013.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
UNLABELLED We hypothesized that stair-jump exercise would induce less muscle damage and greater acute metabolic responses than level-jumps. METHODS Trained males executed 100 unilateral jumps on stairs with one leg, and at level with the other leg, with two weeks hiatus. Maximal isometric voluntary torque (MVC) and rate of torque development (RTD)in the quadriceps, and unilateral vertical jump height (VJ) were determined in the trained leg at pre-exercise,immediately at post- (IP), 24 h and 48 h after exercise. Serum creatine kinase (CK) level and delayed onset muscle soreness (DOMS) were evaluated at pre-exercise, 24 h and 48 h. Acute lactate and heart rate responses were also measured. RESULTS Lactate and heart rate at IP increased similarly under the two conditions. CK was elevated and MVC was depressed while RTD and VJ remained unchanged at 24 h in both types of training. MVC recovered at 48 h only after stair-jump exercise. DOMS developed only after level-jumps. Except DOMS, no effects of condition were found in any other variables. CONCLUSIONS We conclude that vigorous stair-jump exercise highly stresses the aerobic and the anaerobic energy system, and it preserves power and rapid torque generating ability 24 h after exercise. Stair-jump could be one alternative exercise to prevent muscle soreness.
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Affiliation(s)
- Márk Váczi
- University of Pécs Institute of Physical Education and Sport Science Ifjúság útja 6 H-7624 Pécs Hungary
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Takaishi T, Ishihara K, Shima N, Hayashi T. Health promotion with stair exercise. JOURNAL OF PHYSICAL FITNESS AND SPORTS MEDICINE 2014. [DOI: 10.7600/jpfsm.3.173] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Nightingale EJ, Pourkazemi F, Hiller CE. Systematic review of timed stair tests. ACTA ACUST UNITED AC 2014; 51:335-50. [DOI: 10.1682/jrrd.2013.06.0148] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Revised: 10/02/2013] [Indexed: 11/05/2022]
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Ross LA, Schmidt EL, Ball K. Interventions to maintain mobility: What works? ACCIDENT; ANALYSIS AND PREVENTION 2013; 61:167-196. [PMID: 23083492 PMCID: PMC3633644 DOI: 10.1016/j.aap.2012.09.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Revised: 08/27/2012] [Accepted: 09/13/2012] [Indexed: 06/01/2023]
Abstract
Mobility, in broad terms, includes everything from the ability to move within your immediate environment (e.g., get out of bed) to the ability to drive across the country. Mobility is essential to maintaining independence and wellbeing, particularly for older adults. This is highlighted by the large number of interventions developed for older adults with the goal of maintaining such mobility. The current paper reviews the state of the science with respect to mobility interventions. Inclusion criteria for the review were: (1) articles must have been peer-reviewed; (2) interventions were evaluated in a randomized controlled trial (RCT); (3) studies included a mobility outcome such as lifespace, driving, or walking ability; (4) studies included a sample of healthy community-dwelling older adults (e.g., not investigations of disease conditions); and (5) studies must have reported enough empirical data and detail such that results could potentially be replicated. Three main types of interventions were identified: cognitive training, educational interventions, and exercise interventions. A detailed summary and evaluation of each type of intervention, and the current evidence regarding its effectiveness in maintaining mobility, are discussed. Several interventions show clear evidence of effectiveness, and thus are prime areas for translation of results to the older population. Needs and issues for future intervention research are also detailed.
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Affiliation(s)
- Lesley A. Ross
- Department of Psychology; Edward R. Roybal Center for Research on Applied Gerontology; University of Alabama at Birmingham; CH 415; 1530 3 Avenue South; Birmingham, AL 35294-1170; USA
| | - Erica L. Schmidt
- Department of Psychology; Edward R. Roybal Center for Research on Applied Gerontology; University of Alabama at Birmingham; CH 415; 1530 3 Avenue South; Birmingham, AL 35294-1170; USA
| | - Karlene Ball
- Department of Psychology; Edward R. Roybal Center for Research on Applied Gerontology; University of Alabama at Birmingham; CH 415; 1530 3 Avenue South; Birmingham, AL 35294-1170; USA
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Donath L, Faude O, Roth R, Zahner L. Effects of stair-climbing on balance, gait, strength, resting heart rate, and submaximal endurance in healthy seniors. Scand J Med Sci Sports 2013; 24:e93-101. [PMID: 24033611 DOI: 10.1111/sms.12113] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2013] [Indexed: 01/22/2023]
Abstract
Stair-climbing serves as a feasible opportunity to remain physically active within everyday-life. Data on neuromuscular and cardiorespiratory performance after regular stair-climbing in seniors are scarce. Forty-eight seniors were stratified to a one- (taking every step, INT1) or two-step strategy (every second step, INT2) or a control group (CON). Thirty-nine seniors [females: n = 22, males: n = 17; age: 70.5 (SD 5.1) years; BMI: 25.8 (3.1) kg/m(2)] completed the 8-week intervention (three weekly sessions). Before and after the intervention, balance, gait, strength, and submaximal endurance (at different intensities) were assessed. Maximal strength and explosive power did not improve significantly (0.10 < P < 0.78). Resting heart rate was significantly reduced in INT2 (-8/min) compared with INT1 (0/min, P = 0.02) and CON (0/min, P = 0.03). Compared with CON, perceived exertion for all intensities (0.007 < P < 0.03) and submaximal exercise heart rate during moderate uphill walking significantly decreased (-11/min; P < 0.05) in INT2. Step counts for forward beam balancing (4.5 cm width) increased in INT2 (P = 0.007) compared with CON. With more pronounced effects in INT2, stair-climbing significantly improved resting and exercise heart rates, perceived exertion, and dynamic balance performance in healthy seniors and may contribute to better overall fitness, reduced fall risk, and less perceived strain during daily life activities.
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Affiliation(s)
- L Donath
- Institute of Exercise and Health Sciences, University of Basel, Basel, Switzerland
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Rantalainen T, Ruotsalainen I, Virmavirta M. Effect of Weighted Vest Suit Worn During Daily Activities on Running Speed, Jumping Power, and Agility in Young Men. J Strength Cond Res 2012; 26:3030-5. [DOI: 10.1519/jsc.0b013e318245c4c6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
Muscle power declines earlier and more precipitously with advancing age compared with muscle strength. Peak muscle power also has emerged as an important predictor of functional limitations in older adults. Our current working hypothesis is focused on examining lower extremity muscle power as a more discriminant variable for understanding the relationships between impairments, functional limitations, and resultant disability with aging.
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Bergmann JHM, Smith ICH, Mayagoitia RE. Using a body sensor network to measure the effect of fatigue on stair climbing performance. Physiol Meas 2012; 33:287-96. [DOI: 10.1088/0967-3334/33/2/287] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Lindelöf N, Karlsson S, Lundman B. Experiences of a high-intensity functional exercise programme among older people dependent in activities of daily living. Physiother Theory Pract 2011; 28:307-16. [PMID: 22007766 DOI: 10.3109/09593985.2011.611217] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The purpose of this qualitative study was to describe the experience of participating in a high-intensity functional exercise programme among older people dependent in activities of daily living (ADL) and living in residential care facilities. Interviews were conducted with nine older people, aged 73-91, and dependent in ADL who had participated in a high-intensity functional exercise programme. Qualitative content analysis was used in analysing the interviews. The findings show that the informants, despite extensive impairments, multiple diagnoses, and advanced age, displayed a belief in the positive effects of the programme, a strong desire to be active, and the will to strive to avoid further loss of capacity. They were struggling with failing bodies that constituted barriers to exercise. Support from the supervisors and belief in personal success facilitated performance of the exercises. The informants related physical and mental improvements that affected their daily life positively and that exercising in a group was stimulating and created a sense of togetherness. The effort was seen as worthwhile because participating in strenuous exercise could imply that they might overcome bodily limitations to achieve increased vitality and improved quality of life.
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Affiliation(s)
- Nina Lindelöf
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, SE-90187 UMEÅ, Sweden.
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Nakamoto H, Yoshitake Y, Takai Y, Kanehisa H, Kitamura T, Kawanishi M, Mori S. Knee extensor strength is associated with Mini-Mental State Examination scores in elderly men. Eur J Appl Physiol 2011; 112:1945-53. [PMID: 21932068 DOI: 10.1007/s00421-011-2176-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Accepted: 09/08/2011] [Indexed: 12/25/2022]
Abstract
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.
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Affiliation(s)
- Hiroki Nakamoto
- National Institute of Fitness and Sports in Kanoya, 1 Shiramizu, Kanoya, Kagoshima 891-2393, Japan
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Shanyinde M, Pickering RM, Weatherall M. Questions asked and answered in pilot and feasibility randomized controlled trials. BMC Med Res Methodol 2011; 11:117. [PMID: 21846349 PMCID: PMC3170294 DOI: 10.1186/1471-2288-11-117] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Accepted: 08/16/2011] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND In the last decade several authors have reviewed the features of pilot and feasibility studies and advised on the issues that should be addressed within them. We extend this literature by examining published pilot/feasibility trials that incorporate random allocation, examining their stated objectives, results presented and conclusions drawn, and comparing drug and non-drug trials. METHODS A search of EMBASE and MEDLINE databases for 2000 to 2009 revealed 3652 papers that met our search criteria. A random sample of 50 was selected for detailed review. RESULTS Most of the papers focused on efficacy: those reporting drug trials additionally addressed safety/toxicity; while those reporting non-drug trials additionally addressed methodological issues. In only 56% (95% confidence intervals 41% to 70%) were methodological issues discussed in substantial depth, 18% (95% confidence interval 9% to 30%) discussed future trials and only 12% (95% confidence interval 5% to 24%) of authors were actually conducting one. CONCLUSIONS Despite recent advice on topics that can appropriately be described as pilot or feasibility studies the large majority of recently published papers where authors have described their trial as a pilot or addressing feasibility do not primarily address methodological issues preparatory to planning a subsequent study, and this is particularly so for papers reporting drug trials. Many journals remain willing to accept the pilot/feasibility designation for a trial, possibly as an indication of inconclusive results or lack of adequate sample size.
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Affiliation(s)
- Milensu Shanyinde
- Primary Care and Population Sciences, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, UK
| | - Ruth M Pickering
- Primary Care and Population Sciences, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, UK
| | - Mark Weatherall
- School of Medicine and Health Sciences, University of Otago Wellington, Wellington, New Zealand
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Stuifbergen AK, Morris M, Jung JH, Pierini D, Morgan S. Benefits of wellness interventions for persons with chronic and disabling conditions: a review of the evidence. Disabil Health J 2011; 3:133-45. [PMID: 20628583 DOI: 10.1016/j.dhjo.2009.10.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Persons living with the effects of chronic and disabling conditions are often at increased risk for the development of secondary conditions and disabilities that can lead to further decline in health status, independence, functional status, life satisfaction, and overall quality of life. OBJECTIVE The purpose of this study was to review the evidence for the benefits of wellness/health promotion interventions for persons with chronic and disabling conditions. METHODS The authors conducted a Medline search (1990-2007) using terms related to wellness and health promotion cross-referenced with general terms for chronic and disabling conditions, as well as 15 specific chronic and/or disabling conditions (e.g., multiple sclerosis, spinal cord injury). Selection of studies was limited to those published in English that reported randomized controlled trails or prospective studies that involved adult human subjects with a chronic and/or disabling condition. All selected studies focused on some aspect of a wellness or health promotion intervention and involved a comparison or control group. Of the 5,847 studies initially identified in the search using medical subject heading terms, 190 met the criteria for full review. Data were extracted from these publications and summarized using descriptive statistics. RESULTS Almost all studies (95%) explored the effects of wellness intervention in a sample diagnosed with a single condition (e.g., cancer, stroke, arthritis). Although the mean sample size was 100, the range in sample size varied widely (6-688); 25% of the studies had sample of 30 or fewer. Almost all studies (89.5%) reported positive effects of the wellness intervention, although the delivery and content of interventions as well as the measurement of outcomes, varied greatly. CONCLUSIONS Our findings support an immediate post-intervention positive impact of wellness interventions across persons with a wide variety of chronic and disabling conditions. Future research that clearly specifies primary study outcomes and follows the CONSORT guidelines will strengthen future reviews of the evidence and facilitate application of the evidence of practice.
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Affiliation(s)
- Alexa K Stuifbergen
- The University of Texas at Austin School of Nursing, Center for Health Promotion and Disease Prevention Research in Underserved Populations, 1700 Red River, Austin, Texas 78701, USA.
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Stair-Ascent Performance in Elderly Women: Effect of Explosive Strength Training. J Aging Phys Act 2011; 19:117-36. [DOI: 10.1123/japa.19.2.117] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Explosive-type strength training may alter kinetics and neuromuscular activity during stair ascent in elderly women. This may improve functional ability. Nineteen women (69.7 ± 3.4 yr) were randomly allocated to strength training (TG; twice per wk, 12 wk) or a control group (CG). Stair ascent was assessed at self-chosen (AFV), standardized (ASV), and maximal velocity (AMV) pre- and posttraining. Ground-reaction force (GRF) and EMG quantified kinetics and neuromuscular activity. After training, TG increased AMV and AFV velocity by 8% (p= .02) and 17% (p= .007), respectively (TG vs.CG; p< .05). This was accompanied by elevated rectus femoris EMG (from 21% to 48%,p< .047). At AFV, TG increased GRF first peak force 4% (p= .047), and CG increased second peak force 5% (p= .036). Muscle coactivation remained unaltered in both groups. Explosive-type strength training led to enhanced stair-climbing performance at maximal and self-chosen speed, reflecting an improved functional ability.
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Exercise: necessary but not sufficient for improving function and preventing disability? Curr Opin Rheumatol 2011; 23:211-8. [DOI: 10.1097/bor.0b013e3283432c41] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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O'Connor PJ, Herring MP, Caravalho A. Mental Health Benefits of Strength Training in Adults. Am J Lifestyle Med 2010. [DOI: 10.1177/1559827610368771] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This review summarizes evidence from randomized controlled trials to examine whether strength training influences anxiety, chronic pain, cognition, depression, fatigue symptoms, self-esteem, and sleep. The weight of the available evidence supported the conclusion that strength training is associated with reductions in anxiety symptoms among healthy adults (5 trials); reductions in pain intensity among patients with low back pain (5 trials), osteoarthritis (8 trials), and fibromyalgia (4 trials); improvements in cognition among older adults (7 trials); improvements in sleep quality among depressed older adults (2 trials); reductions in symptoms of depression among patients with diagnosed depression (4 trials) and fibromyalgia (2 trials); reductions in fatigue symptoms (10 trials); and improvements in self-esteem (6 trials). The evidence indicates that larger trials with a greater range of patient samples are needed to better estimate the magnitude and the consistency of the relationship between strength training and these mental health outcomes. Plausible social, psychological, and neural mechanisms by which strength training could influence these outcomes rarely have been explored. This review revealed the high-priority research need for animal and human research aimed at better understanding the brain mechanisms underlying mental health changes with strength training.
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Lower extremity muscle function after strength or power training in older adults. J Aging Phys Act 2009; 17:416-43. [PMID: 19940322 DOI: 10.1123/japa.17.4.416] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
It is unclear whether strength training (ST) or power training (PT) is the more effective intervention at improving muscle strength and power and physical function in older adults. The authors compared the effects of lower extremity PT with those of ST on muscle strength and power in 45 older adults (74.8 +/- 5.7 yr) with self-reported difficulty in common daily activities. Participants were randomized to 1 of 3 treatment groups: PT, ST, or wait-list control. PT and ST trained 3 times/wk for 12 wk using knee-extension (KE) and leg-press (LP) machines at approximately 70% of 1-repetition maximum (1RM). For PT, the concentric phase of the KE and LP was completed "as fast as possible," whereas for ST the concentric phase was 2-3 s. Both PT and ST paused briefly at the midpoint of the movement and completed the eccentric phase of the movement in 2-3 s. PT and ST groups showed significant improvements in KE and LP 1RM compared with the control group. Maximum KE and LP power increased approximately twofold in PT compared with ST. At 12 wk, compared with control, maximum KE and LP power were significantly increased for the PT group but not for the ST group. In older adults with compromised function, PT leads to similar increases in strength and larger increases in power than ST.
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Abstract
Neuromuscular control strategies might change with age and predispose the elderly to knee-joint injury. The purposes of this study were to determine whether long latency responses (LLRs), muscle-activation patterns, and movement accuracy differ between the young and elderly during a novel single-limb-squat (SLS) task. Ten young and 10 elderly participants performed a series of resistive SLSs (approximately 0-30 degrees) while matching a computer-generated sinusoidal target. The SLS device provided a 16% body-weight resistance to knee movement. Both young and elderly showed significant overshoot error when the knee was perturbed (p < .05). Accuracy ofthe tracking taskwas similar between the young and elderly (p = .34), but the elderly required more muscle activity than the younger participants (p < .05). The elderly group had larger LLRs than the younger group (p < .05). These results support the hypothesis that neuromuscular control of the knee changes with age and might contribute to injury.
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Abstract
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.
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Affiliation(s)
- Chiung‐ju Liu
- Indiana University at IndianapolisDepartment of Occupational Therapy1140 W Michigan ST CF 303IndianpolisIndianaUSA46202
| | - Nancy K Latham
- Boston UniversityHealth and Disabilty Research Institute, School of Public Health580 Harrison Avenue4th FloorBostonMAUSA02118‐2639
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Chodzko-Zajko WJ, Proctor DN, Fiatarone Singh MA, Minson CT, Nigg CR, Salem GJ, Skinner JS, Skinner JS. Exercise and Physical Activity for Older Adults. Med Sci Sports Exerc 2009; 41:1510-30. [PMID: 19516148 DOI: 10.1249/mss.0b013e3181a0c95c] [Citation(s) in RCA: 2327] [Impact Index Per Article: 155.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Yeom HA, Keller C, Fleury J. Interventions for promoting mobility in community-dwelling older adults. ACTA ACUST UNITED AC 2009; 21:95-100. [PMID: 19228247 DOI: 10.1111/j.1745-7599.2008.00390.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE The purposes of this review were to provide an updated report of intervention studies designed to enhance mobility in older adults and discuss the strengths and limitations of existing intervention studies and their implications for practice. DATA SOURCES Medline, CINAHL, and PsychInfo were searched to identify original research articles reporting interventions for promoting mobility in community-dwelling older adults. CONCLUSION Effective interventions for enhancing mobility in older adults include walking, aerobic exercise, and resistance training focusing on strength, balance, and flexibility. Group-based interventions show significant beneficial effects in increasing mobility. To obtain significant effects of physical activity interventions, the patient should participate in the exercise programs for at least 12 weeks. Strengths of existing clinical trials for promoting mobility in older adults include testing of various types of physical activity and training interventions and the use of an experimental design with a control group. The major challenges of creating mobility enhancement recommendations for older adults include detailing a mobility enhancement program will delay disability, creating a specific program dose for different populations by gender and ethnicity, and developing culturally appropriate mobility enhancement programs to improve adherence over time. IMPLICATIONS FOR PRACTICE Prescribing regular physical activity including aerobic exercise and resistance training in a primary care setting can be a beneficial approach to minimize progression of impaired mobility in older adults. The typical dose of the physical activity prescription is 20-60 min of aerobic activity three times weekly. Adherence to mobility enhancement recommendations by older patients can be followed up by in-person interview or use of mobility monitoring tools such as exercise diary or log.
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Affiliation(s)
- Hye A Yeom
- College of Nursing & Healthcare Innovation, Arizona State University, 500 N. 3rd Street, Phoenix, AZ 85004, USA.
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Bean JF, Kiely DK, LaRose S, O'Neill E, Goldstein R, Frontera WR. Increased velocity exercise specific to task training versus the National Institute on Aging's strength training program: changes in limb power and mobility. J Gerontol A Biol Sci Med Sci 2009; 64:983-91. [PMID: 19414509 DOI: 10.1093/gerona/glp056] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND This study was designed to evaluate the benefits of InVEST (Increased Velocity Specific to Task) training on limb power and mobility among mobility-limited older adults. METHODS We conducted a single blinded, randomized controlled trial among 138 mobility-limited community-dwelling older adults, evaluating two 16-week supervised exercise programs. The intervention group participated in InVEST training, and the control group participated in the National Institute on Aging's (NIA) strength training program. Primary outcomes were changes in limb power per kilogram and mobility performance as measured by the Short Physical Performance Battery (SPPB). RESULTS After 16 weeks, InVEST produced significantly greater improvements in limb power than NIA (p=.02). There was no significant difference in strength improvements. Both groups had significant changes in SPPB of greater than 1 unit. Self-reported function was also significantly improved in both groups. Differences between groups were not statistically different. In a post hoc analysis when participants were categorized by the manifestation of baseline leg velocity impairments (N=68), InVEST training produced effect size differences in SPPB that were clinically meaningful (SPPB Group x Time difference 0.73 units, p=.05). CONCLUSIONS Among mobility-limited older adults, both NIA and InVEST produce robust changes in observed physical performance and self-reported function. These improvements were not meaningfully different by statistical or clinical criteria. Compared with NIA, InVEST training produced greater improvements in limb power and equivalent improvements in strength. Observed differences between NIA and InVEST based upon baseline leg impairment status are informative for futures studies.
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Affiliation(s)
- Jonathan F Bean
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, and Spaulding Rehabilitation Hospital, Boston, MA, USA.
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