The effect of functional tasks exercise and resistance exercise on health-related quality of life and physical activity. A randomised controlled trial

Experiences of older adults participating in dance exergames: A systematic review and meta-synthesis

BACKGROUND

Interventions to encourage adequate physical activity amongst older adults have had limited long-term success. Dancing and exergames, two beneficial and enjoyable physical activities for older adults, may make regular exercise more interesting and effective. Dance exergames are physical exercises that integrate sensory, cognitive, psychological, and physical functions by requiring users to interact with game scenarios through deliberate body motions and receive real-time feedback. They provide an inherently enjoyable gaming and workout experience, which may boost exercise adherence. However, little is known about older adults' experiences with dance exergames.

OBJECTIVE

To synthesise the qualitative experiences of older adults participating in dance exergames.

DESIGN

Systematic review and meta-synthesis.

METHODS

Dance exergame studies (peer-reviewed and grey literature) involving older adults in any setting published in English from inception to 17 August 2023 were included. Qualitative or mixed-method studies must use immersive or non-immersive virtual-reality platforms. PubMed, Scopus, CINAHL, The Cochrane Library, ProQuest Dissertations & Theses Global, Google Scholar, and reference lists of relevant studies and reviews were searched for eligible studies. The search strategy for Scopus was: (TITLE-ABS-KEY (danc*) AND TITLE-ABS-KEY (exergames OR exergame OR video AND games OR virtual AND reality) AND TITLE-ABS-KEY (older AND adults OR elderly OR seniors OR geriatrics)). Thematic synthesis by Thomas and Harden was used for meta-synthesis.

RESULTS

Eleven studies (n = 200 older adults) were included. Three themes and 14 subthemes were synthesised: 1) Dance exergames as dual-task training for physical, cognitive, and psychological well-being, 2) Concerns on usability issues, and 3) Possible enhancements of dance exergames. Older adults recognised that dance exergames could improve their physical, cognitive, and psychological well-being. Existing dance exergame systems had several usability issues. For example, some older adults were unfamiliar with using new technology and had trouble in navigating the game systems. The older adults also provided various suggestions for adaptation to their age group, such as ensuring a variety of dances, difficulty levels suited for older adults' cultural backgrounds, and physical and cognitive capabilities.

CONCLUSIONS

Dance exergames may be an attractive way to encourage older adults to exercise, but appropriate modifications are needed. When designing/selecting dance exergames for older persons, researchers, healthcare professionals, and senior care centres should consider using exergames that have simple designs, varied dances that are locally adapted, and appeal to a large proportion of older adults.

REGISTRATION

PROSPERO CRD42023395709.

Comparative effectiveness of interventions on promoting physical activity in older adults: A systematic review and network meta-analysis

Background

Despite the well-established health benefits of physical activity, a large population of older adults still maintain sedentary life style or physical inactivity. This network meta-analysis (NMA) aimed to compare the effectiveness of wearable activity tracker-based intervention (WAT), electronic and mobile health intervention (E&MH), structured exercise program intervention (SEP), financial incentive intervention (FI) on promoting physical activity and reducing sedentary time in older adults.

Methods

The systematic review based on PRISMA guidelines, a systematic literature search of PubMed, Web of Science, Google Scholar, EMbase, Cochrane Library, Scopus were searched from inception to December 10th 2022. The randomized controlled trials (RCT) were included. Two reviewers independently conducted study selection, data extraction, risk of bias and certainty of evidence assessment. The effect measures were standard mean differences (SMD) and 95% confidence interval (CI) in daily steps, moderate-to-vigorous physical activity (MVPA) and sedentary time.

Results

A total of 69 studies with 14,120 participants were included in the NMA. Among these included studies, the results of daily steps, MVPA and sedentary time was reported by 55, 25 and 15 studies, respectively. The NMA consistency model analysis suggested that the following interventions had the highest probability (surface under the cumulative ranking, SUCRA) of being the best when compared with control: FI + WAT for daily steps (SUCRA = 96.6%; SMD = 1.32, 95% CI:0.77, 1.86), WAT + E&MH + SEP for MVPA (SUCRA = 91.2%; SMD = 0.94, 95% CI: 0.36, 1.52) and WAT + E&MH + SEP for sedentary time (SUCRA = 80.3%; SMD = -0.50, 95% CI: -0.87, -0.14). The quality of the evidences of daily steps, MVPA and sedentary time was evaluated by very low, very low and low, respectively.

Conclusions

In this NMA, there's low quality evidence that financial incentive combined with wearable activity tracker is the most effective intervention for increasing daily steps of older adults, wearable activity tracker combined with electronic and mobile health and structured exercise program is the most effective intervention to help older adults to increase MVPA and reduce sedentary time.

Using Powerlifting Athletes to Determine Strength Adaptations Across Ages in Males and Females: A Longitudinal Growth Modelling Approach

INTRODUCTION

Several retrospective studies of strength sport athletes have reported strength adaptations over months to years; however, such adaptations are not linear.

METHODS

We explored changes in strength over time in a large, retrospective sample of powerlifting (PL) athletes. Specifically, we examined the rate and magnitude of strength adaptation based on age category and weight class for PL competition total, and the squat, bench press, and deadlift, respectively. Mixed effects growth modelling was performed for each operationalised performance outcome (squat, bench press, deadlift, and total) as the dependent variables, with outcomes presented on both the raw, untransformed time scale and on the common logarithmic scale. Additionally, the fitted values were rescaled as a percentage.

RESULTS

Collectively, the greatest strength gains were in the earliest phase of PL participation (~ 7.5-12.5% increase in the first year, and up to an ~ 20% increase after 10 years). Females tended to display faster progression, possibly because of lower baseline strength. Additionally, female Masters 3 and 4 athletes (> 59 years) still displayed ~ 2.5-5.0% strength improvement, but a slight strength loss was observed in Masters 4 (> 69 years) males (~ 0.35%/year).

CONCLUSION

Although directly applicable to PL, these findings provide population-level support for the role of consistent and continued strength training to improve strength across the age span and, importantly, to mitigate, or at least largely attenuate age-related declines in strength compared to established general population norms. This information should be used to encourage participation in strength sports, resistance training more generally, and to support future public health messaging.

Mindfulness Practice versus Physical Exercise in Enhancing Vitality

Vitality is important for subjective well-being and performance, which makes strategies for its enhancement an important research issue. While prior research showed that mindfulness practice and physical exercise are both effective at enhancing vitality, no study has compared their efficacy. This study aimed to address this issue. Seventy-one Chinese adults participated in the study and were randomized to one of the intervention groups, i.e., mindfulness practice or physical exercise. The mindfulness practice group completed guided mindfulness trainings, while the physical exercise group completed self-chosen aerobic trainings for seven days. The levels of vitality and its four factors at three time points (baseline, post-intervention, 7-day follow-up) were measured and compared. Compared with physical exercise, mindfulness practice showed stronger effects in enhancing vitality and maintaining the improvements. The findings suggest that guided mindfulness practice is more effective than self-chosen aerobic physical exercise at enhancing vitality and maintaining its improvements.

A Systematic Review of the Use of Commercial Wearable Activity Trackers for Monitoring Recovery in Individuals Undergoing Total Hip Replacement Surgery

The innovation of wearable devices is advancing rapidly. Activity monitors can be used to improve the total hip replacement (THR) patients' recovery process and reduce costs. This systematic review assessed the body-worn accelerometers used in studies to enhance the rehabilitation process and monitor THR patients. Electronic databases such as Cochrane Database of Systematic Reviews library, CINAHL CompleteVR, Science Citation Index, and MedlineVR from January 2000 to January 2022 were searched. Due to inclusion criteria, fourteen eligible studies that utilised commercial wearable technology to monitor physical activity both before and after THR were identified. Their evidence quality was assessed with RoB 2.0 and ROBINS-I. This study demonstrates that wearable device technology might be feasible to predict, monitor, and detect physical activity following THR. They could be used as a motivational tool to increase patients' mobility and enhance the recovery process. Also, wearable activity monitors could provide a better insight into the individual's activity level in contrast to subjective self-reported questionnaires. However, they have some limitations, and further evidence is needed to establish this technology as the primary device in THR rehabilitation.

Effect of Neuromuscular Training Program on Quality of Life After COVID-19 Lockdown Among Young Healthy Participants: A Randomized Controlled Trial

Study in the period of coronavirus disease 2019 (COVID-19) lockdown and the effect of different exercise training programs on the quality of life (QoL) dimension are limited. This randomized control study as a part of which the impact of an 8-week neuromuscular training program on the 90 healthy young individuals' QoL after COVID-19 lockdown was assessed using a short form of the WHOQOL-BREF questionnaire comprising of four domains (physical health, psychological health, social relations, and the environment). The intervention group (NT) (n = 47) took part in a neuromuscular training program consisting of dynamic neuromuscular stabilization and whole-body vibration training. In contrast, the control group (CG) (n = 43) did not participate in any programmed physical activity. From pre- to post-intervention test, the NT group significantly and substantially improved [mean change (95% CI)] all the QoL domains, physical for 12.78 scores (8.89, 16.64), psychological for 13.12 scores (9.51, 16.74), social relationships for 20.57 scores (16.12, 25.02), and environmental for 24.40 scores (21.45, 27.35). These results suggest that the NT program could enhance QoL in young and healthy participants following COVID-19 lockdown.

Physical Exercise Training Improves Quality of Life in Healthy Older Adults: A Meta-Analysis

The current meta-analysis first aimed to quantify the overall effect of physical exercise training on the quality of life (QoL) in healthy older adults. Second, the effects on the social, physical, and psychological QoL were assessed. In total, 16 randomized controlled trials were included. The primary analysis showed a medium effect of physical exercise training on QoL in healthy older adults (standard mean difference [SMD] = 0.38, confidence interval, CI, [0.18, 0.59], p < .05). The secondary analyses showed a positive medium effect of physical exercise training on the physical component of QoL (SMD = 0.39, CI [0.17, 0.60], p < .05), and a positive medium effect of physical exercise training on the psychological component of QoL (SMD = 0.348, CI [0.125, 0.570], p < .05), and no significant effect of physical exercise training on the social component of QoL was observed (SMD = 0.16, CI [-0.07, 0.38], p = .17). These findings warrant implementation efforts pertaining to exercise training for older adults to improve the QoL in our aging societies.

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

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

Effects of a multicomponent exercise program combined with calcium-vitamin D3-enriched milk on health-related quality of life and depressive symptoms in older men: secondary analysis of a randomized controlled trial

PURPOSE

Osteoporosis is associated with both lower health-related quality of life and depression in older people. We examined the independent and combined effects of a multi-component exercise program and calcium-vitamin D₃ fortified milk on health-related quality of life (HR-QoL) and depression in older men.

METHODS

In this 12-month, factorial design randomized controlled trial, 180 healthy community-dwelling men aged 50-79 years with normal to below average bone mineral density were allocated into one of four groups: exercise + fortified milk; exercise; fortified milk; or controls. Exercise consisted of high-intensity resistance training with weight-bearing exercise (3 days per week; 60-75 min per session). Men assigned to fortified milk consumed 400 ml/day of low-fat milk containing 1000 mg/day calcium and 800IU/day vitamin D₃. Questionnaires were used to assess HR-QoL (SF-36) and depressive symptoms (Center for Epidemiologic Studies Depression Scale) at baseline, and 6 and 12 months. A linear mixed model analysis was used to test whether there was a synergistic interaction between exercise and calcium-vitamin D_3. If no significant interactions were detected, the main effects of exercise and fortified milk were examined.

RESULTS

Mean adherence to the exercise program and fortified milk was 67% (95% CI 61, 73%) and 90% (95% CI 86, 93%), respectively. There were no exercise-by-fortified milk interactions nor main effects of exercise or calcium-vitamin D for any of the HR-QoL measures or depressive symptoms.

CONCLUSION

In healthy community-dwelling older men, exercise training and/or calcium-vitamin D fortified milk did not improve HR-QoL or depressive symptoms.

Digital behavior change interventions to promote physical activity and/or reduce sedentary behavior in older adults: A systematic review and meta-analysis

BACKGROUND

Physical activity and sedentary behavior are modifiable risk factors for non-communicable disease and healthy ageing, however the majority of older adults remain insufficiently active. Digital behavior change interventions (DBCI) have the potential to reach many older adults to promote physical activity and reduce sedentary time. This study aims to assess the efficacy of DBCI interventions in older adults (≥50 years) on physical activity and sedentary behavior.

METHODS

A systematic review of major databases from inception to 03/2018 was undertaken. Randomized controlled trials (RCT) or pre-post interventions assessing effects of DBCI on physical activity and/or sedentary behavior in older adults (≥50 years) were included. Random effects meta-analyses were carried out.

RESULTS

Twenty-two studies were included, including 1757 older adults (mean age = 67 years, %male = 41), 68% showed moderate-high risk of bias. Meta-analyses suggested that DBCI increased total physical activity among RCT studies (n = 8) (SMD = 0.28; 95%CI 0.01, 0.56; p = 0.04) and pre-post studies (n = 6) (SMD = 0.25; 95%CI 0.09, 0.41; p = 0.002), increased moderate-to-vigorous physical activity (SMD = 0.47; 95%CI 0.32, 0.62, p < 0.001; MD = 52 min/week) and reduced sedentary time (SMD = -0.45; 95%CI -0.69, -0.19; p < 0.001; MD = 58 min/day). Reductions in systolic blood pressure (-11 bpm; p = 0.04) and improvements in physical functioning (p = 0.03) were also observed.

CONCLUSIONS

DBCI may increase physical activity and physical functioning, and reduce sedentary time and systolic blood pressure in older adults, however more high-quality studies are required.

Effects of preoperative and postoperative resistance exercise interventions on recovery of physical function in patients undergoing abdominal surgery for cancer: a systematic review of randomised controlled trials

Objective

To systematically review the effects of preoperative and postoperative resistance exercise training on the recovery of physical function in patients undergoing abdominal surgery for cancer.

Data sources

A systematic review of English articles using Medline, Physiotherapy Evidence Database, CINAHL and the Cochrane Library electronic databases was undertaken.

Eligibility criteria for selecting studies

Studies were included if they used a randomised, quasi-randomised or controlled trial study design and compared the effects of a muscle-strengthening exercise intervention (±other therapy) with a comparative non-exercise group; involved adult participants (≥18 years) who had elected to undergo abdominal surgery for cancer; and used muscle strength, physical function, self-reported functional ability, range of motion and/or a performance-based test as an outcome measure.

Results

Following screening of titles and abstracts of the 588 publications retrieved from the initial search, 24 studies met the inclusion criteria and were accessed for review of the full-text version of the article, and 2 eligible studies met the inclusion criteria and were included in the review. One exercise programme was undertaken preoperatively and the other postoperatively, until discharge from hospital. The exercise interventions of the included studies were performed for five and eight sessions, respectively. There were no differences between groups in either study.

Conclusion

The only two studies designed to determine whether preoperative or postoperative resistance muscle-strengthening exercise programmes improved or negatively affected physical function outcomes in patients undergoing abdominal surgery for cancer provide inconclusive results.

The relationship between balance performance, lumbar extension strength, trunk extension endurance, and pain in participants with chronic low back pain, and those without

BACKGROUND

Chronic low back pain is associated with lumbar extensor deconditioning. This may contribute to decreased neuromuscular control and balance. However, balance is also influenced by the hip musculature. Thus, the purpose of this study was to examine balance in both asymptomatic participants and those with chronic low back pain, and to examine the relationships among balance, lumbar extension strength, trunk extension endurance, and pain.

METHODS

Forty three asymptomatic participants and 21 participants with non-specific chronic low back pain underwent balance testing using the Star Excursion Balance Test, lumbar extension strength, trunk extension endurance, and pain using a visual analogue scale.

FINDINGS

Significant correlations were found between lumbar extension strength and Star Excursion Balance Test scores in the chronic low back pain group (r = 0.439-0.615) and in the asymptomatic group (r = 0.309-0.411). Correlations in the chronic low back pain group were consistently found in posterior directions. Lumbar extension strength explained ~19.3% to ~37.8% of the variance in Star Excursion Balance Test scores for the chronic low back pain group and ~9.5% to ~16.9% for the asymptomatic group.

INTERPRETATION

These results suggest that the lumbar extensors may be an important factor in determining the motor control dysfunctions, such as limited balance, that arise in chronic low back pain. As such, specific strengthening of this musculature may be an approach to aid in reversing these dysfunctions.

Effects of a 9-month resistance training intervention on quality of life, sense of coherence, and depressive symptoms in older adults: randomized controlled trial

Purpose

(1) To determine the effects of a 9-month resistance training intervention on quality of life, sense of coherence, and depressive symptoms in older adults, and (2) to compare effects between different training frequencies.

Methods

Men and women aged 65–75 (N = 106) were randomized to four groups according to training frequency: training groups RT1 (n = 26), RT2 (n = 27), and RT3 (n = 28) and non-training control group (n = 25). All training groups attended supervised resistance training twice a week for 3 months. For the following 6 months, they continued training with different frequencies (1, 2 or 3 times per week). Psychological functioning was measured by quality of life (WHOQOL-Bref), sense of coherence (Antonovsky’s SOC-13), and depressive symptoms (Beck’s Depression Inventory II). Measurements were conducted at baseline and 3 and 9 months after baseline. The effects of the intervention were analyzed using generalized estimating equations (GEE).

Results

After 3 months, there was an intervention effect on environmental quality of life (group × time p = .048). Between 3 and 9 months, environmental quality of life decreased among RT1 compared to RT2 and RT3 (group × time p = .025). Between baseline and 9 months, environmental quality of life increased in RT2 compared to all other groups (group × time p = .011). Sense of coherence increased in RT2 compared to the control group and RT3 (group × time p = .032).

Conclusion

Resistance training is beneficial for environmental quality of life and sense of coherence. Attending resistance training twice a week seems to be the most advantageous for these aspects of psychological functioning.

Effects of progressive resistance training combined with a protein-enriched lean red meat diet on health-related quality of life in elderly women: secondary analysis of a 4-month cluster randomised controlled trial

Resistance training (RT) and increased dietary protein are recommended to attenuate age-related muscle loss in the elderly. This study examined the effect of a lean red meat protein-enriched diet combined with progressive resistance training (RT+Meat) on health-related quality of life (HR-QoL) in elderly women. In this 4-month cluster randomised controlled trial, 100 women aged 60-90 years (mean 73 years) from self-care retirement villages participated in RT twice a week and were allocated either 160 g/d (cooked) lean red meat consumed across 2 meals/d, 6 d/week or ≥1 serving/d (25-30 g) carbohydrates (control group, CRT). HR-QoL (SF-36 Health Survey questionnaire), lower limb maximum muscle strength and lean tissue mass (LTM) (dual-energy X-ray absorptiometry) were assessed at baseline and 4 months. In all, ninety-one women (91 %) completed the study (RT+Meat (n 48); CRT (n 43)). Mean protein intake was greater in RT+Meat than CRT throughout the study (1·3 (sd 0·3) v. 1·1 (sd 0·3) g/kg per d, P<0·05). Exercise compliance (74 %) was not different between groups. After 4 months there was a significant net benefit in the RT+Meat compared with CRT group for overall HR-QoL and the physical component summary (PCS) score (P<0·01), but there were no changes in either group in the mental component summary (MCS) score. Changes in lower limb muscle strength, but not LTM, were positively associated with changes in overall HR-QoL (muscle strength, β: 2·2 (95 % CI 0·1, 4·3), P<0·05). In conclusion, a combination of RT and increased dietary protein led to greater net benefits in overall HR-QoL in elderly women compared with RT alone, which was because of greater improvements in PCS rather than MCS.

Interventions to promote or maintain physical activity during and after the transition to retirement: an evidence synthesis

Background

It has been argued that transition points in life, such as the approach towards and early years of retirement, present key opportunities for interventions to improve the health of the population. Interventions that may change or preserve activity levels around the time of retirement have the potential to provide benefits in terms of increased health and well-being for people in later life. Research has highlighted health inequalities in health statuses in the retired population and in response to interventions.

Objective

We aimed to conduct a systematic review and meta-synthesis of the types and effectiveness of interventions to increase physical activity among people around the time of retirement. We also aimed to identify factors that may underpin the effectiveness or acceptability of interventions, and how issues of health inequalities may be addressed.

Data sources

The following electronic databases were searched: (1) MEDLINE; (2) Applied Social Sciences Index and Abstracts; (3) The Cochrane Library (including The Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects, Health Technology Assessment Database); (4) Cumulative Index to Nursing and Allied Health Literature; (5) Science Citation Index; (6) Social Science Citation Index; (7) PsycINFO; (8) Evidence for Policy and Practice Information and Co-ordinating Centre; (9) SPORTDiscus; (10) Social Policy and Practice; (11) Health Management Information Consortium; and (12) Sociological Abstracts. We also searched for grey literature, checked reference lists of included papers and screened other reviews.

Review methods

A systematic review of quantitative and qualitative literature was carried out between February 2014 and April 2015. The searches aimed to identify, first, evidence of effectiveness of interventions for older adults at the point of transition to retirement and, second, data relating to perceptions of barriers and facilitators to intervention effectiveness. A meta-synthesis of the two types of evidence was also carried out to provide further interpretation of the review findings.

Results

A systematic search of the literature identified a large number of potentially relevant studies. Of these, 103 studies examining the effectiveness of interventions and 55 qualitative papers met the criteria for inclusion. A review of the effectiveness literature indicated a dearth of studies that investigate interventions that specifically examine the transition to retirement. More general studies in older adults indicated that a range of interventions might be effective for people around retirement age. The qualitative literature indicated the importance of considering the appeal and enjoyment, and social aspects, of interventions. Although there were a range of different measures in use, many were self-reported and few studies included an evaluation of sedentary time. A meta-synthesis across the data types indicated that elements reported as significant by participants did not always feature in the interventions.

Limitations

Owing to the lack of evidence relating to the retirement transition, we examined the literature relating to older adults. The applicability of these data to people around retirement age may need consideration.

Conclusions

Although the retirement transition is considered a significant point of life change, only a small volume of literature has reported interventions specifically in this period. The included literature suggests that interventions should take account of views and preferences of the target population and evaluate effectiveness by measuring meaningful outcomes and using a control group design.

Study registration

This study is registered as PROSPERO CRD42014007446.

Funding

The National Institute for Health Research Public Health Research programme.

Impact of functional training on cardiac autonomic modulation, cardiopulmonary parameters and quality of life in healthy women

Functional training (FT) promotes benefits in various physical abilities; however, its effect on autonomic modulation, cardiorespiratory parameters and quality of life in the healthy adult population is unknown, and thus, the aim of this study was to evaluate the influence of  FT on these variables in healthy young women. The study consisted of 29 women, distributed into two groups: the FT Group (FTG; n = 13; 23 ± 2·51 years; 21·90 ± 2·82 kg m(-) ²) and the Control Group (CG; n = 16; 20·56 ± 1·03 years; 22·12 ± 3·86 kg m(-) ²). The FTG performed periodized FT for 12 weeks, three times a week. The following were evaluated: autonomic modulation (heart rate variability), cardiorespiratory parameters and quality of life (SF-36 Questionnaire). The Student's t-test for unpaired data or the Mann-Whitney test was used to compare the differences obtained between the final moment and the initial moment of the studied groups (P<0·05). The FTG demonstrated significant improvements in quality of life and autonomic modulation (P<0·05), but not in the cardiorespiratory parameters. Functional training was able to produce improvements in autonomic modulation and quality of life.

Effect of physical activity, social support, and skills training on late-life emotional health: a systematic literature review and implications for public health research

PURPOSE

Given that emotional health is a critical component of healthy aging, we undertook a systematic literature review to assess whether current interventions can positively affect older adults' emotional health.

METHODS

A national panel of health services and mental health researchers guided the review. Eligibility criteria included community-dwelling older adult (aged ≥ 50 years) samples, reproducible interventions, and emotional health outcomes, which included multiple domains and both positive (well-being) and illness-related (anxiety) dimensions. This review focused on three types of interventions - physical activity, social support, and skills training - given their public health significance and large number of studies identified. Panel members evaluated the strength of evidence (quality and effectiveness).

RESULTS

In all, 292 articles met inclusion criteria. These included 83 exercise/physical activity, 25 social support, and 40 skills training interventions. For evidence rating, these 148 interventions were categorized into 64 pairings by intervention type and emotional health outcome, e.g., strength training targeting loneliness or social support to address mood. 83% of these pairings were rated at least fair quality. Expert panelists found sufficient evidence of effectiveness only for skills training interventions with health outcomes of decreasing anxiety and improving quality of life and self-efficacy. Due to limitations in reviewed studies, many intervention-outcome pairings yielded insufficient evidence.

CONCLUSION

Skills training interventions improved several aspects of emotional health in community-dwelling older adults, while the effects for other outcomes and interventions lacked clear evidence. We discuss the implications and challenges in moving forward in this important area.

Effects of a combined physical training and nutrition intervention on physical performance and health-related quality of life in prefrail older women living in the community: a randomized controlled trial

OBJECTIVES

The purpose of this study was to examine whether a 12-week combined physical exercise training and nutritional intervention improves physical performance and enhances health-related quality of life (HRQOL) among prefrail elderly women living in the community.

DESIGN

This was a randomized controlled trial in which participants were recruited and randomly assigned to the exercise and nutrition group (EN, n = 30), exercise only group (E, n = 28), and control group (C, n = 31).

SETTING

Group training classes were held at a research center in Itabashi Ward, Tokyo, Japan.

PARTICIPANTS

Eighty-nine prefrail women aged 70 years or older.

INTERVENTION

The EN group participated in an exercise training and nutritional program (cooking class) once a week, and the E group participated in the exercise training program only.

MEASUREMENTS

Outcome measures that included physical performance (handgrip strength, balance, walking speed) and HRQOL (Medical Outcomes Study 36-Item Short Form Health Survey) were obtained at entry, the end of the 12-week intervention, and 6 months after completion of the intervention program.

RESULTS

At the end of the 12-week intervention, significant improvements in the physical component summary score and 3 (role physical, bodily pain, role emotional) of the 8 domains of the Medical Outcomes Study 36-Item Short Form Health Survey were observed in the EN group. The E group exhibited a significantly increased handgrip strength at postintervention. The positive effects, however, were not maintained at 6-month follow-up, but were reduced.

CONCLUSIONS

The combined physical exercise training and nutritional intervention program has beneficial effects on several domains of HRQOL and handgrip strength in prefrail elderly women living in the community. However, further studies are needed to examine approaches that facilitate maintenance of the improved outcomes by combined exercise training and nutritional intervention.

Participation levels of physical activity programs for community-dwelling older adults: a systematic review

Background

Although many physical activity (PA) programs have been implemented and tested for effectiveness, high participation levels are needed in order to achieve public health impact. This study aimed to determine participation levels of PA programs aimed to improve PA among community-dwelling older adults.

Methods

We searched five databases up until March 2013 (PubMed, PubMed publisher, Cochrane Library, EMBASE, and Web of Science) to identify English-written studies investigating the effect of PA programs on at least one component of PA (e.g. frequency, duration) among community-dwelling populations (i.e. not in a primary care setting and/or assisted living or nursing home) of persons aged 55 years and older. Proportions of participants starting and completing the PA programs (initial and sustained participation, respectively) were determined.

Results

The search strategy yielded 11,994 records of which 16 studies were included reporting on 17 PA programs. The number of participants enrolled in the PA programs ranged between 24 and 582 persons. For 12 PA programs it was not possible to calculate initial participation because the number of older adults invited to participate was unknown due to convenience sampling. Of the five remaining programs, mean initial participation level was 9.2% (±5.7%). Mean sustained participation level of all 17 programs was 79.8% (±13.2%).

Conclusions

Understanding how to optimize initial participation of older adults in PA programs deserves more attention in order to improve the population impact of PA programs for community-dwelling older adults.

Electronic supplementary material

The online version of this article (doi:10.1186/1471-2458-14-1301) contains supplementary material, which is available to authorized users.

High-speed circuit training vs hypertrophy training to improve physical function in sarcopenic obese adults: a randomized controlled trial

BACKGROUND

Progressive loss of muscle and strength with age is often coincident with increases in adiposity, leading to a condition called sarcopenic obesity. Studies have shown sarcopenic obese adults to be at higher risk for declines in physical function. Despite this rising public health concern, no intervention studies currently exist in this population.

METHODS

A total of 21 sarcopenic obese adults, 60 years or older, were randomized into two groups, strength/hypertrophy (SH, n=9) and high-speed circuit (HSC, n=8) and were trained for 15 weeks. The primary outcome was the SPPB modified as a measure of physical function, assessed by assessors blinded to randomization. Secondary outcomes were lower body and upper body power and strength, instrumental activities of daily living (IADL), ratings of perceived exertion (RPE), body fat % (BF%), skeletal muscle index (SMI), and grip strength (GRP).

RESULTS

For the SPPB results favored HSC over SH (1.1, 95% CI (-.1 to 2.4), p=.08) and showed a moderate effect size (Hedge g=0.6, 95% CI (-0.4, 1.6)). For secondary outcomes, lower body power (mean difference=158 W, 95% CI (2, 315); p=.01) and RPE (mean difference=-1.5, 95% CI (-2.9, -0.12); p=.04) also favored HSC. IADL, SMI, BF%, upper and lower body strength and upper body power, showed no statistically significant differences between groups.

CONCLUSIONS

Considering the moderate effect size, the large treatment effect shown by the upper limit of the 95% CI, the low perceived exertion, and no adverse effects, HSC training should be further investigated with a larger sample size in sarcopenic obese adults.

A day in the life of older people in a rehabilitation setting: an observational study

PURPOSE

Nurses' contribution during inpatient rehabilitation is well documented. However, despite being the largest professional group in this setting, the specialty of rehabilitation nursing is poorly recognised. This article reports on the first of a four-phase study that aimed to clarify and develop the nursing contribution to inpatient rehabilitation for older persons. The aim of this study was to identify activity patterns and time use during daytime and evenings of older adult patients undergoing inpatient rehabilitation.

METHODS

Direct observation using behavioural modelling was undertaken of a convenience sample of 37 older people undergoing inpatient rehabilitation in a specialist unit of a large tertiary hospital in New Zealand. The primary outcome was the observation of meaningful activity. Binomial logistic regression was used to study the association between relevant variables.

FINDINGS

Meaningful activity was most likely to involve walking without assistance and to occur 08:00 to 14:00 h and 16:00 to 21:00 h during weekdays. Patients were more likely to receive treatment during the weekend. Irrespective of time, registered nurses were the health professionals most often present with patients.

CONCLUSIONS

There is likely to be unrealised opportunities for registered nurses to support improved rehabilitation outcomes. Registered nurses' involvement in rehabilitation needs to be actively optimised.

IMPLICATIONS FOR REHABILITATION

Nurses' engagement with older adults in rehabilitation settings is likely to be substantial, placing them as key members of the rehabilitation team. Nurses make a pivotal contribution to inpatient rehabilitation based on specialised knowledge and skills but this contribution is not well understood. Opportunities are likely, at times when allied health professionals are less often present, e.g. evenings and weekends, for registered nurses to more intentionally overlap rehabilitation activities with other care requirements.

Assessment of Daily Activity Performance: Exploring the Option of Shortening the Test

The Assessment of Daily Activity Performance (ADAP) test has been developed to measure the physical capacity of older adults to carry out instrumental activities of daily living (ADL). The present study explores the option to create a less time-consuming short version of the ADAP that can be completed in the individual’s home environment and that imposes less of a physical burden. Data from 141 independently living women aged 70 and older were analyzed using principal components analysis (PCA). PCA identified two factors, on which 10 of the original 21 items had loaded sufficiently to be eligible for inclusion in a short version. The ADAP short version is considerably shorter than the original test and provides a good representation of the constructs being measured. More research is necessary to develop a short version of the ADAP that is easily applicable in the home environment of older adults.

Optimizing the benefits of exercise on physical function in older adults

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

Força muscular e qualidade de vida em idosas

OBJETIVO: Verificar o efeito do treinamento físico sobre os níveis de força e a qualidade de vida, considerando capacidade funcional, limitações físicas, dor, estado geral de saúde, vitalidade e variáveis de relação social em idosas institucionalizadas. MÉTODOS: Participaram do estudo 36 idosas com 60 ou mais anos de idade, recrutadas no Serviço Social do Comércio (SESC), na cidade de São Luís-MA, compondo dois grupos: sedentário (n=16) e treinamento (n=20). Determinou-se a força muscular isométrica máxima dos extensores da coluna lombar e joelho, flexores de cotovelo e abdutores dos ombros, com o uso do dinamômetro NPRO2000. Aplicou-se questionário SF-36 para avaliação da qualidade de vida. O treinamento ocorreu em sessões, duas vezes por semana, de 60 minutos, por 12 semanas. A intensidade foi estabelecida pela zona de repetições máximas (três a quatro séries; 8 a 12 repetições) e a ordem dos exercícios foi modificada a cada quatro semanas. Estatisticamente, foi utilizado o teste t Student do programa SPSS 10.0. RESULTADOS: O grupo sedentário não alcançou valor significativo nas variáveis estudadas; o grupo treinamento atingiu escores significativos de ganho de força, nos extensores do joelho (p=0,0032; 30,23%) e extensores da coluna lombar (p=0,0207; 12,33%). A avaliação da qualidade de vida apresentou-se significativa, com aumento percentual nos domínios da capacidade funcional (p=0,0092; 11,05%), estado geral de saúde (p=0,0075; 14,17%), vitalidade (p=0,0015; 15,38%) e saúde mental (p=0,0154; 9,64%). CONCLUSÃO: O treinamento de força proposto promoveu aumento significativo na força muscular, repercutindo na melhoria da qualidade de vida nos domínios capacidade funcional, estado geral de saúde, vitalidade e saúde mental.

Remote and web 2.0 interventions for promoting physical activity

BACKGROUND

Remote and web 2.0 interventions for promoting physical activity (PA) are becoming increasingly popular but their ability to achieve long term changes are unknown.

OBJECTIVES

To compare the effectiveness of remote and web 2.0 interventions for PA promotion in community dwelling adults (aged 16 years and above) with a control group exposed to placebo or no or minimal intervention.

SEARCH METHODS

We searched CENTRAL, MEDLINE, EMBASE, CINAHL, and some other databases (from earliest dates available to October 2012). Reference lists of relevant articles were checked. No language restrictions were applied.

SELECTION CRITERIA

Randomised controlled trials (RCTs) that compared remote and web 2.0 PA interventions for community dwelling adults with a placebo or no or minimal intervention control group. We included studies if the principal component of the intervention was delivered using remote or web 2.0 technologies (for example the internet, smart phones) or more traditional methods (for example telephone, mail-outs), or both. To assess behavioural change over time, the included studies had a minimum of 12 months follow-up from the start of the intervention to the final results. We excluded studies that had more than a 20% loss to follow-up if they did not apply an intention-to-treat analysis.

DATA COLLECTION AND ANALYSIS

At least two authors independently assessed the quality of each study and extracted the data. Non-English language papers were reviewed with the assistance of an interpreter who was an epidemiologist. Study authors were contacted for additional information where necessary. Standardised mean differences (SMDs) and 95% confidence intervals (CIs) were calculated for the continuous measures of self-reported PA and cardio-respiratory fitness. For studies with dichotomous outcomes, odds ratios and 95% CIs were calculated.

MAIN RESULTS

A total of 11 studies recruiting 5862 apparently healthy adults met the inclusion criteria. All of the studies took place in high-income countries. The effect of the interventions on cardiovascular fitness at one year (two studies; 444 participants) was positive and moderate with significant heterogeneity of the observed effects (SMD 0.40; 95% CI 0.04 to 0.76; high quality evidence). The effect of the interventions on self-reported PA at one year (nine studies; 4547 participants) was positive and moderate (SMD 0.20; 95% CI 0.11 to 0.28; moderate quality evidence) with heterogeneity (I2 = 37%) in the observed effects. One study reported positive results at two years (SMD 0.20; 95% CI 0.08 to 0.32; moderate quality evidence). When studies were stratified by risk of bias, the studies at low risk of bias (eight studies; 3403 participants) had an increased effect (SMD 0.28; 95% CI 0.16 to 0.40; moderate quality evidence). The most effective interventions applied a tailored approach to the type of PA and used telephone contact to provide feedback and to support changes in PA levels. There was no evidence of an increased risk of adverse events (seven studies; 2892 participants). Risk of bias was assessed as low (eight studies; 3060 participants) or moderate (three studies; 2677 participants). There were no differences in effectiveness between studies using different types of professionals delivering the intervention (for example health professional, exercise specialist). There was no difference in pooled estimates between studies that generated the prescribed PA using an automated computer programme versus a human, nor between studies that used pedometers as part of their intervention compared to studies that did not.

AUTHORS' CONCLUSIONS

We found consistent evidence to support the effectiveness of remote and web 2.0 interventions for promoting PA. These interventions have positive, moderate sized effects on increasing self-reported PA and measured cardio-respiratory fitness, at least at 12 months. The effectiveness of these interventions was supported by moderate and high quality studies. However, there continues to be a paucity of cost effectiveness data and studies that include participants from varying socioeconomic or ethnic groups. To better understand the independent effect of individual programme components, longer term studies, with at least one year follow-up, are required.

Face-to-face interventions for promoting physical activity

BACKGROUND

Face-to-face interventions for promoting physical activity (PA) are continuing to be popular but their ability to achieve long term changes are unknown.

OBJECTIVES

To compare the effectiveness of face-to-face interventions for PA promotion in community dwelling adults (aged 16 years and above) with a control exposed to placebo or no or minimal intervention.

SEARCH METHODS

We searched CENTRAL, MEDLINE, EMBASE, CINAHL, and some other databases (from earliest dates available to October 2012). Reference lists of relevant articles were checked. No language restrictions were applied.

SELECTION CRITERIA

Randomised controlled trials (RCTs) that compared face-to-face PA interventions for community dwelling adults with a placebo or no or minimal intervention control group. We included studies if the principal component of the intervention was delivered using face-to-face methods. To assess behavioural change over time the included studies had a minimum of 12 months follow-up from the start of the intervention to the final results. We excluded studies that had more than a 20% loss to follow-up if they did not apply an intention-to-treat analysis.

DATA COLLECTION AND ANALYSIS

At least two authors independently assessed the quality of each study and extracted data. Non-English language papers were reviewed with the assistance of an interpreter who was an epidemiologist. Study authors were contacted for additional information where necessary. Standardised mean differences (SMDs) and 95% confidence intervals (CIs) were calculated for continuous measures of self-reported PA and cardio-respiratory fitness. For studies with dichotomous outcomes, odds ratios (ORs) and 95% CIs were calculated.

MAIN RESULTS

A total of 10 studies recruiting 6292 apparently healthy adults met the inclusion criteria. All of the studies took place in high-income countries. The effect of interventions on self-reported PA at one year (eight studies; 6725 participants) was positive and moderate with significant heterogeneity (I² = 74%) (SMD 0.19; 95% CI 0.06 to 0.31; moderate quality evidence) but not sustained in three studies at 24 months (4235 participants) (SMD 0.18; 95% CI -0.10 to 0.46). The effect of interventions on cardiovascular fitness at one year (two studies; 349 participants) was positive and moderate with no significant heterogeneity in the observed effects (SMD 0.50; 95% CI 0.28 to 0.71; moderate quality evidence). Three studies (3277 participants) reported a positive effect on increasing PA levels when assessed as a dichotomous measure at 12 months, but this was not statistically significant (OR 1.52; 95% CI 0.88 to 2.61; high quality evidence). Although there were limited data, there was no evidence of an increased risk of adverse events (one study; 149 participants). Risk of bias was assessed as low (four studies; 4822 participants) or moderate (six studies; 1543 participants). Any conclusions drawn from this review require some caution given the significant heterogeneity in the observed effects. Despite this, there was some indication that the most effective interventions were those that offered both individual and group support for changing PA levels using a tailored approach. The long term impact, cost effectiveness and rates of adverse events for these interventions was not established because the majority of studies stopped after 12 months.

AUTHORS' CONCLUSIONS

Although we found evidence to support the effectiveness of face-to-face interventions for promoting PA, at least at 12 months, the effectiveness of these interventions was not supported by high quality studies. 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, and assess impact on quality of life, adverse events and economic data.

Face-to-face versus remote and web 2.0 interventions for promoting physical activity

BACKGROUND

Face-to-face interventions for promoting physical activity (PA) are continuing to be popular as remote and web 2.0 approaches rapidly emerge, but we are unsure which approach is more effective at achieving long term sustained change.

OBJECTIVES

To compare the effectiveness of face-to-face versus remote and web 2.0 interventions for PA promotion in community dwelling adults (aged 16 years and above).

SEARCH METHODS

We searched CENTRAL, MEDLINE, EMBASE, CINAHL, and some other databases (from earliest dates available to October 2012). Reference lists of relevant articles were checked. No language restrictions were applied.

SELECTION CRITERIA

Randomised trials that compared face-to-face versus remote and web 2.0 PA interventions for community dwelling adults. We included studies if they compared an intervention that was principally delivered face-to-face to an intervention that had principally remote and web 2.0 methods. To assess behavioural change over time, the included studies had a minimum of 12 months follow-up from the start of the intervention to the final results. We excluded studies that had more than a 20% loss to follow-up if they did not apply an intention-to-treat analysis.

DATA COLLECTION AND ANALYSIS

At least two review authors independently assessed the quality of each study and extracted the data. Non-English language papers were reviewed with the assistance of an interpreter who was an epidemiologist. Study authors were contacted for additional information where necessary. Standardised mean differences (SMDs) and 95% confidence intervals (CIs) were calculated for continuous measures of cardio-respiratory fitness.

MAIN RESULTS

One study recruiting 225 apparently healthy adults met the inclusion criteria. This study took place in a high-income country. From 27,299 hits, the full texts of 193 papers were retrieved for examination against the inclusion criteria. However, there was only one paper that met the inclusion criteria. This study reported the effect of a PA intervention on cardio-respiratory fitness. There were no reported data for PA, quality of life, or cost effectiveness. The difference between the remote and web 2.0 versus face-to-face arms was not significant (SMD -0.02; 95% CI -0.30 to 0.26; high quality evidence). The risk of bias in the included study was assessed as low, and there was no evidence of an increased risk of adverse events.

AUTHORS' CONCLUSIONS

There is insufficient evidence to assess whether face-to-face interventions or remote and web 2.0 approaches are more effective at promoting PA.

Physical activity interventions among older adults: a literature review

Physical activity (PA) is important in the management of chronic illness among older adults worldwide. Researchers have conducted several intervention studies to increase PA behavior in this population. This review of the past 12 years of relevant PA intervention research among adults aged 60 years and older systematically summarized research findings, identified characteristics of successful interventions, and proposed areas of future research. There were 20 studies reviewed for this article, most employing a combination of cognitive-behavioral intervention design. Cognitive-based only and combination interventions were more successful in changing PA behavior; however, behavioral-based interventions demonstrated more long-term changes in PA behavior. Among theory-based interventions, self-efficacy was the most commonly operationalized construct. Findings from this review may inform future primary research to promote PA behavior among older adults, as well as gerontological clinical practice.

Older adults recently discharged from the hospital: effect of aerobic interval exercise on health-related quality of life, physical fitness, and physical activity

OBJECTIVES

To compare the effect of high-intensity aerobic interval exercise (HIA) with home-based exercise (HB) in older adults with chronic disease soon after discharge from the hospital.

DESIGN

Randomized controlled trial.

SETTING

Hospital.

PARTICIPANTS

Community-dwelling older adults aged 70 to 92 (N = 115) were recruited while in the hospital. After discharge, they were randomized to HIA group (n = 59) or HB (n = 56).

INTERVENTION

High-intensity aerobic interval exercise (HIA) consisted of endurance, strength, and balance exercises. The HB consisted of low-intensity exercises and telephone follow-up from a physical therapist.

MEASUREMENTS

Health-related quality of life (HRQOL) was assessed using the Medical Outcomes Study 36-item Short Form Survey, physical fitness was measured using the Senior Fitness Test, and physical activity was assessed using the Physical Activity Scale for the Elderly.

RESULTS

Intention-to-treat analysis showed that both groups improved their HRQOL and physical activity after 3 months. Improvements on the Senior Fitness Test (chair stand, arm curl and 6-minute walk (6MWT)) were significantly greater in the HIA group than the HB group. The mean difference was 25.9 m on the 6MWT (P = .001, effect size d = 0.2), 1.3 per 30 seconds on the chair stands mean (P = .001, effect size d = 0.3), and 1.6 per 30 seconds on the arm curl (P = .001, effect size d = 0.4).

CONCLUSION

High-intensity aerobic interval exercise (HIA) participants significantly improved their physical fitness. Both groups increased their HRQOL and physical activity. The findings suggest that exercise therapy should be incorporated as a part of the treatment for older people at risk for functional decline.

Effects of exercise on health-related quality of life and fear of falling in home-dwelling older women

This randomized, controlled trial evaluated the effects of exercise on health-related quality of life (HRQoL) and fear of falling (FoF) among 149 home-dwelling older women. The 12-mo exercise program was intended to reduce the risk of falls and fractures. HRQoL was assessed by the RAND-36 Survey, and FoF, with a visual analog scale, at baseline, 12 mo, and 24 mo. On all RAND-36 scales, the scores indicated better health and well-being. The exercise had hardly any effect on HRQoL; only the general health score improved slightly compared with controls at 12 mo (p = .019), but this gain was lost at 24 mo. FoF decreased in both groups during the intervention with no between-groups difference at 12 or 24 mo. In conclusion, despite beneficial physiological changes, the exercise intervention showed rather limited effects on HRQoL and FoF among relatively high-functioning older women. This modest result may be partly because of insufficient responsiveness of the assessment instruments used.

Physical activity and nutrition behavioural outcomes of a home-based intervention program for seniors: a randomized controlled trial

Background

This intervention aimed to ascertain whether a low-cost, accessible, physical activity and nutrition program could improve physical activity and nutrition behaviours of insufficiently active 60–70 year olds residing in Perth, Australia.

Methods

A 6-month home-based randomised controlled trial was conducted on 478 older adults (intervention, n = 248; control, n = 230) of low to medium socioeconomic status. Both intervention and control groups completed postal questionnaires at baseline and post-program, but only the intervention participants received project materials. A modified fat and fibre questionnaire measured nutritional behaviours, whereas physical activity was measured using the International Physical Activity Questionnaire. Generalised estimating equation models were used to assess the repeated outcomes over both time points.

Results

The final sample consisted of 176 intervention participants and 199 controls (response rate 78.5%) with complete data. After controlling for demographic and other confounding factors, the intervention group demonstrated increased participation in strength exercise (p < 0.001), walking (p = 0.029) and vigorous activity (p = 0.015), together with significant reduction in mean sitting time (p < 0.001) relative to controls. Improvements in nutritional behaviours for the intervention group were also evident in terms of fat avoidance (p < 0.001), fat intake (p = 0.021) and prevalence of frequent fruit intake (p = 0.008).

Conclusions

A minimal contact, low-cost and home-based physical activity program can positively influence seniors’ physical activity and nutrition behaviours.

Trial registration

anzctr.org.au Identifier: ACTRN12609000735257

A 1-year follow-up of effects of exercise programs on well-being in older adults

PURPOSE

The purpose of this study was to investigate the long-term effects of three types of training on wellbeing and frequency of physical activity and to determine whether preintervention motivation moderates the effects.

METHODS

Sixty-two older adults (M = 75 years old, SD = 5; 61% women) completed 4-mo programs of endurance, functional or strength training, with reassessment of well-being (life satisfaction, positive affect, negative affect, vitality) and physical activity 12 mo later.

RESULTS

All groups showed small improvements in most measures of well-being at 4 mo. At follow-up, endurance training still had small beneficial effects, while changes with functional and strength training were generally trivial or harmful. Analysis for moderators indicated that autonomously motivated individuals better maintained gains in well-being and had higher frequencies of physical activity at follow-up compared with controlled individuals.

CONCLUSION

Endurance training is recommended for older adults, but the long-term outcomes depend on the individual's motivational regulation at commencement.

Aerobic versus resistance training effects on health-related quality of life, body composition, and function of older adults

This study aimed to investigate the effects of training on health-related quality of life (HRQoL), body composition, and function in older adults. Fifty participants were randomized into aerobic training (AT--70%-80% HR reserve), resistance training (RT--80% 1RM), or controls. They had HRQoL, body composition, and function assessed before and after 8 months. Training groups reduced body fat, increased performance in the stair ascent, 8-ft up-and-go and sit-to-stand five-times tests, and improved their physical component score (PCS; p ≤ .03). AT increased performance in the 6MWT test, and improved general and mental health (MH) domains when compared to controls (p < .01). Finally, changes in stair ascent were associated with changes in bodily pain, MH, and mental component score (p ≤ .04), while changes in handgrip strength were associated with changes in physical role and MH (p = .03). AT and RT were effective interventions for decreasing body fat and improving functionality and the PCS in older adults.

Evaluation of the Frails' Fall Efficacy by Comparing Treatments (EFFECT) on reducing fall and fear of fall in moderately frail older adults: study protocol for a randomised control trial

BACKGROUND

Falls are common in frail older adults and often result in injuries and hospitalisation. The Nintendo® Wii™ is an easily available exercise modality in the community which has been shown to improve lower limb strength and balance. However, not much is known on the effectiveness of the Nintendo® Wii™ to improve fall efficacy and reduce falls in a moderately frail older adult. Fall efficacy is the measure of fear of falling in performing various daily activities. Fear contributes to avoidance of activities and functional decline.

METHODS

This randomised active-control trial is a comparison between the Nintendo WiiActive programme against standard gym-based rehabilitation of the older population. Eighty subjects aged above 60, fallers and non-fallers, will be recruited from the hospital outpatient clinic. The primary outcome measure is the Modified Falls Efficacy Scale and the secondary outcome measures are self-reported falls, quadriceps strength, walking agility, dynamic balance and quality of life assessments.

DISCUSSIONS

The study is the first randomised control trial using the Nintendo Wii as a rehabilitation modality investigating a change in fall efficacy and self-reported falls. Longitudinally, the study will investigate if the interventions can successfully reduce falls and analyse the cost-effectiveness of the programme.

Effectiveness of a home-based postal and telephone physical activity and nutrition pilot program for seniors

Objective. To evaluate the effectiveness of a 12-week home-based postal and telephone physical activity and nutrition pilot program for seniors. Methods. The program was delivered by mailed material and telephone calls. The main intervention consisted of a booklet tailored for seniors containing information on dietary guidelines, recommended physical activity levels, and goal setting. Dietary and walking activity outcomes were collected via a self-administered postal questionnaire pre- and postintervention and analysed using linear mixed regressions. Of the 270 seniors recruited, half were randomly selected for the program while others served as the control group. Results. The program elicited favourable responses. Postintervention walking for exercise/recreation showed an average gain of 27 minutes per week for the participants in contrast to an average drop of 5 minutes for the controls (P < .01). Little change was evident in errand walking for both groups. The intervention group (n = 114) demonstrated a significant increase in fibre intake (P < .01) but no reduction in fat intake (P > .05) compared to controls (n = 134). Conclusions. The participants became more aware of their health and wellbeing after the pilot program, which was successful in increasing time spent walking for recreation and improving fibre intake.

Impact of physical activity and performance on medical care costs among the Japanese elderly

AIM

Physical activity (PA) is known to be inversely associated with medical care costs. The amount of PA is strongly associated with the level of physical performance among the elderly population. Therefore, it is possible that known relation between PA and medical care merely shows the relation between physical performance and medical care. To know whether PA itself relates to medical care, considering physical performance is necessary. The aim of this study was to ascertain the impact of PA on medical care expenditure by considering the physical performance in an elderly community-dwelling population.

METHODS

We investigated 483 subjects who did not have any history of diseases relating to limited PA and who completed both a self-administered questionnaire including questions on PA and underwent a physical performance measurement. We ascertained the total medical care costs through a computerized linkage with claims lodged between August 2002 and March 2008 with the Miyagi National Health Insurance Association.

RESULTS

The physical performance was positively associated with their level of PA. After multivariate adjustment for covariables including the levels of physical performance, the per capita medical care costs were found to be $US 827.3 (598.0-1056.7) (mean, 95% confidence interval), $US 711.1 (476.4-945.8) and $US 702.0 (461.6-942.4) (P for linear trend = 0.02) per month for those who had the lowest, average and the highest level of PA, respectively.

CONCLUSION

This prospective study indicates that a higher level of PA is associated with lower medical care costs among the Japanese elderly irrespective of physical performance.

Dose-response relationship of resistance training in older adults: a meta-analysis

PURPOSE

The purpose of this study was to determine the dose-response relationship of resistance training (RT) to improve strength and function in older adults.

METHODS

A systematic literature search was performed in relevant databases and study reference lists to identify randomized controlled trials. Randomized controlled trials comparing the effects of different doses of strength training in older people (65 yr and older) on strength and functional outcomes were eligible. Two independent reviewers decided on study inclusion, extracted data, and assessed methodological quality. Standardized mean difference (SMD) and 95% confidence intervals (CI) were calculated for relevant outcomes and pooled using a random-effects model.

RESULTS

Twenty-nine trials with a total of 1313 subjects (mean age = 65-81 yr) are summarized in this review. Trials comparing different training intensities show strong effects of progressive resistance training (PRT) on maximal strength in a dose-dependent manner, with high-intensity (HI) PRT being more effective compared with moderate (MI)- and low-intensity (LI) PRT (SMD [HI vs LI] = 0.88, 95% CI = 0.21-1.55; SMD [HI vs MI] = 0.62, 95% CI = 0.22-1.03). PRT was also successful for improving functional outcomes, but gains were independent of training intensity. Power training (PT) was more effective for improving muscle power (SMD [PT vs PRT] = 1.66, 95% CI = 0.08-3.24) and functional outcomes than PRT. There was only little information available on training volume and frequency.

DISCUSSION

Higher training intensities are superior to lower intensities for improving maximal strength but not necessarily for functional performance of older adults. PT has shown to be a particularly effective method for enhancing muscle power and functional performance. More research is necessary to identify the effect of different training volumes and frequencies and the dose-response relationship for very old and frail populations.

Qualidade de vida em idosos que praticam atividade física - uma revisão sistemática

OBJETIVO: Realizar uma revisão sistematizada da literatura sobre o impacto da prática regular de atividade física na qualidade de vida dos idosos. MÉTODO: Revisão sistemática de estudos publicados até setembro de 2008, nas bases de dados Medline, LILACS e SciELO. Foram excluídos os estudos que possuíam delineamento transversal ou que eram relatos de casos, que avaliavam a qualidade de vida associada a alguma doença específica e aqueles nos quais havia presença de outra intervenção concomitante. RESULTADOS: De acordo com os critérios de inclusão, dos 391 artigos encontrados, apenas três fizeram parte da análise. Foram identificados três tipos de intervenções: 1) exercícios de aquecimento, treino aeróbico, fortalecimento muscular, coordenação e resfriamento; 2) exercícios de fortalecimento muscular, treino funcional; 3) exercícios na água. Os resultados desses estudos sugerem que a qualidade de vida aumenta com a prática de atividade física (intervenções 1 e 3), principalmente se for realizada duas vezes por semana ao invés de somente uma vez. Os benefícios do treino de resistência muscular na qualidade de vida foram limitados e não foi encontrado benefício do treinamento funcional neste desfecho. CONCLUSÃO: O número limitado de artigos encontrados, apenas um único estudo para cada tipo de intervenção, limita as conclusões desta revisão a respeito da eficácia dessas intervenções. Assim, conclui-se que há evidência limitada a respeito dos benefícios da prática de atividade física na qualidade de vida de idosos vivendo na comunidade. Sugere-se que mais estudos longitudinais sejam realizados para que as conclusões a respeito da eficácia destas intervenções sejam mais robustas.

Preoperative therapeutic programme for elderly patients scheduled for elective abdominal oncological surgery: a randomized controlled pilot study

Objective: Investigation of the feasibility and preliminary effect of a short-term intensive preoperative exercise programme for elderly patients scheduled for elective abdominal oncological surgery.

Design: Single-blind randomized controlled pilot study.

Setting: Ordinary hospital in the Netherlands.

Subjects: Forty-two elderly patients (>60 years).

Interventions: Patients were randomly assigned to receive a short-term intensive therapeutic exercise programme to improve muscle strength, aerobic capacity, and functional activities, given in the outpatient department (intervention group; n =22), or home-based exercise advice (control group; n=20).

Main measures: Parameters of feasibility, preoperative functional capacity and postoperative course.

Results: The intensive training programme was feasible, with a high compliance and no adverse events. Respiratory muscle endurance increased in the preoperative period from 259 ± 273 to 404 ± 349 J in the intervention group and differed significantly from that in the control group (350 ± 299 to 305 ± 323 J; P<0.01). Timed-Up-and-Go, chair rise time, LASA Physical Activity Questionnaire, Physical Work Capacity and Quality of Life (EORTC-C30) did not reveal significant differences between the two groups. There was no significant difference in postoperative complications and length of hospital stay between the two groups.

Conclusion: The intensive therapeutic exercise programme was feasible and improved the respiratory function of patients due to undergo elective abdominal surgery compared with home-based exercise advice.