Five-year performance trends for older exercisers: a hierarchical model of endurance, strength, and flexibility

Retention of older veterans with serious mental illness in a clinical exercise program

Older adults with serious mental illness (SMI) have compromised physical function that could be improved with exercise; however, retention in exercise programs is a challenge. This study was a retrospective analysis of retention for the 150 older veterans with SMI that enrolled in Gerofit, a clinical exercise program offered in the Veterans Health Administration. Chi-square and t-tests were conducted to evaluate baseline differences between those that were and were not retained at six and 12 months. Retention was 33% and better health-related quality of life and endurance were related to retention. Future work is needed to improve exercise program retention in this population.

Changes in Self-Reported Fruit and Vegetable Intake following Nutritional Modification in High Risk Older Veterans

This project aimed to determine the feasibility of implementing a dietary intervention in older Veterans participating in an exercise and health promotion program (Gerofit) and whether this intervention could improve self-reported fruit and vegetable (F&V) intake measured by BRFSS and diet quality measured by visual analog scale (0-10 scale). Participation consisted of optional group and individual counseling with a Registered Dietitian (RD). Out of 50 participants approached to participant in the program, 24 Veterans attended ≥2 group sessions (2.9 ± 2.0 classes, which was 82% of total available sessions). There was a reported trend toward increased daily F&V intake (pre vs. post: 3.4 ± 1.9 vs. 4.1 ± 2.0 servings/day, p = 0.07) and a significant increase in diet quality (4.7 ± 0.5 vs. 5.9 ± 0.4, p= 0.03) from baseline compared to the last attended class. These promising preliminary findings can be used to inform efforts to optimize dietary intake in vulnerable Veteran populations.

Impact of Supervised Exercise on One-Year Medication Use in Older Veterans with Multiple Morbidities

Exercise is touted as the ideal prescription to treat and prevent many chronic diseases. We examined changes in utilization and cost of medication classes commonly prescribed in the management of chronic conditions following participation in 12-months of supervised exercise within the Veterans Affairs Gerofit program. Gerofit enrolled 480 veterans between 1999 and 2017 with 12-months participation, with 453 having one or more active prescriptions on enrollment. Active prescriptions overall and for five classes of medications were examined. Changes from enrollment to 12 months were calculated, and cost associated with prescriptions filled were used to estimate net cost changes. Active prescriptions were reduced for opioids (77 of 164, 47%), mental health (93 of 221, 42%), cardiac (175 of 391, 45%), diabetes (41 of 166, 25%), and lipid lowering (56 of 253, 22%) agents. Cost estimates resulted in a net savings of $38,400. These findings support the role of supervised exercise as a favorable therapeutic intervention that has impact across chronic conditions.

Rapid Transition to Telehealth Group Exercise and Functional Assessments in Response to COVID-19

Exercise is critical for health maintenance in late life. The COVID-19 shelter in place and social distancing orders resulted in wide-scale interruptions of exercise therapies, placing older adults at risk for the consequences of decreased mobilization. The purpose of this paper is to describe rapid transition of the Gerofit facility-based group exercise program to telehealth delivery. This Gerofit-to-Home (GTH) program continued with group-based synchronous exercise classes that ranged from 1 to 24 Veterans per class and 1 to 9 classes offered per week in the different locations. Three hundred and eight of 1149 (27%) Veterans active in the Gerofit facility-based programs made the transition to the telehealth delivered classes. Participants' physical performance testing continued remotely as scheduled with comparisons between most recent facility-based and remote testing suggesting that participants retained physical function. Detailed protocols for remote physical performance testing and sample exercise routines are described. Translation to remote delivery of exercise programs for older adults could mitigate negative health effects.

Should Structured Exercise Be Promoted As a Model of Care? Dissemination of the Department of Veterans Affairs Gerofit Program

Exercise provides a wide range of health-promoting benefits, but support is limited for clinical programs that use exercise as a means of health promotion. This stands in contrast to restorative or rehabilitative exercise, which is considered an essential medical service. We propose that there is a place for ongoing, structured wellness and health promotion programs, with exercise as the primary therapeutic focus. Such programs have long-lasting health benefits, are easily implementable, and are associated with high levels of participant satisfaction. We describe the dissemination and implementation of a long-standing exercise and health promotion program, Gerofit, for which significant gains in physical function that have been maintained over 5 years of follow-up, improvements in well-being, and a 10-year 25% survival benefit among program adherents have been documented. The program has been replicated at 6 Veterans Affairs Medical Centers. The pooled characteristics of enrolled participants (n = 691) demonstrate substantial baseline functional impairment (usual gait speed 1.05 ± 0.3 m/s, 8-foot up and go 8.7 ± 6.7 seconds, 30-second chair stands 10.7 ± 5.1, 6-minute walk distance 404.31 ± 141.9 m), highlighting the need for such programs. Change scores over baseline for 3, 6, and 12 months of follow-up are clinically and statistically significant (P < .05 all measures) and replicate findings from the parent program. Patient satisfaction ratings of high ranged from 88% to 94%. We describe the implementation process and present 1-year outcomes. We suggest that such programs be considered essential elements of healthcare systems.

The Duke Center for the Study of Aging: one of our earliest roots

The Duke University Center for the Study of Aging and Human Development (Duke CFA) was established by a multidisciplinary group of visionary scientists in 1955. It is the oldest continually operating center or institute dedicated to aging in the United States. This article outlines the origins of the Duke CFA and summarizes the major research initiatives conducted in its early years. The primary focus is on these landmark studies and their legacies. Those studies made important initial contributions to the knowledge base, introduced measurement tools and research designs that became standards in the field, and served as the impetus for later and current research. The hallmarks of these studies are their multidisciplinary foundations and their focus on the health and well-being of older adults. The Duke CFA's current research clearly builds upon the goals, insights, and empirical results of previous research initiatives. Although aging research is and has been the bedrock of the Duke CFA, developing services responsive to the needs of older adults and multidisciplinary training have also been hallmarks of the Duke CFA. Duke's Geriatric Evaluation and Treatment Clinic was established in 1974 and remains a national model for geriatric assessment. Our postdoctoral research training program has graduated more than 200 scholars and our Geriatric Fellowship program has graduated 113 geriatricians. Many of our graduates have exemplary careers in aging, contributing to important research advances, providing care to thousands of older adults, serving as leaders in the field, and training new generations of gerontologists and geriatricians.

Predictors of longitudinal changes in older adults' physical activity engagement

The study aimed to investigate factors influencing older adults' physical activity engagement over time. The authors analyzed 3 waves of data from a sample of Israelis age 75-94 (Wave 1 n = 1,369, Wave 2 n = 687, Wave 3 n = 154). Findings indicated that physical activity engagement declined longitudinally. Logistic regressions showed that female gender, older age, and taking more medications were significant risk factors for stopping exercise at Wave 2 in those physically active at Wave 1. In addition, higher functional and cognitive status predicted initiating exercise at Wave 2 in those who did not exercise at Wave 1. By clarifying the influence of personal characteristics on physical activity engagement in the Israeli old-old, this study sets the stage for future investigation and intervention, stressing the importance of targeting at-risk populations, accommodating risk factors, and addressing both the initiation and the maintenance of exercise in the face of barriers.

Experience and management of chronic pain among patients with other complex chronic conditions

OBJECTIVE

Managing multiple chronic health conditions is a significant challenge. The purpose of this study was to examine the experience and management of chronic pain among adult patients with other complex chronic conditions, specifically diabetes and heart failure (HF).

METHODS

We surveyed 624 US Department of Veterans Affairs primary care patients in 3 study groups: 184 with HF, 221 with diabetes, and 219 general primary care users. We compared health status and function between those with and without chronic pain within the 3 study groups. Among those with chronic pain, we compared pain location, severity, and treatment across groups.

RESULTS

More than 60% in each group reported chronic pain, with the majority reporting pain in the back, hip, or knee. In all groups, patients with chronic pain were more likely to report fair or poor health than those without pain (P<0.05). In the HF and diabetes groups, a higher percentage of patients with pain were not working because of health reasons. Of those with pain, more than 70% in each group took medications for pain; more than one-half managed pain with rest or sedentary activities; and less than 50% used exercise for managing their pain.

DISCUSSION

Chronic pain is a prevalent problem that is associated with poor functioning among multimorbid patients. Better management of chronic pain among complex patients could lead to significant improvements in health status, functioning, and quality of life and possibly also improve the management of their other major chronic health conditions.

Resistive training and long-term function in older adults

The purpose of this study was to evaluate the effects of a 24-month moderate-intensity resistive-training intervention on strength and function in older adults. A repeated-measures experimental research design was employed as a sample of 55 apparently healthy, older, community-dwelling volunteers (30 exercisers- 25 women and 5 men; 25 comparisons- 16 women and 9 men) were evaluated for strength of 5 muscle groups that influence lower extremity movement and physical function. Strength and function were evaluated at 6-month intervals. The findings from this study indicate that a moderate-intensity resistive-training program increases strength in older adults and that the strength benefits are retained for the duration of the intervention. Furthermore, a long-term strength-training program can increase independent-function skills in older adults and might therefore aid in prolonging functional independence.

Effects of long-term resistive training on mobility and strength in older adults with diabetes

BACKGROUND

Strength training has been shown to be beneficial in older adults. However, very little data exist on the effects of strength training in older diabetics.

METHODS

31 community-dwelling older adults with diabetes (mean age = 66.1 years) were randomly assigned to either an exercise (EX) or control (CO) group. The EX group trained the plantar flexors, knee extensors, knee flexors, hip extensors, and hip flexors muscle groups at 50%, 60%, and 70% of 1-repetition maximum, 2.6 days a week, for 24 months. Mobility tests included the timed up and go, 50-foot walk, and walking up and down 8 stairs. Strength and mobility for both groups were evaluated at 6-month intervals.

RESULTS

There was a group and time effect as the EX group increased 31.4% (p <.001) in strength for all muscle groups after the first 6 months of training, and the strength gains were retained for the duration of the training intervention. There was also a group and time effect for mobility as performance increased 8.6% and 9.8% (p =.032 and p = 0.031) for the first 6 and 12 months, respectively, but decreased to 4.6% above baseline at the end of the intervention. There were essentially no changes from baseline strength or mobility values for the CO group.

CONCLUSION

In conclusion, these data suggest that a moderate-intensity resistive-training program can improve mobility and strength for the duration of a 24-month intervention in older adults with diabetes, thus potentially reducing the rate of mobility loss during aging.

Effectiveness of a home-based strengthening program for elderly males in Italy. A preliminary study

BACKGROUND AND AIMS

The practice of regular physical exercise has been shown to be effective in slowing the age-related progressive functional deterioration. Most exercise trials have been conducted with supervised training programs. The purpose of this study was to investigate the effectiveness of a 4-month home-based strength training on strength, function and personal satisfaction.

METHODS

Ten elderly men (mean age 68.5 years) were enrolled for home-based training one month after completing a 4-month supervised program; 12 age-matched men served as the control group. Subjects were asked to perform 3 sessions a week consisting of six resistance exercises with elastic bands involving the major muscle groups of the upper and lower limbs. We had calculated the correlation between the elongation and resistance of the elastic bands. The subjects were instructed to keep a diary reporting the execution of the session. We measured dynamic concentric strength of the muscle groups involved in the resistance exercises and maximal isometric strength of the knee extensors and elbow flexors before and after the 4-month home training. The Satisfaction Profile (SAT-P) questionnaire was administered before and one month after the completion of the training program for assessing personal satisfaction.

RESULTS

The final to baseline comparison showed a non-significant decrease in mean isometric maximal strength values for knee extensors and elbow flexors in the control group, while the exercise group significantly (p=0.001) improved the average baseline values. Maximal dynamic concentric strength values decreased significantly in the control group, while significant improvements were observed in the exercising subjects. The SAT-P questionnaire did not show any difference in either group from baseline. The adherence-to-protocol rate based on self-report was 78%.

CONCLUSIONS

Home training with elastic bands appears to be an effective low-cost modality of maintaining strength and function in an elderly population.

Physical and performance measures for the identification of mild to moderate frailty

BACKGROUND

The relative importance and association of factors contributing to physical frailty in elderly persons are unclear.

METHODS

Physical measures of upper and lower extremity strength, range of motion, balance, coordination, sensation, and gait were evaluated in relation to scores obtained on a 36-point physical performance test (PPT) in 107 elderly subjects.

RESULTS

Scores on the PPT were significantly associated with the measures of strength and balance, gait, several range of motion values, and sensation. Subjects were also grouped according to score on the PPT as not frail (32-36 points), mildly frail (25-31 points), or moderately frail (17-24 points). ANOVA followed by Bonferroni post hoc analyses were used to examine the relationships of physical measures to this index of frailty. Balance measures, an obstacle course, the Berg scale, the full tandem portion of the Romberg test, and fast gait speed were significantly different among the three groups. Multiple stepwise regression analyses indicated that the strongest combination of variables, explaining 73% of all the variance in the PPT, included obstacle course performance, hip abduction strength, the semitandem portion of the Romberg test, and coordination (pegboard).

CONCLUSIONS

Results provide further insight into the relative importance of factors that contribute to frailty and factors that should be considered in treatment planning for the remediation of physical frailty in old adults.

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

BACKGROUND

Information is lacking about the physiological and psychosocial effects of exercise among very old persons.

AIM

To investigate the effect of a twice-weekly, six-month progressive walking programme on 38 healthy women in their ninth decade, for evidence of the benefits of exercise.

METHODS

Aerobic fitness, blood pressure, skinfold thickness and habitual activity patterns were studied in a randomised controlled trial. Women were chosen, as this is a group of increasing demographic importance for which studies are lacking.

RESULTS

The training group and control group were not significantly different at baseline. However, after six months of progressive exercise the training group showed lower resting (p < 0.05) and working (p < 0.005) heart rates compared with non-exercising controls. ANCOVA analyses indicated higher scores for the training group compared with the control group for Maximum Current Activity and Normative Impairment Index (both p < 0.001), which are both components of the Habitual Activity Profile. Morale also significantly improved within the training group (p < 0.01).

CONCLUSIONS

These data show the trainability of very old women and the positive impact a low frequency, progressive exercise programme can have on cardiorespiratory fitness and daily living activity patterns. Such improvements are likely to be indicative of an enhanced outlook for independence.

Is there a threshold between peak oxygen uptake and self-reported physical functioning in older adults?

PURPOSE

Few studies have examined the relationship between directly measured oxygen uptake (VO2) and self-reported physical function (PF). The purpose of this study was: 1) to examine the relationship between peak V02 and PF and 2) to determine whether a threshold or cut point exist that distinguishes between individuals reporting required assistance in the performance of functional tasks (low PF) and those who report ability to perform tasks independently (high PF).

METHODS

Participants were 161 community-dwelling adults, ages 65-90, who had a baseline evaluation for a clinical trail that included measurement of peak V02 and PF consisted of a summary score combining scores from the Older Americans Resources and Services Multidimensional Functional Assessment Questionnaire, Nagi Disability Study. Rosow-Breslau Scale, Physical Function Scale of the Medical Outcomes Study, and the Falls Efficacy Scale. Decision tree, cubic spline, and logistic regression analyses explored these relationships with age, gender, education, race, body mass index, depression, and total number of chronic diseases included as important covariates.

RESULTS

Among all covariates examined, peak V02 was most strongly associated with (P = 0.004) with PF. There was not threshold effect. Decision tree analyses indicated that 18.3 mL.kg-1.min-1 was the optimal cut point distinguishing between low PF and High PG (P < 0.0001). Between-gender differences in PF (P = 0.002) were no longer significant when peak V02 was included in the PF model (P = 0.17).

CONCLUSIONS

These data indicate that individuals with a V02 < 18 mL.kg-1min-1 report significant difficulty in the performance of daily tasks and that differences in peak V02 may explain, in part, why women report more impairment in PF.