Efficacy of resistance and task-specific exercise in older adults who modify tasks of everyday life

The effects of various stair-climbing exercises on functional mobility and trunk muscle activation in community-dwelling older adults: A pilot randomized controlled trial

BACKGROUND

Stair-climbing (SC) is an essential daily life skill, and stair-climbing exercise (SCE) serves as a valuable method for promoting physical activity in older adults. This study aimed to compare the impact of SCEs with heel contact (HC) and heel off (HO) during SC on functional mobility and trunk muscle (TM) activation amplitudes in community-dwelling older adults.

METHODS

In the pilot randomized controlled trial, participants were randomly allocated to either the HC group (n = 17; mean age 75.9 ± 6.3 years) or the HO group (n = 17; mean age 76.5 ± 4.6 years). The HC participants performed SCE with the heel of the ankle in contact with the ground, while the HO participants performed SCE with the heel of the ankle off the ground during SC. Both groups participated in progressive SCE for one hour per day, three days per week, over four consecutive weeks (totaling 12 sessions) at the community center. We measured timed stair-climbing (TSC), timed up and go (TUG), and electromyography (EMG) amplitudes of the TMs including rectus abdominis (RA), external oblique (EO), transverse abdominus and internal oblique abdominals (TrA-IO), and erector spinae (ES) during SC before and after the intervention.

RESULTS

Both groups showed a significant improvement in TSC and TUG after the intervention (P < .01, respectively), with no significant difference between the groups. There was no significant difference in the EMG activity of the TMs between the groups after the intervention. The amplitude of TMs significantly decreased after the intervention in both groups (P < .01, respectively).

CONCLUSION

Both SCE methods could improve balance and SC ability in older adults while reducing the recruitment of TMs during SC. Both SCE strategies are effective in improving functional mobility and promoting appropriate posture control during SC in older adults.

Functional and Combined Training Promote Body Recomposition and Lower Limb Strength in Postmenopausal Women: A Randomized Clinical Trial and a Time Course Analysis

Encouraging healthy aging in postmenopausal women involves advocating for lifestyle modifications, including regular physical exercise like combined training (CT) and functional training (FT). Regarding this population, age-related alterations in body composition, such as decreased muscle mass and heightened adipose tissue, impact health. The aim of this study was to analyze the effects of FT and CT on body recomposition in postmenopausal women. About the methods, we randomly allocated 96 post-menopausal women to the FT, CT, or control group (CG). We measured body composition by bioimpedance and lower limb muscle strength by sit-to-stand test in five repetitions, respectively. The training protocol lasted 16 weeks, and we measured body composition and lower limb muscle strength every 4 weeks, totaling five assessments. Regarding results, we notice that both training groups increased lean mass from the 8th week of training. In addition, a reduction was observed in total fat percentage and an increase in appendicular lean mass from the 12th week of intervention. No differences were found for body mass. Furthermore, only the experimental groups increase muscle strength, starting from the 4th week of training. The conclusion was that FT and CT promote similar adaptations in body recomposition without affecting body mass in postmenopausal women.

Age-Related Dysfunction in Balance: A Comprehensive Review of Causes, Consequences, and Interventions

This review delves into the multifaceted aspects of age-related balance changes, highlighting their prevalence, underlying causes, and the impact they have on the elderly population. Central to this discussion is the exploration of various physiological changes that occur with aging, such as alterations in the vestibular, visual, proprioceptive systems, and musculoskeletal degeneration. We examine the role of neurological disorders, cognitive decline, and medication side effects in exacerbating balance issues. The review underscores the significance of early detection and effective intervention strategies in mitigating the risks associated with balance problems, such as falls and reduced mobility. It discusses the effectiveness of diverse intervention strategies, including exercise programs, rehabilitation techniques, and technological advancements like virtual reality, wearable devices, and telemedicine. Additionally, the review stresses the importance of a holistic approach in managing balance disorders, encompassing medication review, addressing comorbidities, and environmental modifications. The paper also presents future research directions, emphasizing the need for a deeper understanding of the complex mechanisms underlying balance changes with aging and the potential of emerging technologies and interdisciplinary approaches in enhancing assessment and intervention methods. This comprehensive review aims to provide valuable insights for healthcare providers, researchers, and policymakers in developing targeted strategies to improve the quality of life and ensure the well-being of the aging population.

Assessing muscular power in older adults: evaluating the predictive capacity of the 30-second chair rise test

Background: Timed chair rise tests are frequently used as a substitute for assessing leg muscle strength or power. To determine if timed chair rise tests are an indicator of lower extremity muscle power, we examined the relationship between the repetitions completed in a 30-s chair rise test and the power generated during the test. Methods: Seventy-five individuals participated in this study (n = 30 < 65 years and 45 ≥ 65 years). Participants underwent a 30-s chair rise test while instrumented with a power analyzer. Handgrip strength was also evaluated. Results: The relationship between chair rise repetitions and average chair rise power was R 2 = 0.32 (p < 0.001). Chair rise repetitions when regressed on a total (i.e., summed) chair rise power, it yielded R 2 = 0.70 with data from all participants combined (p < 0.001). A mediation analysis indicated that anthropometrics partially mediates the relationship between chair rise repetitions and total chair rise power accounting for 2.8%-6.9% of the variance. Conclusion: Our findings indicate that in older adults, the overall performance of chair rises offers limited information about the average power per rise but is more indicative of the cumulative power exerted. Thus, the total number of chair rises in a 30-s test is likely a more comprehensive metric of overall muscular power, reflecting endurance aspects as well. Additionally, we found that personal physical attributes, such as height and weight, partially influence the link between chair rise count and total power, highlighting the importance of factoring in individual body metrics in assessments of muscular performance.

High-velocity power training has similar effects to traditional resistance training for functional performance in older adults: a systematic review

QUESTIONS

What is the effect of high-velocity power training (HVPT) compared with traditional resistance training (TRT) on functional performance in older adults? What is the quality of intervention reporting for the relevant literature?

DESIGN

Systematic review and meta-analysis of randomised controlled trials.

PARTICIPANTS

Older adults (aged > 60 years), regardless of health status, baseline functional capacity or residential status.

INTERVENTIONS

High-velocity power training with the intent to perform the concentric phase as quickly as possible compared with traditional moderate-velocity resistance training performed with a concentric phase of ≥ 2 seconds.

OUTCOME MEASURES

Short Physical Performance Battery (SPPB), Timed Up and Go test (TUG), five times sit-to-stand test (5-STS), 30-second sit-to-stand test (30-STS), gait speed tests, static or dynamic balance tests, stair climb tests and walking tests for distance. The quality of intervention reporting was assessed with the Consensus on Exercise Reporting Template (CERT) score.

RESULTS

Nineteen trials with 1,055 participants were included in the meta-analysis. Compared with TRT, HVPT had a weak-to-moderate effect on change from baseline scores for the SPPB (SMD 0.27, 95% CI 0.02 to 0.53; low-quality evidence) and TUG (SMD 0.35, 95% CI 0.06 to 0.63; low-quality evidence). The effect of HVPT relative to TRT for other outcomes remained very uncertain. The average CERT score across all trials was 53%, with two trials rated high quality and four rated moderate quality.

CONCLUSION

HVPT had similar effects to TRT for functional performance in older adults, but there is considerable uncertainty in most estimates. HVPT had better effects on the SPPB and TUG, but it is unclear whether the benefit is large enough to be clinically worthwhile.

Is functional training an efficient approach to improve body composition in older people? A systematic review

Introduction: Increases in fat mass and reductions in lean mass are associated with the frailty and mortality of older people. In this context, Functional Training (FT) is an option to increase lean mass and reduce fat mass in older people. Thus, this systematic review aims to investigate the effects of FT on body fat and lean mass in older people. Methods: We included randomized controlled clinical trials, with at least one intervention group that employed FT, with the age of participants ≥60 years; and participants physically independent and healthy. We performed the systematic investigation in Pubmed MEDLINE, Scopus, Web of Science, Cochrane Library, and Google Scholar. We extracted the information and used the PEDro Scale to assess the methodological quality of each study. Results: Our research found 3,056 references with five appropriate studies. Of the five studies, three presented reductions in fat mass, all of them with interventions between three and 6 months, different training dose parameters, and 100% of the sample was composed of women. On the other hand, two studies with interventions between 10 and 12 weeks presented conflicting results. Conclusion: Despite the limited literature about lean mass, it appears that long-term FT interventions may reduce fat mass in older women. Clinical Trial Registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=399257, identifier CRD42023399257.

Exercise and Behavior: Adjuncts to Pro-Myogenic Compounds for Enhancing Mobility in Older Adults

Physical activity and exercise training exert multiple and varied beneficial effects on a wide array of human tissues, making them therapeutic modalities that can prevent and treat age-related decline in physical function. The Molecular Transducers of Physical Activity Consortium is currently working to elucidate the molecular mechanisms underlying how physical activity improves and preserves health. Exercise training, especially when task specific, is an effective intervention for improving skeletal muscle performance and physical function in everyday activities. As seen elsewhere in this supplement, its adjunctive use with pro-myogenic pharmaceuticals may prove to be synergistic in effect. Behavioral strategies aiming to promote exercise participation and sustain adherence are being considered as additional adjuncts to further improve physical function in comprehensive, multicomponent interventions. One application of this combined strategy may be to target multimodal pro-myogenic therapies in prehabilitation to optimize physical preoperative health to enhance functional recovery postsurgery. We summarize here recent progress on biological mechanisms of exercise training, behavioral approaches to exercise participation, and the role task-specific exercise plays in synergy with pharmacologic therapies with a particular focus on older adults. Physical activity and exercise training in multiple settings should serve as the baseline standard of care around which other therapeutic interventions should be considered when the goal is restoring or increasing physical function.

Functional Resistance Training Improves Thigh Muscle Strength after ACL Reconstruction: A Randomized Clinical Trial

PURPOSE

Quadriceps weakness is common after anterior cruciate ligament (ACL) reconstruction, resulting in prolonged disability and increased risk for reinjury and osteoarthritis. Functional resistance training (FRT) combines resistance training with task-specific training and may prove beneficial in restoring quadriceps strength. The primary purpose of this study was to determine if a walking-specific FRT program (e.g., resisted walking) improves knee strength in individuals after ACL reconstruction.

METHODS

Thirty participants were randomized into one of three groups: 1) FRT with a customized knee BRACE applied to the ACL leg, 2) FRT with elastic BAND tethered to the ankle of the ACL leg, or 3) a TARGET MATCH condition where no resistance was externally applied. Participants in all groups received training while walking on a treadmill 2-3 times per week for 8 wk. Isometric knee extension and flexion strength were measured before the start of the intervention, after the intervention (POST), and 8 wk after intervention completion (POST-2).

RESULTS

The BRACE group had greater knee extensor strength compared with the TARGET MATCH group at POST and POST-2 ( P < 0.05). The BRACE group had greater knee flexor strength than the TARGET MATCH group at POST and POST-2 ( P < 0.05) and the BAND group at POST ( P < 0.05).

CONCLUSIONS

FRT applied via a customized knee brace results in improvements in knee extensor and flexor strength after ACL reconstruction. FRT is a beneficial adjuvant to ACL rehabilitation and leads to better strength compared with standard of care.

The effect of fatigue on running mechanics in older and younger runners

BACKGROUND

The presence of fatigue has been shown to modify running biomechanics. Throughout a run individuals become more fatigued, and the effectiveness of the musculoskeletal protective mechanism can diminish. Older adults are at an elevated risk for sustaining an overuse running related injury. This can be partially explained by changes in the musculoskeletal system and load attenuation.

RESEARCH QUESTION

The purpose was to compare post-fatigue running mechanics between older and younger runners.

METHODS

Thirty runners (15 young, 15 older) between the ages of 18-65 participated in this study. All participants ran at least 15 miles/week. Running kinematics were captured using a 10-camera motion capture system while participants ran over a 10-m runway with force platforms collecting kinetic data under two conditions: C1: rested state at a controlled pace of 3.5 m/s ( ± 5%); C2: post-exertional protocol where pace was not controlled, rather it was monitored based on heartrate and RPE representative of somewhat-hard to hard intensity exercise. Prior to C2, participants underwent an exertional protocol that consisted of a maximal exercise test to induce fatigue and a required cool-down. A 2 (state of fatigue) x 2 (age) MANOVA was run to test for the effects of fatigue and age and their interactions.

RESULTS

No state of fatigue x age interaction was observed. A main effect of age for peak knee extension moment (Y > O; p = 0.01), maximum knee power (Y > O; p = 0.04), maximum hip power (O >Y; p = 0.04), and peak vertical ground reaction force (Y > O; p = 0.007). Regardless of age, participants exhibited decreased knee ROM (p = 0.007) and greater hip extension moment (p < 0.001) in C2 compared to C1.

CONCLUSION

While different in knee and hip mechanics overall, the subtle differences observed demonstrate that older runners exhibit comparable gait adaptions post-fatigue to younger volume-matched runners.

The role of resistance training in mitigating risk for mobility disability in community-dwelling older adults: a systematic review and meta-analysis

OBJECTIVE

To examine the effects of community-based resistance training (RT) on physical function for older adults with mobility disability.

DATA SOURCES

Four databases (PEDro, MedLine, Ovid, CINAHL and Web of Science) were searched from inception to February 2, 2021.

STUDY SELECTION

Randomized controlled trials that examined community-based RT for improving physical function in community-dwelling older adults were included.

DATA EXTRACTION

Two reviewers independently conducted title and abstract screening, full-text evaluation, data extraction, and risk of bias quality assessment.

DATA SYNTHESIS

Twenty-four studies (3,656 participants, age range 63-83 years) were included. RT programs ranged from 10 weeks to 18 months in duration. RT was more effective than control in improving 6MWT distance (n=638; mean difference (MD) 16.1 meters; 95% CI 12.27-19.94, p<0.0001), lower extremity strength (n=785; standard MD 2.01; 95% CI 1.27-2.75, p<0.0001) and usual gait speed (n= 2,106; MD 0.05 meters/second, 95% CI 0.03-0.07, p<0.001). In sensitivity analyses, benefits were maintained when studies with a high risk of bias were excluded. There was no effect of RT on fast gait speed or Short Physical Performance Battery score compared to control.

CONCLUSIONS

RT improves walking distance, lower extremity strength, and usual gait speed in older adults with mobility disability. Improvements in physical function could increase independence in activities of daily living for this at-risk population.

Unsupervised home-based resistance training for community-dwelling older adults: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

We aimed to summarize evidence on the safety, adherence and effectiveness of home-based resistance training (UHBRT) for improving health-related endpoints in community-dwelling older adults.

METHODS

Randomized controlled trials of UHBRT in older adults (≥60yrs) were included after a systematic search (PubMed, CINAHL, PsycInfo, SPORTDiscus, Web of Science, MEDLINE, Cochrane Central Register of Controlled Trials) until 02/19/2021. Adverse events and adherence rates were assessed as indicators of feasibility. Other endpoints included physical (muscle strength, muscle power, balance, physical performance) and mental-related measures (cognition, quality of life [QoL]) as well as other health-related variables (body composition, physical activity levels, falls).

RESULTS

21 studies (N = 4,053) were included. No major adverse events were reported, with adherence averaging 67 % (range 47-97 %). UHBRT significantly improved lower-limb muscle strength (Hedges' g = 0.33; 95 % confidence interval [CI] = 0.11-0.57), muscle power measured through the sit-to-stand test (g = 0.44; 95 %CI = 0.06-0.84), and balance (assessed with the postural sway, g = 0.32; 95 %CI = 0.16-0.49). No benefits were found for other strength indices (handgrip strength), balance (single leg stance and functional reach test), physical performance (walking speed, TUG and SPPB), QoL, nor for the risk or rate of falls (all p > 0.05, g<0.61). No meta-analysis could be performed for the remaining endpoints.

CONCLUSIONS

Although efforts are needed to increase adherence, preliminary evidence suggests that UHBRT can be safe and modestly effective for improving some measures of lower-limb muscle strength, balance, and muscle power in community-dwelling older adults. However, no benefits were found for other physical fitness measures, QoL or falls. More evidence is therefore needed to draw definite conclusions.

Exercise in patients with hip osteoarthritis - effects on muscle and functional performance: A randomized trial

Background: It is believed that clinical management of osteoarthritis should address muscle weakness to improve physical function and prevent disability and frailty.Objectives: This sub-study investigated the effects of supervised progressive resistance training (RT), supervised Nordic Walking (NW), and unsupervised home-based exercise (HBE) on muscle and functional performance; and associations between these exercise-induced changes in persons with hip osteoarthritis.Methods: Forty-two patients with hip osteoarthritis were recruited from a larger RCT (NCT01387867). All the groups (RT, n = 15; NW, n = 12; HBE, n = 15) exercised 1 h 3 times/week for 4 months. Quadriceps cross-sectional area (QCSA, MRI-determined); quadriceps strength (QMVC); leg extensor power (LEP); functional performance (chair stands (30sCS); stair climbs (TSC); and 6-minute walk (6MWT)) were assessed at baseline and 4 months.Results: Per protocol analyses (one-way ANOVA and Bonferroni test) showed significant between-group differences for improvements in QCSA in the most symptomatic leg favoring RT versus NW (2.3 cm², 95% CI [0.6, 3.9]) and HBE (2.3 cm² [0.8, 3.9]); and 30sCS (1.8 repetitions [0.2-3.3]), and 6MWT (35.1 m [3.5-66.7]) favoring NW versus HBE. Associations existed between exercise-induced changes in QCSA and QMVC (r = 0.366, p = .019) for the most symptomatic leg and between changes in 6MWT and QMVC (r = 0.320, p = .04) and LEP (r = 0.381, p = .01), respectively, for the least symptomatic leg.Conclusions: Resistance training appeared effective for improving muscle mass, but less effective for improving muscle strength, power, and functional performance. Only exercise-induced changes in muscle strength and power of the least symptomatic leg, not the most symptomatic leg, were related to changes in functional performance.

Effectiveness of Community-Delivered Functional Power Training Program for Frail and Pre-frail Community-Dwelling Older Adults: a Randomized Controlled Study

Translation of community-based functional training for older adults to reduce frailty is still lacking. We evaluated the effectiveness and implementation of a community-delivered group-based functional power training (FPT) program for frail older adults within their neighborhoods. A two-arm, multicenter assessor-blind stratified randomized controlled trial was conducted at four local senior activity centers in Singapore. Sixty-one community-dwelling older adults with low handgrip strength were randomized to intervention (IG) or control (CG) group. The IG underwent the FPT program (power and balance exercises using simple equipment) delivered by a community service provider. The 12-week program comprised 2 × 60 min sessions/week. CG continued usual activities at the centers. Functional performance, muscle strength, and frailty status were assessed at baseline and 3 months. Program implementation was evaluated using RE-AIM framework. The program was halted due to Coronavirus Disease 2019-related suspension of senior center activities. Results are reported from four centers, which completed the program. IG showed significantly greater improvement in the Short Physical Performance Battery test as compared to CG (p = 0.047). No effects were found for timed up and go test performance, muscle strength, and frailty status. The community program exhibited good reach, effectiveness, adoption, and implementation. Our study demonstrated that FPT was associated with greater improvement in physical function in pre-frail/frail participants as compared to exercise activities offered at local senior activity centers. It is a feasible intervention that can be successfully implemented for frail older adults in their neighborhoods. Trial registration ClinicalTrials.gov, NCT04438876. Registered 19 June 2020-retrospectively registered.

Functional Resistance Training to Improve Knee Strength and Function After Acute Anterior Cruciate Ligament Reconstruction: A Case Study

BACKGROUND

Thigh muscle weakness after anterior cruciate ligament reconstruction (ACLR) can persist after returning to activity. While resistance training can improve muscle function, "nonfunctional" training methods are not optimal for inducing transfer of benefits to activities such as walking. Here, we tested the feasibility of a novel functional resistance training (FRT) approach to restore strength and function in an individual with ACLR.

HYPOTHESIS

FRT would improve knee strength and function after ACLR.

STUDY DESIGN

Case report.

LEVEL OF EVIDENCE

Level 5.

METHODS

A 15-year-old male patient volunteered for an 8-week intervention where he performed 30 minutes of treadmill walking, 3 times per week, while wearing a custom-designed knee brace that provided resistance to the thigh muscles of his ACLR leg. Thigh strength, gait mechanics, and corticospinal and spinal excitability were assessed before and immediately after the 8-week intervention. Voluntary muscle activation was evaluated immediately after the intervention.

RESULTS

Knee extensor and flexor strength increased in the ACLR leg from pre- to posttraining (130 to 225 N·m [+74%] and 44 to 88 N·m [+99%], respectively) and increases in between-limb extensor and flexor strength symmetry (45% to 92% [+74%] and 47% to 72% [+65%], respectively) were also noted. After the intervention, voluntary muscle activation in the ACLR leg was 72%, compared with the non-ACLR leg at 75%. Knee angle and moment during late stance phase decreased (ie, improved) in the ACLR leg and appeared more similar to the non-ACLR leg after FRT training (18° to 14° [-23.4] and 0.07 to -0.02 N·m·kg^-1·m^-1 [-122.8%], respectively). Corticospinal and spinal excitability in the ACLR leg decreased (3511 to 2511 [-28.5%] and 0.42 to 0.24 [-43.7%], respectively) from pre- to posttraining.

CONCLUSION

A full 8 weeks of FRT that targeted both quadriceps and hamstring muscles lead to improvements in strength and gait, suggesting that FRT may constitute a promising and practical alternative to traditional methods of resistance training.

CLINICAL RELEVANCE

FRT may serve as a viable approach to improve knee strength and function after ACL reconstruction.

Resistance Training for Older Adults: Position Statement From the National Strength and Conditioning Association

Fragala, MS, Cadore, EL, Dorgo, S, Izquierdo, M, Kraemer, WJ, Peterson, MD, and Ryan, ED. Resistance training for older adults: position statement from the national strength and conditioning association. J Strength Cond Res 33(8): 2019-2052, 2019-Aging, even in the absence of chronic disease, is associated with a variety of biological changes that can contribute to decreases in skeletal muscle mass, strength, and function. Such losses decrease physiologic resilience and increase vulnerability to catastrophic events. As such, strategies for both prevention and treatment are necessary for the health and well-being of older adults. The purpose of this Position Statement is to provide an overview of the current and relevant literature and provide evidence-based recommendations for resistance training for older adults. As presented in this Position Statement, current research has demonstrated that countering muscle disuse through resistance training is a powerful intervention to combat the loss of muscle strength and muscle mass, physiological vulnerability, and their debilitating consequences on physical functioning, mobility, independence, chronic disease management, psychological well-being, quality of life, and healthy life expectancy. This Position Statement provides evidence to support recommendations for successful resistance training in older adults related to 4 parts: (a) program design variables, (b) physiological adaptations, (c) functional benefits, and (d) considerations for frailty, sarcopenia, and other chronic conditions. The goal of this Position Statement is to a) help foster a more unified and holistic approach to resistance training for older adults, b) promote the health and functional benefits of resistance training for older adults, and c) prevent or minimize fears and other barriers to implementation of resistance training programs for older adults.

Modification of everyday activities and its association with self-awareness in cognitively diverse older adults

Cognitive impairment (CI) in older adults is frequently accompanied by difficulty performing complex everyday activities (e.g., managing finances). However, it is unclear if and how older adults with CI modify their activities (i.e., Do individuals continue, monitor, seek help with, change their approach to, or stop different activities?). In the current study, we examined if older adults with CI are concerned about their ability to carry out complex activities, if and how they modify activities based on their concern, and the factors associated with activity modification. We hypothesized that older adults with CI will more frequently be concerned about, and modify, everyday activities than cognitively healthy (HE) older adults, and that higher awareness of memory loss in the CI group would relate to more frequent modification. The sample included 81 older adults (51 HEs; mean age 70.02 (7.34) and 30 CI; mean age 75.97 (8.12)). Compared to HEs, the CI group reported having more concern about, F(3,77) = 5.50, p = 0.02, and modifying a greater number of activities, F(3,77) = 5.02, p = 0.03. Medication management (30%) and completing taxes (33.3%) were among the most frequently modified activities for the CI and HE groups, respectively. In the CI group, higher memory awareness was associated with more concern (r = .53, p = .005) and activity modification (r = 0.55, p = .003). Findings provide novel information about how cognitively diverse older adults navigate complex activities in daily life. We propose a preliminary theoretical model by which self-awareness may influence navigation of everyday activities in the context of CI.

Bench stepping with incremental heights improves muscle volume, strength and functional performance in older women

AIM

Task-specific exercises such as bench stepping can improve functional ability and reduce falling incidents in older adults. However, such exercises are often not optimized to improve muscle volume and force-velocity characteristics. This study determined the effects of a 12-week stepping program using incremental step heights (STEEP), on muscle volume, strength, power, functional ability and balance performance in older women.

METHODS

Forty-five community-dwelling women (69y ± 4) were randomly assigned to the STEEP group or a non-training CONTROL group. Training intensity was primarily determined by step height, while training volume remained equal. Thigh muscle volume (CT-scan), force-velocity characteristics of the knee extensors (Biodex dynamometer) and functional ability (Short Physical Performance Battery, timed stair ascent, 10-m walk test and countermovement jump height) were determined pre- and post-intervention. In addition, 3D trunk accelerations were recorded at the lower back to assess balance during the Short Physical Performance Battery balance tests.

RESULTS

Two-way ANOVA showed that the STEEP program increased thigh muscle volume, knee extensor isometric peak torque, dynamic peak power, unloaded rate of velocity development and improved performance on all functional tests to a greater extent than CONTROL (p < .05), except the countermovement jump. No improvements were found for peak velocity and balance performance (p > .05).

CONCLUSION

Our results indicate that bench step training with incremental step heights simultaneously improves functional ability, thigh muscle volume and force-velocity characteristics of the knee extensors in older women.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

A wearable resistive robot facilitates locomotor adaptations during gait

BACKGROUND

Robotic-resisted treadmill walking is a form of task-specific training that has been used to improve gait function in individuals with neurological injury, such as stroke, spinal cord injury, or cerebral palsy. Traditionally, these devices use active elements (e.g., motors or actuators) to provide resistance during walking, making them bulky, expensive, and less suitable for overground or in-home rehabilitation. We recently developed a low-cost, wearable robotic brace that generates resistive torques across the knee joint using a simple magnetic brake. However, the possible effects of training with this device on gait function in a clinical population are currently unknown.

OBJECTIVE

The purpose of this study was to test the acute effects of resisted walking with this device on kinematics, muscle activation patterns, and gait velocity in chronic stroke survivors.

METHODS

Six stroke survivors wore the resistive brace and walked on a treadmill for 20 minutes (4×5 minutes) at their self-selected walking speed while simultaneously performing a foot trajectory-tracking task to minimize stiff-knee gait. Electromyography, sagittal plane gait kinematics, and overground gait velocity were collected to evaluate the acute effects of the device on gait function.

RESULTS

Robotic-resisted treadmill training resulted in a significant increase in quadriceps and hamstring EMG activity during walking. Significant aftereffects (i.e., improved joint excursions) were also observed on the hip and knee kinematics, which persisted for several steps after training. More importantly, training resulted in significant improvements in overground gait velocity. These results were consistent in all the subjects tested.

CONCLUSION

This study provides preliminary evidence indicating that robotic-resisted treadmill walking using our knee brace can result in meaningful biomechanical aftereffects that translate to overground walking.

Weight bearing exercise can elicit similar peak muscle activation as medium-high intensity resistance exercise in elderly women

PURPOSE

To assess whether stepping-based weight bearing exercise (WBE) can elicit peak activation of upper leg muscles similar to resistance exercise (RE) at an intensity required to induce strength gains in elderly women.

METHODS

Muscular activation of several upper leg muscles was measured during RE and WBE in a cohort of 19 healthy elderly women (69.3 ± 3.4 years). WBE consisted of forward and lateral stepping with step heights of 10, 20 and 30 cm. Muscular activation was compared to 60% of one-repetition maximum (1-RM) of congruent RE.

RESULTS

Peak activation during WBE was higher than RE at 60% 1-RM during forward and lateral stepping in vastus lateralis starting at 20 cm (p = 0.049 and p = 0.001), and biceps femoris at 30 cm step height (p = 0.024 and p = 0.030). Gluteus maximus peak activation matched RE at 60% 1-RM at 20 and 30 cm step height regardless of step direction (p ≥ 0.077). Peak activation of the rectus femoris and gluteus medius matched RE activation at 60% 1-RM during lateral stepping at 30 cm (p = 0.355 and p = 0.243, respectively) but not during forward stepping. WBE did not induce similar activation as RE in the semitendinosus.

CONCLUSION

In WBE, most upper leg muscles were recruited at an equal or higher intensity than in RE at 60% 1-RM. Lateral stepping at 30 cm step height showed the highest training potential of all WBE's applied.

Understanding frailty: meanings and beliefs about screening and prevention across key stakeholder groups in Europe

Innovative methods to manage frailty are critical to managing the needs of an ageing population. Evidence suggests there are opportunities to reverse or prevent frailty through early intervention. However, little is known about older adults’, families’ and practitioners’ beliefs about the malleability of frailty. This study examined European stakeholders’ accounts of the acceptability and feasibility of frailty screening and prevention to inform future intervention development. Semi-structured focus groups and individual interviews were conducted in three European Union countries (Italy, Poland and the United Kingdom) with key stakeholders – frail and non-frail older adults, family care-givers, and health and social care professionals. Thematic analysis identified four themes: synchronicity between the physical and the psychological in frailty, living with frailty in the social world, the need for a new kind of care, and screening for and preventing frailty. Findings emphasised the need for a holistic approach to frailty care and early intervention. Integrated care services and advocacy were important in the organisation of care. Central to all stakeholders was the significance of the psychological and social alongside the physical elements of frailty and frailty prevention. Support and care for older adults and their family care-givers needs to be accessible and co-ordinated. Interventions to prevent frailty must encompass a social dimension to help older adults maintain a sense of self while building physical and psychological resilience.

Blood flow restricted resistance training in older adults at risk of mobility limitations

High-load resistance training (HL) may be contraindicated in older adults due to pre-existing health conditions (e.g. osteoarthritis). Low-load blood flow restricted (BFR) resistance training offers an alternative to HL with potentially similar strength improvement.

PURPOSE

To compare muscle strength, cross-sectional area (CSA), physical function, and quality of life (QOL) following 12-weeks of HL or BFR training in older adults at risk of mobility limitations.

METHODS

Thirty-six males and females (mean: 75.6years 95% confidence interval: [73.4-78.5], 1.67m [1.64-1.70], 74.3kg [69.8-78.8]) were randomly assigned to HL (70% of one repetition maximum [1-RM]) or low-load BFR (30% 1-RM coupled with a vascular restriction) exercise for the knee extensors and flexors twice per week for 12weeks. A control (CON) group performed light upper body resistance and flexibility training. Muscle strength, CSA of the quadriceps, 400-m walking speed, Short Physical Performance Battery (SPPB), and QOL were assessed before, midway and after training.

RESULTS

Within 6-weeks of HL training, increases in all strength measures and CSA were evident and the gains were significantly greater than the CON group (P<0.05). The BFR group had strength increases in leg extension and leg press 1-RM tests, but were significantly lower in leg extension isometric maximum voluntary contraction (MVC) and leg extension 1-RM than the HL group (P<0.01). At 12-weeks HL and BFR training did not differ in MVC (P=0.14). Walking speed increased 4% among all training groups (P<0.01) and no changes were observed for overall SPPB score and QOL (P>0.05).

CONCLUSION

Both training programs resulted in muscle CSA improvements and HL training had more pronounced strength gains than BFR training after 6-weeks and were more similar to BFR after 12-weeks of training. These changes in both groups did not transfer to improvements in QOL, SPPB, and walking speed. Since both programs result in strength and CSA gains, albeit at different rates, future research should consider using a combination of HL and BFR training in older adults with profound muscle weakness and mobility limitations.

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

Background

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

Methods

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

Results

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

Conclusion

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

Effect of Physical Activity on Self-Reported Disability in Older Adults: Results from the LIFE Study

BACKGROUND/OBJECTIVES

To test the hypothesis that a long-term structured, moderate intensity physical activity (PA) program is more effective than a health education (HE) program in reducing the risk of s elf-reported dependency and disability in basic activities of daily living (BADLs), disability in instrumental ADLs (IADL), and mobility disability.

DESIGN

The Lifestyle Interventions and Independence for Elders (LIFE) study was a multicenter, single-blinded randomized trial.

SETTING

University-based research clinic.

PARTICIPANTS

Thousand six hundred and thirty five sedentary men and women aged 70-89 years, who had functional limitations, defined as a score ≤9 on the Short Physical Performance Battery.

INTERVENTION

Participants were randomized to a structured, moderate intensity PA program (n = 818) that included aerobic, resistance, and flexibility exercises or to a HE program (n = 817).

MEASUREMENTS

All outcomes were derived by self-report using periodic interviews that asked about the degree of difficulty and receipt of help during the past month. Dependency was defined as "receiving assistance" or "unable" to do ≥1 activities. Disability was defined as having "a lot of difficulty" or "unable" doing ≥1 activities. Severe disability was defined as reporting difficulty or being unable to perform ≥3 activities.

RESULTS

Over an average follow-up of 2.6 years, the cumulative incidence of BADL dependency was 15.2% among PA and 15.1% among HE participants (HR = 1.0, 95% CI = 0.78-0.1.3). Intervention groups had similar rates of incident BADL disability, IADL disability and reported mobility disability. Reporting severe mobility disability (HR = 0.78, 95% CI = 0.64-0.96) and ratings of difficulty on mobility tasks were reduced in the PA group.

CONCLUSION

A structured physical activity intervention reduces reported severe mobility disability and difficulty on mobility tasks, but not BADL and IADL disability in older adults with functional limitations.

Improved skeletal muscle mass and strength after heavy strength training in very old individuals

Age-related loss of muscle mass and function represents personal and socioeconomic challenges. The purpose of this study was to determine the adaptation of skeletal musculature in very old individuals (83+ years) performing 12weeks of heavy resistance training (3×/week) (HRT) compared to a non-training control group (CON). Both groups received similar protein supplementations. We studied 26 participants (86.9±3.2 (SD) (83-94, range) years old) per-protocol. Quadriceps cross-sectional area (CSA) differed between groups at post-test (P<0.05) and increased 1.5±0.7cm² (3.4%) (P<0.05) in HRT only. The increase in CSA is correlated inversely with the baseline level of CSA (R²=0.43, P<0.02). Thigh muscle isometric strength, isokinetic peak torque and power increased significantly only in HRT by 10-15%, whereas knee extension one-repetition maximum (1 RM) improved by 91%. Physical functional tests, muscle fiber type distribution and size did not differ significantly between groups. We conclude that in protein supplemented very old individuals, heavy resistance training can increase muscle mass and strength, and that the relative improvement in mass is more pronounced when initial muscle mass is low.

Patterns of sedentary behavior and physical function in older adults

BACKGROUND/AIMS

The purposes of this study were to examine the relationship between various objectively measured sedentary behavior (SB) variables and physical function in older adults, examine the measurement properties of an SB questionnaire, and describe the domains of SB in our sample.

METHODS

Forty-four older adults (70 ± 8 years, 64 % female) had their SB measured via activPAL activity monitor and SB questionnaire for 1 week followed by performance-based tests of physical function.

RESULTS

The pattern of SB was more important than total SB time. Where a gender by SB interaction was found, increasing time in SB and fewer breaks were associated with worse function in the males only. The SB questionnaire had acceptable test-retest reliability but poor validity compared to activPAL-measured SB. The majority of SB time was spent watching television, using the computer and reading.

DISCUSSION/CONCLUSIONS

This study provides further evidence for the association between SB and physical function and describes where older adults are spending their sedentary time. This information can be used in the design of future intervention to reduce sedentary time and improve function in older adults.

Age, human performance, and physical employment standards

The proportion of older workers has increased substantially in recent years, with over 25% of the Canadian labour force aged ≥55 years. Along with chronological age comes age-related declines in functional capacity associated with impairments to the cardiorespiratory and muscular systems. As a result, older workers are reported to exhibit reductions in work output and in the ability to perform and/or sustain the required effort when performing work tasks. However, research has presented some conflicting views on the consequences of aging in the workforce, as physically demanding occupations can be associated with improved or maintained physical function. Furthermore, the current methods for evaluating physical function in older workers often lack specificity and relevance to the actual work tasks, leading to an underestimation of physical capacity in the older worker. Nevertheless, industry often lacks the appropriate information and/or tools to accommodate the aging workforce, particularly in the context of physical employment standards. Ultimately, if appropriate workplace strategies and work performance standards are adopted to optimize the strengths and protect against the vulnerability of the aging workers, they can perform as effectively as their younger counterparts. Our aim in this review is to evaluate the impact of different individual (including physiological decline, chronic disease, lifestyle, and physical activity) and occupational (including shift work, sleep deprivation, and cold/heat exposure) factors on the physical decline of older workers, and therefore the risk of work-related injuries or illness.

Resistance Exercise to Prevent and Manage Sarcopenia and Dynapenia

For well over twenty centuries the muscle wasting (sarcopenia) and weakness (dynapenia) that occurs with old age has been a predominant concern of mankind. Exercise has long been suggested as a treatment to combat sarcopenia and dynapenia, as it exerts effects on both the nervous and muscular systems that are critical to positive physiological and functional adaptations (e.g., enhanced muscle strength). For more than two decades scientists have recognized the profound role that progressive resistance exercise training can have on increasing muscle strength, muscle size and functional capacity in older adults. In this review article we discuss how resistance exercise training can be used in the management and prevention of sarcopenia and dynapenia. We first provide an overview of the evidence for this notion and highlight certain critical factors- namely exercise intensity, volume and progression- that are key to optimizing the resistance exercise prescription. We then highlight how many, if not most, of the commonly prescribed exercise programs for seniors are not the 'best practices', and subsequently present easy-to-read guidelines for a well-rounded resistance exercise training program designed for the management and prevention of sarcopenia and dynapenia, including example training programs for the beginner through the advanced senior resistance exerciser. These guidelines have been written for the academician as well as the student and health care provider across a variety of disciplines, including those in the long term care industry, such as wellness instructors or activity directors.

Task-Oriented Exercise to Reduce Activities of Daily Living Disability in Vulnerable Older Adults: A Feasibility Study of the 3-Step Workout for Life

The purpose of this feasibility study was to evaluate the 3-Step Workout for Life program, a 10-week exercise program that included moderate-intensity muscle strength training followed by task-oriented training. Fourteen participants completed the program (mean age = 73 years; SD = 6.83). The Box and Block test (Z = -2.24, p = .03) and the 30-s chair stand test (Z = -2.21, p = .03) indicate improved physical functioning of the upper and lower extremities. More importantly, results of the function component from the Late-Life Function and Disability Instrument (Z = -2.04, p = .04) and motor skills scale from the Assessment of Motor and Process Skills (Z = -2.97, p = .003) indicate subjective and objective improvements on performing activities of daily living. Supplementing moderate-intensity muscle strength exercise with task-oriented training components is feasible. Preliminary data support the effectiveness of 3-Step Workout for Life in reducing late-life disability.

Training in the functional movement circle to promote strength and mobility-related activities in older adults: a randomized controlled trial

Movements of everyday life (e.g., climbing stairs, rising from a chair, walking) are essential for older adults to stay functional and independent. Due to the aging process, muscle mass decreases and balance abilities are reduced. One major criticism of former interventions is that implemented resistance and balance exercises were not associated with movements needed in older adults' everyday life. The Functional Movement Circle for older adults (FuMoC) includes the combination of three aspects: resistance, balance, and movements of everyday life. The aim of this study was to compare the effects of training in the FuMoC with those of other training programs. A randomized controlled trial (RCT) with three intervention groups (IG1: FuMoC; IG2: resistance and balance training; IG3: coordination training) with a training period of 6 months and one inactive control group (CG) was conducted. At baseline (T1), after three (T2) and six (T3) months, parameters of strength (isometric strength measurement and One-Repetition Maximum test in leg and chest press) and mobility-related activities (gait analysis, Multisurface Obstacle Test for Older Adults (MSOT), Chair Rise Test (CRT), Timed Up & Go Test (TUG), Maximum Step Length Test (MSLT)) were assessed as primary outcomes. Data of 78 (43 males, 35 females) older adults were analyzed (mean age: 68.4 years). Significant (p < 0.05) interactions between time and group were observed in most of the primary outcomes. IG1 showed the highest improvement rates in MSOT (+16 %), CRT (+28 %), TUG (+14 %), and MSLT (+15 %); demonstrating advantages of training in the FuMoC compared to other training programs.

Improving motor control in walking: a randomized clinical trial in older adults with subclinical walking difficulty

OBJECTIVE

To test the proposed mechanism of action of a task-specific motor learning intervention by examining its effect on measures of the motor control of gait.

DESIGN

Single-blinded randomized clinical trial.

SETTING

University research laboratory.

PARTICIPANTS

Adults (N=40) aged ≥65 years with gait speed >1.0m/s and impaired motor skill (figure-of-8 walk time >8s).

INTERVENTIONS

The 2 interventions included a task-oriented motor learning and a standard exercise program; both interventions included strength training. Both lasted 12 weeks, with twice-weekly, 1-hour, physical therapist-supervised sessions.

MAIN OUTCOME MEASURES

Two measures of the motor control of gait, gait variability and smoothness of walking, were assessed pre- and postintervention by assessors masked to the treatment arm.

RESULTS

Of 40 randomized subjects, 38 completed the trial (mean age ± SD, 77.1±6.0y). The motor learning group improved more than the standard group in double-support time variability (.13m/s vs .05m/s; adjusted difference [AD]=.006, P=.03). Smoothness of walking in the anteroposterior direction improved more in the motor learning than standard group for all conditions (usual: AD=.53, P=.05; narrow: AD=.56, P=.01; dual task: AD=.57, P=.04). Smoothness of walking in the vertical direction also improved more in the motor learning than standard group for the narrow-path (AD=.71, P=.01) and dual-task (AD=.89, P=.01) conditions.

CONCLUSIONS

Among older adults with subclinical walking difficulty, there is initial evidence that task-oriented motor learning exercise results in gains in the motor control of walking, while standard exercise does not. Task-oriented motor learning exercise is a promising intervention for improving timing and coordination deficits related to mobility difficulties in older adults, and needs to be evaluated in a definitive larger trial.

The functional movement circle for older adults: feasibility and effects on physical performance

BACKGROUND

To facilitate the transfer of exercise effects to older adults' everyday life, essential daily life movements (stair climbing and walking on different surfaces) were embedded into the functional movement circle for older adults (FuMoC) -- a systematic balance and resistance training programme supplemented by functional movements.

AIMS

This study's aim was to consider the feasibility of the FuMoC and to evaluate the effects of this new training programme in a randomised controlled pilot study.

METHODS

Twenty-one adults aged 60 years and older were randomised into one of two groups. The intervention group (IG; n = 11) trained for 12 weeks in the FuMoC, while the control group (CG; n = 10) maintained their usual activities. The evaluation of feasibility comprised training attendance, realised intensity of load, and perceived exertion. Outcome variables included measures of strength and performance-based tests of mobility-related activities.

RESULTS

Training attendance was 86 % and the prescribed intensity of load was realised by the participants in the IG. Physical performance showed significant improvements in the IG in comparison to the CG: an increase of 24 % in the One-Repetition Maximum test in the chest press (p < 0.05), of 9-13 % in the modified Timed Up and Go test (p < 0.05), and of 10 % in the Maximal Step Length test (p < 0.05) was identified.

DISCUSSION AND CONCLUSION

In conclusion, the FuMoC study was feasible in terms of compliance (training attendance) and the planned exercise regimen (suitable exercises, intensity, and exertion) and showed positive effects on physical performance.

Diving below the surface of progressive disability: considering compensatory strategies as evidence of sub-clinical disability

OBJECTIVES

To provide a comprehensive review regarding the role of activity and participation compensations within the disablement process, identify directions for future research, and discuss the implications of compensation pertaining to public health initiatives aimed at preventing and reversing disability.

METHOD

This article evaluated how using compensatory strategies to cope with functional deficits reveals important transitions within the disablement process and signifies a unique opportunity to identify early declines in function.

RESULTS

Previous research suggests that (a) adopting compensatory strategies to maintain activity/participation is strongly associated with functional decline and disease severity and significantly predicts the onset of limitations/restrictions; (b) compensation can be reliably quantified; and (c) contextual knowledge about how individuals adapt to functional decline can be used to describe transitions in the disablement process.

DISCUSSION

Characterizing subtle adaptations prior to the onset of activity limitations and participation restrictions will not only aid in understanding the complex disablement process but also help inform social services and future prevention strategies. Overall, this article integrates the concept of compensation into the current model of disability and proposes a framework for identifying and interpreting compensatory behavior.

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

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

Optimizing the benefits of exercise on physical function in older adults

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

Interventions to Improve Walking in Older Adults

Interventions to improve walking in older adults have historically been multifactorial (i.e. strengthening, endurance and flexibility programs) focusing on improving the underlying impairments. These impairment-based programs have resulted in only modest improvements in walking. In older adults, walking is slow, less stable, inefficient, and the timing and coordination of stepping with postures and phases of gait is poor. We argue the timing and coordination problems are evidence of the loss of motor skill in walking. Taking a lesson from the sports world and from neurorehabilitation, task-oriented motor learning exercise is an essential component of training to improve motor skill and may be a beneficial approach to improving walking in older adults. In this article we: 1) briefly review the current literature regarding impairment-based interventions for improving mobility, 2) discuss why the results have been only modest, and 3) suggest an alternative approach to intervention (i.e. task oriented motor learning).

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

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

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

OBJECTIVE

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

DESIGN

Cluster-randomized controlled trial.

SETTING

Home care in an urban area.

PARTICIPANTS

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

INTERVENTION

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

MAIN OUTCOME MEASURES

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

RESULTS

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

CONCLUSIONS

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