Index of assessing functional status in elderly Japanese men

Effects of age on vertical jump performance and muscle morphology characteristics in females

BACKGROUND

Declines in muscle morphology and function are commonly reported as a consequence of aging. However, few studies have investigated the influence of age on a comprehensive set of muscle function-related measures (i.e., reactive strength, power, etc.) that focuses on a dynamic performance task such as the vertical jump across the adult life span. This study aimed to examine the effects of age on muscle morphology characteristics (muscle cross-sectional area [CSA] and echo intensity [EI]) and vertical jump height, power, and reactive strength index (RSI) in females.

METHODS

Twenty-six young (22±2 years), 30 middle-aged (36±5 years), and 23 older (71±5 years) females participated in this study. Muscle CSA and EI were determined from ultrasound scans of the vastus lateralis. Countermovement jumps were used to assess jump height, RSI, movement time, and peak power (Pmax).

RESULTS

Muscle CSA, jump height, and Pmax were higher for the young compared to the old and middle-aged (P≤0.027) and for the middle-aged compared to the old (P<0.001). Movement time and EI values were lower (P≤0.004) and RSI values were higher (P<0.001) for the young and middle-aged compared to the old; however, no differences were observed between the young and middle-aged (P=0.367-0.620).

CONCLUSIONS

Of all the variables assessed in this study, RSI exhibited the greatest decline (76%) between the young and old females. Such findings highlight the importance of reactive strength when assessing age-related changes in neuromuscular performance.

Reference values for hand grip strength in Japanese community-dwelling elderly: a meta-analysis

OBJECTIVES

Reference values for hand grip strength in Japanese community-dwelling elderly independent in activities of daily living (ADLs) were calculated by meta-analysis.

METHODS

Papers reporting data on hand grip strength in elderly Japanese adults ≥60 years of age and independent in ADLs were retrieved from electronic databases. Data were extracted from the selected papers and the weighted mean for hand grip strength by sex was calculated by random effect model. The association of hand grip strength with age and body weight was also analyzed using meta-regression analysis.

RESULTS

Data for 15,784 individuals (5216 men and 10,568 women; mean age 67.0-79.8 years) were extracted from 97 sets of data from 33 papers. The weighted mean for hand grip strength was calculated as 33.11 kg [95 % CI 32.27-33.96] in men and 20.92 kg [95 % CI 20.45-21.39] in women. A significant negative correlation was also seen between hand grip strength and age.

CONCLUSIONS

The mean hand grip strength of elderly people calculated in this study can be used as a reference value for the hand grip strength of Japanese community-dwelling elderly who are independent in ADLs. However, age needs to be considered in reference values for hand grip strength.

Seasonality in physical activity and walking of healthy older adults

BACKGROUND

An increasing number of older adults require improvements in their quality of life. Physical activities, particularly walking ability, are of primary importance for older adults. The influence of season on physical activity has not been sufficiently studied among older adults. Therefore, this report compared the physical activity and walking of older individuals between summer and winter seasons using a longitudinal study design in a community in a mid-latitude area.

METHODS

Participants in the study comprised 39 healthy community-dwelling adults ranging in age from 65 to 80 years. Physical parameters and activities as well as the preferred speed of walking were measured at half-year intervals.

RESULTS

Significant seasonal differences from summer to winter and from winter to summer were detected. Specifically, body fat percentage, single-leg stance, walking speed, cadence, stride length, and trunk and head-trunk pitch ranges were greater in winter than in summer, whereas grip strength and steps per day were greater in summer. Temperature and total activity level were considered to be related to body fat percentage. Grip strength was thought to be affected by outdoor temperature. The possibility of relationships between increased activity per unit time in older adults and increased preferred walking speed, cadence, and stride length in winter temperatures was discussed.

CONCLUSION

The seasonal climatic environment of the geographic area of this study affected the activity level of the participants. These results indicate that seasonality should be considered when analyzing physical activity and walking in older adults.

Reliability and validity of the Assessment of Daily Activity Performance (ADAP) in community-dwelling older women

BACKGROUND AND AIMS

The Assessment of Daily Activity Performance (ADAP) test was developed, and modeled after the Continuous-scale Physical Functional Performance (CS-PFP) test, to provide a quantitative assessment of older adults' physical functional performance. The aim of this study was to determine the intra-examiner reliability and construct validity of the ADAP in a community-living older population, and to identify the importance of tester experience.

METHODS

Forty-three community-dwelling, older women (mean age 75 yr +/-4.3) were randomized to the test-retest reliability study (n=19) or validation study (n=24). The intra-examiner reliability of an experienced (tester 1) and an inexperienced tester (tester 2) was assessed by comparing test and retest scores of 19 participants. Construct validity was assessed by comparing the ADAP scores of 24 participants with self-perceived function by the SF-36 Health Survey, muscle function tests, and the Timed Up and Go test (TUG).

RESULTS

Tester 1 had good consistency and reliability scores (mean difference between test and retest scores (DIF), -1.05+/-1.99; 95% confidence interval (CI), -2.58 to 0.48; Cronbach's alpha (alpha) range, 0.83 to 0.98; intraclass correlation (ICC) range, 0.75 to 0.96; Limits of Agreement (LoA), -2.58 to 4.95). Tester 2 had lower reliability scores (DIF, -2.45+/-4.36; 95% CI, -5.56 to 0.67; alpha range, 0.53 to 0.94; ICC range, 0.36 to 0.90; LoA, -6.09 to 10.99), with a systematic difference between test and retest scores for the ADAP domain lower-body strength (-3.81; 95% CI, -6.09 to -1.54), ADAP correlated with SF-36 Physical Functioning scale (r=0.67), TUG test (r=-0.91) and with isometric knee extensor strength (r=0.80).

CONCLUSIONS

The ADAP test is a reliable and valid instrument. Our results suggest that testers should practise using the test, to improve reliability, before applying it to clinical settings.

Functional tasks exercise versus resistance exercise to improve daily function in older women: a feasibility study

OBJECTIVE

To evaluate the feasibility of a new functional tasks exercise program, designed to improve functional performance of community-dwelling older women, by comparing it with a resistance exercise program.

DESIGN

A 12-week, randomized, single-blind pilot study.

SETTING

A community leisure center.

PARTICIPANTS

Twenty-four community-dwelling, medically stable women (mean age, 74.6+/-4.8 y) were randomized to the functional tasks exercises (function group) or the resistance exercises (resistance group). Three participants withdrew from the study.

INTERVENTIONS

Exercises were given 3 times weekly for 12 weeks. The functional tasks exercise program aimed to improve daily tasks in the domains first affected in older adults, whereas the resistance exercise program focused on strengthening the muscle groups that are important for functional performance.

MAIN OUTCOME MEASURES

Participant satisfaction with the exercises, Assessment of Daily Activity Performance (ADAP), and, as a secondary outcome, muscle strength and power.

RESULTS

Exercise adherence was 81% in the function group and 90% in the resistance group. Participants reported greater satisfaction with the resistance exercises than with the functional exercises. The ADAP total score improved with time (P =.001; mean change function group, 7.5 U; 95% confidence interval [CI], 2.1-12.8; resistance group, 2.8 U, 95% CI, -0.4 to 5.9), as did isometric knee extensor strength (P =.001; mean change function group, 6.4%; 95% CI, -1.6 to 14.5; resistance group, 14.4%; 95% CI, 6.4-22.2). Testing for differences in outcomes between the 2 groups showed no statistically significant differences.

CONCLUSIONS

The functional tasks exercise program is feasible and shows promise of being more effective for functional performance than a resistance exercise program. A randomized controlled trial with a larger sample size is needed to test the difference between the 2 programs.

Functional and locomotive characteristics of stroke survivors in Japanese community-based rehabilitation

OBJECTIVE

The purposes of this study were as follows: (1) to compare the characteristics of functional fitness of Japanese stroke survivors with those of control subjects of a similar age; and (2) to relate these characteristics to the extent of physical impairment and the period after stroke onset to better design community-based rehabilitation programs for stroke survivors.

DESIGN

One hundred fifty-three stroke survivors who participated in community-based rehabilitation and 119 control subjects were measured. Twelve performance test items were designed to assess functional fitness.

RESULTS

The average functional fitness score for the stroke survivors was significantly lower than that of the control group. However, some survivors had higher performance scores than the control group. Significant correlations were shown between some functional fitness items and Brunnstrom recovery stage in the stroke survivors.

CONCLUSION

The large variability in functional fitness scores for stroke survivors indicates a need to design variable rehabilitation programs so that survivors can be grouped according to their specific levels of functional fitness.

The interrelationship among muscle mass, strength, and the ability to perform physical tasks of daily living in younger and older women

The purpose of this study was to objectively compare the difficulty and determine the contribution of strength and muscle mass to the performance of physical tasks of daily living in a group of younger and older women. A cross-sectional design was used. Volunteer participants were from the community of Birmingham, AL; there were 21 older (aged 60-75 years) and 20 younger (23-34 years) healthy women in the study. Subjects were matched for height and weight. Their testing included total and regional body composition evaluation by use of dual-energy x-ray absorptiometry, isometric strength tests of elbow flexors and knee extensors, and integrated electromyography (IEMG) evaluation while the subjects were standing from and sitting into a chair, and while they were carrying a small load (weight relative to strength). A two-way analysis of variance and a two-way analysis of covariance with repeated measures, Pearson product correlation, and first-order partial correlations were used to analyze the data. A significant inverse correlation was observed between age and isometric strength of both the knee extensors and elbow flexors. Adjusting for upper leg lean tissue did not change the significant inverse correlation between age and knee extensor strength. However, after an adjustment for arm lean tissue, there was no significant correlation between elbow flexor strength and age. Older women experienced significantly greater difficulty in standing than younger women as measured by quadriceps normalized IEMG (i.e., IEMG during task/IEMG during maximum isometric strength test). This difference persisted even after the covariate upper leg lean tissue was added to the model. No significant difference was observed between younger and older women for difficulty (biceps normalized IEMG) during the carry task after the covariate arm lean tissue was added to the model. The older women in this study had less strength in the knee extensors and experienced greater difficulty standing from a chair than the younger women, even after the covariate upper leg lean tissue was added to the model. This suggests that other factors, in addition to loss of lean tissue, contribute to the age-related decline of muscular strength and the ability to perform tasks with the legs. In contrast, although elbow flexor strength declined, this appeared to be largely due to decreased arm lean tissue mass.

Physical performance tests after stroke: reliability and validity

OBJECTIVE

To evaluate the reliability and validity of the modified physical performance tests for stroke survivors who live in a community.

DESIGN

The subjects included 40 stroke survivors and 40 apparently healthy independent elderly persons. The physical performance tests for the stroke survivors comprised two physical capacity evaluation tasks that represented physical abilities necessary to perform the main activities of daily living, e.g., standing-up ability (time needed to stand up from bed rest) and walking ability (time needed to walk 10 m).

RESULTS

Regarding the reliability of tests, significant correlations were confirmed between test and retest of physical performance tests with both short and long intervals in individuals after stroke. Regarding the validity of tests, the authors studied the significant correlations between the maximum isometric strength of the quardriceps muscle and the time needed to walk 10 m, centimeters reached while sitting and reaching, and the time needed to stand up from bed rest.

CONCLUSIONS

The authors confirmed that there were significant correlations between the instrumental activity of daily living and the time needed to stand up from bed rest, along with the time needed to walk 10 m for the stroke survivors. These physical performance tests are useful guides for evaluating a level of activity of daily living and physical frailty of stroke survivors living in a community.

Age scale for assessing functional fitness in older Japanese ambulatory women

Our aim was to develop an age scale for the assessment of functional fitness in older women. The subjects were 430 older Japanese ambulatory women. They were divided into three groups: (a) less active (N=373, age 72.5+/-6.7 years); (b) active (N=23, age 71.0+/-5.4 years); and (c) sedentary (N=34, age 72.9+/-4.7 years). The less active group was used for the development of the instrumental activities of daily living (IADL) age equation, while data from active and sedentary groups were utilized for the assessment of the criterion-related validity. Seventeen functional fitness variables were selected as test items related to IADL. IADL were defined as extra activities people engaged in during daily living, such as preparing meals, housecleaning activities, and washing. After applying the first principal component analysis to the correlation matrix among the 17 items, the following IADL age equation was obtained: IADL age = - 0.43X1 - 0.57X2 - 0.32X3 + 0.37X4 + 0.37CA + 61.88, where X1 = arm curl (n / 30 s), X2 = moving beans with chopsticks (n / 30 s), X3 = functional reach (cm), X4 = walking around two cones (s), and CA = chronological age (years). The mean IADL age of the less active group (72.2+/-8.4 years) obtained from this equation was matched with their mean CA. The mean IADL age of the active group (66.0+/-3.2 years) was significantly lower than their mean CA (71.0+/-5.4 years, p<0.05), and the mean IADL age of the sedentary group (79.1+/-6.0 years) was significantly higher than their mean CA (72.9+/-4.7 years, p<0.05). In conclusion, the criterion-related validity of the IADL age equation was clearly demonstrated as a means to assess the functional fitness required for IADL in older Japanese women.

Significance of health fitness appraisal in an aging society

There is no doubt that the older population in Japan is rapidly increasing. The over-65 age group is the fastest growing age group in Japanese society. The quality of life for this rapidly growing segment of the population can no longer be ignored without disastrous consequences. The advent of an increased life expectancy has focused attention on the issue of functionality versus disability. We are all faced with the inevitable consequences of aging, yet each of us has the capacity to modify the aging process physiologically through appropriate physical activity and other preventive health measures. Therefore, with the aid of a physically healthy lifestyle, an exercise participant can be physically capable, energetic, and live actively beyond the ages of 50, 60, or even 70 years. Consequently, a key issue for successful or healthy aging would appear to be the improvement in perception of physical ability through education, as well as improvement in health-related physical fitness through a change in lifestyle involving regular exercise. In addition, it is a major responsibility of the physical education profession and related health fields to clarify and publicize the benefits, risks, and specific parameters of physical activity, and to develop an effective prescription for physical activity in programs that are age adjusted. This review discusses from this perspective the significance of health fitness appraisal in the aged society. Much more research is needed to clarify these issues in Japanese society.

The relative utility of health-related fitness tests and skilled motor performance tests as measures of biological age in Japanese men

In the present paper we report the results of a study in which we compared 2 different approaches to the computation of biological age (BA) in a sample of 322 Japanese men (age range 20 to 79 years). In the first approach, 4 commonly used measures of health-related fitness (VO2peak, trunk flexion from a standing position, body fat, and grip strength) were reduced to a single BA score (HRF Age) using principal component analysis. In contrast, in the second approach, 3 commonly used measures of skilled motor performance and agility (vertical jump, stepping side-to-side, and balancing on one leg with eyes closed) were reduced to a single BA score (SMP Age) using similar multivariate procedures. The criterion-related validity of both of the BA measures was examined by assessing each measure's ability to discriminate between healthy and active groups of subjects. This was achieved by classifying the original subject pool into regularly active (ACT; n = 108) and healthy (HLTH; n = 169) subgroups on the basis of self-reported activity levels. Analyses revealed that HRF Age was a more powerful discriminator between the two activity groups than SMP Age. While HRF Age of HLTH subjects was very close to their chronological age (CA), in the ACT group, HRF Age was on average 15 years less than their CA (P < 0.05). In a separate analysis, we assessed the HRF Age of patients with ischemic heart disease, hypertension, obesity, or diabetes (PAT; n = 45). The HRF Age of these subjects averaged 10 years above their CA. Our data suggest that commonly used measures of health-related fitness can be usefully employed as indices of BA which differentiate between individuals of similar ages but differing health and physical activity status. In contrast, measures of skilled motor performance were found to be less valuable measures of BA. The implication of our findings for future experimental design in exercise and aging research is discussed.