Walking with its training effects on the fitness and activity patterns of 79-91 year old females

Effects of Walking-Only Intervention on Physical Function, Fall-Related Outcomes, and Health-Related Quality of Life in Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis

This study aimed to determine the effects of walking-only intervention (walking was the only exercise in which people participated) on physical function, fall-related outcomes, and health-related quality of life in community-dwelling older adults. We conducted a systematic search across five electronic databases, assessing risk of bias using Minds Manual for Guideline Development. Meta-analyses were performed, and pooled standardized mean differences were calculated. Nine studies (a total of 1,309 participants) were included, showing that walking-only interventions improved walking endurance (standardized mean difference: 1.11, 95% confidence interval: [0.08, 2.15]) and health-related quality of life (standardized mean difference: 0.71, 95% confidence interval: [0.18, 1.25]). However, there were no significant improvements in other outcomes. The certainty of the evidence based on the Grading of Recommendations, Assessment, Development, and Evaluation approach for all outcomes was graded as very low, primarily due to significant inconsistency and imprecision. Our results suggest that walking-only intervention can be effective for enhancing walking endurance and health-related quality of life for community-dwelling older adults. Further studies are required to investigate the effects of walking-only intervention. This need stems from the limited number of randomized controlled trials, heterogeneous intervention settings and results, and the very low certainty of the evidence.

Increasing Lifestyle Walking by 3000 Steps per Day Reduces Blood Pressure in Sedentary Older Adults with Hypertension: Results from an e-Health Pilot Study

Increasing daily steps by an additional 3000 steps/day on 5 days/week equates to ~150 min/week of aerobic physical activity to meet the physical activity guidelines; however, its effectiveness for blood pressure control in older adults with hypertension is unknown. A 20-week, single-arm, pilot e-health lifestyle walking intervention was conducted in 21 sedentary older adults (73 ± 5 years old) with hypertension (13 female, 8 male) to investigate the effectiveness of increasing daily steps by an additional 3000 steps/day for blood pressure control. The intervention consisted of two phases, with behavior change assistance provided during the first active phase (weeks 1-10) to help reach step goals and minimal assistance provided during the second self-maintenance phase (weeks 11-20). Nineteen participants (91%) completed both the 10- and 20-week assessments. The participants wore the pedometer for ≥10 h on 97% of the days over 20 weeks. They significantly increased average steps/day from 3899 ± 2198 at baseline to 6512 ± 2633 at 10 weeks and 5567 ± 2587 at 20 weeks. After 20 weeks, both systolic (137 ± 10 to 130 ± 11 mm Hg, p < 0.001) and diastolic (81 ± 6 to 77 ± 6 mm Hg, p = 0.01) blood pressure improved. The response was consistent in participants with (n = 8) and without (n = 13) anti-hypertensive medication. The results of our lifestyle walking intervention are encouraging for reducing blood pressure in older adults with hypertension; however, larger randomized, controlled trials need to be performed to confirm these findings.

The Effect of Therapeutic Exercise Interventions on Physical and Psychosocial Outcomes in Adults Aged 80 Years and Older: A Systematic Review and Meta-Analysis

This systematic review aimed to evaluate the effects of therapeutic exercise on physical and psychosocial outcomes in community-dwelling adults aged 80 years or older. Databases were searched from inception to July 8, 2020. Randomized controlled trials (RCTs) were screened by two reviewers who extracted data and assessed study quality. Sixteen RCTs (1,660 participants) were included. Compared to nonexercise controls there was no evidence of an effect of exercise on performance based (standardized mean differences: 0.58, 95% confidence interval: [-0.19, 1.36]; I2: 89%; six RCTs; 290 participants; very low-quality evidence) or self-reported physical function (standardized mean differences: 1.35, 95% confidence interval: [-0.78, 3.48]; I2: 96%; three RCTs; 280 participants; very low-quality evidence) at short-medium term follow-up. Four RCTs reporting psychosocial outcomes could not be combined in meta-analysis and reported varying results. Exercise appeared to reduce the risk of mortality during follow-up (risk ratio: 0.47, 95% confidence interval: [0.32, 0.70]; I2: 0.0%; six RCTs; 1,222 participants; low-quality evidence).

The effect of exercise training on blood pressure in menopause and postmenopausal women: A systematic review of randomized controlled trials

The prevalence of hypertension is higher in postmenopausal than in premenopausal women. Regular exercise training has been shown to be effective in addressing hypertension. The aim of this systematic review was to synthesize the effect of exercise training on systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) in menopausal and postmenopausal women. This review was reported according to the PRISMA statement and registered in PROSPERO. The literature search was done in MEDLINE, Embase, Cochrane CENTRAL and ClinicalTrials. Randomized controlled trials involving menopausal and postmenopausal women undergoing exercise training were included. Two blinded reviewers assessed risk of bias in the included studies by using the Cochrane Risk of Bias tool. A random-effects model was used for all analyses. Significance was set at P < 0.05. Compared with the control group, exercise training resulted in clinically significant reductions on SBP (MD -3.43 mmHg; 95% CI, -5.16, -1.71; P < 0.0001), DBP (MD, -2.25 mmHg; 95% CI, -3.40, -1.11; P = 0.0001) and MAP (MD, -3.48 mmHg; 95% CI, -5.84, -1.11; P = 0.004). Aerobic training (AT) did not produce a significant reduction in SBP, DBP and MAP (P >0.05). Combined training (CT) generated larger reductions. Exercise training generated small but clinically relevant reductions in SBP, DBP and MAP in menopausal and postmenopausal women, younger or older than 65 years, with prehypertension or hypertension. AT did not lead to a clinically relevant improvement in blood pressure (BP) in this population. In addition, CT showed the largest reductions in SBP, DBP and MAP.

The form of exercise to decrease resting blood pressure in older adults: A systematic review and meta-analysis

BACKGROUND/OBJECTIVES

The current systematic review and meta-analysis evaluated the relationship between the form of exercise and changes in resting blood pressure (RBP) in older adults and the overall level of evidence.

METHODS

The inclusion criteria were studies involving intervention with only regular exercise limited to subjects ≥65 years old. The combined changes in RBP in each study were calculated and the relationship between the form of exercise and changes in the RBP were evaluated. The overall evidence was assessed using the GRADE approach.

RESULTS

Nineteen studies (1081 subjects) were analyzed. The combined changes in the RBP decreased as a result of aerobic exercise or resistance exercise. The intensity of resistance exercise (METs) was related to the change in the RBP of systolic (meta-regression coefficient, -2.5 [95% confidence interval, -4.7 to -0.4]; R²=35.4%). When excluding studies with high overall risk of bias, the overall duration of aerobic exercise (weeks) was related to the change in the RBP of systolic (meta-regression coefficient, -0.6 [95% confidence interval, -1.0 to -0.2]; R²=93.2%). In addition, there was a low level of evidence overall for a decrease in RBP as a result of aerobic exercise, but there was a moderate level of evidence for a decrease in RBP as a results of resistance exercise.

CONCLUSION

A decrease in the RBP of systolic may be associated with active exercise in older adults. However, there may be insufficient evidence for the decrease in RBP as a result of aerobic exercise.

Walking for hypertension

BACKGROUND

Increased physical activity has been recommended as an important lifestyle modification for the prevention and control of hypertension. Walking is a low-cost form of physical activity and one which most people can do. Studies testing the effect of walking on blood pressure have revealed inconsistent findings.

OBJECTIVES

To determine the effect of walking as a physical activity intervention on blood pressure and heart rate.

SEARCH METHODS

We searched the following databases up to March 2020: the Cochrane Hypertension Specialised Register, CENTRAL (2020, Issue 2), Ovid MEDLINE, Ovid Embase, CINAHL, PsycINFO, SPORTDiscus, PEDro, the WHO International Clinical Trials Registry Platform, and ClinicalTrials.gov. We also searched the following Chinese databases up to May 2020: Index to Taiwan Periodical Literature System; National Digital Library of Theses and Dissertation in Taiwan; China National Knowledge Infrastructure (CNKI) Journals, Theses & Dissertations; and Wanfang Medical Online. We contacted authors of relevant papers regarding further published and unpublished work. The searches had no language restrictions.

SELECTION CRITERIA

Randomised controlled trials of participants, aged 16 years and over, which evaluated the effects of a walking intervention compared to non-intervention control on blood pressure and heart rate were included.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane. Where data were not available in the published reports, we contacted authors. Pooled results for blood pressure and heart rate were presented as mean differences (MDs) between groups with 95% confidence intervals (CIs). We undertook subgroup analyses for age and sex. We undertook sensitivity analyses to assess the effect of sample size on our findings.

MAIN RESULTS

A total of 73 trials met our inclusion criteria. These 73 trials included 5763 participants and were undertaken in 22 countries. Participants were aged from 16 to 84 years and there were approximately 1.5 times as many females as males. The characteristics of walking interventions in the included studies were as follows: the majority of walking interventions was at home/community (n = 50) but supervised (n = 36 out of 47 reported the information of supervision); the average intervention length was 15 weeks, average walking time per week was 153 minutes and the majority of walking intensity was moderate. Many studies were at risk of selection bias and performance bias. Primary outcome We found moderate-certainty evidence suggesting that walking reduces systolic blood pressure (SBP) (MD -4.11 mmHg, 95% CI -5.22 to -3.01; 73 studies, n = 5060). We found moderate-certainty evidence suggesting that walking reduces SBP in participants aged 40 years and under (MD -4.41 mmHg, 95% CI -6.17 to -2.65; 14 studies, n = 491), and low-certainty evidence that walking reduces SBP in participants aged 41 to 60 years (MD -3.79 mmHg, 95% CI -5.64 to -1.94, P < 0.001; 35 studies, n = 1959), and those aged 60 years of over (MD -4.30 mmHg, 95% CI -6.17 to -2.44, 24 studies, n = 2610). We also found low certainty-evidence suggesting that walking reduces SBP in both females (MD -5.65 mmHg, 95% CI -7.89 to -3.41; 22 studies, n = 1149) and males (MD -4.64 mmHg, 95% CI -8.69 to -0.59; 6 studies, n = 203). Secondary outcomes We found low-certainty evidence suggesting that walking reduces diastolic blood pressure (DBP) (MD -1.79 mmHg, 95% CI -2.51 to -1.07; 69 studies, n = 4711) and heart rate (MD -2.76 beats per minute (bpm), 95% CI -4.57 to -0.95; 26 studies, n = 1747). We found moderate-certainty evidence suggesting that walking reduces DBP for participants aged 40 years and under (MD -3.01 mmHg, 95% CI -4.44 to -1.58; 14 studies, n = 491) and low-certainty evidence suggesting that walking reduces DBP for participants aged 41 to 60 years (MD -1.74 mmHg, 95% CI -2.95 to -0.52; 32 studies, n = 1730) and those aged 60 years and over (MD -1.33 mmHg, 95% CI -2.40 to -0.26; 23 studies, n = 2490). We found moderate-certainty evidence that suggests walking reduces DBP for males (MD -2.54 mmHg, 95% CI -4.84 to -0.24; 6 studies, n = 203) and low-certainty evidence that walking reduces DBP for females (MD -2.69 mmHg, 95% CI -4.16 to -1.23; 20 studies, n = 1000). Only 21 included studies reported adverse events. Of these 21 studies, 16 reported no adverse events, the remaining five studies reported eight adverse events, with knee injury being reported five times.

AUTHORS' CONCLUSIONS

Moderate-certainty evidence suggests that walking probably reduces SBP. Moderate- or low-certainty evidence suggests that walking may reduce SBP for all ages and both sexes. Low-certainty evidence suggests that walking may reduce DBP and heart rate. Moderate- and low-certainty evidence suggests walking may reduce DBP and heart rate for all ages and both sexes.

The Effect of Exercise on the Older Adult's Blood Pressure Suffering Hypertension: Systematic Review and Meta-Analysis on Clinical Trial Studies

Background

Senescence refers to spontaneous and progressive irreversible degenerative changes in which both the physical and psychological power diminish significantly. Hypertension is the most common cardiovascular disease in the elderly. Several studies have been conducted regarding the effect of exercise on reducing the blood pressure of the elderly, which have found contradictory results. One of the uses of meta-analysis study is responding to these assumptions and resolving the discrepancies. Accordingly, the aim of the present study is to determine the impact of exercise on the blood pressure of older adults.

Method

In this research, in order to find electronic published papers from 1992 to 2019, the papers published in both domestic and foreign databases including SID, MagIran, IranMedex, IranDox, Gogole Scholar, Cohrane, Embase, Science Direct, Scopus, PubMed, and Web of Science (ISI) were used. Heterogeneity index between the studies was determined based on Cochran test Q(c) and I². Considering existence of heterogeneity, random effects model was employed to estimate the standardized subtraction of the mean exercise test score for reduction of blood pressure in the older adults across the intervention group before and after the test.

Results

In this meta-analysis and systematic review, eventually 69 papers met the inclusion criteria. The total number of participants was 2272 in the pre- and postintervention groups when examining the systolic changes and 2252 subjects in the pre- and postintervention groups when inspecting the diastolic changes. The standardized mean difference in examining the systolic changes before the intervention was 137.1 ± 8.09 and 132.98 ± 0.96 after the intervention; when exploring the diastolic changes, the pre- and postintervention values were 80.3 ± 0.85 and 76.0 ± 6.56, respectively, where these differences were statistically significant (P < 0.01).

Conclusion

The results of this study indicated that exercise leads to significant reduction in both systolic and diastolic blood pressure. Accordingly, regular exercise can be part of the treatment plan for hypertensive elderly.

Effects of Exercise on the Resting Heart Rate: A Systematic Review and Meta-Analysis of Interventional Studies

Resting heart rate (RHR) is positively related with mortality. Regular exercise causes a reduction in RHR. The aim of the systematic review was to assess whether regular exercise or sports have an impact on the RHR in healthy subjects by taking different types of sports into account. A systematic literature research was conducted in six databases for the identification of controlled trials dealing with the effects of exercise or sports on the RHR in healthy subjects was performed. The studies were summarized by meta-analyses. The literature search analyzed 191 studies presenting 215 samples fitting the eligibility criteria. 121 trials examined the effects of endurance training, 43 strength training, 15 combined endurance and strength training, 5 additional school sport programs. 21 yoga, 5 tai chi, 3 qigong, and 2 unspecified types of sports. All types of sports decreased the RHR. However, only endurance training and yoga significantly decreased the RHR in both sexes. The exercise-induced decreases of RHR were positively related with the pre-interventional RHR and negatively with the average age of the participants. From this, we can conclude that exercise-especially endurance training and yoga-decreases RHR. This effect may contribute to a reduction in all-cause mortality due to regular exercise or sports.

Effects of frequency, intensity, duration and volume of walking interventions on CVD risk factors: a systematic review and meta-regression analysis of randomised controlled trials among inactive healthy adults

OBJECTIVE

Walking interventions in healthy populations show clinically relevant improvements for many cardiovascular disease (CVD) risk factors. We aimed to assess the changes in CVD risk factors and the dose-response relationship between frequency, intensity, duration and volume of walking and cardiovascular risk factors based on randomised controlled trials (RCTs).

DESIGN

A systematic review with meta-analysis and meta-regression.

DATA SOURCES

Four electronic databases searched from January 1971 to April 2017.

ELIGIBILITY CRITERIA

Walking RCTs reporting one or more CVD risk factor outcomes; trials including at least one group with walking intervention and a no-walking control group; duration ≥8 weeks; participants ≥18 years old, inactive but healthy; risk factors assessed preintervention and postintervention; English-language articles in peer-reviewed journals.

RESULTS

Thirty-seven RCTs, involving 2001 participants (81% women) and assessing 13 CVD risk factors, were identified. Pooled meta-analysis showed favourable effects (P≤0.05) of walking intervention for seven CVD risk factors (body mass, body mass index, body fat, systolic and diastolic blood pressure, fasting glucose and VO₂max). _There were no significant effects (P>0.05) for waist circumference, waist-to-hip ratio and four blood lipid variables.Despite testing 91 possible dose-response relationships, linear meta-regression analysis adjusted for age indicated just 7 (or 7.7%) statistically significant findings.

SUMMARY/CONCLUSION

Walking interventions benefit a number of CVD risk factors. Despite multiple studies and tested metrics, only a few dose-response relationships were identified and the possibility of chance findings cannot be ruled out. There is insufficient evidence to quantify the frequency, length, bout duration, intensity and volume of the walking required to improve CVD risk factors.

PROSPERO REGISTRATION NUMBER

CRD42016039409.

Exercise and other nonpharmacological strategies to reduce blood pressure in older adults: a systematic review and meta-analysis

The incidence of hypertension increases with advancing age and represents a significant burden of disease. Lifestyle modification represents the first-line intervention in treatment algorithms; however, the majority of evidence for this comes from studies involving young participants using interventions that may not always be feasible in the elderly. This manuscript presents a systematic review of all randomized controlled trials involving participants with a mean age of 65 or over investigating nonpharmacological strategies to reduce blood pressure (BP). Fifty-three randomized controlled trials were included. The majority of interventions described aerobic exercise training, dynamic resistance exercise training, or combined aerobic and dynamic resistance exercise training (COM), with limited studies reporting isometric exercise training or alternative lifestyle strategies. Aerobic exercise training, dynamic resistance exercise training, COM, and isometric exercise training all elicited significant reductions in both systolic and diastolic BP, with no additional benefit of COM compared with single modality exercise training. Three months of traditional exercise-based lifestyle intervention may produce a reduction in BP of approximately 5 mmHg systolic and 3 mmHg diastolic in older individuals, similar to that expected in younger individuals.

A SYSTEMATIC REVIEW OF GROUP WALKING IN PHYSICALLY HEALTHY PEOPLE TO PROMOTE PHYSICAL ACTIVITY

BACKGROUND

Walking is a good way to meet physical activity guidelines. We examined the effectiveness of walking in groups compared with walking alone or inactive controls in physically healthy adults on physical activity and quality of life. (PROSPERO CRD42016033752).

METHODS

We searched Medline, Embase, Cinahl, Web of Knowledge Science Citation Index, and Cochrane CENTRAL until March 2016, for any comparative studies, in physically healthy adults, of walking in groups compared with inactive controls or walking alone, reporting any measure of physical activity. We searched references from recent relevant systematic reviews. Two reviewers checked study eligibility and independently extracted data. Disagreements were resolved through discussion. Quality was assessed using likelihood of selection, performance, attrition, and detection biases. Meta-analysis was conducted using Review Manager 5.3.

RESULTS

From 1,404 citations, 18 studies were included in qualitative synthesis and 10 in meta-analyses. Fourteen compared group walking to inactive controls and four to walking alone. Eight reported more than one measure of physical activity, none reported according to current guidelines. Group walking compared with inactive controls increased follow-up physical activity (9 randomized controlled trials, standardized mean difference [SMD] 0.58 [95 percent confidence interval {CI}, 0.34-0.82] to SMD 0.43 [95 percent CI, 0.20-0.66]). Compared with walking alone, studies were too few and too heterogeneous to conduct meta-analysis, but the trend was improved physical activity at follow-up for group walking participants. Seven (all inactive control) reported quality-of-life: five showed statistically significantly improved scores.

DISCUSSION

Better evidence may encourage government policy to promote walking in groups. Standardized physical activity outcomes need to be reported in research.

Effect of a 6-Month Brisk Walking Program on Walking Endurance in Sedentary and Physically Deconditioned Women Aged 60 or Older: A Randomized Trial

BACKGROUND

Walking endurance is a predictor of healthy ageing.

OBJECTIVE

To examine if a 6-month brisk walking program can increase walking endurance in sedentary and physically deconditioned older women.

TRIAL DESIGN

Randomized controlled trial.

SETTING

Women recruited from public meetings aimed at promoting physical activity in women aged 60 or older.

SUBJECTS

121 women aged 65.7 ± 4.3 years, with sedentary lifestyle (Physical Activity Questionnaire for the Elderly score < 9.4), and a 6-minute walking distance (6MWD) below normal value based on their gender, age, and body weight, and weight.

METHODS

Women were randomly assigned to a 150 min/week brisk walking program (two supervised sessions and one session on their own per week) for six months (exercisers) (n=61) or a control group with physical activity allowed freely (n=60).

OUTCOME

The primary outcome was relative change in 6MWD.

RESULTS

54/61 exercisers and 55/60 control subjects completed the program and data analysis was possible for 51 exercisers and 47 controls. At baseline, 6MWD was on average 23.1% and 22.5% below age-matched norms in exercisers and controls, respectively. Attendance rate for supervised sessions was 92% in exercisers. The 6MWD increased more significantly in exercisers than in controls (mean increase of 41.5% vs 11.0 %; p<0.0001). Over the 6-month program, 38 exercisers (74.5%) vs 5 controls (10.6%) had a 6MWD over the age-matched norm (p<0.0001). Exercisers with the highest tertile of 6MWD improvement (>46%) were those with baseline lowest values of 6MWD (p=0.001) and highest values of body mass index (BMI) (p<0.01).

CONCLUSION

Present results support recommendation that brisk walking programs should be encouraged to improve walking endurance in physically deconditioned women aged 60 or older, especially in those with high BMI.

The effect of walking on risk factors for cardiovascular disease: an updated systematic review and meta-analysis of randomised control trials

OBJECTIVE

To conduct a systematic review and meta-analysis of randomised control trials that examined the effect of walking on risk factors for cardiovascular disease.

METHODS

Four electronic databases and reference lists were searched (Jan 1971-June 2012). Two authors identified randomised control trials of interventions ≥ 4 weeks in duration that included at least one group with walking as the only treatment and a no-exercise comparator group. Participants were inactive at baseline. Pooled results were reported as weighted mean treatment effects and 95% confidence intervals using a random effects model.

RESULTS

32 articles reported the effects of walking interventions on cardiovascular disease risk factors. Walking increased aerobic capacity (3.04 mL/kg/min, 95% CI 2.48 to 3.60) and reduced systolic (-3.58 mm Hg, 95% CI -5.19 to -1.97) and diastolic (-1.54 mm Hg, 95% CI -2.83 to -0.26) blood pressure, waist circumference (-1.51 cm, 95% CI -2.34 to -0.68), weight (-1.37 kg, 95% CI -1.75 to -1.00), percentage body fat (-1.22%, 95% CI -1.70 to -0.73) and body mass index (-0.53 kg/m(2), 95% CI -0.72 to -0.35) but failed to alter blood lipids.

CONCLUSIONS

Walking interventions improve many risk factors for cardiovascular disease. This underscores the central role of walking in physical activity for health promotion.

Controlled aerobic exercise training reduces resting blood pressure in sedentary older adults

The results of existing controlled clinical trials were synthesized to determine effects of aerobic exercise training on resting systolic (SBP) and diastolic blood pressure (DBP) among previously sedentary older adults, to quantify the magnitude of observed changes, and to examine the influence of the associated interventional variables on these changes. Studies were identified via a systematic computer database search, hand searching, and cross-referencing of previously located articles. All potentially eligible articles were carefully reviewed and examined with the established inclusion criteria. Twenty-three studies, representing a total of 1226 older subjects, were included in the final analysis. Robust statistically significant effects were found in terms of the pooled standardized effect size of - 0.33 ± 0.06 (p < 0.0001) in SBP and - 0.39 ± 0.09 (p < 0.0001) in DBP. When compared with the control group, net decreases in both SBP (- 5.39 ± 1.21 mmHg, p < 0.0001) and DBP (-3.68 ± 0.83 mmHg, p < 0.0001) were observed in older exercisers, representing a 3.9% and a 4.5% reduction, respectively. This meta-analytic study provides robust quantitative data to support the efficacy and effectiveness of controlled endurance exercise training in decreasing resting SBP and DBP among previously sedentary older adults.

The effect of walking intervention on blood pressure control: a systematic review

BACKGROUND

Hypertension is a major public health problem and a key risk factor of cardiovascular diseases. Increased physical activity has been recommended as an important lifestyle modification for the prevention and control of hypertension. However the optimal characteristics for a physical activity programme remain open to debate. Walking is recommended by healthcare professionals as a form of exercise for controlling hypertension and nurses find it difficult to provide advice about this form of physical activity. Studies testing the effect of walking on blood pressure have produced inconsistent findings.

OBJECTIVES

To systematically review the evidence for the effectiveness of walking intervention on blood pressure.

METHODS

A systematic search of the literature was conducted using a range of electronic and evidence-based databases to identify studies. Criteria for study inclusion were a randomised controlled trial design with a non-intervention control group; study samples were aged 16 years and over; the intervention was predominantly focused on walking and blood pressure was an outcome. Data extraction and quality appraisal were carried out independently by two reviewers; a third reviewer was consulted when needed.

RESULTS

A total of 27 randomised controlled trials were included and nine of the 27 trials found an effect of walking intervention on blood pressure control. Walking intervention tends to be effective from studies with larger sample size. A beneficial effect of walking on blood pressure tended to employ moderate to high-intensity walking and a longer intervention period than those trials not showing the effect.

CONCLUSIONS

The results of this review provide evidence of the beneficial effects of walking on lowering blood pressure. Recommendations on lowering blood pressure with a walking activity should address the issue of walking intensity to achieve a beneficial effect on lowering blood pressure. Future research investigating the effect of walking intensity on blood pressure levels and rigorous design of walking interventions to achieve better adherence and methodological quality is required.

Output that counts: pedometers, sociability and the contested terrain of older adult fitness walking

Based on five months of participant observation and interviews with members of a hospital-sponsored walking club, I explore the rejection of pedometer technology among older adult walkers. Health researchers praise pedometers as a useful tool for measuring walking activity, setting fitness goals, and charting progress towards goals. Older adult walkers, however, viewed pedometers and the monitoring they enable as anathema to walking group norms that stress sociability. I assess the differential construction of pedometers by fitness researchers, group leaders, and walkers themselves. While fitness researchers construct pedometer technology as a motivator for exercise adherence, walkers believed pedometers would create competition and hierarchy that might destroy group camaraderie. In contrast to biomedical models of health and wellness, which focus predominantly on exercise outputs like step counts, these findings suggest that sociability is an important component of health maintenance leisure activities for older adult walkers.

A meta-analysis of pedometer-based walking interventions and weight loss

PURPOSE

Cross-sectional studies show that individuals who walk more tend to be thinner than those who walk less. This does not mean, however, that the association between higher step counts and lower weight is causal or that encouraging sedentary individuals to increase step counts helps them lose weight.

METHODS

In this meta-analysis, we searched 6 electronic databases and contacted pedometer experts to identify pedometer-based walking studies without a dietary intervention that reported weight change as an outcome. We included randomized controlled trials and prospective cohort studies published after January 1, 1995, in either English or Japanese, with 5 or more adult participants and at least 1 cohort enrolled in a pedometer-based walking intervention lasting at least 4 weeks.

RESULTS

Nine studies met the study inclusion criteria. Cohort sample size ranged from 15 to 106, for a total of 307 participants, 73% of whom were women and 27% of whom were men. The duration of the intervention ranged from 4 weeks to 1 year, with a median duration of 16 weeks. The pooled estimate of mean weight change from baseline using a fixed-effects model and combining data from all 9 cohorts was -1.27 kg (95% confidence interval, -1.85 to -0.70 kg). Longer intervention duration was associated with greater weight change. On average, participants lost 0.05 kg per week during the interventions.

CONCLUSION

Pedometer-based walking programs result in a modest amount of weight loss. Longer programs lead to more weight loss than shorter programs.

Physical and Psychological Outcomes of a Supported Physical Activity Program for Older Carers

This study evaluated health benefits of a supported physical activity program for 116 older carers (mean age 64.4 [SD = 7.9], 85% women). Participants undertook a 6-month center-based physical activity program (strength training, yoga, or Tai Chi). Eighty-eight participants (76%) completed the program. Multivariate repeated-measures ANOVA identified overall significant improvement postint-ervention (p = .004). Univariate analyses revealed significant improvements for balance, strength, gait endurance, depression, and SF-36 (physical component; p < .05). There was no change in the Zarit Carer Burden Scale (p > .05). Change in performance scores did not differ significantly between those with higher and lower attendance at classes, although there was significantly greater improvement in gait endurance and balance (p < .05) in those attending classes run twice weekly than in those attending once-weekly classes. In conclusion, a carer physical activity program, providing additional carer support to facilitate participation, can achieve high levels of involvement by carers and significant health benefits.

The effect of walking on fitness, fatness and resting blood pressure: a meta-analysis of randomised, controlled trials

OBJECTIVE

The purpose of this review was to perform a meta-analysis on walking intervention studies in order to quantify the magnitude and direction of walking-induced changes that may alter selected cardiovascular risk factors.

METHOD

Twenty-four randomised controlled trials of walking were assessed for quality on a three-point scale. Data from these studies were pooled and treatment effects (TEs) were calculated for six traditional cardiovascular risk variables: body weight, body mass index (BMI), percentage body fat, aerobic fitness (V(O(2) )max in ml kg(-1) min(-1)) and resting systolic and diastolic blood pressure. Weighted TEs were analysed using a random effects model with weights obtained using the inverse of the individual TE variances. Random effects models were used to investigate the influence of both study quality and exercise volume (<150 vs. > or =150 min week(-1)).

RESULTS

Random effects modelling showed that walking interventions increased V(O(2) )max and decreased body weight, BMI, percent body fat and resting diastolic blood pressure in previously sedentary adults (p<0.05 for all).

CONCLUSION

The results of this study provide evidence that healthy but sedentary individuals who take up a programme of regular brisk walking improves several known risk factors for cardiovascular disease.

Evidence for prescribing exercise as therapy in chronic disease

Considerable knowledge has accumulated in recent decades concerning the significance of physical activity in the treatment of a number of diseases, including diseases that do not primarily manifest as disorders of the locomotive apparatus. In this review we present the evidence for prescribing exercise therapy in the treatment of metabolic syndrome-related disorders (insulin resistance, type 2 diabetes, dyslipidemia, hypertension, obesity), heart and pulmonary diseases (chronic obstructive pulmonary disease, coronary heart disease, chronic heart failure, intermittent claudication), muscle, bone and joint diseases (osteoarthritis, rheumatoid arthritis, osteoporosis, fibromyalgia, chronic fatigue syndrome) and cancer, depression, asthma and type 1 diabetes. For each disease, we review the effect of exercise therapy on disease pathogenesis, on symptoms specific to the diagnosis, on physical fitness or strength and on quality of life. The possible mechanisms of action are briefly examined and the principles for prescribing exercise therapy are discussed, focusing on the type and amount of exercise and possible contraindications.

The effect of a worksite based walking programme on cardiovascular risk in previously sedentary civil servants [NCT00284479]

BACKGROUND

A significant proportion of Europeans do not meet the recommendations for 30 mins of physical activity 5 times per week. Whether lower frequency, moderate intensity exercise alters cardiovascular disease (CVD) risk has received little attention. This study examined the effects of 45 minutes self-paced walking, 2 d. wk(-1) on aerobic fitness, blood pressure (BP), body composition, lipids and C-Reactive Protein (CRP) in previously sedentary civil servants.

METHODS

37 subjects (24 women) aged 41.5 +/- 9.3 years were randomly assigned to either two 45 minute walks per week (walking group) or no training (control group). Aerobic fitness, body composition, blood pressure (BP), CRP and lipoprotein variables were measured at baseline and following 8 weeks. Steps counts were measured at baseline and during weeks 4 and 8 of the intervention.

RESULTS

Compared to the control group, the walking group showed a significant reduction in systolic BP and maintained body fat levels (P < 0.05). There were no changes other risk factors. Subjects took significantly more steps on the days when prescribed walking was performed (9303 +/- 2665) compared to rest days (5803 +/- 2749; P < 0.001).

CONCLUSION

These findings suggest that walking twice per week for 45 minutes at approximately 62% HRmax, improves activity levels, reduces systolic BP and prevents an increase in body fat in previously sedentary adults. This walking prescription, however, failed to induce significant improvements in other markers of cardiovascular disease risk following eight weeks of training.

The effects of resistance training and walking on functional fitness in advanced old age

The authors assessed the effects of resistance training and walking exercise on measures of functional fitness. Sixty-four volunteers (average age 83.5 years) from an independent-living facility were randomly assigned to walking, resistance training, or control groups. Participants in the walking and resistance-training groups engaged in two exercise sessions per week for 16 weeks. Measures of functional fitness included upper and lower body strength, hip and shoulder flexibility, agility and balance, coordination, blood pressure, and resting heart rate. Repeated measures analysis of variance was used to examine pretest to posttest differences. Both exercise groups showed significant improvements relative to control group in upper and lower body strength, shoulder flexibility, and agility and balance exercise. Findings demonstrate that exercise can lead to improvements in multiple domains of functional fitness even among very old, previously sedentary individuals, possibly making activities of daily living easier to perform.

Effects of endurance training on blood pressure, blood pressure-regulating mechanisms, and cardiovascular risk factors

Previous meta-analyses of randomized controlled trials on the effects of chronic dynamic aerobic endurance training on blood pressure reported on resting blood pressure only. Our aim was to perform a comprehensive meta-analysis including resting and ambulatory blood pressure, blood pressure-regulating mechanisms, and concomitant cardiovascular risk factors. Inclusion criteria of studies were: random allocation to intervention and control; endurance training as the sole intervention; inclusion of healthy sedentary normotensive or hypertensive adults; intervention duration of > or =4 weeks; availability of systolic or diastolic blood pressure; and publication in a peer-reviewed journal up to December 2003. The meta-analysis involved 72 trials, 105 study groups, and 3936 participants. After weighting for the number of trained participants and using a random-effects model, training induced significant net reductions of resting and daytime ambulatory blood pressure of, respectively, 3.0/2.4 mm Hg (P<0.001) and 3.3/3.5 mm Hg (P<0.01). The reduction of resting blood pressure was more pronounced in the 30 hypertensive study groups (-6.9/-4.9) than in the others (-1.9/-1.6; P<0.001 for all). Systemic vascular resistance decreased by 7.1% (P<0.05), plasma norepinephrine by 29% (P<0.001), and plasma renin activity by 20% (P<0.05). Body weight decreased by 1.2 kg (P<0.001), waist circumference by 2.8 cm (P<0.001), percent body fat by 1.4% (P<0.001), and the homeostasis model assessment index of insulin resistance by 0.31 U (P<0.01); HDL cholesterol increased by 0.032 mmol/L(-1) (P<0.05). In conclusion, aerobic endurance training decreases blood pressure through a reduction of vascular resistance, in which the sympathetic nervous system and the renin-angiotensin system appear to be involved, and favorably affects concomitant cardiovascular risk factors.

Resting Heart Rate Changes after Endurance Training in Older Adults: A Meta-Analysis

PURPOSE

Question remains regarding endurance training and changes in resting heart rate (HR) among older individuals. The objective of this meta-analysis was to determine the effects of controlled aerobic training on resting HR among sedentary older adults.

METHODS

Studies were identified by a systematic computer database search, hand article search, and cross-reference. The inclusion criteria were (i) controlled clinical trials, (ii) endurance exercise as the only intervention, (iii) a nonexercise control group, (iv) within-group mean ages of subjects > or = 60 yr, (v) a measure of changes in resting HR, (vi) studies published in English journals.

RESULTS

Outcome was derived from 13 studies with a total of 651 individuals in 14 control (N = 241) and 16 exercise groups (N = 410). The pooled standardized effect size by a fixed-effect model showed an upper moderate effect of -0.58 +/- 0.08 (mean +/- SEM, 95% CI = -0.74 to -0.42). This homogeneity effect was statistically significant (P = 0.001). The magnitude of net change averaged -6 bpm (-2 to -12 bpm), representing an 8.4% reduction. Greater and statistically significant decrease of resting HR among the elderly was found in the studies with training length more than 30 wk.

CONCLUSIONS

This meta-analytic investigation supports the efficacy of endurance exercise training in decreasing HR at rest in older adults. This training induced adaptation may have protective benefits for cardiovascular aging. A longer exercise training length, probably more than 30 wk, may be needed for older individuals to be more effective in terms of resting HR reduction.

Participatory Research to Promote Physical Activity at Congregate-Meal Sites

The purpose of this study was to determine the feasibility and effectiveness of an on-site physical activity (PA) program offered with congregate meals. Study 1 surveyed meal-site users on their likelihood to participate. Study 2 used meal-site-manager interviews and site visits to determine organizational feasibility. Study 3, a controlled pilot study, randomized meal sites to a 12-week group-based social-cognitive (GBSC) intervention or a standard-care control. Studies 1 and 2 indicated that most meal-site users would participate in an on-site PA program, and meal sites had well-suited physical resources and strong organizational support for this type of program. In Study 3, GBSC participants increased their weekly PA over those in the control condition (p < .05, ES = .79). Results indicated that changes in task cohesion might have mediated intervention effectiveness. These studies demonstrate that a PA program offered in this venue is feasible, is effective in promoting PA, and could have a strong public health impact.

Physical activity and older adults: a review of health benefits and the effectiveness of interventions

The purpose of this multidisciplinary review paper is to critically review evidence from descriptive, efficacy and effectiveness studies concerned with physical activity and older people. Both levels of fitness (aerobic power, strength, flexibility and functional capability) and measures of physical activity involvement decline with age, and the extent to which this is due to a biological ageing processes or disuse (physical inactivity) is critically examined. The review will consider the evidence for a causal relationship between sedentary behaviour/physical activity programmes and cardiovascular, musculoskeletal and psycho-social health, independent living and health-related quality of life into old age. The review also considers the effectiveness of different physical activity interventions for older people and issues relating to cost-effectiveness. The implications for future policy in terms of research, health care services, and education and training are briefly discussed.

Interventions for promoting physical activity

BACKGROUND

Little is known about the effectiveness of strategies to enable people to achieve an increase in their physical activity.

OBJECTIVES

To assess the effects of interventions for promoting physical activity in adults aged 16 years and older, not living in an institution.

SEARCH STRATEGY

We searched CENTRAL (Issue 4, 2001), MEDLINE, EMBASE, CINAHL, PsychLIT, BIDS ISI, SPORTDISCUS, SIGLE, SCISEARCH (from earliest date available to December 2001) and reference lists of articles.

SELECTION CRITERIA

Randomised, controlled, trials comparing different interventions to encourage sedentary adults not living in an institution to become physically active. Studies required a minimum of six months follow up from the start of the intervention to the collection of final data and either used an intention to treat analysis or, failing that, had no more than 20% loss to follow up.

DATA COLLECTION AND ANALYSIS

At least two reviewers independently assessed each study quality and extracted data. Study authors were contacted for additional information where necessary. Standardised mean differences and 95% confidence intervals were calculated for continuous measures of self reported physical activity and cardio-respiratory fitness. For studies with dichotomous outcomes, odds ratios and 95% confidence intervals were calculated.

MAIN RESULTS

The effect of interventions on self reported physical activity (11 studies; 3940 participants) was positive and moderate, with a pooled standardised mean difference of 0.31 (95% CI 0.12 to 0.50), as was the effect on cardio-respiratory fitness (7 studies; 1406 participants) pooled SMD 0.4 (95% CI 0.09 to 0.70). The effect of interventions in achieving a predetermined threshold of physical activity (6 studies; 2313 participants) was not significant with an odds ratio of 1.30 (95% CI 0.87 to 1.95). There was significant heterogeneity in the reported effects as well as heterogeneity in characteristics of the interventions. The heterogeneity in reported effects was reduced in higher quality studies, when physical activity was self-directed with some professional guidance and when there was on-going professional support.

AUTHORS' CONCLUSIONS

Our review suggests that physical activity interventions have a moderate effect on self reported physical activity and cardio-respiratory fitness, but not on achieving a predetermined level of physical activity. Due to the clinical and statistical heterogeneity of the studies, only limited conclusions can be drawn about the effectiveness of individual components of the interventions. Future studies should provide greater detail of the components of interventions.

Urban form and older residents' service use, walking, driving, quality of life, and neighborhood satisfaction

PURPOSE

This study explored the relationship between pedestrian-friendly urban form as reflected in new urbanism design guidelines, and neighborhood service use, walking, driving, quality of life, and neighborhood satisfaction among older women.

DESIGN

A cross-sectional survey compared residents of census tracts similar indemographic characteristics but differing in urban form.

SETTING

The setting was urban and suburban areas of Portland, Oregon.

SUBJECTS

The sample consisted of 372 females living alone over age 70 in six census tracts; 133 (36%) completed surveys.

MEASURES

The New Urbanism Index rated the physical features of respondents' neighborhoods. The Neighborhood Resident Survey assessed travel modes and neighborhood satisfaction. The Quality of Life Index measured resident well-being. The Dartmouth COOP Functional Health Charts measured health status. Group comparisons were made with t-tests and regression analysis.

RESULTS

Although limited by the cross-sectional design, the study showed that new urbanism partially explained several differences in service use and activity: distance to a grocery store (r2 change = .11, p = .001), number of services used within 1 mile from home (r2 change = .06, p = .007), number of walking activities (r2 change = .08, p = .001), number of services accessed by walking (r2 change = .14, p = .000), and number of services accessed by driving (r2 change = .05, p = .001).

CONCLUSIONS

Traditional urban neighborhoods with mixed services and good pedestrian access were associated with increased walking among older residents.

Age responses to multicomponent training programme in older adults

PURPOSE

The purpose of this study was to determine the effects of 9-week multicomponent training on the functional fitness of healthy older adults in different age groups.

METHOD

Forty-two participants were randomly assigned and stratified by their age group: Training and Control Young Old Groups (TYOG, CYOG) (between 60-73 years), Training and Control Old Groups (TOG, COG) (between 74-86 years). The training programme consisted of three sessions per week of walking, strengthening, and flexibility exercises. A recently developed Functional Fitness Test battery to assess the physical parameters associated with independent functioning in older adults was performed before and after training.

RESULTS

Training caused significant increases in all functional fitness tests in the TYOG and also in the TOG. There was no difference according to the absolute changes between TYOG and TOG due to the training (p>0.05). Training produced a significant improvement in chair sit and reach, arm curl, chair stand and 6 min walk test scores in the TYOG and TOG when they were compared to the control groups (p<0.05).

CONCLUSION

Multicomponent training can produce substantial increase in functional fitness tests in young old adults and older adults and the rate of restoration of function is approximately similar in the two old age groups.

State of the science for care of older adults with heart disease

This article provided an overview of the current state of knowledge related to cardiovascular disease in elders. Some depth has been provided related to CHD and HF, two common diagnoses in older persons. The most striking finding is that although trials are increasingly including older cohorts of patients, research specifically testing known therapies in older patients is essential. In particular, research testing the safety, efficacy, and acceptability of therapies in the oldest old is greatly needed.

Habitual walking and its correlation to better physical function: implications for prevention of physical disability in older persons

BACKGROUND

Our objective was to determine the association between participation in habitual physical activity (including walking, shopping, and indoor and outdoor activities) and leisure-time or sports activities on physical performance and fitness in older persons.

METHODS

In an observational study, 123 predominantly ethnic Chinese participants aged 50 years and older were recruited from a health promotion program. Main outcome measures were bioelectric impedance for body fat composition, peak oxygen consumption (VO(2)max), gait speed, handgrip strength, and chair rise time.

RESULTS

The mean age of participants was years. Those with a higher self-reported walking level had a better VO(2)max; every 1 minute per day increase in habitual walking increases VO(2)max by 0.096 (ml/kg)/min (95% confidence interval [CI] 0.027-0.165, p=.007) and is possibly associated with a faster gait speed; (95% CI 0.000-0.005, p=.078). There is an age-related rise in body fat composition, decline in VO(2)max, and slower chair rise time. Men had a lower body fat composition, better VO(2)max, and stronger handgrip.

CONCLUSIONS

Habitual walking may impart important health benefits in terms of improvement in physical performance, fitness, and its implications for the prevention of physical disability in older adults. This also reinforces the theory that low- to moderate-intensity activities may improve cardiorespiratory fitness. There is an inevitable physiological age-related decline in physical fitness.

Reliability and validity of a dual-task force platform assessment of balance performance: effect of age, balance impairment, and cognitive task

OBJECTIVES

The primary aim of this study was to identify whether performing a balance task on a force platform while performing a cognitive task (backwards counting by three) could discriminate between healthy older people and older people at mildly increased risk of falling better than performing the balance task alone. Additional aims were to identify the effect of age on balance performance and to investigate the retest reliability and concurrent validity of the balance measures.

DESIGN

Cross-sectional-cohort, three-group comparison design.

SETTING

Gait and balance testing laboratory.

PARTICIPANTS

Twenty healthy young adults (HY, mean age +/- standard deviation = 26.4 +/- 1 years), 20 healthy older adults (HO, 73.8 +/- 6.0 years), and 20 older adults with mild increase in falls risk (MIFR, 74.8 +/- 3 years).

MEASUREMENTS

All subjects were tested on the balance task alone and while performing a concurrent cognitive task on the Chattecx Balance System (CBS) under three platform conditions: stable platform (stable), dynamic platform with forward-backward tilting (F-B), and dynamic platform with side-to-side tilting (S-S) and on the step test, timed up-and-go, and gait measures.

RESULTS

There was a significant difference between HY and HO on the S-S and F-B conditions, both with and without the addition of the cognitive task (P< .05), but not under stable platform conditions. There were also significant differences between the HO and MIFR groups under stable and F-B conditions (P< .05). A three-way analysis of variance identified significant main effects for group, platform condition and task (P< .05), group-by-platform interaction, and platform-by-task interaction. The F-B condition with the cognitive task most effectively discriminated between groups. Post hoc analyses revealed that the F-B condition with cognitive task was associated with the highest accuracy in classifying subjects from the two older groups, with a sensitivity of 0.8 and a specificity of 0.8. Retest reliability for most CBS measures was moderate to high, and correlations between dynamic CBS measures and clinical measures were high.

CONCLUSION

Measurement of dynamic balance on the CBS (F-B) with a cognitive task is a reliable measure that discriminates well between healthy older people and those with a mild increase in risk of falling.