Muscle function and functional ability improves more in community-dwelling older women with a mixed-strength training programme

The Effect of Eccentric vs. Traditional Resistance Exercise on Muscle Strength, Body Composition, and Functional Performance in Older Adults: A Systematic Review With Meta-Analysis

The effects of eccentric exercise (ECC) in older adults have received limited scientific attention, considering the ample evidence for its effectiveness in general and athletic populations. The purpose of this paper is to review the effects of ECC exercise modalities vs. traditional or concentric (CON) exercise on muscle strength, body composition and functional performance in older adults. Inclusion criteria regarding the age was >55 years. Three major scientific literature databases (PubMed, Scopus and Web of Science) were screened for trials comparing the effect of ECC and CON exercise programs, and 19 papers were included in the meta-analysis. ECC and CON training programs were typically matched by the duration of each session. The difference between ECC and CON was expressed as standardized mean difference (SMD). Regarding isometric knee strength, the pooled effect favored ECC (SMD = 0.50), but was not statistically significant (p = 0.160). ECC exercise elicited greater improvements in timed up and go test (SMD = −0.68; p = 0.004), 2-min sit-stand test (SMD = 0.53; p = 0.030) and 30-s sit-stand test (SMD = 0.81; p = 0.002), but not in 6-min walking test (SMD = 0.01; p = 0.960). The effects on body composition and muscle architecture were unclear (SMD = −1.44 to 1.95; p = 0.060–0.689). In conclusion, our literature review indicates that ECC exercise is superior to, or at least as good as CON exercise for preserving health and overall function in older adults.

Joint Association of Moderate-to-vigorous Intensity Physical Activity and Sedentary Behavior With Incident Functional Limitation: Data From the Osteoarthritis Initiative

OBJECTIVE

To examine the joint association of moderate-to-vigorous intensity physical activity (MVPA) and sedentary behavior with the risk of developing functional limitation 4 years later in adults with knee osteoarthritis (OA).

METHODS

Using 48-month (baseline) accelerometry data from the Osteoarthritis Initiative, we classified participants as Active-Low Sedentary (≥ 1 10-min bout/week of MVPA, lowest tertile for standardized sedentary time), Active-High Sedentary (≥ 1 10-min bout/week of MVPA, top 2 tertiles for standardized sedentary time), Inactive-Low Sedentary (zero 10-min bouts/week of MVPA, lowest tertile for standardized sedentary time), and Inactive-High Sedentary (zero 10-minute bouts/week of MVPA, top 2 tertiles for standardized sedentary time) groups. Functional limitation was defined as > 12 seconds for the 5-repetition sit-to-stand test (5XSST) and < 1.22 m/s gait speed during the 20-meter walk test. To investigate the association of exposure groups with risk of developing functional limitation 4 years later, we calculated adjusted risk ratios (aRR; adjusted for potential confounders).

RESULTS

Of 1091 and 1133 participants without baseline functional limitation, based on the 5XSST and 20-meter walk test, respectively, 15% and 21% developed functional limitation 4 years later. The Inactive-Low Sedentary and Inactive-High Sedentary groups had increased risk of developing functional limitations compared to the Active-Low Sedentary and Active-High Sedentary groups. The Inactive-Low Sedentary group had 72% (aRR 1.72, 95% CI 1.00-2.94) and 52% (aRR 1.52, 95% CI 1.03-2.25) more risk of developing functional limitation based on the 5XSST and 20-meter walk test, respectively, compared to the Active-Low Sedentary group.

CONCLUSION

Regardless of sedentary category, being inactive (zero 10-min bouts/week in MVPA) may increase the risk of developing functional limitation in adults with knee OA.

Effects of Horizontal Impeding Force Gait Training on Older Adult Push-Off Intensity

INTRODUCTION

Aging and many gait pathologies are often characterized by deficits in push-off intensity (i.e., propulsive ground reaction forces and peak ankle moment and power output) during walking. Unfortunately, conventional interventions such as progressive resistance training, designed to enhance calf muscle mechanical output, generally fail to translate strength gains to functional improvements in habitual push-off intensity.

METHODS

Horizontal impeding forces applied to the body's center of mass systematically augment the mechanical output required from muscle-tendon units spanning the ankle during the push-off phase of walking, which could convey long-term benefits via training. Therefore, the purpose of this study was to investigate the preliminary efficacy of a 6-wk horizontal impeding force training paradigm on improving habitual push-off intensity in 11 healthy but not physically active older adults (age = 76 ± 4 yr, 6 females and 5 males).

RESULTS

We found that older adults significantly (P < 0.05) increased measures of isometric strength by 18%, maximum walking speed by 10%, and 6-min walk test distance by 9% as a result of horizontal impeding force training. As a more clinically significant contribution of this work, we found that those subjects also increased habitual peak ankle moment and peak ankle power during push off after training by a significant 10% and 15%, respectively (P ≤ 0.036).

CONCLUSIONS

We conclude that the use of horizontal impeding forces in older adults improves their maximum muscular and walking capacities while encouraging access to newfound strength gains, thereby improving habitual push-off intensity during walking.

Effects of an 8-week resistance training intervention on plantar flexor muscle quality and functional capacity in older women: A randomised controlled trial

The present study examined 8 weeks of resistance training and its effects on muscle quality measures, plantar flexor muscle strength, muscle thickness and functional capacity in older women. Moreover, we tested if changes in muscle quality were associated with functional capacity. Twenty-four older women (66.3 ± 5.8 years; 69.0 ± 3.0 kg; 25.3 ± 1.4 kg·m^-2) were recruited to the study. After completion of the baseline assessment, participants were randomly assigned to either the resistance training (RET, n = 12) or an active control group (CTR, n = 12). Muscle quality was evaluated through muscle echo intensity (MQ_EI) and specific tension (MQ_ST). Muscle thickness, unilateral plantar flexor muscle strength and functional tests were evaluated at baseline and after the training period. After 8 weeks, both MQ_EI and MQ_ST did not respond to the intervention. Furthermore, significant changes in stair climb performance (P < 0.05) were not associated with plantar flexor-derived muscle quality (P > 0.05). Finally, significant gains in muscle hypertrophy were observed in the RET group (P < 0.01), while muscle strength failed to change significantly (P > 0.05). In conclusion, a resistance training program provided significant benefits in the stair climb test, unrelated to plantar flexor-derived muscle quality measures as previously demonstrated in quadriceps femoris.

Potential benefits of environmental volunteering programs of the health of older adults: a pilot study

PURPOSE

To study the effects of participating in a 12-week environmental volunteering program on the physical performance of older adults across different age groups MATERIALS AND METHODS: We conducted a pretest-posttest pilot study with a single group. The intervention consisted of twice-weekly recycling activities and once-weekly rehabilitation exercise at community-based care centers. The recycling activities of the environmental volunteering program included sorting and handling paper products, plastics, and metals; disposing electronic products; and sorting clothes. The rehabilitation exercise program comprised a 90-min course for special needs and 30 min of health education. The evaluation tools were the handgrip strength, five-times-sit-to-stand test, sit-and-reach test, Timed Up and Go (TUG) test and usual and fast gait speeds.

RESULTS

In total, 45 participants completed the program. After the program, the participants showed significantly great improvements compared to baseline in all outcome measures. We further divided these participants into two age subgroups [65-75 years (n = 31) and >75 years (n = 14)]. The 65-75-year subgroup only showed significant improvements in handgrip strength, TUG and usual gait speed. However, the >75-year subgroup showed significant improvements in all outcome measures.

CONCLUSIONS

This innovative environmental volunteering program conducted in a local Taiwanese community can be a sustainable and feasible model to improve physical performance in the participants, the subgroup aged >75 years in particular. It also provides a potential avenue for researchers and policymakers to address environmental and aging-related issues.

Combined Resistance and Stretching Exercise Training Benefits Stair Descent Biomechanics in Older Adults

Introduction

Stair descent is a physically demanding activity of daily life and common risk for falls. Age-related deteriorations in ankle joint capacities make stair descent particularly challenging for older adults in built environments, where larger rise steps are encountered. Exercise training may allow older adults to safely cope with the high biomechanical demands of stair descent. However, little is known about the demands of increased rise stairs for older adults, nor the impact of exercise.

Aim

We investigated whether the effects of lower-limb resistance training would alter joint kinetics and movement strategies for older adults when descending standard rise, and increased rise stairs.

Methods

Fifteen older adults descended a four-step stair adjusted to standard rise (170 mm), and increased rise (255 mm) on separate visits. Between these two visits, randomly allocated participants underwent 16 weeks of either: resistance exercise training (n = 8) or habitual activity (n = 7). Kinetic data were measured from step-mounted force plates, and kinematic data from motion-capture cameras. Training involved twice-weekly sessions of lower-limb resistance exercises (three sets of ∼8 repetitions at ∼80% three-repetition maximum), and static plantarflexor stretching (three, 45 s holds per leg).

Results

Standard stairs – Peak ankle joint moments increased (p < 0.002) and knee joint moments decreased (p < 0.01) during descent after exercise training. Peak centre of pressure-centre of mass (CoP-CoM) separations increased in posterior (p = 0.005) and medio-lateral directions (p = 0.04) after exercise training. Exercise training did not affect CoM descent velocity or acceleration. Increased rise stairs – Required greater ankle, knee, and hip moments (p < 0.001), peak downward CoM velocity and acceleration (p = 0.0001), and anterior-posterior CoP-CoM separation (p = 0.0001), but lower medial-lateral CoP-CoM separation (p < 0.05), when compared to standard stair descent. Exercise training did not affect joint kinetics or movement strategies.

Discussion

Exercise training increased the maximum joint ROM, strength and force production of the ankle, and enabled a greater ankle joint moment to be produced in single-leg support (lowering phase) during standard stair descent. Descending increased rise stairs raised the task demand; exercise training could not overcome this. Future research should prioritize the ankle joint in stair descent, particularly targeting plantarflexor torque development across stairs of varying riser heights.

Effects of a Community Care Station Program With Structured Exercise Intervention on Physical Performance and Balance in Community-Dwelling Older Adults: A Prospective 2-Year Observational Study

The Taiwanese government has developed community care stations (CCSs) for community-based older adult care. We investigated the effects of a structured exercise intervention, applied at CCS for 6 months, on physical performance and balance in community-dwelling older adults, including a 2-year reassessment. Fifty-eight participants (aged 76.9 ± 6.3 years) participated in the study. The Elderly Mobility Scale, Short Physical Performance Battery (SPPB), Timed Up and Go (TUG), gait speed, functional reach, one-leg-stance (OLS), and flexibility were evaluated at baseline, 6 months, and 2 years. Compared with baseline, the participants improved significantly in the SPPB (0.93 points), TUG (1.94 s), gait speed (0.13 m/s), and right and left OLS (2.56 and 3.12 s) at 6 months. Furthermore, these significant effects, except for OLS, were maintained at the 2-year reassessment according to repeated-measures ANOVA (p < .01). Our preliminary data suggest that adding a structured exercise program can benefit older adults participating in Taiwanese CCSs.

Short- and long-term reliability of leg extensor power measurement in middle-aged and older adults

Muscular power is important for maintaining physical functioning with aging. Proper quantification of the reliability of muscular power tests is crucial to inform monitoring of individuals and sample size planning for interventional studies. This study evaluated short- and long-term reliability of leg extensor power measurement in 72 adults (age 62.7 ± 8.6 years). Participants completed four repeat trials on the Nottingham leg extensor power rig, with a further trial twelve weeks later. Mean change, typical error, and intraclass correlation coefficients (ICC) were calculated. For short-term reliability, mean change in power output was trivial after two trials (1.2-4.8%). Typical errors were small following four trials in the dominant leg of males (10.9-5.8%), three in the non-dominant leg of males (9.9-6.2%) and the dominant leg of females (10.0-9.6%) and two in the non-dominant leg in females (8.3%). Intraclass correlation coefficients (ICCs) were very high (0.88-0.96). For long-term reliability, mean change remained trivial (1.0-2.5%), typical errors remained small (5.8-8.6%), and ICCs very high (0.94-0.96). The leg extensor power rig is a reliable method for assessing lower body muscular power, both short- and long-term, with only minimal habituation effects.

Falls, Balance Confidence, and Lower-Body Strength in Patients Seeking Outpatient Venous Ulcer Wound Care

PURPOSE & ABSTRACT

To provide information about a quality improvement project examining falls in persons seeking outpatient wound care.

TARGET AUDIENCE

This continuing education activity is intended for physicians and nurses with an interest in skin and wound care.

OBJECTIVES

After participating in this educational activity, the participant should be better able to:1. Describe the scope of the problem and the related quality improvement project. 2. Delineate the results of the project and their implications for treatment of patients with venous ulcers.

OBJECTIVE

The authors aim to examine fall occurrence and fall injuries in persons seeking outpatient wound care and to compare falls, balance confidence, and lower-body strength in persons with injection-related venous ulcers (IRVUs) versus persons with venous ulcers (VUs) related to other risk factors besides injection drugs (VUs-other).

DESIGN

This quality improvement project used a cross-sectional, comparative design. Participants responded to demographic questions, the Activities-specific Balance Confidence (ABC) Scale, fear of falling, fall numbers, and injuries and performed the 30-second chair-rise test.

SETTING

Outpatient wound service.

PATIENTS

Patients (N = 106; mean age, 59.94 years) included men (66%) and women.

RESULTS

Sixty patients reported falling; 47 were recurrent fallers. Twenty patients stated they were injured, but did not go to an emergency department. A higher number of total falls was significantly related to more comorbidities. Total falls were significantly related to fear of falling and ABC Scale scores. Those with VUs-other had significantly more comorbidities and higher body mass index values than those with IRVUs. Those with IRVUs were comparable to those VUs-other on number of falls and fear of falling, respectively. Those with IRVUs (7.30) performed significantly more chair rises than those with VUs-other (4.72). Persons with IRVUs had significantly higher ABC Scale scores (63.24%) than those with VUs-other (49.38%).

CONCLUSIONS

Falls are a common occurrence in persons seeking outpatient wound care. Despite greater strength sufficient to perform more chair rises among those with IRVUs, fall rates were comparable to those of weaker individuals with other types of VUs. With the high occurrence of falls during the project, long-term risk for fall injury would be high. Further research is needed to clarify interactions between VU risk and patient factors such as strength, age, agility, and impaired cognition.

The effects of water-based exercise in combination with blood flow restriction on strength and functional capacity in post-menopausal women

Water-based exercise and low-intensity exercise in combination with blood flow restriction (BFR) are two methods that have independently been shown to improve muscle strength in those of advancing age. The objective of this study was to assess the long-term effect of water-based exercise in combination with BFR on maximum dynamic strength and functional capacity in post-menopausal women. Twenty-eight women underwent an 8-week water-based exercise program. The participants were randomly allocated to one of the three groups: (a) water exercise only, (b) water exercise + BFR, or (c) a non-exercise control group. Functional capacity (chair stand test, timed up and go test, gait speed, and dynamic balance) and strength testing were tested before and after the 8-week aquatic exercise program. The main findings were as follows: (1) water-based exercise in combination with BFR significantly increased the lower limb maximum strength which was not observed with water-based exercise alone and (2) water-based exercise, regardless of the application of BFR, increased functional performance measured by the timed up and go test over a control group. Although we used a healthy population in the current study, these findings may have important implications for those who may be contraindicated to using traditional resistance exercise. Future research should explore this promising modality in these clinical populations.

Gait disturbances as specific predictive markers of the first fall onset in elderly people: a two-year prospective observational study

Falls are common in the elderly, and potentially result in injury and disability. Thus, preventing falls as soon as possible in older adults is a public health priority, yet there is no specific marker that is predictive of the first fall onset. We hypothesized that gait features should be the most relevant variables for predicting the first fall. Clinical baseline characteristics (e.g., gender, cognitive function) were assessed in 259 home-dwelling people aged 66 to 75 that had never fallen. Likewise, global kinetic behavior of gait was recorded from 22 variables in 1036 walking tests with an accelerometric gait analysis system. Afterward, monthly telephone monitoring reported the date of the first fall over 24 months. A principal components analysis was used to assess the relationship between gait variables and fall status in four groups: non-fallers, fallers from 0 to 6 months, fallers from 6 to 12 months and fallers from 12 to 24 months. The association of significant principal components (PC) with an increased risk of first fall was then evaluated using the area under the Receiver Operator Characteristic Curve (ROC). No effect of clinical confounding variables was shown as a function of groups. An eigenvalue decomposition of the correlation matrix identified a large statistical PC1 (termed “Global kinetics of gait pattern”), which accounted for 36.7% of total variance. Principal component loadings also revealed a PC2 (12.6% of total variance), related to the “Global gait regularity.” Subsequent ANOVAs showed that only PC1 discriminated the fall status during the first 6 months, while PC2 discriminated the first fall onset between 6 and 12 months. After one year, any PC was associated with falls. These results were bolstered by the ROC analyses, showing good predictive models of the first fall during the first six months or from 6 to 12 months. Overall, these findings suggest that the performance of a standardized walking test at least once a year is essential for fall prevention.

A comparative study of the five-times-sit-to-stand and timed-up-and-go tests as measures of functional mobility in persons with and without injection-related venous ulcers

PURPOSE

To provide information on the Five-Times-Sit-to-Stand (FTSTS) and Timed-Up-and-Go (TUG) tests in persons with injection-related venous ulcers (VU+) and persons without venous ulcers (VU-).

TARGET AUDIENCE

This continuing education activity is intended for physicians and nurses with an interest in skin and wound care.

OBJECTIVES

After participating in this educational activity, the participant should be better able to:

ABSTRACT

OBJECTIVE

To examine functional mobility using Five-Times-Sit-to-Stand (FTSTS) and Timed-Up-and-Go (TUG) tests in persons with injection-related venous ulcers (VU+) and compare these findings to persons without venous ulcers (VU-).

DESIGN

Cross-sectional, comparative design.

SETTING

Outpatient clinic.PARTICPANTS: Participants (n = 61) were 31 persons VU+ and 30 persons VU-; 57.4% men; mean age, 54 years; 93% African American.

MAIN OUTCOME MEASURES

Five-Times-Sit-to-Stand, TUG, physical activity, quality of life, comorbidities, falls, and body mass index.

RESULTS

Participants VU+ were 36.8% slower on completion of the TUG test (P = .012) and 26.5% slower on completion of the FTSTS test (P = .081). Five-Times-Sit-to-Stand and TUG were strongly correlated with each other, r = 0.93, 0.87, P < .001 for VU- and VU+, respectively. Test-retest reliabilities for the FTSTS and TUG tests were high (intraclass correlation coefficient = 0.89-0.94) for the VU+ and VU-. Within each group, correlations of FTSTS and TUG were similar for each of the variables examined. Across groups, correlations showed that the time to complete FTSTS and TUG increased as a function of comorbidities in the VU+ group; the correlations in the VU- group were not significantly different from zero.

CONCLUSIONS

The VU+ group exhibited poorer physical performance than the VU- group. The high correlation between FTSTS and TUG and the similarity of correlations with other variables suggest that these physical performance measures may be interchangeable in their ability to predict physical functioning in these clinical groups despite differences in test demands. Clinicians need easy-to-perform reliable clinical tests such as FTSTS and TUG to assess mobility of aging injection users with venous ulcers.

Effect of 808 nm low-level laser therapy in exercise-induced skeletal muscle fatigue in elderly women

Aging process involves several structural changes in muscle tissue which lead to decrease in musculoskeletal function. One of the most common physiological modifications is the increase in fatigability in elderly people, which leads to inability to maintain strength and motor control. In this context, low-level laser therapy (LLLT) has demonstrated positive results in reducing fatigue during physical exercise. Thus, this study aimed to investigate the effects of LLLT on skeletal muscle fatigue in elderly women. Twenty-four subjects divided in two groups entered a crossover randomized triple-blinded placebo-controlled trial. Active LLLT (808 nm wavelength, 100 mW, energy 7 J) or an identical placebo LLLT was delivered on the rectus femoris muscle immediately before a fatigue protocol. Subjects performed a fatigue protocol which consisted of voluntary isotonic contractions of knee flexion-extension performed with a load corresponding to 75 % of 1-MR (Maximum Repetition) during 60 s. Surface electromyography (SEMG) signals were recorded from rectus femoris muscle of dominant lower limb to evaluate peripheral fatigability using median frequency analysis of SEMG signal. The number of repetitions of flexion-extension during fatigue protocol was also compared between groups. The values of median frequency were used to calculate the slope coefficient. The results showed no difference in the slope comparing placebo LLLT and active LLLT groups (p = 0.293). However, a significant difference was observed in the number of repetitions between groups, after active LLLT, subjects demonstrated significantly higher number of repetitions (p = 0.047). In this study, LLLT was efficient in increasing the mean number of repetitions during knee flexion-extension exercise, although results have not shown delay electromyographic fatigue.

Effects of Resistance Training on Functional Ability in Elderly Individuals

Purpose.

Determine the effects of 16 weeks of strength training on measures of functional ability in elderly who are functionally limited.

Design.

Quasi-experimental trial in which elderly volunteers were assigned to either an exercise group or a control group.

Participants.

Eighty-seven participants (65–93 years) living independently but with some functional limitations.

Intervention.

Thirteen different strength training exercises using Thera-Band resistive bands (Hygenic Corporation, Akron, Ohio). The program was 16 weeks in duration, and the frequency was three times per week. Participants exercised in a group setting one time per week and were given a home exercise book to follow for two additional sessions per week.

Measures.

Functional ability was operationalized to include a variety of measures related to functional ability that impact activities of daily living, morbidity, and mortality in the elderly, including upper- and lower-body strength and gait.

Analysis.

Intervention effects were analyzed using a 2 (groups: exercise group vs. control group) X 3 (time: baseline vs. mid vs. post) analysis of variance.

Results.

The exercise group demonstrated significant improvements in upper-body strength as measured by biceps curl (F[2,140] = 39.870; p < .05) and lower-body strength as measured by chair sit-to-stand (F[2,124] = 25.887; p < .05). Gait velocity (F[2,140] = 37.317; p < .05) and step length (F[2,140] = 4.182; p < .05) both increased for the exercise group at week 9, but this increase disappeared by week 17. Compared with minimal changes in the control group, the exercise group demonstrated significant improvements in upper-body strength as measured by biceps curl and lower-body strength as measured by chair sit-to-stand.

Conclusion.

Some measures of function ability were improved after a 16-week structured exercise program for functionally limited elderly. Because functional ability has been inversely correlated with short-term morbidity and the need for assisted living among older adults, providing opportunities to exercise is crucial to future functioning and independence of the elderly population. (Am J Health Promot 2011;25[4]:237–243.)

Effects of Training and Detraining on Physical Fitness, Physical Activity Patterns, Cardiovascular Variables, and HRQoL after 3 Health-Promotion Interventions in Institutionalized Elders

The purpose of this study is to assess the effects of different strategies of health on the levels of physical activity (PA), physical fitness (PF), cardiovascular disease (CVD) risk factors and quality of life (QoL) of the institutionalized elderly. Concurrently studies were made of the effect of detraining on these same variables. In this investigation we carried out a prospective longitudinal study with an experimental design, with 1 year plus 3 months of a detraining period. Methodology. (a) A questionnaire with socio-demographic characteristics and a QoL scale (MOS SF-36); (b) Functional Fitness Test to assess PF; (c) An MTI Actigraph to evaluate the PA; (d) Biochemical analysis of blood, blood pressure and bio-impedance. The Main Results Indicated That: (i) ST significantly improved strength and body flexibility and AT the aerobic endurance, agility/dynamic balance and lower strength and flexibility; (ii) Implications of detraining were more evident on the PA groups in the lower body flexibility, which is associated with agility/dynamic balance and lower strength in the AT group; (iii) Cardiovascular variables improved significantly especially blood pressure, cholesterol and glucose in the ST and HDL in the AT group; not having undergone significant changes with the detraining. The results of this thesis contribute positively to highlight the importance of PA in the promotion of health, prevention and reduction of CVD risk factors and the improvement of the PF and QoL.

Physical activity levels and functional performance in the osteoarthritis initiative: a graded relationship

OBJECTIVE

Physical activity improves function in adults with arthritis, but it is unknown if there is a graded relationship between physical activity and functional benefit. This study was undertaken to examine the cross-sectional and longitudinal relationship between self-reported physical activity and observed functional performance in adults with knee osteoarthritis (OA).

METHODS

The Osteoarthritis Initiative cohort included 2,589 patients with knee OA (2,301 with longitudinal followup data) who were ages 45-79 years at baseline. Prospective annual functional performance was assessed for 2 years using timed 20-meter walk tests. We used linear regression to estimate differences across physical activity quartiles in subsequent function (baseline and 1-year activity predicts 1-year and 2-year function, respectively) adjusted for demographic factors (age, sex, race/ethnicity, education level, and marital status) and health factors (OA severity, knee symptoms, knee pain, knee injury, body mass index, comorbidity, depression, smoking, alcohol use, and other joint pain).

RESULTS

Increasing physical activity levels had a significant graded relationship to functional performance. Adults in physical activity quartile groups from least active to most active had an average gait speed of 4.0, 4.2, 4.3, and 4.5 feet/second, respectively, at baseline (P for trend<0.001) and 4.0, 4.2, 4.3, and 4.5 feet/second, respectively, after 1 year (P for trend<0.001); increasing trends remained significant after adjusting for covariates. Findings were similar within sex and age groups.

CONCLUSION

These prospective data indicate a consistent graded relationship between physical activity level and better performance in adults with knee OA. These findings support guidelines that encourage patients with arthritis who cannot attain minimum recommended physical activity to be as active as possible.

Maintaining functionality in later years: a review of nutrition and physical activity interventions in postmenopausal women

Independence and quality of life of postmenopausal women are influenced by functional status. Nutrition and physical activity impact functional changes through changes in body composition. The article presents a narrative review of the literature to identify interventions that improve the functionality of community-dwelling postmenopausal women. The authors used the Evidence Analysis Approach developed by the American Dietetic Association to appraise current research. Strong evidence does exist that interventions that incorporate both physical activity and nutrition can improve physical function of older women. However, research focusing on functional status and quality of life, in addition to nutrition and exercise, is extremely limited.

Relação da força explosiva e potência muscular com a capacidade funcional no processo de envelhecimento

INTRODUÇÃO: O declínio na força explosiva e potência muscular de membros inferiores (MMII) tem sido relacionado ao prejuízo funcional de idoso; entretanto, a influência do envelhecimento nestas variáveis, considerando os movimentos multiarticulares, não tem sido bem documentada. OBJETIVOS: 1) comparar a força explosiva e a potência muscular de MMII de mulheres entre 50 e 79 anos em relação aos valores de referência aos 18 anos; e 2) associar essas variáveis com a capacidade funcional. MÉTODOS: Foram avaliadas 227 mulheres não sedentárias, subdivididas nos grupos 50-59, 60-69 e 70-79 anos de idade. Como força explosiva foi considerada a impulsão vertical sem auxílio dos braços (FE) e como capacidade funcional a velocidade normal de andar (VEL), o tempo para levantar da cadeira (CAD) e o equilíbrio estático (EQ). A potência muscular (POT) foi estimada pela altura obtida no salto vertical. O valor correspondente aos 18 anos foi considerado como referência. RESULTADOS: Foram observados menores valores (p < 0,05) em FE e POT nos três grupos de idade comparados aos 18 anos, sendo tais variáveis ainda menores no grupo 70-79 anos (p < 0,05). Somente o grupo 70-79 anos apresentou menor valor (p < 0,05) em VEL e EQ. A alteração em FE comparada à POT foi significativamente maior em todos os grupos (p < 0,05). À exceção da variável CAD nos grupos de 50-59 e 70-79 anos, a FE apresentou maior associação com a capacidade funcional do que a POT. CONCLUSÃO: FE e POT apresentaram menor valor quando comparadas ao grupo de 18 anos; entretanto, a POT não se altera em função da faixa etária. Contudo, a FE apresentou maior associação com a capacidade funcional.

Nutritional recommendations for the management of sarcopenia

The Society for Sarcopenia, Cachexia, and Wasting Disease convened an expert panel to develop nutritional recommendations for prevention and management of sarcopenia. Exercise (both resistance and aerobic) in combination with adequate protein and energy intake is the key component of the prevention and management of sarcopenia. Adequate protein supplementation alone only slows loss of muscle mass. Adequate protein intake (leucine-enriched balanced amino acids and possibly creatine) may enhance muscle strength. Low 25(OH) vitamin D levels require vitamin D replacement.

Comparação da força funcional de membros inferiores e superiores entre idosas fisicamente ativas e sedentárias

RESUMO O objetivo desta pesquisa foi comparar a força funcional dos membros inferiores e superiores entre idosas fisicamente ativas e sedentárias. A amostra foi constituída de 540 voluntárias, divididas em: Grupo Fisicamente Ativo (GFA) e Grupo Sedentário (GS), que se subdividiram em: GFA1 (n=107 com 61,6±1,5 anos e IMC=27,1±3,9), GFA2 (n=94, com 66,7±1,3 anos e IMC=27,5±3,6), GFA3 (n=82, com 72,2±1,4 anos e IMC=27,5±3,8), GFA4 (n=75, com 77,2±1,3 anos e IMC=28,1±3,9), GS1 (n=36, com 62,9±1,2 anos e IMC=27,7±4,4), GS2 (n=39, com 67,7±1,3 anos e IMC=28,1±3,1), GS3 (n=49, com 72,5±1,3 anos e IMC=28,3±2,9) e GS4 (n=58, com 77,6±1,1 anos e IMC=28,3±3,8). Para mensurar a variável em questão, utilizaram-se os testes Chair stand e Arm curl. A estatística foi realizada através dos programas Office Excel 2007 e SPSS16, adotando-se como nível de significância U<0,05. Quanto à força funcional de membros inferiores (MMII), todos GFA apresentaram diferenças significativas sobre seus respectivos GS. Para a força funcional de membros superiores (MMSS), apenas os GFA1 e GFA2 apresentaram diferenças significativas sobre os GS1 e GS2. Conclui-se que os programas de atividade física foram capazes de manter, ainda que limitadamente, os níveis de força funcional de MMII e MMSS das idosas fisicamente ativas.

Relationship between performance-based and laboratory tests for lower-limb muscle strength and power assessment in healthy older women

The aim of the study was to assess the relationship between performance-based and laboratory tests for muscular strength and power assessment in older women. Thirty-two women aged 68.8 +/- 2.8 years were recruited. All participants were asessed for: (a) two performance-based tests--the box-stepping test (mean 296 +/- 51 J) and two-revolution maximum test (mean 7.1 +/- 2 kg) performed while pedalling on a cycle ergometer; and (b) muscular function tests--maximal instantaneous peak power jumping on a force platform (mean 1528 +/- 279 W); maximal voluntary contraction (MVC) during knee extension (mean 601 +/- 571 N) and leg press (mean 626 +/- 126 N), and leg press power (mean 483 +/- 98 W) on a dynamometer. Using univariate analysis, performance-based tests were compared with laboratory muscle strength and power measurements. Muscle power correlated most strongly with the performance-based tests for both jumping and leg press power (r-values between 0.67 and 0.75; P < 0.01). The correlation with muscle strength measures ranged between 0.48 and 0.61 (P < 0.01). The proposed tests may have particular relevance in geriatric and rehabilitation environments as they represent an easy, practical, and inexpensive alternative for the assessment of muscular strength and power.

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

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

Anti-aging therapy through fitness enhancement

Physical exercise is proposed as a highly effective means of treating and preventing the main causes of morbidity and mortality – most of which are associated with aging – in industrialized countries. Low physical fitness is an important risk factor for cardiovascular and all-causes morbidity and mortality; indeed, it is even a predictor of these problems. When properly measured, the assessment of physical fitness can be a highly valuable indicator of health and life expectancy and, therefore, should be performed routinely in the clinical setting. Individually adapted training programs could be prescribed based on fitness assessment results and an adequate knowledge of patient lifestyle and daily physical activity. Such training programs would allow people to develop their maximum physical potential, improve their physical and mental health, and attenuate the negative consequences of aging.

The impact of physical training on locomotor function in older people

Locomotor function declines in old age. Based on 55 studies, this review appraises current evidence on the impact of physical training interventions on locomotor function in older people. Overall, the literature indicates that physical training can have a beneficial impact on locomotor function in older people. This also holds true in various sub-populations including those who are very old, those who have functional limitations and those with chronic health problems. Improvements in locomotor function can be seen within 4-6 weeks of physical training, although the potential that improvements may appear earlier has not been investigated. Recent studies provide evidence of a dose-response relationship between intensity of strength training and improvement in locomotor function in older people. However, whether such a relationship exists for other training modes has not yet been investigated. Based on current evidence, the optimal training modes or combination of training modes (strength, aerobic, balance, coordination, etc.) and the optimal frequency of training for improvement in locomotor function are unclear.

Combination training and resistance training as effective interventions to improve functioning in elders

The purpose of the study was to determine whether resistance training (RT) or a combination of resistance and aerobic training (CT) resulted in the most improvement in measures of functional ability in functionally limited elders. Elderly adults who exhibited some limits in functional ability were randomly assigned to either a CT, RT, or control (C) group. Both RT and CT exercised three times per week for 16 weeks. At Weeks 0 and 17, participants completed six measures of strength and six functional tests. A 3 (group) x 3 (time) ANOVA with repeated measures on the time factor was used to analyze the results. CT and RT scored significantly better than C at Week 17 for biceps curl, elbow extension, chair stand, and time up the stairs. These findings demonstrate that RT and CT are both effective at increasing measures of strength and functional ability in elderly adults who begin exercise with functional limitations.

Effects of a one-year exercise training program in adults over 70 years old: a study with a control group

BACKGROUND AND AIMS

Exercise training is known to improve exercise tolerance in elderly subjects. Therefore the present study aimed at investigating the effects of one year of combined endurance and resistance training in healthy older people.

METHODS

After baseline evaluation, subjects were assigned to either the training group (n=24, age 77.2+/-3.6) or the control group (n=16, age 76.1+/-4.8). Subjects in the control group did not change anything in their everyday activities, whereas subjects in the training group underwent moderately intensive combined exercise training, 3 hours a week over the course of one year. Breath-by-breath oxygen uptake and heart rate were measured at each workload during the symptom-limited cardiopulmonary exercise test. Performance on the 6-minute (6-MWT) and 200-meter (200-MWT) walk tests was registered and maximal strength was measured on knee extensor and plantar flexor muscles.

RESULTS

After training, oxygen uptake was significantly increased, both at the ventilatory threshold (+11.6%, p<0.01) and at the end of exercise (+14.8%, p<0.001). The distance walked in 6 min (+10%, p<0.001), the time required to cover 200 m (-7.3%, p<0.001) and the maximal muscle strength (+15.2% and +17.4% for knee extensors and plantar flexors respectively, p<0.05) also improved after training. All these parameters had not significantly changed in the control group after the one-year period.

CONCLUSIONS

The results of the present study show that one year of combined exercise training is well-tolerated and improves aerobic capacity, performance on field tests and muscle strength in healthy subjects over 70 years old.

A randomised controlled trial of Tai Chi and resistance exercise on bone health, muscle strength and balance in community-living elderly people

BACKGROUND

The beneficial role of exercise in improving bone mineral density, muscle strength and balance, has been documented predominantly in younger populations. These findings may not apply to elderly populations with limited ability to perform exercises of high intensity.

OBJECTIVE

To examine the effects of Tai Chi (TC) and resistance exercise (RTE) on bone mineral density (BMD), muscle strength, balance and flexibility in community living elderly people.

DESIGN

Randomised controlled trial, using blocked randomization with stratification by sex.

SETTING

A community in the New Territories Region of Hong Kong, China.

SUBJECTS

One hundred eighty subjects (90 men, 90 women) aged 65-74, were recruited through advertisements in community centres.

METHODS

Subjects were assigned to participate in TC, RTE three times a week, or no intervention (C) for 12 months. Measurements were carried out at baseline, 6 and 12 months. Analyses of covariance (ANCOVA) adjusted for age, and baseline values of variables that were significantly different between groups: i.e. smoking and flexibility for men; quadriceps strength for women.

RESULTS

Compliance was high (TC 81%, RTE 76%). In women, both TC and RTE groups had less BMD loss at total hip compared with controls. No effect was observed in men. No difference in either balance, flexibility or the number of falls was observed between either intervention or controls after 12 months.

CONCLUSION

The beneficial effects of TC or RTE on musculoskeletal health are modest and may not translate into better clinical outcomes.

A multi-component exercise regimen to prevent functional decline and bone fragility in home-dwelling elderly women: randomized, controlled trial

SUMMARY

This study showed that combination of strength, balance, agility and jumping training prevented functional decline and bone fragility in home-dwelling elderly women. The finding supports the idea that it is possible to maintain good physical functioning by multi-component exercise program and thus postpone the age-related functional problems.

INTRODUCTION

This 1-year randomized, controlled exercise intervention trial assessed the effects of two different training programs and their combination on physical functioning and bone in home-dwelling elderly women.

METHODS

One hundred and forty-nine healthy women aged 70-78 years were randomly assigned into: group 1-resistance training (RES), group 2-balance-jumping training (BAL), group 3-combination of resistance and balance-jumping training (COMB), and group 4-controls (CON). Self-rated physical functioning, leg extensor force, dynamic balance, and bone mass and structure were measured.

RESULTS

Self-rated physical functioning improved in the COMB group, but was reduced in the CON group; the mean inter-group difference was 10% (95% CI: 0-22%). Mean increase in the leg extensor force was higher in the RES (14%; 4-25%) and COMB (13%; 3-25%) compared with the CON groups. Dynamic balance improved in the BAL (6%; 1-11%) and in the COMB (8%; 3-12%) groups. There were no inter-group differences in BMC at the proximal femur. In those COMB women who trained at least twice a week, the tibial shaft structure weakened 2% (0-4%) less than those in the CON group.

CONCLUSIONS

Strength, balance, agility, and jumping training (especially in combination) prevented functional decline in home-dwelling elderly women. In addition, positive effects seen in the structure of the loaded tibia indicated that exercise may also play a role in preventing bone fragility.

Effects of a group-based exercise program on the physical performance, muscle strength and quality of life in older women

This study was aimed at determining the effect of a group-based exercise program on the physical performance, muscle strength and quality of life (QoL) in older women. Twenty women performed an exercise program for 8 weeks, at the rehabilitation unit. Outcome measures included a 4-m and 20-m walk test, a 6-min walk test, stair climbing and chair rise time, timed up and go test, isokinetic muscle testing of the knee and ankle, and the short form-36 (SF-36) and geriatric depression scale (GDS) questionnaires. The mean age of the study group was 70.3+/-6.5 years. After the completion of the exercise program, all of the physical performance tests and the SF-36 scores for the participants showed statistically significant improvements (p<0.05). In the isokinetic evaluations, most of angular velocities showed a significant increase in the peak torque (PT) values for knee extension and flexion, and for ankle plantar flexion (p<0.05). We concluded that this exercise program, when applied to older women, resulted in improved physical performance, increased muscle strength measured in both the knee and ankle, and improvement in the scores, estimating the QoL. We have shown that this exercise program is both effective and reliable for this age group of women.