A 12-Week Vigorous Exercise Protocol in a Healthy Group of Persons over 65: Study of Physical Function by means of the Senior Fitness Test

Abstract

The aim of this study was to assess the effects of vigorous exercise on functional abilities by means of a Senior Fitness Test (SFT) in a group of elderly adults. Twenty healthy and inactive people performed vigorous exercise (VE: 12 men and 8 women, aged 69.6 ± 3.9 years). At the beginning of the study (T0) and after 3 months (T1), each subject’s functional ability was tested for muscular strength, agility, cardiovascular fitness, flexibility, and balance. The VE was designed with continuous and interval exercise involving large muscle activities. Functional exercises were performed between 60% and 84% of heart rate reserve (HRR) for a duration of 65 minutes. Five out of the 6 SFTs performed were found significantly improved: Chair Stand (T0 12.4 ± 2.4, T1 13.5 ± 2.6,

p
<
0.01

), Arm Curl (T0 14.2 ± 3.6, T1 16.6 ± 3.6,

p
<
0.01

), 2 min step (T0 98.2 ± 15.7, T1 108.9 ± 16.2,

p
<
0.01

), Chair Sit-and-Reach (T0 −9.9 ± 7.7 cm, T1 1.7 ± 6.3 cm,

p
<
0.01

), and Back Scratch (T0 −15.8 ± 10.9 cm, T1 −8.4 ± 13.1 cm,

p
<
0.01

). Our results suggest that a high intensity protocol and functional exercises can improve functional mobility and muscle endurance in those over 65 years of age. SFTs are an effective method for assessing improvements in the functional capacity of elderly adults.

Full text

Research Article
A 12-Week Vigorous Exercise Protocol in
a Healthy Group of Persons over 65: Study of Physical
Function by means of the Senior Fitness Test
Francesco Todde,1Franco Melis,1Roberto Mura,1Massimiliano Pau,2Francesco Fois,3
Sara Magnani,1Gianfranco Ibba,1Antonio Crisafulli,1and Filippo Tocco1
1Department of Medical Sciences, Sport Physiology Laboratory, University of Cagliari, 09124 Cagliari, Italy
2Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, 09124 Cagliari, Italy
3Italian National Olympic Committee (CONI), Sardinia, Italy
Correspondence should be addressed to Filippo Tocco; lippo.tocco@tiscali.it
Received  December ; Revised  March ; Accepted  April 
Academic Editor: Danilo S. Bocalini
Copyright ©  Francesco Todde et al. is is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly
cited.
e aim of this study was to assess the eects of vigorous exercise on functional abilities by means of a Senior Fitness Test (SFT) in a
group of elderly adults. Twenty healthy and inactive people performed vigorous exercise (VE:  men and  women, aged . ±.
years). At the beginning of the study (T) and aer  months (T), each subject’s functional ability was tested for muscular strength,
agility, cardiovascular tness, exibility, and balance. e VE was designed with continuous and interval exercise involving large
muscle activities. Functional exercises were performed between % and % of heart rate reserve (HRR) for a duration of 
minutes. Five out of the  SFTs performed were found signicantly improved: Chair Stand (T . ±., T . ±., 𝑝 < 0.01),
Arm Curl (T . ±., T . ±., 𝑝 < 0.01),  min step (T . ±., T . ±., 𝑝 < 0.01), Chair Sit-and-Reach (T
−. ±. cm, T . ±. cm, 𝑝 < 0.01), and Back Scratch (T −. ±. cm, T −. ±. cm, 𝑝 < 0.01). Our results suggest that
a high intensity protocol and functional exercises can improve functional mobility and muscle endurance in those over  years of
age. SFTs are an eective method for assessing improvements in the functional capacity of elderly adults.
1. Introduction
It is well known that exercise in the older population may
prevent several diseases [–]. Reduced physical activity
impairs the quality of life in elderly people with Alzheimer’s
Disease [], Parkinson’s Disease [], and Depressive Disor-
ders []. Moreover, musculoskeletal, cardiopulmonary, and
cerebrovascular decline are associated with poor physical
tness because of the cumulative eects of illness, multiple
drug intake, fatigue, and bed rest [, ]. e eects of
physical activity and exercise programs on tness and health-
related quality of life (HRQOL) in elderly adults have been
widely studied by several authors [–]. De Vries et al. []
conducted a meta-analysis focusing on elderly patients with
mobility problems and/or multimorbidity. Eighteen articles
describing a wide variety of actions were analyzed. Most
used a multicomponent training program focusing on the
combination of strength, balance, and endurance training. In
 of the  studies included, interventions were supervised
by a physical therapist. Intensity of the intervention was not
reported and the duration of the intervention varied from
 weeks to  months. is meta-analysis concluded that,
considering quality of life, the exercise versus no-exercise
studies found no signicant eects. High-intensity exercise
appearstobesomewhatmoreeectiveinimprovingphysical
functioning than low-intensity exercise. ese positive eects
are of great value in the patient population but the most
eective type of intervention remains unclear. Brovold et al.
[] recently examined the eects of high-intensity training
versus home-based exercise programs using the Norwegian
Ullevaal Model [] on a group of over--year-olds aer
discharge from hospital. ese authors based their study on
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BioMed Research International
Volume 2016, Article ID 7639842, 6 pages
http://dx.doi.org/10.1155/2016/7639842

BioMed Research International
the Swedish Friskis-Svettis model [] which was designed by
Johan Holmsater for patients with coronaropathy to promote
their return to work and everyday activities and improve
their prognoses. is model includes three intervals of high
intensity and two intervals of moderate intensity, each one
lastingfortominutes.Includedineachiscoordination.
Exercises consist of simple aerobic dance movements and
involve the use of both upper and lower extremities to chal-
lenge postural control []. Exercise intensity was adjusted
using the Borg Rating of Perceived Exertion (RPE) Scale.
Moderate intensity was set between  and , and high
intensity was set between  and  on the Borg Scale.
us, little is known about the eects of monitored
vigorous exercise in elderly people. While signicant benets
for basic motor tasks (such as balance and gait) can be
achieved through dierent kinds of physical activity (i.e.,
stretching exercises, treadmill, Pilates, and strength and
balance training), no conclusive relationship has been proven
between its intensity and such improvements. Recently, Pau et
al. [] reported that spatiotemporal gait parameters and sit-
to-stand performance signicantlyimprove through vigorous
(but not light) exercises, thus suggesting that higher levels of
intensity might be more suitable in generally improving static
and dynamic daily motor tasks.
On the basis of the aforementioned consideration, this
study aimed to evaluate the eect of monitored vigorous
exercise (VE) on several functional capacities by applying the
Senior Fitness Test (SFT) [] in a group of healthy over--
year-olds.
2. Methods
2.1. Experimental Approach to the Problem. Recruitment cri-
teria were one or both of sedentariness and dysmetabolism.
us, we selected subjects who were not physically active or
involved in any exercise program; that is, they had a sedentary
lifestyle. Moreover, before entering the study, they were
carefully screened for metabolic problems which attested a
dysmetabolic status, as increased levels of plasma glucose,
free fatty acids, triglyceride, and urate in fasting state. Both
criteria were veried by means of family doctor databases of
subjects.
Exclusion criteria included major diseases or conditions
such as severe heart disease, uncontrolled hypertension,
obesity, osteoarticular pathology, and neurological disease.
Criteria were evaluated on the basis of clinical history, resting
ECG, and physical examination. Participants maintained
their lifestyles and were instructed not to take part in
any other physical programs throughout the study. At the
timeoftheinitialdesign,thestudyconsistedofa-week
randomized controlled trial with a frequency of  times a
week,  sessions in all, ending with a new assessment of
their wellness and the potential persistence of the results on
functional/physical capacities.
2.2. Subjects. Recruiting lasted  months starting from
September . Participants were recruited by means of
family doctors to whom the goal of the study was explained.
350 people invited
180 agreed
20 enrolled to
participate in
vigorous exercise
protocol
20 reached the goal
20 assigned to
control group
12 failed 8 reached the goal
170 refused
F : Flow chart showing the study trend.
e recruitment ow chart is shown in Figure . ree
hundred and y people aged ≥ were invited to participate.
Of these, .% agreed to be included in the screening list
while .% refused to participate, mainly for family reasons
such as illness/hospitalization/old age of a family member.
Forty people were found eligible to participate in the research
protocol. Randomly, twenty were assigned to VE and twenty
to the control group. e latter were instructed not to take
part in any physical activity throughout the study period. All
the selected participants signed an informed consent. e
study was performed according to the Declaration of Helsinki
and approved by the local ethics committee on September ,
.
2.3. Procedures. According to the ACSM guidelines, the
physical activity (PA) was set between % and % of the
heart rate reserve (HRR) [] and continuously monitored
with a heart rate monitor (PolarT Coded)connectedto
a telemetry system (Hosand).
Each participant’s individual HRR was calculated accord-
ing to the Estimated Maximal Heart Rate Formula []:
HRmax =.−(. ×Age).ebaselineHRvalues
were collected from all subjects for three consecutive days in
themorningrightaerwakingupandthemeanvaluewas
calculated.
Since specic characteristics of music such as rhythm and
melody have been shown to provide a strong incitement to
performing physical exercise [], a Remix Pop Music com-
pilation of the s was used as a background soundtrack for
the present training protocol.
2.4. Vigorous Exercise. e training protocol consisted of
three phases:
() Warm-Up P h a s e , up to  min.

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() Active Phase,  min, including mixed exercises.
() Recovery Phase,uptomin.
(1) Warm-Up Phase (over 60%HRR).Slow,dynamicmove-
ments of the lower-, mid-, and upper-body main muscle
groups through the full range of motion followed by static and
dynamic stretching exercises.
(2) Active Phase (between 60%and 84%HRR).Continuous
dynamic and interval training mode exercise involving large
muscle activities with an increasing level of diculty and
intensity. Subjects began with a short walk, alternated with
various step exercises (e.g., both side and forward-backward
step up and down on the platform, with alternate footsteps).
en, they went on performing alternate upper-limb lis
(while keeping inferior limbs exed) and lower limb exions
and extensions (knee lis, both side and forward-backward
leg lis, and leg curls), as a sort of brief and easy sequence
to be repeated for a xed time. Integrated multiple plane
exercises for upper and lower limbs using elastic resistances
(Xertube) completed the last part of the Active Phase. To
reach the goal of gradually augmenting the intensity of the
program, the coach continuously checked the HRR level of
subjects who were progressively increasing the duration and
thenumberofexercises.eresistanceoftheelasticbands
was also increased by one level (from very light to medium)
every  weeks.
(3) Recovery Phase (<60%HRR).Posturalcontrolandspine
mobility exercises in a quadrupedal position with the plat-
form support, exercises of static balance over either  or 
supports,eyeseitheropenorclosed,andwithcoremuscle
activation. e latter phase also included various poststretch
exercises to restore the preexercise muscle length.
e VE was conducted under continuous HR monitoring
by a professional tness coach with a degree in Motor and
Sport Science.
2.5. Description of the Senior Fitness Test (SFT). In accordance
with Rikli and Jones [], we used the following tests at the
beginning (T) of the study and aer  weeks (T).
2.5.1. 30-Second Chair Stand Test
Purpose. Its purpose is to assess lower-body strength needed
for numerous tasks such as climbing stairs, walking, and
getting out of a chair, bathtub, or car (increased ability in
performing this exercise may reduce the possibility of falling).
Description. It consists of a number of full stands from a
seated position which can be completed in  seconds with
arms folded across the chest.
2.5.2. 30-Second Arm Curl Test
Purpose. Its purpose is to assess upper-body strength needed
for performing household and other activities involving
liing and carrying things such as groceries, suitcases, and
grandchildren.
Description. It consists of a number of biceps curls that can be
completedinseconds,holdingahandweightofpounds
(. kg) for women and  pounds (. kg) for men.
2.5.3. 2-Minute Step Test
Purpose. It is an alternative aerobic endurance test to be
used when time restraints and/or space limitations impede
administering the -minute walk test.
Description. It consists of a number of full steps completed in
 minutes, raising each knee to a point midway between the
patella and the iliac crest; the score is the number of times the
rightkneereachestherequiredheight.
2.5.4. Chair Sit-and-Reach Test
Purpose. Its purpose is to assess lower-body exibility, which
is important for good posture, normal gait patterns, and
various mobility tasks, such as getting in and out of a bathtub
or car.
Description. e patient is seated in a chair with legs extended.
He/she was instructed to keep the back straight and reach the
toes with both hands. e number of inches (centimeters)
between the extended ngers and the tip of the toe was
measured.
2.5.5. Back Scratch Test
Purpose. Its purpose is to assess upper-body (shoulder)
exibility, which is important in tasks such as combing one’s
hair, putting on overhead garments, and reaching for a seat
belt.
Description. e patient put one hand over the same shoulder
with the palm touching the back and reached down the back.
He/she placed the other hand up the back from the waist
with the palm facing outwards. Pointing the middle ngers
of each hand towards each other, patient tried to touch the
ngers of each hand in the middle of the back. e number
of inches (centimeters) between the extended middle ngers
was measured. e test was always done with the right hand
overtheshoulderandthelebehindtheback.
2.5.6. 8-Foot Up and Go Test
Purpose. Its purpose is to assess the agility and dynamic
balance important in tasks that require quick maneuvering,
such as getting o a bus in time, getting up to attend
to something in the kitchen, going to the bathroom, or
answering the phone.
Description.Itisthenumberofsecondsrequiredtorisefrom
a seated position, walk  feet (. meters), turn, and resume
the seated position.

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0
5
10
15
Repetitions
T0 T1
∗
(a)
0
5
10
15
20
25
Repetitions
T0 T1
∗
(b)
0
50
100
150
Repetitions
T0 T1
∗
(c)
F : Comparison between the collected results at T and T during the Chair Stand (a), the Arm Curl (b), and the  min step (c). Values
are mean ±SD. ∗𝑝<. versus T.
2.6. Statistical Analysis. e assumption of normality was
checked using the Kolmogorov-Smirnov test. e 𝛼level was
set at 𝑝 < 0.05.A𝑡-test for repeated measures was used for
statistical analysis, with a signicance level set at 𝑝 < 0.05.
e soware used for statistical analysis was Prism-GraphPad
..
3. Results
e VE group consisted of  women and  men (age . ±
. years; weight . ±. kg; height . ±. cm). e
control group consisted of  women and  men (age . ±
. years; weight . ±. kg; height . ±. cm). Only
 subjects of the VE group and  of the control group
correctly completed the trials (see Figure  and Limitation of
the Study paragraph). Adherence to protocol of the VE group
was checked daily by our motor scientist by means of a daily
record where he noted the week and participation number,
the mean HR of the sessions, the type of exercises, and the
number of repetitions per set carried out. During the training
period, no adverse events such as dizziness, musculoskeletal
pain, or cardiovascular issues were recorded. Aer  weeks,
there were signicant improvements in strength, exibility,
balance, and agility tested by SFT. T-T dierences are
shown in Figures  and . Namely,  tests out of  showed
signicant improvement: Chair Stand (T . ±.; T . ±
., 𝑝 < 0.01), Arm Curl (T . ±.; T . ±.,
𝑝 < 0.01),  min step (T . ±.; T . ±., 𝑝<
0.01), Chair Sit-and-Reach (T −. ±. cm; T . ±. cm,
𝑝 < 0.01), and Back Scratch (T −. ±. cm; T −. ±
. cm, 𝑝 < 0.01). Conversely, the -foot up and go test (T
. ±.  s e c ; T   .  ±. sec, 𝑝 > 0.05)showednosignicant
statistical dierence due to a high SD in T assessment.
4. Discussion
e novelty of the present study is that of demonstrating the
possibility of applying a specic vigorous physical exercise
program [] on healthy elderly adults over  years and
evaluating its eects on functional capacity using the classical
SFT []. To administer the high exercise intensity, we used a
HR control under continuous accurate visual monitoring by
a sport scientist. As expected, aer only  weeks of training,
we found signicant enhancements of almost all skills tested.
Our results clearly show that our VE program is relevant
andhasapositiveimpactonpeopleoverinhelping
them to maintain a high quality of life. e dierence from
most of the literature [–] regards the exercise protocol
intensity, which is usually milder than ours. Also, in the
aforementioned studies there was a poor attention about the
consequences of the exercise program on general quality of
life of subjects. ey mainly focused on the attenuated risks
of falling. On the contrary, the SFTs applied in our study
clearly show that our VE program may ameliorate several
motor abilities and in turn the general quality of life in healthy
elderly adults over  years of age. However, two other studies
showed that elderly people need to exercise close to their
limitofmaximumcapacity[,]toimprovetheirphysical
tness but, unlike the present research, they were conducted
on patients who were in deconditioning status linked to their
chronic illnesses.

BioMed Research International 
T0 T1
−20
−10
0
10
(cm)
∗
(a)
T0 T1
−30
−20
−10
0
(cm)
∗
(b)
T0 T1
0
5
10
15
(Seconds)
(c)
F : Comparison between the collected results at T and T during the Chair Sit-and-Reach (a), the Back Scratch (b), and the -foot up
andgo(c).Valuesaremean±SD. ∗𝑝<. versus T.
Brovold et al. [] supposed the importance of an exercise
is based on a high-intensity and continuous monitoring
model because in their research a nonmonitored home-
based group did not improve their physical tness as much
as the monitored group that accomplished a high-intensity
aerobic exercise adjusted by means of the Borg Scale and
a musical pace []. However, Brovold et al. [], despite
an exercise protocol with a high-intensity aerobic interval
(HIA), found a small eect on SFT. is may be due to the
fact that the exercise protocol used by Brovold et al. [] did
not interact favorably with the skills tested by SFT. us, a
positive relationship among vigorous physical exercise []
or HIA exercise [] and the functional abilities tested by
the SFT is not fully evident. On the contrary, the vigorous
exercise protocol used here enhanced  out of  of the SFT
and seems to be more focused than the aforementioned one.
e small eect of vigorous physical exercise through the -
foot up and go test is not fully clear and may depend on
several factors: (i) a large standard deviation at T due to the
presence of two subjects who showed a very low functional
capacity; (ii) inadequacy of the exercises to improve this
ability; and/or (iii) inadequate sensitivity of an -foot up and
go test. In a recent study by Furtado et al. [] conducted
on a large number of elderly females, even though the SFT
wasusedatbaselineandaermonthsfromanintervention
program of multimodal exercise training ( days per week),
not all skills tested were found improved. However, according
to a meta-analysis [] that included  dierent exercise
studies, even a small positive eect can be considered to
be of great value in this group of individuals who are at
risk of further functional decline. In conclusion, the present
study shows that vigorous physical exercise in healthy elderly
people provides signicant improvements in the majority of
the dierent skills assessed by the SFT.
Limitation of the Study. One potential limit of the present
study undoubtedly regards the limited number of subjects
involved in the study and the operating loss of the control
group. Unfortunately, too many participants of the latter
did not satisfy the requirements during the study, thus
impeding a comparative statistical approach. Further studies
are therefore needed to conrm our conclusions, in particular
with a larger sample and control group.
5. Conclusions
e positive trend shown here is an encouraging result in this
population in relation to the possibility of increasing their
ability in performing daily activities, reducing the occurrence
of falls and potential femoral fractures. Further research is
needed to understand how to design a vigorous exercise
protocol, which may focus not only on aerobics but also
on the dierent skills assessed by the SFT and which may
include specic training sessions to enhance those particular
skills, such as -foot up and go test. To maximize the
functional/physical capacities of those over , a close link
between high-intensity exercise and functional exercises is
required. A mixed circuit training program including both

BioMed Research International
kinds of the aforementioned exercises and measurable by SFT
should be followed.
Competing Interests
e authors declare they have no nancial or any other kind
of personal conicts with this paper.
Acknowledgments
e authors wish to thank Mr. Gianfranco Fara for his
precious cooperation. e study was supported by the Italian
National Olympic Committee (CONI), Sardinia, and the
UniversityofCagliari.eauthorsalsothankMr.DavidC.
Nilson for his linguistic and editing assistance.
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