Aerobic reserve and physical functional performance in older adults

A Mobile Health App to Support Home-Based Aerobic Exercise in Neuromuscular Diseases: Usability Study

BACKGROUND

Home-based aerobic exercise in people with neuromuscular diseases (NMDs) has benefits compared to exercise in the hospital or a rehabilitation center because traveling is often cumbersome due to mobility limitations, and societal costs are lower. Barriers to home-based aerobic exercise include reduced possibilities for monitoring and lack of motivation. To overcome these and other barriers, we developed a mobile health app: Keep on training with ReVi (hereafter referred to as ReVi).

OBJECTIVE

We aimed to determine the usability of the ReVi app.

METHODS

Patients followed a 4-month, polarized, home-based aerobic exercise program on a cycle or rowing ergometer, with 2 low-intensity sessions and 1 high-intensity session per week supported by the ReVi app. The app collected training data, including heart rate and ratings of perceived exertion, provided real-time feedback on reaching target intensity zones, and enabled monitoring via an online dashboard. Physiotherapists instructed patients on how to use the ReVi app and supervised them during their training program. Patients and physiotherapists separately evaluated usability with self-developed questionnaires, including 9 questions on a 5-point Likert scale, covering the usability elements efficiency, effectiveness, and satisfaction.

RESULTS

Twenty-nine ambulatory adult patients (n=19 women; mean age 50.4, SD 14.2 years) with 11 different slowly progressive NMDs participated. Both patients and physiotherapists (n=10) reported that the app, in terms of its efficiency, was easy to use and had a rapid learning curve. Sixteen patients (55%) experienced 1 or more technical issue(s) during the course of the exercise program. In the context of effectiveness, 23 patients (81%) indicated that the app motivated them to complete the program and that it helped them to exercise within the target intensity zones. Most patients (n=19, 70%) and physiotherapists (n=6, 60%) were satisfied with the use of the app. The median attendance rate was 88% (IQR 63%-98%), with 76% (IQR 69%-82%) of time spent within the target intensity zones. Four adverse events were reported, 3 of which were resolved without discontinuation of the exercise program.

CONCLUSIONS

The usability of the ReVi app was high, despite the technical issues that occurred. Further development of the app to resolve these issues is warranted before broader implementation into clinical practice.

Age and asymmetry of corticospinal excitability, but not cardiorespiratory fitness, predict cognitive impairments in multiple sclerosis

Background

Cognitive impairment is a disabling and underestimated consequence of multiple sclerosis (MS), with multiple determinants that are poorly understood.

Objectives

We explored predictors of MS-related processing speed impairment (PSI) and age-related mild cognitive impairment (MCI) and hypothesized that cardiorespiratory fitness and corticospinal excitability would predict these impairments.

Methods

We screened 73 adults with MS (53 females; median [range]: Age 48 [21-70] years, EDSS 2.0 [0.0-6.5]) for PSI and MCI using the Symbol Digit Modalities Test and Montréal Cognitive Assessment, respectively. We identified six persons with PSI (No PSI, n = 67) and 13 with MCI (No MCI, n = 60). We obtained clinical data from medical records and self-reports; used transcranial magnetic stimulation to test corticospinal excitability; and assessed cardiorespiratory fitness using a graded maximal exercise test. We used receiver operator characteristic (ROC) curves to discern predictors of PSI and MCI.

Results

Interhemispheric asymmetry of corticospinal excitability was specific for PSI, while age was both sensitive and specific for MCI. MS-related PSI was also associated with statin prescriptions, while age-related MCI was related to progressive MS and GABA agonist prescriptions. Cardiorespiratory fitness was associated with neither PSI nor MCI.

Discussion

Corticospinal excitability is a potential marker of neurodegeneration in MS-related PSI, independent of age-related effects on global cognitive function. Age is a key predictor of mild global cognitive impairment. Cardiorespiratory fitness did not predict cognitive impairments in this clinic-based sample of persons with MS.

Management of Prostate Cancer in Older Adults

The majority of men with prostate cancer are diagnosed when they are older than 65 years; however, clinical trial participants are disproportionately younger and more fit than the real-world population treated in typical clinical practices. It is, therefore, unknown whether the optimal approach to prostate cancer treatment is the same for older men as it is for younger and/or more fit men. Short screening tools can be used to efficiently assess frailty, functional status, life expectancy, and treatment toxicity risk. These risk assessment tools allow for targeted interventions to increase a patient's reserve and improve treatment tolerance, potentially allowing more men to experience the benefit of the significant recent treatment advances in prostate cancer. Treatment plans should also take into consideration each patient's individual goals and values considered within their overall health and social context to reduce barriers to care. In this review, we will discuss evidence-based risk assessment and decision tools for older men with prostate cancer, highlight intervention strategies to improve treatment tolerance, and contextualize these tools within the current treatment landscape for prostate cancer.

Cardiorespiratory Fitness and Neuromuscular Function of Mechanically Ventilated ICU COVID-19 Patients

OBJECTIVES

The aim of the current study was to investigate the level of cardiorespiratory fitness and neuromuscular function of ICU survivors after COVID-19 and to examine whether these outcomes are related to ICU stay/mechanical ventilation duration.

DESIGN

Prospective nonrandomized study.

SETTING

Patients hospitalized in ICU for COVID-19 infection.

PATIENTS

Sixty patients hospitalized in ICU (mean duration: 31.9 ± 18.2 d) were recruited 4-8 weeks post discharge from ICU.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Patients visited the laboratory on two separate occasions. The first visit was dedicated to quality of life questionnaire, cardiopulmonary exercise testing, whereas measurements of the knee extensors neuromuscular function were performed in the second visit. Maximal oxygen uptake (V o2 max) was 18.3 ± 4.5 mL·min -1 ·kg -1 , representing 49% ± 12% of predicted value, and was significantly correlated with ICU stay/mechanical ventilation (MV) duration ( R = -0.337 to -0.446; p < 0.01 to 0.001), as were maximal voluntary contraction and electrically evoked peak twitch. V o2 max (either predicted or in mL· min -1 ·kg -1 ) was also significantly correlated with key indices of pulmonary function such as predicted forced vital capacity or predicted forced expiratory volume in 1 second ( R = 0.430-0.465; p ≤ 0.001) and neuromuscular function. Both cardiorespiratory fitness and neuromuscular function were correlated with self-reported physical functioning and general health status.

CONCLUSIONS

V o2 max was on average only slightly above the 18 mL·min -1 ·kg -1 , that is, the cut-off value known to induce difficulty in performing daily tasks. Overall, although low physical capacities at admission in ICU COVID-19 patients cannot be ruled out to explain the association between V o2 max or neuromuscular function and ICU stay/MV duration, altered cardiorespiratory fitness and neuromuscular function observed in the present study may not be specific to COVID-19 disease but seem applicable to all ICU/MV patients of similar duration.

ICU Readmission in Cardiac Surgical Subset: A Problem Worth Pondering

Over the past decades, there have been noteworthy advancements in the cardiac surgical practice that have assisted fast-tracking and enhanced recovery after cardiac surgery (ERACS). With that said, intensive care unit (ICU) readmission in this high-risk patient cohort entails a significant morbidity–mortality burden. As an extension of the same, there has been a heightened emphasis on a comprehensive evaluation of the predisposition to readmission following a primary ICU discharge. However, the variability of the institutional perioperative practices and the research complexities compound our understanding of this heterogeneous outcome of readmission, which is intricately linked to both patient and organizational factors. Moreover, a discussion on ICU readmission in the recent times can only be rendered comprehensive when staged in close conjunction to the fast-tracking practices in cardiac surgery. From a more positive probing of the matter, a preventative outlook can likely mitigate a part of the larger problem of ICU readmission. Herein, focused cardiac prehabilitation programs can play a potential role given the emerging literature on the positive impact of the former on the most relevant readmission causes. Therefore, the index review article aims to address the subject of cardiac surgical ICU readmission, highlighting the magnitude and burden, the causes and risk-factors, and the research complexities alongside deliberating the topic in the present-day context of ERACS and cardiac prehabilitation.

Sustainable and Active Program—Development and Application of SAVING Methodology

The SAVING project aimed to create a sustainable and active aging program to promote the transition to sustainable aging in residential structures for the elderly (RSEs), developing research activities to apply the best strategies and good practices regarding the promotion of an active, healthy, and sustainable aging regarding social, economic, environmental, and pedagogic aspects. All this innovative methodology was built on a living-lab approach applied in one RSE, that was used as a case study. The results showed that the creation of the SAVING Brigade allowed not only increased reflection and mutual learning, but also created better conditions to face uncertainties and obstacles. Moreover, the use of indicators supported the basic themes and enabled comparison with other studies, between institutions or programs. Finally, the Action Plan acted as a tool for the development of previously defined strategies. It is possible to conclude that the breadth of the concept of quality of life encompasses the physical health of the individual, their psychological state, their social relationships, their perceptions, and the relationship with the characteristics of the context in which they are inserted. Therefore, active, sustainable, and healthy aging should be the goal.

Effects of Intermittent Hypoxia-Hyperoxia Exposure Prior to Aerobic Cycling Exercise on Physical and Cognitive Performance in Geriatric Patients—A Randomized Controlled Trial

Background: It was recently shown that intermittent hypoxic-hyperoxic exposure (IHHE) applied prior to a multimodal training program promoted additional improvements in cognitive and physical performance in geriatric patients compared to physical training only. However, there is a gap in the literature to which extent the addition of IHHE can enhance the effects of an aerobic training. Therefore, the aim of this study was to investigate the efficacy of IHHE applied prior to aerobic cycling exercise on cognitive and physical performance in geriatric patients.

Methods: In a randomized, two-armed, controlled, and single-blinded trial, 25 geriatric patients (77–94 years) were assigned to two groups: intervention group (IG) and sham control group (CG). Both groups completed 6 weeks of aerobic training using a motorized cycle ergometer, three times a week for 20 min per day. The IG was additionally exposed to intermittent hypoxic and hyperoxic periods for 30 min prior to exercise. The CG followed the similar procedure breathing sham hypoxia and hyperoxia (i.e., normoxia). Within 1 week before and after the interventions, cognitive performance was assessed with the Dementia-Detection Test (DemTect) and the Clock Drawing Test (CDT), while physical performance was measured using the Timed “Up and Go” Test (TUG) and the Short-Physical-Performance-Battery (SPPB).

Results: No interaction effect was found with respect to the DemTect (η_p² = 0.02). An interaction effect with medium effect size (η_p² = 0.08) was found for CDT performance with a higher change over time for IG (d = 0.57) compared to CG (d = 0.05). The ANCOVA with baseline-adjustment indicated between-group differences with a large and medium effect size at post-test for the TUG (η_p² = 0.29) and SPPB (η_p² = 0.06) performance, respectively, in favour of the IG. Within-group post-hoc analysis showed that the TUG performance was worsened in the CG (d = 0.65) and remained unchanged in the IG (d = 0.19). Furthermore, SPPB performance was increased (d = 0.58) in IG, but no relevant change over time was found for CG (d = 0.00).

Conclusion: The current study suggests that an additional IHHE prior to aerobic cycling exercise seems to be more effective to increase global cognitive functions as well as physical performance and to preserve functional mobility in geriatric patients in comparison to aerobic exercise alone after a 6-week intervention period.

Effects of smartphone mirroring-based telepresence exercise on body composition and physical function in obese older women

AIMS

This study aimed to develop a smartphone mirroring-based telepresence exercise program that can be performed at home while allowing for real-time feedback by instructors.

METHODS

For this randomized controlled trial, 29 obese older women aged 66-87 years with ≥ 30% body fat were recruited at a senior citizen center. The intervention group was provided with the smartphone mirroring-based telepresence exercise program, in which participants exercised in their homes for 20-40 min three times a week for 12 weeks. Participants in the control group performed the same exercise program at the senior citizen center. Body composition and functional abilities were measured before and after the program.

RESULTS

Women in the intervention group showed a decrease in their body fat percentage (P = 0.026) and an increase in grip strength (P = 0.008). In the control group, women demonstrated a decrease in their weight (P = 0.006) and body fat percentage (P = 0.001) and an increase in skeletal muscle (P = 0.044) and grip strength (P = 0.006).

CONCLUSION

Smartphone mirroring-based telepresence exercises at home lower body fat percentage and increase muscle strength similar to traditional group exercises. They present an innovative way for obese older women to improve and maintain their health.

TRIAL REGISTRATION

Clinical Research Information Service KCT0006147.

Prehabilitation, enhanced recovery after surgery, or both? A narrative review

This narrative review presents a biological rationale and evidence to describe how the preoperative condition of the patient contributes to postoperative morbidity. Any preoperative condition that prevents a patient from tolerating the physiological stress of surgery (e.g. poor cardiopulmonary reserve, sarcopaenia), impairs the stress response (e.g. malnutrition, frailty), and/or augments the catabolic response to stress (e.g. insulin resistance) is a risk factor for poor surgical outcomes. Prehabilitation interventions that include exercise, nutrition, and psychosocial components can be applied before surgery to strengthen physiological reserve and enhance functional capacity, which, in turn, supports recovery through attaining surgical resilience. Prehabilitation complements Enhanced Recovery After Surgery (ERAS) care to achieve optimal patient outcomes because recovery is not a passive process and it begins preoperatively.

Aerobic reserve capacity in multiple sclerosis-Preliminary evidence

OBJECTIVES

Aerobic reserve capacity reflects the available energy for performing everyday life tasks, and it has been studied in older adult populations. This preliminary study examined proof of concept and measurement of aerobic reserve capacity in multiple sclerosis (MS).

MATERIALS & METHODS

Twenty-one fully ambulatory people with MS performed a maximal, cardiopulmonary exercise test (CPET). We calculated aerobic reserve capacity based on the difference between peak aerobic power (VO_2peak ) and first stage oxygen consumption (VO₂ ). Participants completed assessments for disability (Expanded Disability Status Scale, EDSS), cognition (Symbol Digit Modalities Test, SDMT), mood (Beck Depression Inventory, BDI), walking endurance (six-minute walk distance, 6MWD), walking speed (Timed Twenty-Foot Walk, T25FW), impact of MS (Multiple Sclerosis Impact Scale, MSIS-29), and anthropometric measurements (height and weight).

RESULTS

Aerobic reserve capacity was 9.3 ± 3.7 ml/kg/min. Aerobic reserve capacity was positively associated with VO_2peak (ρ = .67, p < .01), time to exhaustion (ρ = .63, p < .01), and SDMT (ρ = .51, p < .05). Aerobic reserve capacity was negatively associated with BMI (ρ = -.62, p < .01) and RHR (ρ = -0.47, p < .05).

CONCLUSION

We provide preliminary evidence that aerobic reserve capacity is a feasible outcome derived from maximal CPET (eg, modified Balke protocol) in MS. Aerobic reserve capacity was associated with clinically relevant outcomes and could become an important outcome for rehabilitation in future research.

Strenuous Physical Training, Physical Fitness, Body Composition and Bacteroides to Prevotella Ratio in the Gut of Elderly Athletes

Regular physical activity seems to have a positive effect on the microbiota composition of the elderly, but little is known about the added possible benefits of strenuous endurance training. To gain insight into the physiology of the elderly and to identify biomarkers associated with endurance training, we combined different omics approaches. We aimed to investigate the gut microbiome, plasma composition, body composition, cardiorespiratory fitness, and muscle strength of lifetime elderly endurance athletes (LA) age 63.5 (95% CI 61.4, 65.7), height 177.2 (95% CI 174.4, 180.1) cm, weight 77.8 (95% CI 75.1, 80.5) kg, VO2max 42.4 (95% CI 39.8, 45.0) ml.kg^–1.min^–1 (n = 13) and healthy controls age 64.9 (95% CI 62.1, 67.7), height 174.9 (95% CI 171.2, 178.6) cm, weight 83.4 (95% CI 77.1, 89.7) kg, VO2max 28.9 (95% CI 23.9, 33.9), ml.kg^–1.min^–1 (n = 9). Microbiome analysis was performed on collected stool samples further subjected to 16S rRNA gene analysis. NMR-spectroscopic analysis was applied to determine and compare selected blood plasma metabolites mostly linked to energy metabolism. The machine learning (ML) analysis discriminated subjects from the LA and CTRL groups using the joint predictors Bacteroides 1.8E + 00 (95% CI 1.1, 2.5)%, 3.8E + 00 (95% CI 2.7, 4.8)% (p = 0.002); Prevotella 1.3 (95% CI 0.28, 2.4)%, 0.1 (95% CI 0.07, 0.3)% (p = 0.02); Intestinimonas 1.3E-02 (95% CI 9.3E-03, 1.7E-02)%, 5.9E-03 (95% CI 3.9E-03, 7.9E-03)% (p = 0.002), Subdoligranulum 7.9E-02 (95% CI 2.5E-02, 1.3E-02)%, 3.2E-02 (95% CI 1.8E-02, 4.6E-02)% (p = 0.02); and the ratio of Bacteroides to Prevotella 133 (95% CI -86.2, 352), 732 (95% CI 385, 1079.3) (p = 0.03), leading to an ROC curve with AUC of 0.94. Further, random forest ML analysis identified VO2max, BMI, and the Bacteroides to Prevotella ratio as appropriate, joint predictors for discriminating between subjects from the LA and CTRL groups. Although lifelong endurance training does not bring any significant benefit regarding overall gut microbiota diversity, strenuous athletic training is associated with higher cardiorespiratory fitness, lower body fat, and some favorable gut microbiota composition, all factors associated with slowing the rate of biological aging.

Dancing With Health: Quality of Life and Physical Improvements From an EU Collaborative Dance Programme With Women Following Breast Cancer Treatment

Background: Women's health has received renewed attention in the last few years including health rehabilitation options for women affected by breast cancer. Dancing has often been regarded as one attractive option for supporting women's well-being and health, but research with women recovering from breast cancer is still in its infancy. Dancing with Health is multi-site pilot study that aimed to evaluate a dance programme for women in recovery from breast cancer across five European countries.

Methods: A standardized 32 h dance protocol introduced a range of Latin American dances presented within a sports and exercise framework with influences from dance movement therapy. Fifty-four women (M age 53.51; SD 7.99) participated in the study who had a breast cancer diagnosis <3 years, chemotherapy >6 weeks, no indication of metastasis, or scheduled surgery/chemotherapy/radiation treatment for the duration of the intervention. Primary outcome data was collected for anthropometric and fitness measures next to cancer-related quality of life. T-tests and Wilcoxon signed ranked tests were used to establish differences pre and post intervention. Cohen's d was also calculated to determine the effect size of the intervention.

Results: Statistically significant changes were found for: (i) weight, right and left forearm circumference and hip; (ii) 6 min walking, right and left handgrip, sit-to-stand and sit-and-reach; (iii) the EORTC-QLQ C30 summary score as well as the subscales of emotional and social functioning and symptoms. In all cases the direction of change was positive, while Cohen's d calculated showed that the effect of the intervention for these parameters ranged from intermediate to large.

Conclusion: Changes on the above anthropometric, fitness and quality of life measures suggest that the intervention was of value to the participating women recovering from breast cancer. Results also advocate collaborative efforts across countries to further research.

Is Stretching Exercise An Adequate Control Group in Clinical Trials Aimed at Improving Physical Fitness and Function of Older Adults? A Systematic Review and Meta-Analysis

This study aimed to determine if stretching exercise can be implemented as an adequate control therapy in exercise randomized controlled trials aimed at improving physical fitness and physical function in older adults. Five electronic databases were systematically searched for randomized controlled trials focused in the physical fitness and function of older adults using stretching exercise as control group. The methodological quality was assessed and a meta-analysis was carried out. Sixteen studies were included, 13 in the meta-analysis. The methodological quality ranged from fair to good. The meta-analysis only in the controls resulted in significant improvements in different functional parameters related to walking, balance, knee flexion strength, or global physical function. The interventions, compared with the controls, significantly improved balance and knee strength parameters. Stretching exercise as control therapy in older people can lead to beneficial effects and could influence the interpretation of the effect size in the intervention groups.

Systematic Review of Changes and Recovery in Physical Function and Fitness After Severe Acute Respiratory Syndrome-Related Coronavirus Infection: Implications for COVID-19 Rehabilitation

OBJECTIVE

This review sought to (1) compare physical function and fitness outcomes in people infected with Severe Acute Respiratory Syndrome-related Coronavirus (SARS-CoV) with healthy controls, (2) quantify the recovery of physical function and fitness following SARS-CoV infection, and (3) determine the effects of exercise following SARS-CoV infection.

METHODS

Four databases (CINAHL, MEDLINE, ProQuest, and Web of Science Core Collections) were searched in April 2020 using keywords relating to SARS-CoV, physical function, fitness, and exercise. Observational studies or randomized controlled trials were included if they involved people following SARS-CoV infection and either assessed the change or recovery in physical function/fitness or evaluated the effects exercise postinfection.

RESULTS

A total 10 articles were included in this review. Evidence from 9 articles demonstrated that SARS-CoV patients had reduced levels of physical function and fitness postinfection compared with healthy controls. Furthermore, patients demonstrated incomplete recovery of physical function, with some experiencing residual impairments 1 to 2 years postinfection. Evidence from 1 randomized controlled trial found that a combined aerobic and resistance training intervention significantly improved physical function and fitness postinfection compared with a control group.

CONCLUSIONS

Physical function and fitness are impaired following SARS-CoV infection, and impairments may persist up to 1 to 2 years postinfection. Researchers and clinicians can use these findings to understand the potential impairments and rehabilitation needs of people recovering from the current coronavirus 2019 (COVID-19) outbreak. While 1 study demonstrated that exercise can improve physical function and fitness postinfection, further research is required to determine the effectiveness of exercise in people recovering from similar infections (eg, COVID-19).

IMPACT

Considering the similarities in pathology and clinical presentation of SARS-CoV and COVID-19, it is likely that COVID-19 patients will present with similar impairments to physical function. Accordingly, research is required to measure the extent of functional impairments in COVID-19 cohorts. In addition, research should evaluate whether rehabilitation interventions such as exercise can promote postinfection recovery.

Shifting Tides Toward a Proactive Patient-Centered Approach in Dysphagia Management of Neurodegenerative Disease

Purpose Persons with neurodegenerative disease frequently develop comorbid dysphagia as part of their disease process. Current "reactive" approaches to dysphagia management address dysphagia once it manifests clinically and consist of compensatory approaches. The purpose of this article is to propose a paradigm shift in dysphagia management of patients with neurodegenerative disease from a "reactive to proactive" approach by highlighting amyotrophic lateral sclerosis (ALS) and dementia as case examples. Method The authors present several areas of special consideration for speech-language pathologists (SLPs) treating dysphagia in patients with neurodegenerative disease. The drawbacks of historical "reactive" approaches to dysphagia management are described. Concepts of functional reserve for swallowing and homeostenosis are discussed. A "proactive" patient-centered paradigm of care for these patients is proposed with evidence to support its importance. A rationale for use of this approach in patients with ALS and dementia is provided with strategies for implementation. Results When treating dysphagia in patients with neurodegenerative disease, SLPs must balance a variety of factors in their decision making, including disease severity and expected progression, cultural considerations, goals of care, patient empowerment, and caregiver support. Reactive approaches to dysphagia management in these populations are problematic in that they disempower patients by focusing on use of compensatory techniques (e.g., diet modification, postural changes, feeding tube placement). Proactive approaches that employ rehabilitative interventions to increase functional reserve, such as resistance training, may result in improvement or maintenance of swallowing function longer into disease progression. An interdisciplinary team with early SLP involvement is necessary. Conclusions SLPs play a critical role in the management of dysphagia in patients with neurodegenerative disease and should be integrated early in the care of these patients. By focusing on a proactive patient-centered approach, patients with neurodegenerative conditions, such as ALS and dementia, will experience improved quality of life and health outcomes for a longer time.

Effects of Caloric Restriction on Cardiorespiratory Fitness, Fatigue, and Disability Responses to Aerobic Exercise in Older Adults With Obesity: A Randomized Controlled Trial

BACKGROUND

Obesity compounds aging-related declines in cardiorespiratory fitness, with accompanying fatigue and disability. This study determined the effects of two different levels of caloric restriction (CR) during aerobic training on cardiorespiratory fitness, fatigue, physical function, and cardiometabolic risk.

METHODS

The INFINITE study was a 20-week randomized trial in 180 older (65-79 years) men and women with obesity (body mass index = 30-45 kg/m2). Participants were randomly assigned to (i) aerobic training (EX; treadmill 4 days/wk for 30 minutes at 65%-70% of heart rate reserve), (ii) EX with moderate (-250 kcal/d) CR (EX + Mod-CR), or (iii) EX with more intensive (-600 kcal/d) CR (EX + High-CR). Cardiorespiratory fitness (peak aerobic capacity, VO2 peak, primary outcome) was determined during a graded exercise test.

RESULTS

One hundred and fifty-five participants returned for 20-week data collection (87% retention). VO2 peak increased by 7.7% with EX, by 13.8% with EX + Mod-CR, and by 16.0% with EX + High-CR, and there was a significant treatment effect (EX + High-CR = 21.5 mL/kg/min, 95% confidence interval = 19.8-23.2; EX + Mod-CR = 21.2 mL/kg/min, 95% confidence interval = 19.4-23.0; EX = 20.1 mL/kg/min, 95% confidence interval = 18.4-21.9). Both CR groups exhibited significantly greater improvement in self-reported fatigue and disability and in glucose control, compared with EX.

CONCLUSION

Combining aerobic exercise with even moderate CR is more efficacious for improving cardiorespiratory fitness, fatigue and disability, and glucose control than exercise alone and is as effective as higher-dose CR.

Effect of 9 weeks continuous vs. interval aerobic training on plasma BDNF levels, aerobic fitness, cognitive capacity and quality of life among seniors with mild to moderate Alzheimer's disease: a randomized controlled trial

Background

Evidence suggests that aerobic-type training confers physical benefits and appears to contribute positively to brain health. This study aims to compare the effect of 9-weeks continuous (CAT) to interval aerobic training (IAT) on brain derived neurotrophic factor (BDNF) plasma level, aerobic fitness, cognitive performance, and quality of life among senior with Alzheimer's disease (AD).

Methods

52 participants were randomly allocated into three groups (CAT n = 14; IAT n = 17; and Controls n = 21). CAT and IAT consisted of 18 sessions of 30-min cycling, twice a week, over 9 weeks. During the same period, controls were engaged in interactive information sessions. Plasma BDNF level; aerobic fitness parameters (Metabolic equivalent task - METs; Maximal Tolerated Power - MTP); functional capacities (6-Minute Walk Test - 6MWT); cognitive performance (Mini Mental State Examination; Rey auditory verbal learning test; and digit span test) and quality of life (Quality Of Life of Alzheimer's Disease scale - QoL-AD) were measured in all participants at baseline and 9 weeks later. A third plasma BDNF level was quantified following a 4 weeks detraining.

Results

No significant change was measured in terms of plasma BDNF level and cognitive performance after interventions, in all groups compared to baseline. After 9 weeks, CAT and IAT significantly improved aerobic fitness parameters compared to controls (METs: + 0.6 and + 1.0 vs. + 0.4; MTP: + 16 watts and + 20 watts vs. + 10 watts; and functional capacities (6MWT: + 22 m and + 31 m vs. -40 m). Compared to controls, QoL-AD after CAT was improved (+ 2 points; p = 0.02).

Conclusions

Neither aerobic exercise modalities significantly modified plasma BDNF levels and cognitive performances. CAT and IAT enhanced aerobic fitness and functional capacities in AD patients and CAT their QoL.

Trial registration

ClinicalTrials.gov website (NCT02968875); registration date: 7 September 2016. "Retrospectively registered".

Change in Fitness and the Relation to Change in Cognition and Neuropsychiatric Symptoms After Aerobic Exercise in Patients with Mild Alzheimer's Disease

BACKGROUND

Physical activity has the potential to improve physical function in patients with Alzheimer's disease (AD) and may contribute to modify disease processes and cognitive function.

OBJECTIVE

The aim of this study was to investigate 1) the effect of moderate-high-intensity aerobic exercise on cardiorespiratory fitness, i.e., peak oxygen uptake (VO2peak) determined by direct breath-by-breath cardiopulmonary exercise test, and 2) the association between changes in VO2peak and changes in cognition and neuropsychiatric symptoms in patients with mild AD.

METHODS

The study is based on secondary outcome analyses from the large single-blinded multi-center study ADEX (Preserving Cognition, Quality of Life, Physical Health and Functional Ability in Alzheimer's Disease: The Effect of Physical Exercise). A preselected sub-group of 55 participants (age 52-83 years), 29 from the intervention group (IG) and 26 from the control group (CG), was included. IG performed 16 weeks of supervised moderate-to-high intensity aerobic exercise. Assessments of VO2peak, mental speed and attention (Symbol Digit Modalities Test, SDMT), and neuropsychiatric symptoms (Neuropsychiatric Inventory, NPI) were performed at baseline and at 16 weeks.

RESULT

VO2peak increased 13% in the IG and a between-group difference in mean change (3.92 ml/kg/min, 95% CI 6.34-1.51, p = 0.003) was present in favor of the IG. Combined data from IG and CG showed positive associations between changes in VO2peak and changes in NPI (Rho = - 0.41, p = 0.042) and changes in SDMT (Rho = 0.36, p = 0.010), respectively.

CONCLUSION

Aerobic exercise improves VO2peak in community-dwelling patients with mild AD. Furthermore, changes in VO2peak appear to be associated to changes in cognition and neuropsychiatric symptoms.

Oxygen Cost During Mobility Tasks and Its Relationship to Fatigue in Progressive Multiple Sclerosis

OBJECTIVE

To compare the oxygen costs of mobility tasks between individuals with progressive multiple sclerosis (MS) using walking aids and matched controls and to determine whether oxygen cost predicted fatigue.

DESIGN

Cross-sectional descriptive.

SETTING

A rehabilitation research laboratory.

PARTICIPANTS

A total of 14 adults with progressive MS (mean age ± SD [y], 54.07±8.46) using walking aids and 8 age- and sex-matched controls without MS (N=22).

INTERVENTIONS

Participants performed 5 mobility tasks (rolling in bed, lying to sitting, sitting to standing, walking, climbing steps) wearing a portable metabolic cart.

MAIN OUTCOME MEASURES

Oxygen consumption (V˙o₂) during mobility tasks, maximal V˙o₂ during graded maximal exercise test, perceived exertion, and task-induced fatigue were measured on a visual analog scale before and after mobility tasks.

RESULTS

People with progressive MS had significantly higher oxygen cost in all tasks compared to controls (P<.05): climbing steps (3.60 times more in MS), rolling in bed (3.53), walking (3.10), lying to sitting (2.50), and sitting to standing (1.82). There was a strong, positive correlation between task-induced fatigue and oxygen cost of walking, (ρ [13]=0.626, P=.022).

CONCLUSIONS

People with progressive MS used 2.81 times more energy on average for mobility tasks compared to controls. People with progressive MS experienced accumulation of oxygen cost, fatigue, and exertion when repeating tasks and higher oxygen cost during walking was related to greater perception of fatigue. Our findings suggest that rehabilitation interventions that increase endurance during functional tasks could help reduce fatigue in people with progressive MS who use walking aids.

Serum levels of insulin-like growth factor-1 and brain-derived neurotrophic factor as potential recovery biomarkers in stroke

OBJECTIVES

Our objectives were: 1) to determine whether maximal aerobic exercise increased serum neurotrophins in chronic stroke and 2) to determine the factors that predict resting and exercise-dependent levels.

METHODS

We investigated the potential predictors of resting and exercise-dependent serum insulin-like growth factor-1 and brain-derived neurotrophic factor among 35 chronic stroke patients. Predictors from three domains (demographic, disease burden, and cardiometabolic) were entered into 4 separate stepwise linear regression models with outcome variables: resting insulin-like growth factor, resting brain-derived neurotrophic factor, exercise-dependent change in insulin-like growth factor, and exercise-dependent change brain-derived neurotrophic factor.

RESULTS

Insulin-like growth factor decreased after exercise (p = 0.001) while brain-derived neurotrophic factor did not change (p = 0.38). Greater lower extremity impairment predicted higher resting brain-derived neurotrophic factor (p = 0.004, r² = 0.23). Higher fluid intelligence predicted greater brain-derived neurotrophic factor response to exercise (p = 0.01, r² = 0.18). There were no significant predictors of resting or percent change insulin-like growth factor-1.

DISCUSSION

Biomarkers have the potential to characterize an individual's potential for recovery from stroke. Neurotrophins such as insulin-like growth factor-1 and brain-derived neurotrophic factor are thought to be important in neurorehabilitation; however, the factors that modulate these biomarkers are not well understood. Resting brain-derived neurotrophic factor and percent change in brain-derived neurotrophic factor were related to physical and cognitive recovery in chronic stroke, albeit weakly. Insulin-like growth factor-1 was not an informative biomarker among chronic stroke patients. The novel finding that fluid intelligence positively correlated with exercise-induced change in brain-derived neurotrophic factor warrants further research.

Effects of dancing compared to walking on cardiovascular risk and functional capacity of older women: A randomized controlled trial

INTRODUCTION

Aging is characterized by reductions in lean mass simultaneously to increases in visceral adipose tissue, elevating cardiovascular risk (CVR) and physical dependence. Dancing has been recommended for improving fall-risk and CVR, however, comparisons with traditional exercises are limited. This study aimed to compare the effects of dancing with walking on CVR and functionality of older women.

METHODS

Thirty sedentary women (65 ± 5 years, BMI 27 ± 4 kg/m²) were randomized into three groups (n = 10/group): dancing, walking or stretching (active control). All interventions lasted 8 weeks (60 min sessions): dancing/walking 3×/week, stretching 1×/week. Dancing: several styles, no partner. Walking: treadmill, 60% peak oxygen consumption (VO₂peak). Stretching: large muscle groups, no discomfort. Before and after interventions assessments: VO₂peak (primary outcome), total cholesterol, HDL-C, LDL-C, glucose, insulin, CRP, TNF-α, waist and hip circumferences, visceral adipose tissue (VAT), muscle thickness, maximal muscle strength/power, static and dynamic balance, gait ability, flexibility, chair-raise and level of physical activity (PA).

STATISTICS

generalized estimating equations, post-hoc LSD (p < 0.05), SPSS 22.0.

RESULTS

(Mean-CI): (before vs after): group vs time interaction showed increases in VO₂peak (mL·kg^-1·min^-1) for dancing 23.3 (20.8-25.8) vs 25.6 (23.4-27.8), and walking 23.4 (21.3-25.5) vs 27.0 (25.4-28.6), with no differences for stretching 23.5 (21.3-25.7) vs 23.0 (21.0-24.9). Lower body muscle power and static balance also improved for dancing and walking, but not for stretching. Main time effect showed improvements in CRP, TNF-α, LDL-C, HDL-C, VAT, waist, hip, chair raise, flexibility and level of daily PA for all groups.

CONCLUSION

Dancing induced similar increases in VO₂peak, lower body muscle power and static balance as walking, while the stretching group remained unchanged. Pooled effects showed improvements in body composition, lipid and inflammatory profile, which are supported by increased PA levels.

TRIAL REGISTRATION

NCT03262714.

The effects of circuit training on the indexes of sarcopenia and the risk factors of metabolic syndrome in aged obese women

The purpose of this study is to examine the effects of circuit training on the indexes of sarcopenia and the risk factors of metabolic syndrome in aged obese women. To address the goal, this author selected aged women whose body mass index was higher than 25.0 kg/m² visiting the welfare center for the aged located in Gangwon-do Province and measured the indexes of sarcopenia and the risk factors of metabolic syndrome after circuit training. Through that, this study has gained following results. First, after circuit training, aged obese women’s indexes of sarcopenia indicated statistically significant difference in terms of interaction between the measuring times and groups. Second, after circuit training, aged obese women’s risk factors of metabolic syndrome (systolic blood pressure, diastolic blood pressure, fasting blood sugar, triglycerides, high-density lipoprotein-cholesterol, and waist circumference) showed statistically significant difference in terms of interaction between the measuring times and groups. To sum up the above results, circuit training improves aged obese women’s indexes of sarcopenia and risk factors of metabolic syndrome positively, which means circuit training is found to be effective. Therefore, the circuit training intervention enhances aged obese women’s muscular and metabolic functions positively. As it helps prevent and manage the risk factors of sarcopenia and metabolic syndrome resulted from aging, it will elevate life quality in senescence.

The relationship between functional status, physical fitness and cognitive performance in physically active older adults: A pilot study

OBJECTIVE

Ageing is associated with a progressive decline in physical function and cognitive performance which could result in a shift from an independent to a more dependent lifestyle. The aim of this research study was to assess the fitness, functional performance and cognitive ability in independently living older South Africans and to determine which fitness parameters and functional performance tests best explain the variance in cognitive function.

DESIGN

Descriptive observational study.

PARTICIPANTS

Older adults with a mean age 71±4.7 years (n = 70; 28 men and 42 women) were recruited. Sixty percent of the sample completed at least secondary schooling and more than two-thirds were taking medication for a chronic medical condition.

MEASUREMENTS

Self-reported physical activity was assessed using the Yale Physical Activity Survey. Fitness tests included the 6-minute walk test and Bicep Curls. The functional performance tests were; Static and Dynamic balance, Timed Up and Go, Sit to Stand, Grip strength and Functional Reach. The Stroop Task and 6-Item cognitive impairment test were used to measure cognitive performance. Bivariate and multivariate analyses were conducted between performance on the novel cognitive Stroop Task and functional and cognitive tests.

RESULTS

We found significant relationships between the number of correct responses on the Stroop Task and scores on the 6-Item Cognitive Impairment test (-0.520, p < 0.01) and grip strength (r = 0.42, p< 0.01). The number of incorrect responses was inversely associated with functional reach (r = -0.445, p< 0.01). The final regression model included: age, dynamic balance, right arm grip strength and the score on the 6-item cognitive impairment test, and explained 44% of the variance in performance of the Stroop Task.

CONCLUSIONS

The results of this study showed that measures of physical function were associated with cognitive performance even in highly functioning older South African adults. Further research is needed to determine the extent to which exercise training can improve functional capacity and the effect on cognitive performance.

Four birds with one stone? Reparative, neuroplastic, cardiorespiratory, and metabolic benefits of aerobic exercise poststroke

PURPOSE OF REVIEW

Converging evidence from animal models of stroke and clinical trials suggests that aerobic exercise has effects across multiple targets.

RECENT FINDINGS

The subacute phase is characterized by a period of heightened neuroplasticity when aerobic exercise has the potential to optimize recovery. In animals, low intensity aerobic exercise shrinks lesion size and reduces cell death and inflammation, beginning 24 h poststroke. Also in animals, aerobic exercise upregulates brain-derived neurotrophic factor near the lesion and improves learning. In terms of neuroplastic effects, clinical trial results are less convincing and have only examined effects in chronic stroke. Stroke patients demonstrate cardiorespiratory fitness levels below the threshold required to carry out daily activities. This may contribute to a 'neurorehabilitation ceiling' that limits capacity to practice at a high enough frequency and intensity to promote recovery. Aerobic exercise when delivered 2-5 days per week at moderate to high intensity beginning as early as 5 days poststroke improves cardiorespiratory fitness, dyslipidemia, and glucose tolerance.

SUMMARY

Based on the evidence discussed and applying principles of periodization commonly used to prepare athletes for competition, we have created a model of aerobic training in subacute stroke in which training is delivered in density blocks (duration × intensity) matched to recovery phases.

Physical Fitness in Older People Recently Diagnosed with Cognitive Impairment Compared to Older People Recently Discharged from Hospital

BACKGROUND/AIMS

There is evidence of an association between cognitive function and physical fitness. The aim of this study was to compare physical fitness in patients with cognitive impairment with a group of older people recently discharged from hospital.

METHODS

A cross-sectional study with 98 patients recently diagnosed with cognitive impairment and 115 patients recently discharged from hospital. Associations between the study group variable and different components in the Senior fitness test were examined, controlling for demographic factors and comorbidity.

RESULTS

The group recently diagnosed with cognitive impairment indicated poorer results on three of six physical fitness components (p < 0.05).

CONCLUSION

Older adults with cognitive impairment are in need of individually tailored physical activity programs to increase the level of physical fitness.

Physical Activity Intervention Effects on Physical Function Among Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis

The purpose of this systematic review and meta-analysis was to determine the effects of supervised resistance and/or aerobic training physical activity interventions on performance-based measures of physical functioning among community-dwelling older adults, and to identify factors impacting intervention effectiveness. Diverse search strategies were used to identify eligible studies. Standardized mean difference effect sizes (d, ES) were synthesized using a random effects model. Moderator analyses were conducted using subgroup analyses and meta-regression. Twenty-eight studies were included. Moderator analyses were limited by inconsistent reporting of sample and intervention characteristics. The overall mean ES was 0.45 (k = 38, p ≤ .01), representing a clinically meaningful reduction of 0.92 s in the Timed Up and Go for treatment versus control. More minutes per week (p < .01) and longer intervention session duration (p < .01) were associated with larger effects. Interventions were especially effective among frail participants (d = 1.09). Future research should clearly describe sample and intervention characteristics and incorporate frail populations.

Effects of dance interventions on cardiovascular risk with ageing: Systematic review and meta-analysis

BACKGROUND

Exercising, including dancing, has been recommended to improve cardiovascular health of older people. Herein, we conducted a systematic review and meta-analysis verifying the effects of dance interventions on cardiovascular risk (CVR) in the elderly, comparing dancers to non-exercise controls and other types of exercise, in randomised (RCTs) and non-randomised control trials (nRCTs). Primary/Secondary outcomes: peak oxygen consumption (VO₂peak)/anthropometric measurements (body weight, BMI), and lipid profile.

METHODS

Data Sources: MEDLINE, Cochrane Wiley, Clinical Trials.gov, PEDRO and LILACS databases.

STUDY SELECTION

RCTs and nRCTs comparing elderly before and after dance interventions with non-exercising controls and/or practitioners of other types of exercise. Two independent reviewers extracted data and assessed the quality of included studies.

RESULTS

A total of 937 articles were retrieved, 64 full texts were assessed for eligibility, and 7 articles met the inclusion criteria. Pooled mean differences between intervention and control were calculated by random-effects model. VO₂peak improved in favour of dancers (3.4mLkg^-1min^-1, 95%CI: 1.08, 5.78, I2=71%), compared to non-exercise controls. No differences were found between dance and other exercises. Body weight and BMI were not altered by dance interventions.

CONCLUSIONS

Dance interventions may increase VO₂peak compared to non-exercising controls. Results also indicate it is as effective as other types of exercise in improving aerobic capacity of the elderly. Dancing might be a potential exercise intervention for improving cardiorespiratory fitness and consequent CVR associated with ageing. Proper reporting on adverse events is needed to base the benefits of dancing for the older on both efficacy and safety of the interventions.

Functional reserve in functionally independent elderly persons: a calculation of gait speed and physiological cost

Abstract Aim: To analyze the behavior of functional reserve percentage (%FR) by gender in functional elderly persons, considering speed and the physiological cost of gait. Methods: A total of 53 self-reliant elderly persons, 40 of whom were women (age 69.4±4.7 years old; BMI 31.2±4.3 kg/m2) and 13 of whom were men (age 70.8±7.2 years old; BMI 28.7±3.5 kg/m2) participated in an observational and cross-sectional study. Participants were requested to walk at comfortable (CG) and maximum gait (MG). Both modalities were performed on a 70-meter elliptical circuit over three minutes. Distance and working heart rate were recorded for the corresponding calculation of average gait speed (AGS), physiological cost index (PCI) and used working heart rate percentage (% uWHR). With this information the FR% was determined by the percentage ratio with AGS, PCI and %uWHR under comfortable versus maximum demand walk conditions. Results: The association between %FR and AGS was significantly higher in males (p=0.017), reaching values of +-20% in most subjects. The physiological %FR for PCI was ≈30% in both men and women (p=0.156), while for % uWHR was ≈40% in females and ≈45% in males (p=0.131). Conclusion: AGS is a critical threshold functionality indicator to determine FR in functionally independent Chilean elderly persons.

The clinimetric properties of aerobic and anaerobic fitness measures in adults with cerebral palsy: A systematic review of the literature

OBJECTIVE

To analyze the clinimetric properties of maximal aerobic and anaerobic fitness measurement protocols in adults with cerebral palsy (CP).

DATA SOURCES

A systematic search through March 2015 of databases PubMed, Embase, SPORTDiscus and PsycINFO was performed with medical subject heading terms for 'cerebral palsy' combined with search terms adults or adolescents and multiple text words for fitness and exercise tests that yielded 864 articles.

STUDY SELECTION

Abstracts were screened by two reviewers to identify use of maximal fitness measurements in adolescents (14-18yrs) or adults (>18yrs) with CP of all abilities. Ninety-four articles were reviewed. No studies of adolescent (14-18yrs) qualified. Eight articles reported clinimetric properties for adults with CP who walk or propel a wheelchair independently. Five articles reported on aerobic capacity, one reported on anaerobic capacity and two reported on both.

DATA EXTRACTION

Methodological quality of the studies was rated using portions of the COSMIN (COnsensus-based Standards for the selection of health status Measurement INstruments) checklist. Quality of the measurement protocols was evaluated based on statistical strength of the clinimetrics. Synthesis of the overall evidence was based on the Cochrane review group guidelines which combine methodological quality and statistical strength.

DATA SYNTHESIS

Eight articles reported on 4 aerobic and 1 anaerobic protocols. Overall synthesis revealed that for ambulatory adults with CP there is (i) moderate evidence for good reliability and good construct validity of maximal aerobic and anaerobic cycle tests, (ii) moderate evidence for good criterion validity of sub-maximal aerobic cycle tests, and (iii) strong evidence for poor criterion validity of the six-minute walk test as a maximal aerobic test. And for adults who propel a wheelchair there is limited evidence of good reliability for maximal aerobic wheelchair ergometer tests.

CONCLUSIONS

Limited quality research exists on the clinimetric properties of aerobic and anaerobic capacity measures for adults with CP who have independent mobility. Quality aerobic and anaerobic measures for adults with more severe mobility impairments are absent.

Physical Activity and Change in Long Distance Corridor Walk Performance in the Health, Aging, and Body Composition Study

OBJECTIVES

To examine the prospective relationship between self-reported physical activity and aerobic fitness in the Health, Aging, and Body Composition Study (Health ABC) using the Long Distance Corridor Walk (LDCW).

DESIGN

Cohort study with 7 years of follow-up.

SETTING

Two U.S. clinical sites.

PARTICIPANTS

Community-dwelling older adults enrolled in Health ABC (N = 3,075, aged 70-79, 52% female, 42% black) with no self-reported difficulty walking one-quarter of a mile or climbing 10 steps.

MEASUREMENTS

Participants were classified based on a physical activity questionnaire as being inactive (≤1,000 kcal/wk exercise activity, ≤2,719 kcal/wk total physical activity), lifestyle active (≤1,000 kcal/wk exercise activity, >2,719 kcal/wk total physical activity), or exercisers (≥1,000 kcal/wk exercise activity). The LDCW, an endurance walking test (400 m), was administered at Years 1 (baseline), 2, 4, 6, and 8 to assess aerobic fitness.

RESULTS

At baseline, LDCW completion times (adjusted for age and sex) were 351.8 seconds (95% confidence interval (CI) = 346.9-356.8 seconds) for the inactive group, 335.9 seconds (95% CI = 332.7-339.1 seconds) for the lifestyle active group, and 307.7 seconds (95% CI = 303.2-312.3 seconds) for the exerciser group (P < .001). From baseline to Year 8, the inactive group slowed 36.1 seconds (95% CI = 28.4-43.8 seconds), the lifestyle active group slowed 38.1 seconds (95% CI = 33.6-42.4 seconds), and the exerciser group slowed 40.8 seconds (95% CI = 35.2-46.5 seconds), and did not differ significantly between groups. In linear mixed-effects models, the rate of change in LDCW time did not differ between the groups, although exercisers consistently had the fastest completion times (P < .001 for all pairwise comparisons).

CONCLUSION

Decline in LDCW time occurred regardless of baseline activity, although exercisers maintained higher aerobic fitness, which may delay reaching a critically low threshold of aerobic fitness at which independence is impaired.

Physical fitness is predictive for a decline in the ability to perform instrumental activities of daily living in older adults with intellectual disabilities: Results of the HA-ID study

The ability to perform instrumental activities of daily living (IADL) is important for one's level of independence. A high incidence of limitations in IADL is seen in older adults with intellectual disabilities (ID), which is an important determinant for the amount of support one needs. The aim of this study was to assess the predictive value of physical fitness for the ability to perform IADL, over a 3-year follow-up period, in 601 older adults with ID. At baseline, an extensive physical fitness assessment was performed. In addition, professional caregivers completed the Lawton IADL scale, both at baseline and at follow-up. The average ability to perform IADL declined significantly over the 3-year follow-up period. A decline in the ability to perform IADL was seen in 44.3% of the participants. The percentage of participants being completely independent in IADL declined from 2.7% to 1.3%. Manual dexterity, balance, comfortable and fast gait speed, muscular endurance, and cardiorespiratory fitness were significant predictors for a decline in IADL after correcting for baseline IADL and personal characteristics (age, gender, level of ID, and Down syndrome). This can be interpreted as representing the predictive validity of the physical tests for a decline in IADL. This study shows that even though older adults with ID experience dependency on others due to cognitive limitations, physical fitness also is an important aspect for IADL, which stresses the importance of using physical fitness tests and physical fitness enhancing programs in the care for older adults with ID.

Physical fitness is predictive for a decline in daily functioning in older adults with intellectual disabilities: results of the HA-ID study

A high incidence of limitations in daily functioning is seen in older adults with intellectual disabilities (ID), along with poor physical fitness levels. The aim of this study was to assess the predictive value of physical fitness for daily functioning after 3 years, in 602 older adults with borderline to profound ID (≥ 50 years). At baseline, physical fitness levels and daily functioning (operationalized as basic activities of daily living [ADL] and mobility) were assessed. After 3 years, the measurements of daily functioning were repeated. At follow-up, 12.6% of the participants were completely independent in ADL and 48.5% had no mobility limitations. More than half of the participants (54.8%) declined in their ability to perform ADL and 37.5% declined in their mobility. Manual dexterity, visual reaction time, balance, comfortable and fast gait speed, muscular endurance, and cardiorespiratory fitness were significant predictors for a decline in ADL. For a decline in mobility, manual dexterity, balance, comfortable and fast walking speed, grip strength, muscular endurance, and cardiorespiratory fitness were all significant predictors. This proves the predictive validity of these physical fitness tests for daily functioning and stresses the importance of using physical fitness tests and implementing physical fitness enhancing programs in the care for older adults with ID.

The Effect of an 8-Week Tai Chi Exercise Program on Physical Functional Performance in Middle-Aged Women

The purpose of this study was to determine the effectiveness of an 8-week Tai Chi Chih exercise program on physical functional performance (PFP) among women aged 45 to 65 years. A quasi-experimental design with a nonequivalent comparison group was used. Forty-one healthy inactive women were assigned to either an intervention group (n = 19) or a comparison group (n = 19). A 60-min Tai Chi Chih exercise class was conducted twice a week for 8 weeks. PFP was measured at baseline and postintervention using the Continuous Scale Physical Functional Performance-10 (CS-PFP 10). Between-group differences were analyzed using one-way analysis of covariance (ANCOVA). After participating in the 8-week program, intervention group participants showed greater improvement in the CS-PFP measures (p < .05, η(2) > .06). However, the comparison group had little changes. The findings from this study suggest that participation in an 8-week Tai Chi Chih exercise program can improve PFP in healthy, community-dwelling middle-aged women.

Measuring Physical Activity in Older Adults with and without Early Stage Alzheimer's Disease

We compared subjective reports of physical activity with objective measures of physical fitness including cardiorespiratory capacity, body composition, and physical performance in 146 older adults with and without early stage Alzheimer's disease (ESAD). Respondents reported primarily unstructured and low-intensity activities, including walking and housework. Individuals with ESAD participated in fewer and lower intensity physical activities than those without ESAD. In those without ESAD, housework was related to lower body mass index, leisure walking was related to faster speed on a timed walking test, and participation in sports was related to higher peak oxygen intake. In individuals with ESAD, reported physical activities did not predict any of the physical fitness, body composition, or physical performance measures. We conclude that measures of physical activity require expansion of unstructured and low intensity activities to improve sensitivity in sedentary populations, especially in older adults with ESAD.

The relationship of the energetic cost of slow walking and peak energy expenditure to gait speed in mid-to-late life

OBJECTIVE

Peak energy expenditure is highly correlated with usual gait speed; however, it is unknown whether the energetic cost of walking is also an important contributor to usual gait speed when considered as a component of peak walking capacity.

DESIGN

The energetic cost of 5 mins of slow treadmill walking (0.67 m/sec), peak overground walking energy expenditure, and usual gait speed over 6 m were assessed cross-sectionally in 405 adults aged 33 to 94 yrs in the Baltimore Longitudinal Study of Aging.

RESULTS

Mean (SD) energy expenditures during slow and peak sustained walking were 8.9 (1.4) and 18.38 (4.8) ml kg(-1) min(-1), respectively. Overall, the energetic cost of slow walking as a percentage of peak walking energy expenditure was strongly associated with usual gait speed (P < 0.001); however in stratified analyses, this association was maintained only in those with peak walking capacity below 18.3 ml kg(-1) min(-1) (P = 0.04), the threshold associated with independent living.

CONCLUSIONS

In older persons with substantially reduced peak walking capacity, the energetic cost of walking is associated with gait speed, particularly when peak walking capacity nears the minimum level considered necessary for independent living. Thus, optimal habilitation in older frail persons may benefit from both improving fitness and reducing the energetic cost of walking.

Left atrial enlargement and reduced physical function during aging

Diastolic dysfunction, often seen with increasing age, is associated with reduced exercise capacity and increased mortality. Mortality rates in older individuals are linked to the development of disability, which may be preceded by functional limitations. The goal of this study was to identify which echocardiographic measures of diastolic function correlate with physical function in older subjects. A total of 36 men and women from the Louisiana Healthy Aging Study, age 62-101 yr, received a complete echocardiographic exam and performed the 10-item continuous-scale physical-functional performance test (CS-PFP-10). After adjustment for age and gender, left atrial volume index (ρ = -0.59; p = .0005) correlated with the total CS-PFP-10 score. Increased left atrial volume index may be a marker of impaired performance of activities of daily living in older individuals.

Association between Physical Functionality and Falls Risk in Community-Living Older Adults

Ageing-related declines in physiological attributes, such as muscle strength, can bring with them an increased risk of falls and subsequently greater risk of losing independence. These declines have substantial impact on an individual's functional ability. However, the precise relationship between falls risk and physical functionality has not been evaluated. The aims of this study were to determine the association between falls risk and physical functionality using objective measures and to create an appropriate model to explain variance in falls risk. Thirty-two independently living adults aged 65–92 years completed the FallScreen, the Continuous-Scale Physical Functional Performance 10 (CS-PFP10) tests, and the 12-Item Short-Form Health Survey (SF-12). The relationships between falls risk, physical functionality, and age were investigated using correlational and multiple hierarchical regression analyses. Overall, total physical functionality accounted for 24% of variance in an individual's falls risk while age explained a further 13%. The oldest-old age group had significantly greater falls risk and significantly lower physical functional performance. Mean scores for all measures showed that there were substantial (but not significant) differences between males and females. While increasing age is the strongest single predictor of increasing falls risk, poorer physical functionality was strongly, independently related to greater falls risk.

The role of energetic cost in the age-related slowing of gait speed

OBJECTIVES

To determine whether slow gait represents a compensatory strategy to reduce the energetic cost of walking with age.

DESIGN

Cross-sectional analysis.

SETTING

Community-dwelling volunteers from the Baltimore Longitudinal Study of Aging (BLSA).

PARTICIPANTS

Four hundred twenty community-dwelling persons aged 32 to 96 (mean 68.1 ± 12.5) who underwent a physical examination, physical function testing, and energy expenditure assessment.

MEASUREMENTS

Energy expenditure per minute (mL/kg/min) and per meter (mL/kg/m) during 2.5 minutes of overground walking at customary speed and usual gait speed over 6 m (m/s) were examined. General linear regression models were used to assess the relationship between customary walking energy expenditure and usual gait speed, adjusted for potential confounders including smoking, medical diagnoses, walking-related pain, and balance difficulty.

RESULTS

Usual gait speed was slower with increasing age after age 65. Energy expenditure per minute during customary walking averaged 13.0 ± 2.8 mL/kg/min and was independent of age (ρ < 0.01, P = .88). In contrast, energy expenditure per meter walked was progressively higher after age 65 (ρ = 0.35, P < .001) and heightened after age 80 (r = 0.57, P < .001), mirroring the observed pattern of usual gait speed. This relationship remained significant after adjusting for multiple impairments and comorbidities.

CONCLUSION

These observations support the hypothesis that slower gait at older ages may reflect a compensatory action to offset the greater energetic cost of walking associated with aging and chronic conditions. Future studies should evaluate the specific mechanisms that contribute to this phenomenon as novel targets for clinical intervention.

The physical performance test predicts aerobic capacity sufficient for independence in early-stage Alzheimer disease

BACKGROUND

Early identification of physical impairment related to Alzheimer disease (AD) is increasingly identified as an important aspect of diagnosis and care. Clinically accessible tools for evaluating physical capacity and impairment in AD have been developed but require further characterization for their effective use.

PURPOSE

To assess the utility of the Physical Performance Test (PPT) for identifying functionally limiting aerobic capacity in older adults with AD and without dementia.

METHODS

Secondary analysis of a dataset of community dwelling older adults, 70 without dementia and 60 with early-stage AD. Participants were administered the PPT and performed a graded maximal exercise test. The clinical utility of 2 versions of the PPT was described by determining sensitivity and specificity to functionally limiting aerobic capacity.

RESULTS

The 9-item PPT is predictive of diminished aerobic capacity in older adults with AD. A score of 28 or less indicates likelihood of functionally limiting aerobic capacity that would limit independent function with 67% sensitivity and 67% specificity. The 4-item mini-PPT demonstrates improved capability for identifying impaired functional aerobic capacity with 85% sensitivity and 62% specificity. The PPT was not useful for identifying impaired functional aerobic capacity in older adults without dementia.

CONCLUSIONS

The PPT, which incorporates basic and instrumental activities of daily living as test items, and the mini-PPT which focuses on basic activities of daily living and simple physical functions, are both clinically useful tool for the evaluation for individuals in the earliest stages of AD and both provide important information about functional performance. The mini-PPT additionally inform the clinician as to whether or not individual with early-stage AD is likely to have insufficient aerobic capacity to perform instrumental daily functions.

Hormone replacement therapy and physical function in healthy older men. Time to talk hormones?

Improving physical function and mobility in a continuously expanding elderly population emerges as a high priority of medicine today. Muscle mass, strength/power, and maximal exercise capacity are major determinants of physical function, and all decline with aging. This contributes to the incidence of frailty and disability observed in older men. Furthermore, it facilitates the accumulation of body fat and development of insulin resistance. Muscle adaptation to exercise is strongly influenced by anabolic endocrine hormones and local load-sensitive autocrine/paracrine growth factors. GH, IGF-I, and testosterone (T) are directly involved in muscle adaptation to exercise because they promote muscle protein synthesis, whereas T and locally expressed IGF-I have been reported to activate muscle stem cells. Although exercise programs improve physical function, in the long-term most older men fail to comply. The GH/IGF-I axis and T levels decline markedly with aging, whereas accumulating evidence supports their indispensable role in maintaining physical function integrity. Several studies have reported that the administration of T improves lean body mass and maximal voluntary strength in healthy older men. On the other hand, most studies have shown that administration of GH alone failed to improve muscle strength despite amelioration of the detrimental somatic changes of aging. Both GH and T are anabolic agents that promote muscle protein synthesis and hypertrophy but work through separate mechanisms, and the combined administration of GH and T, albeit in only a few studies, has resulted in greater efficacy than either hormone alone. Although it is clear that this combined approach is effective, this review concludes that further studies are needed to assess the long-term efficacy and safety of combined hormone replacement therapy in older men before the medical rationale of prescribing hormone replacement therapy for combating the sarcopenia of aging can be established.

Development and application of biological age prediction models with physical fitness and physiological components in Korean adults

BACKGROUND

Several biological age (BA) prediction models have been suggested with a variety of biomarkers. Valid models should be able to measure BA in a relatively short time period and predict subsequent physiological capability. Physiological and physical fitness variables have been shown to be distinctive markers for predicting BA and morbidity. The practical and noninvasive nature of such variables makes them useful as clinical assessment tools in estimating BA for in-depth diagnosis and corresponding intervention.

OBJECTIVE

To identify, develop and evaluate biomarkers and BA prediction models and validate their clinical usefulness for the practical diagnosis of functional aging.

METHODS

Fourteen variables were measured in 3,112 male and 1,233 female participants aged 30 and older between the years 2004 and 2007. Through a series of parsimonious stepwise elimination processes, two sets of 8 gender-specific variables were selected as candidate biomarkers for 1,604 men and 760 women. Principal component analysis, linear regression analysis and adjustment methods were further applied to obtain two sets of true BA (TBA) prediction models. The TBA models were examined for validity by comparing TBA to the corresponding chronological age (CA) with clinical risk factors.

RESULTS

TBA prediction models with r(2) values of 0.638 and 0.672 were developed, each unique to men and women, respectively. The overall mean TBA and CA of the participants were 53.9 and 51.8 years, respectively, with a marginal difference of -2.1 and -1.3 years. The regression slopes or rates of TBA as a function of CA were 1.00 and 1.28 for men and women with r values of 0.799 and 0.820 (p < 0.001), respectively. In comparing TBA to CA rates between healthy and clinical risk groups, both sarcopenic and obese groups showed significant increases in TBA.

CONCLUSIONS

The selected biomarkers encompass various complex physiopathological factors related to intrinsic and extrinsic physiological and functional aging. The BA prediction models based on the selected biomarkers could be practical in assessing BA for Korean adults.

Assessment of Cardiorespiratory Fitness without Exercise in Elderly Men with Chronic Cardiovascular and Metabolic Diseases

Low cardiorespiratory (CRF) is associated with health problems in elderly people, especially cardiovascular and metabolic disease. However, physical limitations in this population frequently preclude the application of aerobic tests. We developed a model to estimate CRF without aerobic testing in older men with chronic cardiovascular and metabolic diseases. Subjects aged from 60 to 91 years were randomly assigned into validation (n = 67) and cross-validation (n = 29) groups. A hierarchical linear regression model included age, self-reported fitness, and handgrip strength normalized to body weight (R² = 0.79; SEE = 1.1 METs). The PRESS (predicted residual sum of squares) statistics revealed minimal shrinkage in relation to the original model and that predicted by the model and actual CRF correlated well in the cross-validation group (r = 0.85). The area under curve (AUC) values suggested a good accuracy of the model to detect disability in the validation (0.876, 95% CI: 0.793–0.959) and cross-validation groups (0.826, 95% CI: 0.677–0.975). Our findings suggest that CRF can be reliably estimated without exercise test in unhealthy elderly men.

Impaired economy of gait and decreased six-minute walk distance in Parkinson's disease

Changes in the biomechanics of gait may alter the energy requirements of walking in Parkinson's Disease (PD). This study investigated economy of gait during submaximal treadmill walking in 79 subjects with mild to moderate PD and the relationship between gait economy and 6-minute walk distance (6 MW). Oxygen consumption (VO(2)) at the self-selected treadmill walking speed averaged 64% of peak oxygen consumption (VO(2) peak). Submaximal VO(2) levels exceeded 70% of VO(2) peak in 30% of the subjects. Overall the mean submaximal VO(2) was 51% higher than VO(2) levels expected for the speed and grade consistent with severe impairment in economy of gait. There was an inverse relationship between economy of gait and 6MW (r = -0.31, P < 0.01) and with the self-selected walking speed (r = -0.35, P < 0.01). Thus, the impairment in economy of gait and decreased physiologic reserve result in routine walking being performed at a high percentage of VO(2) peak.