Should Physical Activity Programs Be Tailored When Older Adults Have Compromised Function?

Dept. of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA.
Journal of aging and physical activity (Impact Factor: 1.97). 07/2009; 17(3):294-306.
Source: PubMed


The purpose of this study was to determine whether a walking program supplemented by tasks designed to challenge balance and mobility (WALK+) could improve physical function more than a traditional walking program (WALK) in older adults at risk for mobility disability. 31 community-dwelling older adults (M +/- SD age = 76 +/- 5 yr; Short Physical Performance Battery [SPPB] score = 8.4 +/- 1.7) were randomized to treatment. Both interventions were 18 sessions (1 hr, 3x/wk) and progressive in intensity and duration. Physical function was assessed using the SPPB and the 400-m-walk time. A subset of participants in the WALK group who had relatively lower baseline function showed only small improvement in their SPPB scores after the intervention (0.3 +/- 0.5), whereas a subset of participants in the WALK+ group with low baseline function showed substantial improvement in their SPPB scores (2.2 +/- 0.7). These preliminary data underscore the potential importance of tailoring interventions for older adults based on baseline levels of physical function.

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Available from: Anthony P Marsh
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    • "Several years ago, we conducted a small pilot study in which we randomized older adults with a range of function to either a standard walking program for 6 weeks or to one that involved walking combined with intermittent stations that challenged balance, coordination, and a combination of movement and executive cognition function – walk+.54 By virtue of the physical demands, participants had to consciously focus their awareness on coordinated movements and were fully absorbed in what they were attempting to accomplish. "
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    • "The research that has been done among older adults with chronic disease or low fitness has indicated that multicomponent programs (including endurance, strength, flexibility, and balance) focusing on physical activity only (versus multiple behavior targets such as activity, nutrition, and medication), building exercise slowly over time, and using behavior change principles (e.g., social support, health contracts, self-monitoring, goal-setting) help promote physical activity [96–100]. Effective physical activity programs among older adults target moderate intensity activities, are inexpensive, are convenient [80], can be done independently though with some instruction [101], and are tailored [102]. For women, particularly, inclusion of a social component can be important [80]. "
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    • "There is precedence for greater benefits of physical activity training among individuals with lower baseline functioning in other outcomes. For example, Marsh, et al. found baseline lower extremity functioning moderated the influence of two different walking programs on improvements in physical functioning [50]. Whereas those with higher levels of functioning responded more positively to a traditional walking program, the lower functioning participants responded more positively to a novel walking program that included more complex walking tasks, such as stepping over obstacles. "
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