Exercise for the older woman: choosing the right prescription

Effects of over 10 weeks of resistance training on muscle and bone mineral density in older people with sarcopenia over 70 years old: A systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

We aimed to examine the effects of more than 10 weeks of resistance training (RT) on muscle structure, muscle function, and bone mineral density (BMD) in older people with sarcopenia over 70 years old METHODS: PubMed, Web of Science, Embase, MEDLINE, Cochrane Library, and CINAHL databases were searched for randomized controlled trials. Standardized mean difference (MD) or standard mean difference (SMD) was used to pool the effect of the RT intervention RESULTS: Thirteen studies with 2080 older adults with sarcopenia were included. Resistance exercise significantly affected handgrip strength (MD = 1.67 kg; P = 0.02) and isometric muscle strength (standard mean difference [SMD] = 0.53; P = 0.02). Significant differences in chair stand test (SMD = 0.40; P = 0.02) and skeletal muscle mass index (mean difference [MD] = 1.67 kg/m2; P = 0.0002) were found between the RT and control groups CONCLUSION: More than 10 weeks of RT has beneficial effects on muscle but no favorable effect on BMD in older people with sarcopenia over 70 years old.

Motivational Factors and Barriers Towards Initiating and Maintaining Strength Training in Women: a Systematic Review and Meta-synthesis

Strength training (ST) or resistance training is important in the development and maintenance of musculoskeletal and cardiovascular health in women of all ages; however, uptake of ST amongst women is low. To improve female musculoskeletal health, it is vital that more women are encouraged to participate in ST to maintain musculoskeletal integrity. This systematic review aimed to identify motivators and barriers to women initiating and maintaining ST. Following protocol registration and systematic search, studies were included if they were primary qualitative or mixed-method studies reporting participant verbatim quotes, included adult women, and focused on motivators and barriers for ST. Searches generated 2534 articles from 3 databases, with 20 studies (N = 402 participants) meeting eligibility criteria. Participant quotes and authors' interpretations were analysed using thematic synthesis. The most frequently observed barriers were gender-based stigmas, discouragement, and negative comments, particularly in women currently engaging in ST. Other factors associated with poor adherence included boredom, poor knowledge of ST, poor gym accessibility, lack of supervision or routine, and difficulty in balancing work and family life. Social support from friends and family, words of affirmation, and accompaniment facilitated ST, particularly in older women. Women who saw expected results such as weight loss were motivated to continue ST. Interventions aimed at increasing participation in ST amongst women should focus on the specific benefits valued by women and the dissemination of accurate information to counter misconceptions and increase knowledge. The adaptation of gym environments to make them more welcoming to women, and reduce gender-focused criticism, is especially important.

High Intensity Interval Training Improves Physical Performance and Frailty in Aged Mice

Sarcopenia and frailty are highly prevalent in older individuals, increasing the risk of disability and loss of independence. High intensity interval training (HIIT) may provide a robust intervention for both sarcopenia and frailty by achieving both strength and endurance benefits with lower time commitments than other exercise regimens. To better understand the impacts of HIIT during aging, we compared 24-month-old C57BL/6J sedentary mice with those that were administered 10-minute uphill treadmill HIIT sessions three times per week over 16 weeks. Baseline and end point assessments included body composition, physical performance, and frailty based on criteria from the Fried physical frailty scale. HIIT-trained mice demonstrated dramatic improvement in grip strength (HIIT 10.9% vs -3.9% in sedentary mice), treadmill endurance (32.6% vs -2.0%), and gait speed (107.0% vs 39.0%). Muscles from HIIT mice also exhibited greater mass, larger fiber size, and an increase in mitochondrial biomass. Furthermore, HIIT exercise led to a dramatic reduction in frailty scores in five of six mice that were frail or prefrail at baseline, with four ultimately becoming nonfrail. The uphill treadmill HIIT exercise sessions were well tolerated by aged mice and led to performance gains, improvement in underlying muscle physiology, and reduction in frailty.

Preliminary Evaluation of a 10-wk. Resistance and Cardiovascular Exercise Protocol on Physiological and Psychological Measures for a Sample of Older Women

A preliminary 10-wk. study was conducted to determine the effect a combined strength and cardiovascular exercise protocol had on both physiological and psychological change in 17 older ( M age = 66.8 yr.), formerly sedentary women. The protocol was associated with better adherence than typically found for new and returning exercisers. Significant improvements over 10 wk. were found on Body Mass Index, body fat, resting heart rate, and balance. Significant, positive changes in mean ratings were also found on Physical Self-concept, Total Mood Disturbance, Depression, and Fatigue (small to moderate treatment effect sizes). Although no significant changes were found for rated Tension, Vigor, Anger, and Confusion, mean changes were in the desired direction and rated Tension showed a moderate effect size. The need for replication, including a control group and follow-up, plus continued research on exercise protocols both well-tolerated and effective for older individuals and other specific groups, were discussed.

Age-related changes of grip force control in physically active adults

The age-related changes for controlling grip force in adults who practice regular and supervised physical activity have not been investigated. Fifty-five physically active adults ages 50 years and older and a group of 20 young adults (18-30 years old) performed a task of grasping and lifting an object. The grip force and the object's acceleration were recorded and used to calculate the parameters of grip force control. The levels of daily physical activities were also examined in all age groups. There were no differences in grip force control between the age groups. Conversely, the group over 76 years old used stronger grip force and increased latency (the time from grip force application to the time the object is lifted off the table) to manipulate the object. The results of this study suggest that middle-aged and older adults who exercise regularly can reduce or delay the possible grip force control deficits associated with aging.

Feasibility study of walking for exercise in individuals living in assisted living settings

BACKGROUND AND PURPOSE

Decreased physical activity levels are an increasing concern, specifically for the aging population. Older adults (>65 years) are able to achieve health benefits from participating in a regular exercise program based on studies done in younger community-dwelling older adults. There is less research investigating the efficacy of exercise for improving physical function among the older adult population in assisted living settings. This study investigated using a treadmill with a harness system, to engage older adults in aerobic exercise. The primary objective of the study was to assess the feasibility of a large trial by evaluating the recruitment and short-term retention rate of older adults with limited mobility. Secondary objectives were to determine whether older adults could achieve the frequency, intensity, and duration of aerobic exercise recommended by the American College of Sports Medicine.

METHODS

A feasibility study of residents of an assisted living facility who had care needs ranging from retirement home to palliative care. The feasibility of recruitment and retention was determined by recording the number of older adults who consented to participate in treadmill walking for 3 weeks, declined treadmill participation including reasons why, and completed the 6 treadmill sessions. All participating residents completed a baseline assessment, including a medical chart review, and had the choice to walk on the treadmill or not. To determine whether participants could achieve what is recommended in physical activity guidelines, exercise, frequency, intensity, and duration achieved after the final treadmill sessions were reported.

RESULTS

Among eligible residents, 30% consented to participate in the study. There were no significant differences between treadmill participants and those who chose not to walk on the treadmill. The average compliance to treadmill sessions was 94.4% ± 10.8%. Treadmill participants achieved an average intensity of 50.3% heart rate reserve (SD = 30.2%) and an average frequency of 3 sessions in 1 week. Average duration of the final session was 14 minutes 53 seconds ± 6 minutes 43 seconds.

CONCLUSION

This study provides preliminary evidence that it is feasible to recruit and retain older adults in assisted living facilities to participate in a short-term treadmill walking study; however, it may be difficult to recruit a large number of individuals. Treadmill participants were able to achieve the American College of Sports Medicine's recommended intensity and frequency for aerobic exercise. For older adults in assisted living settings to achieve 20 minutes a day, they may need more than 3 weeks of progression or multiple sessions per day.

Legumes and soy products consumption and functional disability in older women

OBJECTIVES

This study was to examine the association between frequency of legumes and soy products consumption and functional disability in older Korean women.

STUDY DESIGN

Cross-sectional study. Data came from the 2005 Korea National Health and Nutrition Examination Survey (KNHANES). Subjects were 562 women aged 65 years and older living in the community.

MAIN OUTCOME MEASURES

Frequency of legume consumption was obtained by using food frequency questionnaire and functional disability was assessed using the instrumental activities of daily living (IADL) and ADL scales. Poisson regression analyses were conducted to examine the association of frequency of legume and soy consumption with functional disability, controlling for covariates.

RESULTS

Dietary intake of legumes and soy products was associated with a significantly reduced risk of IADL disability after controlling for potential risk factors (p = 0.002 for trend). Compared with women who consumed legumes and soy products < 1 time per week, those who consumed ≥ 3 times per day had a reduced risk of IADL disability (prevalence ratio = 0.70; 95% confidence interval: 0.51-0.96). In contrast, legumes and soy products consumption was not significantly associated with ADL disability.

CONCLUSIONS

Frequent legumes and soy products consumption was inversely associated with IADL disability in older women. Further studies are needed to clarify the protective effect of legume consumption on functional disability in older people.

Even low-intensity and low-volume exercise training may improve insulin resistance in the elderly

OBJECTIVE

Moderate to high intensity exercise training is known to ameliorate the coronary risk factors in relation to an improvement in body composition. However, the benefit of low-intensity and low-volume training for these risk factors remains unclear in elderly people. Therefore, we investigated the effects of low-intensity and low-volume exercise training on blood lipid values and insulin resistance in the elderly.

METHODS

A total of 56 healthy elderly individuals (42 females and 14 males) aged 64+/-6 years participated in a 12-week exercise program, comprising aerobic training and resistance training.

RESULTS

After the program, there were no significant changes in high-density lipoprotein cholesterol, triglyceride serum levels, or in peak oxygen uptake on average. However, the homeostasis of minimal assessment of insulin resistance (HOMA-IR) value was significantly reduced by 21%. The participants were categorized into tertiles based on initial Body Mass Index (BMI). The Middle-BMI group (non-obese subjects) showed reduced HOMA-IR (2.0-->1.3, P<0.01), but this reduction was not associated with the reduction in BMI (r=0.08, P=0.74), whereas the two reductions were significantly associated in the High-BMI group (r=0.61, P=0.01).

CONCLUSION

Even low-intensity and low-volume exercise training, which would ordinarily be insufficient for improving mean lipid values or aerobic fitness, was found to be effective in improving insulin resistance in the elderly. The improvement in insulin resistance was independent of the improvement in obesity.

Quality of life of rural menopausal women in response to a customized exercise programme

AIM

This paper reports a study examining the effects of physical exercise on the quality of life of menopausal women.

BACKGROUND

People who perform no type of physical activity have poorer physical and mental health. Despite the well-documented benefits of exercise, ageing women remain largely sedentary, and interventions designed to help them to maintain exercise programmes may prove particularly valuable. Measures should focus on increasing women's confidence so that they can overcome barriers to exercise. Conflicting results have been reported in intervention studies to promote exercise in postmenopausal women.

METHODS

Forty-eight menopausal women aged 55-72 years were recruited at a primary care centre as voluntary participants in a quasi-experimental study. They were randomly assigned to one of two groups: control (n = 24) and experimental (n = 24). The experimental group participated in a 12-month programme of cardiorespiratory, stretching, muscle-strengthening and relaxation exercises carried out during two fully supervised exercise sessions per week (total of 3 hours weekly). Health-related quality of life was assessed by using the Quality of Life Profile for Chronically Ill Patients, a generic questionnaire widely used in epidemiological and clinical studies to measure well-being and function, incorporating as an optional module the Kupperman Index of Menopausal Symptomatology.

RESULTS

There was a statistically significant improvement in the health-related quality of life of the experimental group, whereas the health-related quality of life of the control group significantly worsened. Menopausal symptoms also significantly improved in the experimental group and significantly worsened in the control group over the 12-month study period.

CONCLUSIONS

A customized exercise programme is valuable for improving the health-related quality of life of menopausal women.

Influencing exercise and diet to prevent osteoporosis: lessons from three studies

Osteoporosis is a major public health problem, causing fractures of wrist, back and hip with high associated morbidity and mortality. Particularly at risk are postmenopausal women. Recent moves away from hormone replacement therapy as a preventative measure have focused attention on exercise and dietary supplementation with calcium for prevention and treatment. This article reports three studies of women screened for osteoporosis - an outpatient sample (n = 129), a GP sample (n = 25) of women before and after bone mineral density screening, and a sample of women diagnosed with osteoporosis in the past 5 years (n = 26). Only 57% in the outpatient sample consume the recommended amount of calcium (1500 mg calcium daily); 65% in primary care consume 1200 mg five times per week, although 90% intend to do so. For bone-loading exercise, the recommendation is three 20-minute periods per week. Most women thought they were undertaking enough exercise, and diaries showed that 74% of the women undertook 60 minutes per week, and 44% undertook 30 minutes five times per week. Women were more willing to change diet than exercise. Suggestions are made to help primary care teams to motivate women to make sustained changes in diet and exercise.

Increased physiotherapy in sheltered housing in Sweden: a study of structure and process in elderly care

The effect of increasing the level of physiotherapy services in elderly care was studied using an intervention and a control unit. The units had 20 and 2 hours of physiotherapy services per week, respectively. Physiotherapy and occupational therapy records were reviewed before and during the project. Physiotherapists also kept extended documentation over an 11-month period. Data analyses employed the chi-square test and content analysis. There was a significant increase in the number of patients receiving physiotherapy and occupational therapy within both units. No significant differences between the units were found for the number of patients receiving physiotherapy. The number of patients receiving occupational therapy differed significantly between units before as well as during the intervention. Primarily care assistants and auxiliary nurses initiated contact with the physiotherapists mainly for patient-orientated errands. Fifty per cent of the instructions given by the physiotherapist at the 20-hour unit related to movement-orientated activities of daily living. At the 2-hour unit, the majority of instructions (52%) were programme-orientated.

Musculoskeletal fitness: the keystone in overall well-being and injury prevention

Musculoskeletal fitness is an important and inadequately appreciated component of overall health and well-being. Wellness as it applies to strength and conditioning has numerous benefits. It allows maintenance of functional independence for longer periods in older adults. It impacts the metabolic capabilities of children and adults affecting the ability to maintain an ideal body weight. It has been shown to influence the prevalence and possibly the prevention of many musculoskeletal disorders such as muscle sprains, low back pain, osteoarthritis, osteoporosis, shoulder instability, and knee stability and pain. The current author summarizes the most recent recommendations for achievement and maintenance of musculoskeletal fitness for children and adults.

Femur bone mineral density is independently associated with functional recovery after hip fracture in elderly women

OBJECTIVE

To evaluate the association between femur bone mineral density (BMD) and functional recovery after hip fracture.

DESIGN

Cross-sectional study.

SETTING

Rehabilitation hospital in Italy.

PARTICIPANTS

A total of 233 of 263 white women with hip fracture consecutively admitted to a rehabilitation hospital.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Patients underwent BMD assessment by dual-energy x-ray absorptiometry (DXA) at the proximal femur (5 sites) on admission. Functional recovery was evaluated by using Barthel Index scores.

RESULTS

A positive correlation was found between BMD and Barthel Index scores assessed on both admission and discharge (r range,.16-.24, depending on the site of BMD measurement). Linear multiple regression showed that the association between BMD and Barthel Index score was independent of 10 confounding variables: age, body mass index, fracture type, pressure ulcers, cognitive impairment, neurologic diseases, total lymphocyte count as a nutritional index, time between fracture occurrence and DXA assessment, comorbidity, and surgical procedure. Conversely, no significant associations were found between BMD and the change in Barthel Index score attributable to rehabilitation.

CONCLUSIONS

In the study population, femur BMD was an independent predictor of the functional recovery assessed by Barthel Index score after hip fracture, but not of the change in the functional score resulting from rehabilitation.

Physical Activity and Cardiovascular Health in Aging Women: A Health-Promotion Perspective

Cardiovascular disease is the leading cause of death in women. The purpose of this study was to explore the relationship between physical activity and other determinants of cardiovascular health in aging women from a health-promotion perspective. Participants (N= 206) completed a cardiovascular health-promotion profile, and various physical measures were recorded. The findings suggest that physically active aging women, especially those who exercise regularly or vigorously, have healthier cardiovascular profiles than do their less active counterparts. They were more likely to be members of a health and fitness facility, to be younger, and have higher socioeconomic status. Their diets were healthier, and their perception of their health status was more positive. Physical measures of cardiovascular health also decreased with increased levels of activity (p< .05). These findings validate physical activity promotion as an effective strategy to ameliorate the cardiovascular health profile of aging women. The study also lends support for population-based cardiovascular health-promotion strategies.

Muscle strength and tibolone: a randomised, double-blind, placebo-controlled trial

OBJECTIVE

To investigate the effects of tibolone, a tissue-specific compound with a mixed (estrogenic, progestogenic and androgenic) hormonal profile, on skeletal muscle strength in a group of healthy postmenopausal women.

DESIGN

Randomised, parallel group, double-blind, placebo-controlled, single-centre trial conducted between August 1997 and July 1999.

PARTICIPANTS

Eighty-five healthy women, between one and 15 years postmenopausal, (mean [SD] age, 54.2 [4.7] years) recruited from local paper advertisements. Participants were randomly assigned to 2.5 mg tibolone or to identically appearing placebo pills daily for 12 months, taken orally in the morning.

METHODS

Both maximal handgrip strength, representing upper body strength, and maximal quadriceps strength, representing lower body strength, were measured isometrically.

MAIN OUTCOME MEASURES

Treatment effect estimates (between group differences) in handgrip strength and isometric knee extension at last visit.

RESULTS

Tibolone significantly (P = 0.04) increased handgrip strength compared with placebo (difference 0.99 kg, [95% CI 0.1-1.9]). No significant treatment effect (P = 0.61) was observed in isometric knee extension strength. Isometric strength adjusted for body mass index resulted in a trend favouring tibolone (P = 0.06). Individual trend analysis showed a significant difference in rate of change throughout the year (6.8% [95% CI 2.1-10.7]) favouring tibolone.

CONCLUSIONS

Administration of tibolone increased handgrip strength in postmenopausal women compared with placebo. A trend indicating a positive effect in isometric knee extension strength adjusted for body mass index was observed. Tibolone seems to mitigate the menopause-related decline in muscle strength.

Temporal relationships of self-efficacy and social support as predictors of adherence in a 6-month strength-training program for older women

The present study investigated how self-efficacy and social support predicted adherence to a strength training program for elderly women over two time periods in the initial 6 mo. of the program. Participants were 30 elderly women volunteers aged 75 to 80 who completed measures of barrier self-efficacy and general social support at baseline and 3 mo. later. Social support from the program was also measured at 3 mo. Adherence to the program was measured by attendance. Hierarchical regression equations were utilized to identify the contributions of self-efficacy and social support for adherence at 0 to 3 mo. and 4 to 6 mo. For prediction of the first 3 mo. of adherence, both self-efficacy and social support contributed significant unique variance towards the total explained variance of 36%. For the 4- to 6-mo. period, self-efficacy explained significant (12%) variance in adherence even when controlling for the previous 3-mo. adherence. Inclusion of general social support and social support from the program, however, did not account for significant variance. Researchers must continue to examine self-efficacy and social support in exercise adherence within various time periods among older adults to develop effective intervention strategies.

A lifetime of fitness. Exercise in the perimenopausal and postmenopausal woman

The peri- and postmenopausal woman experiences physiologic changes of aging that include alterations in hormone levels. Research has shown that the perimenopausal and postmenopausal woman can benefit significantly from exercise, whether endurance or strength training. Exercise can improve the quality of life and attenuate some of the physiologic changes associated with aging. Additionally, exercise can ameliorate the decline in fitness and bone, prevent chronic disease, and promote functional independence. Women who exercise regularly throughout life are physiologically 20 to 30 years younger than their sedentary counterparts. Fitness is a lifetime endeavor that has many positive benefits. Weightbearing activities are especially important as bone loss increases in the perimenopausal phase of life. Women should perform aerobic exercise 3 to 7 days per week for 15 to 60 minutes at 65% to 70% HRreserve. Strengthening exercises should be done 2 to 3 days per week at 40% to 80% 1RM with appropriately selected exercises. An exercise program should be functional and enjoyable. There is no better motivation to exercise than having a partner to work out with and keep the motivation alive. Most important, age itself is not a deterrent to exercise.

Aging and exercise: are they compatible in women?

The benefits of physical exercise and fitness have long been understood. With the aging of society and longevity of women relative to men, interest finally is being given to the female population. There are many benefits to maintaining an active lifestyle as women age. These benefits include maintenance of bone mineral density and prevention of osteoporosis, decreased susceptibility to falls, and decreased susceptibility to breast cancer and other chronic diseases. There are great psychologic benefits to maintaining an active lifestyle, and the connection between cardiovascular fitness and lowering the incidence of cardiac disease is well established. Finally, physical activity and exercise can decrease the symptoms of arthritis. The Centers for Disease Control recommends at least 30 minutes of moderately intensive activity on most days of the week. In older women, the loss of lean body mass (sarcopenia) can be diminished through a strength training program. With these benefits of maintaining an active lifestyle, healthcare providers should become proactive in emphasizing the benefits of physical activity to the older female population.