Article

Functional strength training: Seated machine vs standing cable training to improve physical function in elderly

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Abstract

Background: The majority of the strength training studies in older adults have incorporated fixed-form exercises using seated resistance training machines. In light of the modest improvements in physical function shown in these studies, functional or task-specific exercises, involving movement patterns that mimic daily activities, have been studied. Free-form exercises, using free-weights or cable, is another form of functional strength training. Currently, no intervention studies exist comparing free-form exercises, using cable machines, and fixed-form exercises, using seated machines in older adults. Methods: A total of 29 independently-living older adults, 65years or older, were randomized into two groups, seated machine (SM, n=10) and standing cable (SC, n=12). After 12weeks of training twice per week, groups were compared. The primary outcome was the Physical Performance Battery (PPB), a measure of physical function. Secondary outcomes were lower and upper body strength and power, activities of daily living evaluated by multiple tests including: Physical Performance Test (PPT), pan carry and gallon jug transfers, ratings of perceived exertion (RPE), and self-reported function using Patient Reported Outcomes Measurement Information System (PROMIS). Outcome assessors were blinded to participants' intervention assignments. Results: The PPB (SC=0.23 points; SM=0.15 points) showed clinical and significant improvements, but there was no significant difference between the groups (g=0.2, 95% CI (- 0.6, 1.0). For secondary outcomes, chair stand (g=0.7, 95% CI (0.2, 1.6), p=0.03) and pan carry (g=0.8, 95% CI (0.07, 1.07), p=0.04) favored SC, while chest press 1RM (g=0.2, 95% CI (0.06, 1.1), p=0.02) favored SM. There were no statistically significant group differences between PPB, gallon jug transfer, leg press 1RM, power, RPE or self-reported function. Conclusions: Standing cable training was not superior to seated machine training in improving physical performance in older adults. However, both training interventions were effective in improving function. The findings also suggest that exercise specificity should be considered when prescribing resistance exercises to improve physical function in older adults.

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... Recent studies with older adults between 50 and 94 years (Balachandran et al., 2016;Brill et al., 1998;Maddalozzo and Snow, 2000) identified no significant group differences in strength improvements comparing different training modalities within an intervention period of 8 to 24 weeks. Nevertheless, they reported superior results for the FWT group improving function (Balachandran et al., 2016), and bone mineral density (Maddalozzo and Snow, 2000). ...
... Recent studies with older adults between 50 and 94 years (Balachandran et al., 2016;Brill et al., 1998;Maddalozzo and Snow, 2000) identified no significant group differences in strength improvements comparing different training modalities within an intervention period of 8 to 24 weeks. Nevertheless, they reported superior results for the FWT group improving function (Balachandran et al., 2016), and bone mineral density (Maddalozzo and Snow, 2000). Both studies incorporated a high number of exercises (10-13) with 3 sets of 12 repetitions, which might have led to a progressive increase in participant's fatigue affecting their overall training success. ...
... For example, Guizelini et al. (2018) and Barrett and Smerdely (2002) showed in a 10-week-training intervention with elderly people (63.9-72.5 years; n = 40) a strength improvement of 6.3 to 18.1% (quadriceps) respectively 0.5 to 15.7% (biceps). Additionally Balachandran et al. (2016) showed after a 12 weeks training period with elderly (≥65 years; n = 22) an improvement of 23 to 24% (leg press) and 10 to 24% (chest press). A possible explanation for these differences could be the length of the intervention, although it is assumed, that the greatest rates of growth reveal at the beginning of an intervention (c.f. ...
Article
Background: Resistance training is assumed to be a key player in counteracting the age-related decline of functional capacity as well as the incidence of falls in older adults. Functional training using free weights is presumed to mimic daily activities, but there is a lack of studies comparing free weight training with barbells and machine training in older adults. The purpose of this study was to evaluate the development of muscle strength for high resistance training in high functioning older people for machines as well as free-weights as well as testing the feasibility of free weight training for this target group. Methods: Thirty-two fitness trained women and men aged 60 to 86 years (mean: 66.9, SD: ±5.5) participated in this study. Machine exercisers (n = 16; chest press, leg press, upper row, biceps cable curls, triceps cable extension) vs. free weight exercisers (n = 16; squat, bench press, bent-over rowing, biceps curls, lying triceps press) participated twice à week for a total of 26 weeks. They trained the same five muscle groups for three sets with 10 to 12 repetitions at the 10-Repetition-Maximum, followed by 20 min of endurance training over six months. Three measurements (dynamic, isometric strength and endurance) were taken at the beginning, after 10 weeks and again after 26 weeks. Results: Repeated measures MANCOVA analysis revealed significant increases in the free weights training group (FWT) as well as in the machine training group (MT) over the period of 6 months. However, only for leg strength (113 vs. 44%) and triceps (89.0 vs. 28.3%) the free-weights group exhibited significant differences for the percentage increase over a period of 26 weeks compared to the machine group. A detraining period revealed the decline of the dynamic strength without training. The analysis of the follow-up questionnaire resulted in higher demands for safety, but also higher values for fun, motivation, future, and benefit for daily life for the FWT group compared to the MT group indicating an overall better evaluation of their training specific regime. Conclusion: Our results demonstrate that especially free-weight training has benefits in improving leg and triceps strength as well as in the subjective perception in older adults. Nevertheless, our results do not overall indicate that free-weight training is superior to machine training for increasing strength.
... Handgrip strength is traditionally monitored as a functional outcome related to upper body muscle loss with aging (Forrest, Zmuda, & Cauley, 2007;Sayer et al., 2006). However, the specificity of movements in a resistance exercise program is relevant to many activities of daily living (Balachandran et al., 2016). For example, the dumbbell step-up exercise and the dumbbell bent-over row exercise mimic real-life movements (Sayer et al., 2006). ...
... Numerous studies have demonstrated improved muscular strength in older adults engaged in resistance training (Balachandran et al., 2016;Coetsee & Terblanche, 2017) or with enhanced protein intake (Bauer et al., 2013;Cramer et al., 2016;Volpi et al., 2001), independently. However, less is known about whether increased protein intake augments the expected performance changes during a resistance-training program, especially in an older population (Galbreath et al., 2018;Liao et al., 2018). ...
Article
The purpose of this trial was to examine the effects of self-selected exercise intensities plus either whey protein or placebo supplementation on vital signs, body composition, bone mineral density, muscle strength, and mobility in older adults. A total of 101 participants aged 55 years and older (males [ n = 34] and females [ n = 67]) were evaluated before and after 12 weeks of self-selected, free-weight resistance exercise plus 30 min of self-paced walking three times per week. The participants were randomized into two groups: whey protein ( n = 46) or placebo ( n = 55). Three-way mixed factorial analyses of variance were used to test for mean differences for each variable. The 12 weeks of self-selected, self-paced exercise intensities improved resting heart rate, fat-free mass, percent body fat, handgrip strength, bench press strength, leg press strength, and all mobility measurements ( p < .05) in males and females despite supplementation status. This suggests that additional protein in well-fed healthy older adults does not enhance the benefit of exercise.
... Balachandran and colleagues [76] randomly assigned 29 previously untrained but independently-living older males and females (~69 years old) to either a standing Cybex Bravo Pro cable machine (SC) or seated Cybex VR2 machine (SM) resistance training protocol. The participants in the SC group executed all cable exercises in a standing position while the SM group performed similar exercises seated in traditional exercise machines. ...
... With the exception of the one study by Balachandran and colleagues [76], none of the aforementioned resistance training studies discussed in this critical analysis controlled for blinded outcomes assessments. Consequently, all those studies were potentially subjected to some degree of confirmation bias. ...
Article
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A significant portion of a recent review on the development of research-based strength training in the National Strength and Conditioning Association focused on their opinion that free weight strength training is superior to machine training for increasing muscular strength and power. The purpose of this critique is to challenge that widely held belief, trace that belief to its probable genesis, and show that it is based primarily on a plethora of unsupported opinions and one highly flawed training study rather than science-based research.
... Coordination and global mobility were only modulated by TT. Corroborating the present findings, Balachandran, et al. [18] after a 12-week intervention in machine strength training, found a 15% increase in the GJST test in independent older adults. Possibly, the precise increase of the physical efforts during the training is associated to the greater control of the load. ...
... The sample size was calculated using G*Power software version 3.1.9.2 based on previous results [18]. In the GJST test we expected a change of about 1.5 seconds in the recorded time, being the main variable to verify the functionality in the present study, thus, we consider for the sample of the present study a power of 0, 85 for the analyzes performed. ...
Article
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AIM: To compare changes after 12 weeks of functional and traditional training in physical fitness related to daily activities in physically active elderly women. METHODS: 30 elderly women were randomized into two groups: 1) Functional Training (FT - n= 15, 65.12 ± 4.49 years) and 2) and Traditional Training (TT - n = 15, 64.87 ± 3.25 years). For the verification of functional responses, the following tests were applied: Dress and undress a sleeveless shirt (DUSS), Gallon-jug shelf-transfer (GJSF), Get up from the chair and move around the house (GCMA), Sit and stand up in 5 reps (SS5R) and 400 meters walk. Data were analyzed from a repeated measures ANOVA followed by Bonferroni’s post-hoc. RESULTS: After 12 weeks, both FT and TT showed significant increases in the power of lower limbs (SS5R: FT + 18.0%, TT + 21.7%) compared to the initial values. The FT showed statistically significant differences in agility/dynamic balance (GCMA: + 5.3%, p = 0.02) and cardiorespiratory capacity (400W: + 10.4%; p = 0.007); and TT showed significant improvements in mobility and overall coordination (GJSF: + 8.1%, p = 0.001) when compared to the pre-test. No differences were found between the groups in any of the analyzes. CONCLUSION: The training protocols analyzed are equally effective for the improvement of indicators of physical fitness in physically active elderly women and can be alternately administered in health promotion programs.
... An attendance register was used to record each session to determine adherence. The intensity of the IVG and CM supervised exercise sessions were self-monitored by the use of the Borg's RPE scale (1)(2)(3)(4)(5)(6)(7)(8)(9)(10). Individuals were asked to provide feedback during their respective program sessions on their rate of perceived exertion on a scale from 1 to 10 and the researchers ensured that the individuals participated within their limit. ...
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Purpose The effects of aging on physical and mental health may be ameliorated by regular participation in physical activity (PA). There is also evidence for the benefits of various training modalities on cognition and functional ability in older adults. The aim of this study was to compare effects of a 12-week active video gaming intervention (X Box Kinect Sports) to conventional multimodal supervised exercise on fitness, functional ability and cognitive performance in older adults with memory complaints. Methods Participants (n = 45, 72±5 yrs.) were recruited from 6 retirement homes and cluster-randomized into the Interactive Video Gaming (IVG) group (N = 23) or Conventional Multimodal (CM) group (N = 22), meeting 2 x 1 hour sessions, weekly for 12 weeks. Pre-post measures included: 6 min walk, timed up and go, dynamic balance, functional reach, Mini-Mental State Examination, N-back Task and the Modified Stroop task. Results The IVG group demonstrated significant improvement in the total number correct responses on the Stroop task (P = 0.028) and for average reaction time of correct colour-words (P = 0.024), compared to the CM group. Functional ability improved significantly in the IVG group, including the 6-min walk (P = 0.017), dynamic balance (P = 0.03), timed up and go (P<0.001) and functional reach (P<0.0010). Conclusion An active interactive video gaming intervention was more effective than conventional multimodal exercise in improving executive and global cognitive performance and functional capacity in older adults with subjective memory complaints. Trial registration Pan African Clinical Trial Registry—PACTR202008547335106.
... For example, perturbation of the position of the center of gravity occurs during walking due to the alternation of steps, weight transfer from one leg to the other leg and variation in the base of support, increasing the levels of instability. Thus, FT also incorporates instability through the use of unstable bases (Rabay et al., 2012), stable bases but with a small surface of support and/or variable surfaces (Pacheco et al., 2013), unstable loads (Kohler et al., 2010), and exercises performed in a standing position (Balachandran et al., 2016). These tools stimulate strength development concomitantly with the development of balance, motor coordination, and body/postural perception (Behm and Colado, 2012;Behm et al., 2015). ...
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In the twenty-first century, functional training (FT) has become a strong worldwide fitness trend (Thompson, 2016), resulting in a growing interest to investigate its effects on many variables (e.g., morphological, physiological, and psychological) with different populations (children, adults, and elderly). Confirming this view, the current position stand of the American College of Sports Medicine on the prescription of physical exercise for healthy individuals includes FT (also termed: “neuromotor training”) as one of the modalities to be considered (Garber et al., 2011). Although the tools (exercises, equipment, and accessories) used in current functional training have long been employed in rehabilitation and conditioning programs, the systematic use of these tools, as well as scientific interest in this topic, are recent phenomena (Anderson and Behm, 2004; Rhea et al., 2008; Gordon and Bloxham, 2016). However, since it is still a subject of recent scientific interest, there are many methodological conflicts and divergences in training prescriptions (La Scala Teixeira et al., 2016). For example, some studies have associated FT with the use of instability and applied unstable bases in many exercises (Pacheco et al., 2013), while other studies have used instability in a small part of exercises (Weiss et al., 2010; Distefano et al., 2013) or have not used any unstable bases (Lohne-Seiler et al., 2013). In view of these considerations, detailing the actual concepts and characteristics of FT forms the basis for maximizing the benefits of both research and day-to-day interventions in terms of performance or rehabilitation (Behm et al., 2010). However, the methodological divergence observed with practical interventions in several fitness facilities, as well as in scientific studies, points to a reality in which the real concept of FT and all that it encompasses are still not well-elucidated (Fowles, 2010). A major factor that has contributed to this problem in the general population are probably the marketing campaigns promoting FT, which explore random several medias in order to attract consumers (Da Silva-Grigoletto et al., 2014). For example, publications of functional exercises can contain at the same time exercises of low (e.g., planks and squats) and high complexity (e.g.,Olympic weightlifting and calisthenics/gymnastics exercises). Similarly, marketing explores simple and low-cost accessories (e.g., balls, balance disk, elastic bands, medicine balls), as well as expensive equipment (e.g., multi-station machines, pneumatic resistance equipment). Although contributing to the consolidation of the term “functional training” in the fitness scenario, this wide variation in publications impairs consolidation of its true concepts and characteristics (La Scala Teixeira and Evangelista, 2014). Taken together, these facts highlight the need for researchers to establish a consensus about the concept of FT so that studies can be conducted according to a methodological pattern using pre-established criteria and, finally, that coaches and practitioners can make practical applications based on sound theoretical and scientific evidence. Therefore, in this paper we defined the concepts and characteristics of FT based on the analysis of current and relevant specific technical and scientific literature.
... As an example, instead of performing the bench press in its traditional form (lying on the bench), the same motor action is executed while standing, against the resistance of a cable and pulley system (e.g., crossover). Although this variation does not favor the lifting of heavy loads, which may not be optimal for maximum strength, the demand for balance, coordination, postural, and joint stability increases may favor general functional fitness (de Vreede et al., 2004Vreede et al., , 2005Balachandran et al., 2016). Thus, from generic exercises performed sitting or lying down, the increase of complexity can occur by performing specific, standing exercises. ...
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Traditional training progressions have involved changes in volume, intensity and density (amount of work per period of time). An alternative, recently popular, and action specific (sport, work, activities of daily living) functional training progression involves alterations in the complexity of movement. Increased complexity modulates the technical difficulty level of the exercise. Technical challenges can include more task specific, multi-segmental, multi-planar, double task (cognitive and physical), non-cyclical, unilateral, or alternating execution of exercises, changes in movement velocity, instability and visual deprivation.
... Applying manual resistance training can also be a viable approach, whereby a professional applies resistance with the hands against the knee-extension movement. Although such strategies may present some difficulty in progressing intensity of load, they can be an appropriate option for eliciting adaptations in the early stages of RT [44]. In addition, it is noteworthy that the training angles near maximum knee extension are those that present the greatest compressive force in the knee joint [45,46]. ...
Article
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Resistance training has been widely recommended as a strategy to enhance the functional autonomy and quality of life in older individuals. Among the variables that comprise a training session, the selection of exercises stands out as an important consideration for the elderly. Although a wide range of resistance exercise options exists, current guidelines generally do not indicate which exercises should be included and which muscles should be prioritized when prescribing training for older individuals. Therefore, given the lack of evidence-based information on the topic, this paper endeavors to establish recommendations to help guide the prescription of resistance exercises for older adults.
... Based on the sample size calculation (G*Power version 3.1.9.2, Kiel, Germany) at least eighteen participants are required per group, adopting an α level of 0.05 and a power (1 − β) of 80%. This estimate was based on the results obtained by Shimizu et al. (2011) on CD8 + CD28 + T cells in the exercise group results and Balachandran et al. (2016) on Gallon-jug shelf-transfer in the standing cable training group. Specifically, we calculate Cohen's d (Cohen, 1988) using Rhea's proposal (Rhea, 2004), then convert Cohen d to effect size f for sample size estimation in G*power (Lenhard and Lenhard, 2016). ...
Article
Purpose To evaluate the effects of functional and concurrent training on immune function and functional fitness in postmenopausal women. Materials and methods A randomized controlled trial was performed on 108 women aged 60 or older who were randomly assigned among the groups: control group (CG: n = 40; 63.88 ± 3.64 years); functional training (FT: n = 32; 63.88 ± 3.79 years); and concurrent training (CT: n = 36; 64.83 ± 4.00 years). Immune function was measured by the expression of the T-lymphocyte function-related surface markers (CD28 and CD57). Functional fitness was assessed using physical tests similar to daily activities, i.e., five times sit to stand, timed up and go, and gallon-jug shelf-transfer. Results Regarding immune function, there was only a time effect, without between-group differences. Specifically, FT and CT show a reduction and increase in CD4+ and CD8+ T cells, respectively, without impairment in the subpopulations analyzed, while CG showed a reduction in naive T cells (CD8+CD28+). For functional fitness tests, there was a time × group interaction effect for all tests, the FT and CT were superior to the CG, with FT showing differences after the fourth week, while the CT showed this effect after the eighth week of intervention. Conclusion FT and CT do not impair immune function and similarly improve functional fitness in postmenopausal women. Clinical trials registry RBR-2d56bt.
... This is in line with data on older adults, which indicates improvements in physical ability, getting out of a chair and gait speed, with a significant reduction of pain in osteoarthritis patients [50]. Although the optimal method has yet to be determined, free weight training specifically might provide certain benefits for the elderly, as related to the performance of certain functional tests (chair stand, pan carry) [51]. ...
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Purpose of Review The aim of this paper is to provide an overview of recent findings concerning the utilization of resistance exercise (RE) in prostate cancer (PCa), in particular as pertaining to the management of cancer therapy side effects. Recent Findings As of late, studies investigating the effects of RE in PCa patients have found positive effects on muscle strength, body composition, physical functioning, quality of life, and fatigue. The combination of RE and impact training appears to decrease the loss of bone mineral density. RE seems to be well accepted and tolerated, even by patients with bone metastatic disease, although a modification of the RE prescription is often necessary. Summary In PCa patients, RE has been well-researched and the data are clear that it is beneficial in multiple ways. Future directions should look at the long-term effects of RE, including mortality and relapse, as well as implementation of exercise programs.
Article
Background: Physical exercise is widely recommended for improving physical fitness. However, the most effective training method in improving the daily life of postmenopausal women is not clear. Therefore, this study compares different ways of functional training, focused on the task, and directed to the physical abilities on the functionality and quality of life of the postmenopausal women. Methods: Forty-seven participants were randomly assigned into three groups: element-based functional training (EBFT); task-specific-based functional training (TSBFT); and the control group (CG). The intervention lasted fourteen weeks, with three weekly sessions stimulating several physical valences in the same session. The global functionality, functional reach, gait speed, handgrip strength, jumping ability, and quality of life before and after the intervention were evaluated. Results: A similar increase was detected in both experimental groups for the variables-analyzed when compared to the initial moment (P<0.05), except in the dynamic postural control (P>0.05), which showed no difference. However, in the tests of rising from the floor and handgrip strength, only the task-specific-based functional training showed difference over time (P<0.05). Conclusions: Functional training protocols improve the performance in daily activities of postmenopausal women. However, task-specific-based functional training is more effective when compared to the control group in the analyzed variables.
Article
Purpose: To investigate the effects of 8 weeks of upright water-based exercise training in people with type 2 diabetes. Methods: Thirteen participants with type 2 diabetes (54% male; 60.9 ± 9.6 years, mean ± standard deviation) completed eight weeks of upright water-based exercise training at a moderate intensity (60-80% of exercise test-derived maximum heart rate), for one hour, three times a week (TG). Fourteen participants (64% male; 63.9 ± 9.8 years) acted as a control group (CG) who maintained their usual activities. Pre- and post-intervention, participants performed cardiopulmonary exercise testing to determine VO2peak and one-repetition maximum testing to assess muscular strength. Blood profiles were assessed with standard assays. Body mass index and waist:hip ratio were employed as measures of anthropometry. Endothelium dependent (brachial artery flow mediated dilation (FMD)) and independent (GTN mediated) function were assessed using vascular ultrasound. Results: Water-based training increased VO2peak (18.5 ± 4.3 to 21.5 ± 5.4 ml.kg-1.min-1) (p=0.002), overall muscle strength (123 ± 44 to 139 ± 43kg) and leg strength (92 ± 28 to 104 ± 29kg), compared with the CG (p=0.001). The effect on pectoral strength (31 ± 17 to 35 ± 16kg) was not significantly different to the CG (24 ± 12 to 26 ± 14kg) (p=0.08). No change was observed in anthropometry, blood profiles, or GTN mediated vascular function. FMD was increased following training (6.1 ± 2.4 to 6.5 ± 3.0%), compared with controls who demonstrated a slight decrease (6.2 ± 1.6 to 5.4 ± 1.6%) (p=0.002). Conclusion: Water-based circuit training was well tolerated and appears to be an effective exercise modality for improving aerobic fitness, strength and vascular function in people with type 2 diabetes.
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Objectives Lower body power declines with age and is associated with decreased physical function in older adults. However, the majority of the tools available to measure power are expensive and require considerable space and expertise to operate. The purpose of this study was to assess the validity, reliability, and measurement error of a sit-to-stand power test (STSp) to assess lower body power. Methods 51 community-dwelling adults, 65 years or older, completed a power test using a pneumatic leg press (LP), the Short Physical Performance Battery (SPPB) that includes a test of balance, usual walking speed, and chair stand tests; Timed Up and Go (TUG) test at both usual and fast paces, and Patient-Reported Outcome Measures (PROMs). A two-week test-retest assessed the reliability in 36 participants. The study hypotheses and analysis were pre-registered prior to data collection and statistical analyses were blinded. Results The mean age was 71.3 years, with 63% females, and an average SPPB score of 10.6 (median = 12). STSp peak power was strongly correlated with LP (r = 0.90, 95% CI (0.82, 0.94). As hypothesized, the STSp peak power showed similar or higher correlations with physical function tests relative to LP peak power: SPPB (0.41 vs. 0.29), chair stand test (−0.44 vs. -0.35), TUG test at usual pace (−0.37 vs. −0.29) and fast pace (−0.41 vs. −0.34) and balance (0.33 vs. 0.22), but not for mobility (0.34 vs. 0.38) and function (0.41 vs. 0.48) questionnaire. For discriminant validity, as hypothesized, males showed higher STSp peak power compared to females (Δ = 492 W, p < .001, Cohen's d = 2.0). Test-retest assessment yielded an intraclass correlation coefficient of 0.96 and a standard error of measurement of 70.4 W. No adverse events were reported or observed for both tests. Conclusion The STSp showed adequate validity and reliability in measuring lower body power in community-dwelling older adults. The test is quick, relatively inexpensive, safe, and portable and thus should be considered for use in aging research.
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The purpose of this study was to evaluate whether dumbbell resistance training (DBRT) and elastic band resistance training (EBRT) are equally beneficial in the older adult. Sixty-five healthy participants (mean±SD; age=66.5±7.09 years; height=165.2±10.6 cm; body mass=74.5±14.6 kg) volunteered for this study. Participants underwent a total body dual-energy x-ray absorptiometry (DXA) scan for segmental and total body muscle and fat estimation. Functional tests included the short physical performance battery, timed up-and-go, and heel-to-toe walk. Strength was measured on dominant handgrip strength, maximal bench press, and leg press. Participants were block randomized into one of three groups: elastic band resistance training (EBRT), dumbbell resistance training (DBRT), or control (CON). EBRT and DBRT were asked to visit the laboratory twice weekly over 6-weeks while CON maintained their daily routine. Data were analyzed using a two-way repeated measures ANOVA and an alpha set at 0.05. Results indicated there was a two-way interaction for bench press, leg press, upper- and lower-body muscle quality and total arm lean mass (p<0.05). Specifically, the EBRT and DBRT improved from pre to post for total arm lean mass (p<0.021, p<0.004, respectively). Additionally, for bench press and leg press, all groups improved pre to post training (p<0.05) with DBRT superior to CON. These data suggest that EBRT provides an effective, portable, and cost-effective means to enhance lower-body function and muscle quality in an aging population, yet DBRT may be more impactful for total-body improvements.
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›Using resistance training on unstable supports or with instability devices athletes aim to prepare their neuromuscular system for sudden and unforeseen impairments in equilibrium impeded by the environment or through sports partners. In contrast to athletes, older adults aim to avoid such situations impeded by instability to reduce a possible risk of falling. The goal of this review is to outline the specific benefits of resistance training on unstable supports or with instability devices, denote as metastability resistance training (MRT), in older adults while extending knowledge of past reviews in this field. Existing studies comparing MRT to traditional resistance training (RT) on stable surfaces are reviewed and summarized. Our review shows that MRT: a) is safe for the older adult when properly introduced and supervised; b) requires smaller training loads and stresses larger articular areas while providing similar or larger gains in strength as traditional RT on stable surfaces; c) provides extended gains in functional mobility, balance, and power; d) offers a strengthening of stabilizer muscles whose strength loss is assumed to facilitate falls; e) stabilizes gait performance and, thus, reduces the risk of falls; f) improves cognitive performance reducing reductions the fear of falling and improves executive functions. Moreover, MRT was found to be particularly beneficial for Parkinson’s disease patients. Hence, MRT could be a very useful tool to complement the physical conditioning of older adults.
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Evaluating muscular strength is vital to the application of effective training protocols that target quality of life and independence in older individuals. Resistance training is a valuable tool to improve functional capacity, strength, and power in this population; however, the lack of normative values for common lifts such as the leg press (LP) and chest press (CP) reduce its utility. This study developed age- and sex-specific normative strength values for older individuals. LP and CP 1-repetition maximum (1RM) values on Keiser A420 pneumatic machines were compiled from 445 older adults, ages 60-85y. Descriptive statistics and quartile rankings are reported, and two-way ANOVAs were conducted to determine differences between sex and age groups. There were significant sex x age group interactions for LP and CP. Men were significantly stronger than women across all age groups for both exercises (p < .01); however, the mean difference decreased with age. For men, no differences were seen among the 60–64 (237 ± 39 kg), 65–69 (223 ± 43 kg) and 70–74 (219 ± 50 kg) age groups; but the 60–64 group showed higher strength values than the 75–79 group (193 ± 52 kg) and all three groups contained higher strength values than the 80–85 group (172 ± 40 kg). Similarly, for relative strength, the 60–64 group (2.80 ± 0.53 kg·kgBM) surpassed values for all groups but the 65–69, and the 65–69 (2.70 ± 0.54 kg·kgBM) produced greater strength values than the 70–74 (2.45 ± 0.47 kg·kgBM), 75–79 (2.09 ± 0.37 kg·kgBM) and 80–85 (2.19 ± 0.38 kg·kgBM) groups. In contrast, no significant differences in absolute or relative strength were seen among age groups for the women. Our study establishes absolute and relative age- and sex-specific normative values for the LP1RM and CP1RM in older individuals. These values allow practitioners and researchers to interpret the results of various interventions, and evaluate their importance to evaluation of sarcopenia, injury risk, functional mobility and quality of life. Additionally, our results reveal that age-related declines in strength are prominent for male LP and CP, but not female CP or LP.
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Objective: To explore the use of step aerobics (SA) and the stability ball (SB) as tools for balance improvement in community-dwelling older adults. Method: Forty-two women (age: 72.2?5.8 years) who attended a community day center volunteered to participate in the study. Following the first assessment session, 28 women were assigned randomly to one of two experimental groups (the use of either SA or SB). The other 14 participants, who were engaged in a ceramic class, served as the control group. The study design was based on four assessment sessions and eight weeks of intervention. Assessment included four balance tests: Timed Up and Go (TUG), One-Leg Stand, Functional Reach, and the Performance-Oriented Assessment of Mobility (POMA). Quality of life was assessed by the use of the Short Form-36 Health Survey questionnaire. Results: The TUG and POMA intervention improved significantly (d=.83 and d=.95, respectively) following the SA. In addition, general health perception following both the SA and SB interventions improved significantly relative to the control condition (d=.62 and d=.22, respectively). Discussion: The findings of this study may imply that trainers should consider the inclusion of SA and SB as components of physical activity programs for seniors, aimed at improving balance ability and quality of life.
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This study examined the validity, reliability, and discriminatory capacity of the gallon-jug shelf-transfer (GJST) test. Six hundred fifty-three independent-living older adults (463 women age 72.9 +/- 7.0 years, 190 men age 74.3 +/- 6.7 years) participated. Participants moved five 1-gallon jugs (=3.9 kg) from a knee-high to a shoulder-high shelf as quickly as possible. The GJST showed an exponential performance decline with age, and there were significant correlations between the GJST and common functional tests (p <.001). High within-day and between-days reliability was detected. The test also detected differences resulting from training status (p <.01) and training protocols (p <.05). The GJST is a valid, reliable, inexpensive, safe, and easily administered clinical test for identifying physically vulnerable elders who could benefit from interventions such as exercise to improve their physical capacities and maintain independence.
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Identification of older persons at risk for the loss of independence, onset of (co)-morbidity or functional limitations through screening/assessment is of interest for the public health-care system. To date several different measurement instruments for overall physical function are frequently used in practice, but little information about their psychometric properties is available. Objectives and Our aim was to assess instruments with an overall score related to functional status and/or physical performance on content and psychometric properties. Electronic databases (Medline, EMBASE, AMED, Cochrane Library and CINAHL) were searched, using MeSH terms and relevant keywords. Studies, published in English, were included if their primary or secondary purpose was to evaluate the measurement properties of measurement instruments for overall physical function in community-dwelling older persons aged 60 years and older. Reliability, validity, responsiveness and practicability were evaluated, adhering to a specified protocol. In total 78 articles describing 12 different functional assessment instruments were included and data extracted. Seven instruments, including their modified versions, were evaluated for reliability. Nine instruments, including their modified versions, were evaluated with regard to validity. In conclusion, the Short Physical Performance Battery can be recommended most highly in terms of validity, reliability and responsiveness, followed by the Physical Performance Test and Continuous Scale Physical Functional Performance.
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To determine whether a lifestyle integrated approach to balance and strength training is effective in reducing the rate of falls in older, high risk people living at home. Three arm, randomised parallel trial; assessments at baseline and after six and 12 months. Randomisation done by computer generated random blocks, stratified by sex and fall history and concealed by an independent secure website. Residents in metropolitan Sydney, Australia. Participants aged 70 years or older who had two or more falls or one injurious fall in past 12 months, recruited from Veteran's Affairs databases and general practice databases. Exclusion criteria were moderate to severe cognitive problems, inability to ambulate independently, neurological conditions that severely influenced gait and mobility, resident in a nursing home or hostel, or any unstable or terminal illness that would affect ability to do exercises. Three home based interventions: Lifestyle integrated Functional Exercise (LiFE) approach (n=107; taught principles of balance and strength training and integrated selected activities into everyday routines), structured programme (n=105; exercises for balance and lower limb strength, done three times a week), sham control programme (n=105; gentle exercise). LiFE and structured groups received five sessions with two booster visits and two phone calls; controls received three home visits and six phone calls. Assessments made at baseline and after six and 12 months. Primary measure: rate of falls over 12 months, collected by self report. Secondary measures: static and dynamic balance; ankle, knee and hip strength; balance self efficacy; daily living activities; participation; habitual physical activity; quality of life; energy expenditure; body mass index; and fat free mass. After 12 months' follow-up, we recorded 172, 193, and 224 falls in the LiFE, structured exercise, and control groups, respectively. The overall incidence of falls in the LiFE programme was 1.66 per person years, compared with 1.90 in the structured programme and 2.28 in the control group. We saw a significant reduction of 31% in the rate of falls for the LiFE programme compared with controls (incidence rate ratio 0.69 (95% confidence interval 0.48 to 0.99)); the corresponding difference between the structured group and controls was non-significant (0.81 (0.56 to 1.17)). Static balance on an eight level hierarchy scale, ankle strength, function, and participation were significantly better in the LiFE group than in controls. LiFE and structured groups had a significant and moderate improvement in dynamic balance, compared with controls. The LiFE programme provides an alternative to traditional exercise to consider for fall prevention. Functional based exercise should be a focus for interventions to protect older, high risk people from falling and to improve and maintain functional capacity. Australia and New Zealand Clinical Trials Registry 12606000025538.
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The aim was to determine whether strength training using machines versus functional strength training at 80% of 1RM improves muscular strength and power among elderly. 63 subjects (69.9+4.1years) were randomized to a high power strength group (HPSG), a functional strength group (FSG) or a non-randomized control group (CG). Data were collected using a force platform and linear encoder. The training dosage was 2wk-1, 3 sets × 8 reps for 11 weeks. There were no differences in effect between HPSG and FSG concerning sit-to-stand power, box-lift power, and bench press maximum force. Leg press maximum force improved in HPSG (19.8%) and FSG (19.7%) compared to CG (4.3%, p=0.026). Bench press power improved in HPSG (25.1%) compared to FSG (0.5%, p=0.02) and CG (2%, p=0.04). Except for bench press power there were no differences in the effect of the training interventions on functional power and maximal body strength.
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The purpose of this Position Stand is to provide guidance to professionals who counsel and prescribe individualized exercise to apparently healthy adults of all ages. These recommendations also may apply to adults with certain chronic diseases or disabilities, when appropriately evaluated and advised by a health professional. This document supersedes the 1998 American College of Sports Medicine (ACSM) Position Stand, "The Recommended Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory and Muscular Fitness, and Flexibility in Healthy Adults." The scientific evidence demonstrating the beneficial effects of exercise is indisputable, and the benefits of exercise far outweigh the risks in most adults. A program of regular exercise that includes cardiorespiratory, resistance, flexibility, and neuromotor exercise training beyond activities of daily living to improve and maintain physical fitness and health is essential for most adults. The ACSM recommends that most adults engage in moderate-intensity cardiorespiratory exercise training for ≥30 min·d on ≥5 d·wk for a total of ≥150 min·wk, vigorous-intensity cardiorespiratory exercise training for ≥20 min·d on ≥3 d·wk (≥75 min·wk), or a combination of moderate- and vigorous-intensity exercise to achieve a total energy expenditure of ≥500-1000 MET·min·wk. On 2-3 d·wk, adults should also perform resistance exercises for each of the major muscle groups, and neuromotor exercise involving balance, agility, and coordination. Crucial to maintaining joint range of movement, completing a series of flexibility exercises for each the major muscle-tendon groups (a total of 60 s per exercise) on ≥2 d·wk is recommended. The exercise program should be modified according to an individual's habitual physical activity, physical function, health status, exercise responses, and stated goals. Adults who are unable or unwilling to meet the exercise targets outlined here still can benefit from engaging in amounts of exercise less than recommended. In addition to exercising regularly, there are health benefits in concurrently reducing total time engaged in sedentary pursuits and also by interspersing frequent, short bouts of standing and physical activity between periods of sedentary activity, even in physically active adults. Behaviorally based exercise interventions, the use of behavior change strategies, supervision by an experienced fitness instructor, and exercise that is pleasant and enjoyable can improve adoption and adherence to prescribed exercise programs. Educating adults about and screening for signs and symptoms of CHD and gradual progression of exercise intensity and volume may reduce the risks of exercise. Consultations with a medical professional and diagnostic exercise testing for CHD are useful when clinically indicated but are not recommended for universal screening to enhance the safety of exercise.
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This study was designed to evaluate the benefits of InVEST (Increased Velocity Specific to Task) training on limb power and mobility among mobility-limited older adults. We conducted a single blinded, randomized controlled trial among 138 mobility-limited community-dwelling older adults, evaluating two 16-week supervised exercise programs. The intervention group participated in InVEST training, and the control group participated in the National Institute on Aging's (NIA) strength training program. Primary outcomes were changes in limb power per kilogram and mobility performance as measured by the Short Physical Performance Battery (SPPB). After 16 weeks, InVEST produced significantly greater improvements in limb power than NIA (p=.02). There was no significant difference in strength improvements. Both groups had significant changes in SPPB of greater than 1 unit. Self-reported function was also significantly improved in both groups. Differences between groups were not statistically different. In a post hoc analysis when participants were categorized by the manifestation of baseline leg velocity impairments (N=68), InVEST training produced effect size differences in SPPB that were clinically meaningful (SPPB Group x Time difference 0.73 units, p=.05). Among mobility-limited older adults, both NIA and InVEST produce robust changes in observed physical performance and self-reported function. These improvements were not meaningfully different by statistical or clinical criteria. Compared with NIA, InVEST training produced greater improvements in limb power and equivalent improvements in strength. Observed differences between NIA and InVEST based upon baseline leg impairment status are informative for futures studies.
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Muscle dysfunction and associated mobility impairment, common among the frail elderly, increase the risk of falls, fractures, and functional dependency. We sought to characterize the muscle weakness of the very old and its reversibility through strength training. Ten frail, institutionalized volunteers aged 90 ± 1 years undertook 8 weeks of high-intensity resistance training. Initially, quadriceps strength was correlated negatively with walking time (r= -.745). Fat-free mass (r=.732) and regional muscle mass (r=.752) were correlated positively with muscle strength. Strength gains averaged 174% ±31% (mean ± SEM) in the 9 subjects who completed training. Midthigh muscle area increased 9.0%± 4.5%. Mean tandem gait speed improved 48% after training. We conclude that high-resistance weight training leads to significant gains in muscle strength, size, and functional mobility among frail residents of nursing homes up to 96 years of age. (JAMA. 1990;263:3029-3034)
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The effects of strength conditioning on skeletal muscle function and mass were determined in older men. Twelve healthy untrained volunteers (age range 60-72 yr) participated in a 12-wk strength training program (8 repetitions/set; 3 sets/day; 3 days/wk) at 80% of the one repetition maximum (1 RM) for extensors and flexors of both knee joints. They were evaluated before the program and after 6 and 12 wk of training. Weekly measurements of 1 RM showed a progressive increase in strength in extensors and flexors. By 12 wk extensor and flexor strength had increased 107.4 (P less than 0.0001) and 226.7% (P less than 0.0001), respectively. Isokinetic peak torque of extensors and flexors measured on a Cybex II dynamometer increased 10.0 and 18.5% (P less than 0.05) at 60 degrees/s and 16.7 and 14.7% (P less than 0.05) at 240 degrees/s. The torque-velocity relationship showed an upward displacement of the curve at the end of training, mainly in the slow-velocity high-torque region. Midthigh composition from computerized tomographic scans showed an increase (P less than 0.01) in total thigh area (4.8%), total muscle area (11.4%), and quadriceps area (9.3%). Biopsies of the vastus lateralis muscle revealed similar increases (P less than 0.001) in type I fiber area (33.5%) and type II fiber area (27.6%). Daily excretion of urinary 3-methyl-L-histidine increased with training (P less than 0.05) by an average 40.8%. Strength gains in older men were associated with significant muscle hypertrophy and an increase in myofibrillar protein turnover.
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Resistance training is commonly used in sports for prevention of injuries and in rehabilitation. The purpose of this study was to compare closed vs. open kinetic chain weight training of the thigh muscles and to determine which mode resulted in the greatest performance enhancement. Twenty-four healthy subjects were randomized into a barbell squat or a knee extension and hip adduction variable resistance weight machine group and performed maximal, progressive weight training twice a week for 6 weeks. All subjects were tested prior to training and at the completion of the training period. A barbell squat 3-repetition maximum, an isokinetic knee extension 1-repetition maximum, and a vertical jump test were used to monitor effects of training. Significant improvements were seen in both groups in the barbell squat 3-repetition maximum test. The closed kinetic chain group improved 23 kg (31%), which was significantly more than the 12 kg (13%) seen in the open kinetic chain group. In the vertical jump test, the closed kinetic chain group improved significantly, 5 cm (10%), while no significant changes were seen in the open kinetic chain group. A large increase of training load was observed in both subject groups; however, improvements in isotonic strength did not transfer to the isokinetic knee extension test. The results may be explained by neural adaptation, weight training mode, and specificity of tests.
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It has long been believed that resistance training is accompanied by changes within the nervous system that play an important role in the development of strength. Many elements of the nervous system exhibit the potential for adaptation in response to resistance training, including supraspinal centres, descending neural tracts, spinal circuitry and the motor end plate connections between motoneurons and muscle fibres. Yet the specific sites of adaptation along the neuraxis have seldom been identified experimentally, and much of the evidence for neural adaptations following resistance training remains indirect. As a consequence of this current lack of knowledge, there exists uncertainty regarding the manner in which resistance training impacts upon the control and execution of functional movements. We aim to demonstrate that resistance training is likely to cause adaptations to many neural elements that are involved in the control of movement, and is therefore likely to affect movement execution during a wide range of tasks. We review a small number of experiments that provide evidence that resistance training affects the way in which muscles that have been engaged during training are recruited during related movement tasks. The concepts addressed in this article represent an important new approach to research on the effects of resistance training. They are also of considerable practical importance, since most individuals perform resistance training in the expectation that it will enhance their performance in related functional tasks.
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The purpose of this study was to determine skeletal muscle cutpoints for identifying elevated physical disability risk in older adults. Subjects included 4,449 older (> or = 60 years) participants from the Third National Health and Nutrition Examination Survey during 1988-1994. Physical disability was assessed by questionnaire, and bioimpedance was used to estimate skeletal muscle, which was normalized for height. Receiver operating characteristics were used to develop the skeletal muscle cutpoints associated with a high likelihood of physical disability. Odds for physical disability were compared in subjects whose measures fell above and below these cutpoints. Skeletal muscle cutpoints of 5.76-6.75 and < or =5.75 kg/m2 were selected to denote moderate and high physical disability risk in women. The corresponding values in men were 8.51-10.75 and < or =8.50 kg/m2. Compared with women with low-risk skeletal muscle values, women with moderate- and high-risk skeletal muscle values had odds for physical disability of 1.41 (95% confidence interval (CI): 0.97, 2.04) and 3.31 (95% CI: 1.91, 5.73), respectively. The corresponding odds in men were 3.65 (95% CI: 1.92, 6.94) and 4.71 (95% CI: 2.28, 9.74). This study presents skeletal muscle cutpoints for physical disability risk in older adults. Future applications of these cutpoints include the comparison of morbidity risk in older persons with normal muscle mass and those with sarcopenia, the determination and comparison of sarcopenia prevalences, and the estimation of health-care costs attributable to sarcopenia.
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The Continuous-Scale Physical Functional Performance Test (CS-PFP) can be used to obtain valid, reliable, and sensitive measurements of physical functional capacity. This test requires a fixed laboratory space and approximately 1 hour to administer. This study was carried out in 4 steps, or substudies, to develop and validate a short, community-based version (PFP-10) that requires less space and equipment than the CS-PFP. Retrospective data (n=228) and prospective data (n=91) on men and women performing the CS-PFP or the PFP-10 are reported. A 12-week exercise program was used to examine sensitivity to change. Data analyses were done using paired t-test, Pearson correlation, intraclass correlation coefficient (ICC), and delta index (DI) procedures. The PFP-10 total score and 4 of the 5 domain scores were statistically similar (within 3%) to those of the CS-PFP. The PFP-10 upper-body strength domain score was 17% lower, but was highly correlated (ICC=.97). Community and established laboratory PFP-10 scores were similar (ICC=.85-.97). The PFP-10 also is sensitive to change (DI=.21-.54). The PFP-10 yields valid, reliable, and sensitive measurements and can be confidently substituted for the CS-PFP.
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Data regarding the effect of exercise programmes on older adults' health-related quality of life (HRQOL) and habitual physical activity are inconsistent. To determine whether a functional tasks exercise programme (enhances functional capacity) and a resistance exercise programme (increases muscle strength) have a different effect on the HRQOL and physical activity of community-dwelling older women. Ninety-eight women were randomised to a functional tasks exercise programme (function group), a resistance exercise programme (resistance group), or normal activity group (control group). Participants attended exercise classes three times a week for 12 weeks. The SF-36 Health Survey questionnaire and self-reported physical activity were obtained at baseline, directly after completion of the intervention (3 months), and 6 months later (9 months). At 3 months, no difference in mean change in HRQOL and physical activity scores was seen between the groups, except for an increased SF-36 physical functioning score for the resistance group compared with the control group (p = 0.019) and the function group (p = 0.046). Between 3 and 9 months, the self-reported physical functioning score of the function group decreased to below baseline (p = 0.026), and physical activity (p = 0.040) decreased in the resistance group compared with the function group. Exercise has a limited effect on the HRQOL and self-reported physical activity of community-living older women. Our results suggest that in these subjects HRQOL measures may be affected by ceiling effects and response shift. Studies should include performance-based measures in addition to self-report HRQOL measures, to obtain a better understanding of the effect of exercise interventions in older adults.
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The purpose of this study was to determine the efficacy of 10 weeks of resistance (RT), functional (FT), or functional plus resistance (FRT) training in older adults who modify tasks of everyday life and are at risk for subsequent disability. Thirty-two older adults (75.8 +/- 6.7 years) were tested following a control period and training. The primary outcome of the study was the number of task modifications and timed performance on eight tasks of daily life. Secondary outcomes included knee and elbow strength (extension and flexion), body composition, self-reported physical function, single-leg balance time, walking speed, and time to vacuum a carpet. The RT group performed progressive intensity training, and the FT group performed task-specific exercises 2 days per week. The FRT group performed 1 day of each training type. No changes occurred in the control period. All three training groups reduced the need to modify tasks of everyday life (RT: 21%, FRT: 26%, and FT: 28%) and improved self-rated function and time to vacuum a carpet. Individuals who performed FT either 1 or 2 days per week also reduced their timed performance (RT: 2.5% [p = 0.48], FRT: 18.5%, and FT: 23%). Strength gains were primarily found in groups that performed RT either 1 or 2 days per week (RT and FRT). No significant changes occurred in walking speed, single-leg balance, or body composition. The benefits of exercise are dependent on tasks performed during training. Exercise recommendations for low-functioning older adults should reflect task-specific exercise to prevent the onset of disability.
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To examine whether the association of inadequate or unclear allocation concealment and lack of blinding with biased estimates of intervention effects varies with the nature of the intervention or outcome. Combined analysis of data from three meta-epidemiological studies based on collections of meta-analyses. 146 meta-analyses including 1346 trials examining a wide range of interventions and outcomes. Ratios of odds ratios quantifying the degree of bias associated with inadequate or unclear allocation concealment, and lack of blinding, for trials with different types of intervention and outcome. A ratio of odds ratios <1 implies that inadequately concealed or non-blinded trials exaggerate intervention effect estimates. In trials with subjective outcomes effect estimates were exaggerated when there was inadequate or unclear allocation concealment (ratio of odds ratios 0.69 (95% CI 0.59 to 0.82)) or lack of blinding (0.75 (0.61 to 0.93)). In contrast, there was little evidence of bias in trials with objective outcomes: ratios of odds ratios 0.91 (0.80 to 1.03) for inadequate or unclear allocation concealment and 1.01 (0.92 to 1.10) for lack of blinding. There was little evidence for a difference between trials of drug and non-drug interventions. Except for trials with all cause mortality as the outcome, the magnitude of bias varied between meta-analyses. The average bias associated with defects in the conduct of randomised trials varies with the type of outcome. Systematic reviewers should routinely assess the risk of bias in the results of trials, and should report meta-analyses restricted to trials at low risk of bias either as the primary analysis or in conjunction with less restrictive analyses.
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Cross-sectional studies are likely to underestimate age-related changes in skeletal muscle strength and mass. The purpose of this longitudinal study was to assess whole muscle and single muscle fiber alterations in the same cohort of 12 older (mean age: start of study 71.1+/-5.4 yr and end of study 80+/-5.3 yr) volunteers (5 men) evaluated 8.9 yr apart. No significant changes were noted at follow-up in body weight, body mass index, and physical activity. Muscle strength, evaluated using isokinetic dynamometry, and whole muscle specific force of the knee extensors were significantly lower at follow-up. This was accompanied by a significant reduction (5.7%) in cross-sectional area of the total anterior muscle compartment of the thigh as evaluated by computed tomography. Muscle histochemistry showed no significant changes in fiber type distribution or fiber area. Experiments with chemically skinned single muscle fibers (n=411) demonstrated no change in type I fiber size but an increase in IIA fiber diameter. A trend toward an increase in maximal force in both fiber types was observed. Maximum unloaded shortening velocity did not change. In conclusion, single muscle fiber contractile function may be preserved in older humans in the presence of significant alterations at the whole muscle level. This suggests that surviving fibers compensate to partially correct muscle size deficits in an attempt to maintain optimal force-generating capacity.
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It has long been believed that resistance training is accompanied by changes within the nervous system that play an important role in the development of strength. Many elements of the nervous system exhibit the potential for adaptation in response to resistance training, including supraspinal centres, descending neural tracts, spinal circuitry and the motor end plate connections between motoneurons and muscle fibres. Yet the specific sites of adaptation along the neuraxis have seldom been identified experimentally, and much of the evidence for neural adaptations following resistance training remains indirect. As a consequence of this current lack of knowledge, there exists uncertainty regarding the manner in which resistance training impacts upon the control and execution of functional movements. We aim to demonstrate that resistance training is likely to cause adaptations to many neural elements that are involved in the control of movement, and is therefore likely to affect movement execution during a wide range of tasks. We review a small number of experiments that provide evidence that resistance training affects the way in which muscles that have been engaged during training are recruited during related movement tasks. The concepts addressed in this article represent an important new approach to research on the effects of resistance training. They are also of considerable practical importance, since most individuals perform resistance training in the expectation that it will enhance their performance in related functional tasks.
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Patient-reported outcome (PRO) questionnaires record health information directly from research participants because observers may not accurately represent the patient perspective. Patient-reported Outcomes Measurement Information System (PROMIS) is a US National Institutes of Health cooperative group charged with bringing PRO to a new level of precision and standardization across diseases by item development and use of item response theory (IRT). With IRT methods, improved items are calibrated on an underlying concept to form an item bank for a "domain" such as physical function (PF). The most informative items can be combined to construct efficient "instruments" such as 10-item or 20-item PF static forms. Each item is calibrated on the basis of the probability that a given person will respond at a given level, and the ability of the item to discriminate people from one another. Tailored forms may cover any desired level of the domain being measured. Computerized adaptive testing (CAT) selects the best items to sharpen the estimate of a person's functional ability, based on prior responses to earlier questions. PROMIS item banks have been improved with experience from several thousand items, and are calibrated on over 21,000 respondents. In areas tested to date, PROMIS PF instruments are superior or equal to Health Assessment Questionnaire and Medical Outcome Study Short Form-36 Survey legacy instruments in clarity, translatability, patient importance, reliability, and sensitivity to change. Precise measures, such as PROMIS, efficiently incorporate patient self-report of health into research, potentially reducing research cost by lowering sample size requirements. The advent of routine IRT applications has the potential to transform PRO measurement.
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OBJECTIVES: To determine the effect of a 12-week intervention to improve the ability of disabled older adults to rise from a bed and from a chair. DESIGN: Subjects were randomly allocated to either a 12-week task-specific resistance-training intervention (training in bed- and chair-rise subtasks, such as sliding forward to the edge of a chair with the addition of weights) or a control flexibility intervention. SETTING: Seven congregate housing facilities. PARTICIPANTS: Congregate housing residents age 65 and older (n = 161, mean age 82) who reported requiring assistance (such as from a person, equipment, or device) in performing at least one of the following mobility-related activities of daily living: transferring, walking, bathing, and toileting. MEASUREMENTS: At baseline, 6 weeks, and 12 weeks, subjects performed a series of bed- and chair-rise tasks where the rise task demand varied according to height of the head of the bed, chair seat height, and use of hands. Outcomes were able or unable to rise and, if able, the time taken to rise. Logistic regression for repeated measures was used to test for differences between tasks in the ability to rise. Following log transformation of rise time, a linear effects model was used to compare rise time between tasks. RESULTS: Regarding the maximum total number of bed- and chair-rise tasks that could be successfully completed, a significant training effect was seen at 12 weeks (P = .03); the training effect decreased as the total number of tasks increased. No statistically significant training effects were noted for rise ability according to individual tasks. Bed- and chair-rise time showed a significant training effect for each rise task, with analytic models suggesting a range of approximately 11% to 20% rise-time (up to 1.5 seconds) improvement in the training group over controls. Training effects were also noted in musculoskeletal capacities, particularly in trunk range of motion, strength, and balance. CONCLUSIONS: Task-specific resistance training increased the overall ability and decreased the rise time required to perform a series of bed- and chair-rise tasks. The actual rise-time improvement was clinically small but may be useful over the long term. Future studies might consider adapting this exercise program and the focus on trunk function to a frailer cohort, such as in rehabilitation settings. In these settings, the less challenging rise tasks (such as rising from an elevated chair) and the ability to perform intermediate tasks (such as hip bridging) may become important intermediate rehabilitation goals.
Article
Objectives: To determine whether a functional-task exercise program and a resistance exercise program have different effects on the ability of community-living older people to perform daily tasks. Design: A randomized, controlled, single-blind trial. Setting: Community leisure center in Utrecht, the Netherlands. Participants: Ninety-eight healthy women aged 70 and older were randomly assigned to the functional-task exercise program (function group, n=33), a resistance exercise program (resistance group, n=34), or a control group (n=31). Participants attended exercise classes three times a week for 12 weeks. Measurements: Functional task performance (Assessment of Daily Activity Performance (ADAP)), isometric knee extensor strength (IKES), handgrip strength, isometric elbow flexor strength (IEFS), and leg extension power were measured at baseline, at the end of training (at 3 months), and 6 months after the end of training (at 9 months). Results: The ADAP total score of the function group (mean change 6.8, 95% confidence interval (CI)=5.2-8.4) increased significantly more than that of the resistance group (3.2, 95% CI=1.3-5.0; P=.007) or the control group (0.3, 95% CI=-1.3-1.9; P<.001). Moreover, the ADAP total score of the resistance group did not change significantly compared with that of the control group. In contrast, IKES and IEFS increased significantly in the resistance group (12.5%, 95% CI=3.8-21.3 and 8.6%, 95% CI=3.1-14.1, respectively) compared with the function group (-2.1%, 95% CI=-5.4-1.3; P=.003 and 0.3%, 95% CI=-3.6-4.2; P=.03, respectively) and the control group (-2.7%, 95% CI=-8.6-3.2, P=.003 and 0.6%, 95% CI=-3.4-4.6; P=.04, respectively). Six months after the end of training, the increase in ADAP scores was sustained in the function group (P=.002). Conclusion: Functional-task exercises are more effective than resistance exercises at improving functional task performance in healthy elderly women and may have an important role in helping them maintain an independent lifestyle.
Article
Practitioners training the older adult may benefit from a low-cost, easy-to-administer field test of upper body power. This study evaluated validity and reliability of the seated medicine ball throw (SMBT) in older adults. Subjects (n = 33; age 72.4 ± 5.2 years) completed 6 trials of an SMBT in each of 2 testing days and 2 ball masses (1.5 and 3.0 kg). Subjects also completed 6 trials of an explosive push-up (EPU) on a force plate over 2 testing days. Validity was assessed via a Pearson Product-Moment correlation (PPM) between SMBT and EPU maximal vertical force. Reliability of the SMBT was determined using PPMs (r), Intraclass correlation (ICC, R) and Bland-Altman plots (BAPs). For validity, the association between the SMBT and the EPU revealed a PPM of r = 0.641 and r = 0.614 for the 1.5- and 3.0-kg medicine balls, respectively. Test-retest reliability of the 1.5- and 3.0-kg SMBT was r = 0.967 and r = 0.958, respectively. The ICC values of the 1.5- and 3.0-kg SMBT were R = 0.994 and 0.989, respectively. The BAPs revealed 94% of the differences between day 1 and 2 scores were within the 95% confidence interval of the mean difference. Test-retest reliability for the EPU was r = 0.944, R = 0.969. The BAPs showed 94% of the differences between day 1 and 2 scores were within the 95% confidence interval of the mean difference, for both medicine ball throws. In conclusion, for the older adult, the SMBT appears to be highly reliable test of upper body power. Its validity relative to the maximal force exerted during the EPU is modest. The SMBT is an inexpensive, safe, and repeatable measure of upper body power for the older adult.
Article
The decline of muscle strength is associated with physical disability in late adulthood. Progressive resistance strength training has been demonstrated to be an effective intervention to increase muscle strength, however, its effect on reducing physical disability in older adults is unclear. The purpose of this study is to examine the effect of progressive resistance strength training on physical disability via meta-analysis. Two reviewers independently searched for qualified trials, assessed trial quality and extracted data. Trial inclusion criteria are: (1) Randomised controlled trials, (2) Mean age of participant sample is ≥ 60 years, (3) Progressive resistance strength training as the primary intervention and (4) the trial included outcome measures of physical disability (i.e. physical function domain of the Short-Form 36). Thirty-three trials were analysed. Although the effect size is small, the intervention groups showed reduced physical disability when compared to the control groups (SMD = 0.14, 95% CI = 0.05 to 0.22). Progressive resistance strength training appears to be an effective intervention to reduce physical disability in older adults. To maximise the effect, we suggest therapists use responsive outcome measures and multi-component intervention approach.
Article
The effectiveness of resistance exercise for strength improvement among aging persons is inconsistent across investigations, and there is a lack of research synthesis for multiple strength outcomes. The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. A meta-analysis was conducted to determine the effect of resistance exercise (RE) for multiple strength outcomes in aging adults. Randomized-controlled trials and randomized or non-randomized studies among adults > or = 50 years, were included. Data were pooled using random-effect models. Outcomes for 4 common strength tests were analyzed for main effects. Heterogeneity between studies was assessed using the Cochran Q and I(2) statistics, and publication bias was evaluated through physical inspection of funnel plots as well as formal rank-correlation statistics. A linear mixed model regression was incorporated to examine differences between outcomes, as well as potential study-level predictor variables. Forty-seven studies were included, representing 1079 participants. A positive effect for each of the strength outcomes was determined however there was heterogeneity between studies. Regression revealed that higher intensity training was associated with greater improvement. Strength increases ranged from 9.8 to 31.6 kg, and percent changes were 29+/-2, 24+/-2, 33+/-3, and 25+/-2, respectively for leg press, chest press, knee extension, and lat pull. RE is effective for improving strength among older adults, particularly with higher intensity training. Findings therefore suggest that RE may be considered a viable strategy to prevent generalized muscular weakness associated with aging.
Article
The present study adopted a social cognitive framework to examine the role played by perceptions of personal efficacy in adherence to exercise behavior in sedentary middle-aged adults. Subjects were followed for 5 months in order to study the process of exercise as it moved through the adoption to maintenance stage of the behavior. Participation rates paralleled those reported elsewhere in the literature. Path analytic techniques examined the role over time of efficacy, perceptual, and behavioral indicators of frequency and intensity of exercise. Self-efficacy cognitions were shown to predict adoption of exercise behavior but previous behavior proved to be the strongest predictor of subsequent exercise participation. Results are discussed in terms of examining process versus static design models in exercise and physical activity research. Implications for future research and health promotion are suggested.
Article
Direct observation of physical function has the advantage of providing an objective, quantifiable measure of functional capabilities. We have developed the Physical Performance Test (PPT), which assesses multiple domains of physical function using observed performance of tasks that simulate activities of daily living of various degrees of difficulty. Two versions are presented: a nine-item scale that includes writing a sentence, simulated eating, turning 360 degrees, putting on and removing a jacket, lifting a book and putting it on a shelf, picking up a penny from the floor, a 50-foot walk test, and climbing stairs (scored as two items); and a seven-item scale that does not include stairs. The PPT can be completed in less than 10 minutes and requires only a few simple props. We then tested the validity of PPT using 183 subjects (mean age, 79 years) in six settings including four clinical practices (one of Parkinson's disease patients), a board-and-care home, and a senior citizens' apartment. The PPT was reliable (Cronbach's alpha = 0.87 and 0.79, interrater reliability = 0.99 and 0.93 for the nine-item and seven-item tests, respectively) and demonstrated concurrent validity with self-reported measures of physical function. Scores on the PPT for both scales were highly correlated (.50 to .80) with modified Rosow-Breslau, Instrumental and Basic Activities of Daily Living scales, and Tinetti gait score. Scores on the PPT were more moderately correlated with self-reported health status, cognitive status, and mental health (.24 to .47), and negatively with age (-.24 and -.18). Thus, the PPT also demonstrated construct validity. The PPT is a promising objective measurement of physical function, but its clinical and research value for screening, monitoring, and prediction will have to be determined.
Article
The aging of the population of the United States and a concern for the well-being of older people have hastened the emergence of measures of functional health. Among these, measures of basic activities of daily living, mobility, and instrumental activities of daily living have been particularly useful and are now widely available. Many are defined in similar terms and are built into available comprehensive instruments. Although studies of reliability and validity continue to be needed, especially of predictive validity, there is documented evidence that these measures of self-maintaining function can be reliably used in clinical evaluations as well as in program evaluations and in planning. Current scientific evidence indicates that evaluation by these measures helps to identify problems that require treatment or care. Such evaluation also produces useful information about prognosis and is important in monitoring the health and illness of elderly people.
Article
This study was designed to demonstrate the feasibility of forecasting functional health for the elderly. Using life-table techniques, we analyzed the expected remaining years of functional well-being, in terms of the activities of daily living, for noninstitutionalized elderly people living in Massachusetts in 1974. The expected years, or active life expectancy, showed a decrease, from 10 years for those aged 65 to 70 years to 2.9 for those 85 or older. Active life expectancy was shorter for the poor than for others, and women had a longer average duration of expected dependence than men. The measure of active life expectancy provides important information about health at a given population level, in terms other than death. This information can be used for actuarial purposes in planning and policy making. It is also useful in identifying high-risk populations for which preventive health care and medical care can compress morbidity during the last years of life.
Article
The objective of this study was to compare two methods of measuring physical function in subjects with a broad range of abilities and to evaluate the effects of cognitive, social, educational, and age factors on the relationship between the two methods. Multiple regression analysis was used to compare self-perceived (dependent variables) with performance measures (independent variables). Covariates included age, gender, Mini-Mental State Exam score, education, living status, and depression score. Five community-dwelling and two nursing home sites. 417 community-dwelling subjects and 200 nursing home residents aged 62-98 years. Self-perceived physical function was assessed with the physical dimension summary score of the Sickness Impact Profile, which comprises three subscales: ambulation, mobility, and body care and movement. Physical performance was evaluated by self-selected gait speed, chair-stand time, maximal grip strength, and a balance score. Nursing home residents and community-dwellers were significantly different (P < .0001) in all variables except age and gender. Self-perceived and performance-based measures were moderately correlated, with a range from r = -.194 to r = -.625 (P < .05). Gait speed was the strongest independent predictor of self-perceived physical function in both groups. Symptoms of depression were also an independent predictor of self-perceived function in nursing home residents; subjects who had such symptoms report more self-perceived dysfunction than would be predicted based on performance tests. Self-selected gait speed is a global indicator of self-perceived physical function over a broad range of abilities. External determinants (depressive symptoms, cognitive function, marital status, etc.) affect self-perceived function in both groups, but gait speed is the greatest single predictor of self-perceived function. In nursing home residents depressive symptomatology is related to self-perceived.
Article
To determine the prevalence of impaired vision, peripheral sensation, lower limb muscle strength, reaction time, and balance in a large community-dwelling population of women aged 65 years and over, and to determine whether impaired performances in these tests are associated with falls. One-year prospective study. Conducted as part of the Randwick Falls and Fractures Study, in Sydney, Australia. Four hundred fourteen women aged 65 to 99 years (mean age 73.7 years, SD = 6.3) were randomly selected from the community; 341 of these women were included in the 1-year prospective study. The prevalence of impairment in all tests increased with age. In the year following assessment, 207 subjects (60.7%) experienced no falls, 63 subjects (18.5%) fell one time only, and 71 subjects (20.8%) fell on two or more occasions. After controlling for age, multiple falling was associated with low contrast visual acuity and contrast sensitivity, poor vibration sense and proprioception, reduced lower limb strength, slow reaction time, and impaired balance, as indicated by four sway tests and two clinical stability measures. Discriminant function analysis identified visual contrast sensitivity, proprioception in the lower limbs, quadriceps strength, reaction time, and sway on a compliant (foam rubber) surface with the eyes open as the variables that significantly discriminated between subjects who experienced multiple falls and subjects who experienced no falls or one fall only (Wilks' lambda = 0.73 (P < 0.001), canonical correlation = 0.52). This procedure correctly classified 75% of subjects into multiple faller or nonmultiple faller groups. These findings support previous results conducted in retirement village and institutional setting and indicate that the test procedure aids in the identification of older community-dwelling women at risk of falls.
Article
We investigated cross-sectional as well as longitudinal associations between performance-based measures of functional status and self-reported measures of functional status. In the Zutphen Elderly Study, 494 men, born between 1900 and 1920, were examined in 1990, of whom 303 were reexamined in 1993. A performance score was constructed on the basis of four tests: standing balance, walking speed, ability to rise from a chair, and external shoulder rotation. Self-reported functional status was based on disabilities in basic activities of daily living, mobility, and instrumental activities of daily living. A hierarchic disability scale was constructed. Cross-sectional correlation coefficients between the performance score and the disability scale were 0.22 in 1990 and 0.39 in 1993. Correlations were highest between the test for walking speed and self-reported mobility and IADL, and between the test for external shoulder rotation and self-reported disabilities in basic activities of daily living. The correlation between the 3-year changes in performance and in self-report was 0.20 (p < 0.001). Both performance and self-report at baseline predicted performance and self-report after 3 years. Performance-based measures of functional status are cross-sectionally and longitudinally associated at modest levels with self-reported disabilities. Performance measures and self-reported measures are complementary, but do not measure the same construct.
Article
Within the field of aging, the conceptualization and measurement of functioning has been dominated by the disability model. In this paper, one limitation of that model is described by calling attention to a distinction between three "tenses" of functioning. Inadequate attention has been paid to the distinction between the capacity to function in the abstract (hypothetical tense) and actual performance in daily life (enacted tense). Failure to attend to this distinction has obscured considerable discordance between what people say they are able to do in standard functional disability assessments, and what they actually do at home. To illustrate this point, data from the MacArthur Studies of Successful Aging comparing the hypothetical to the enacted tenses are presented. These data show a consistent pattern of discordance between these two tenses.
Article
Skeletal muscle loss or sarcopenia in aging has been suggested in cross-sectional studies but has not been shown in elderly subjects using appropriate measurement techniques combined with a longitudinal study design. Longitudinal skeletal muscle mass changes after age 60 yr were investigated in independently living, healthy men (n = 24) and women (n = 54; mean age 73 yr) with a mean +/- SD follow-up time of 4.7 +/- 2.3 yr. Measurements included regional skeletal muscle mass, four additional lean components (fat-free body mass, body cell mass, total body water, and bone mineral), and total body fat. Total appendicular skeletal muscle (TSM) mass decreased in men (-0.8 +/- 1.2 kg, P = 0.002), consisting of leg skeletal muscle (LSM) loss (-0.7 +/- 0.8 kg, P = 0.001) and a trend toward loss of arm skeletal muscle (ASM; -0.2 +/- 0.4 kg, P = 0.06). In women, TSM mass decreased (-0.4 +/- 1.2 kg, P = 0.006) and consisted of LSM loss (-0.3 +/- 0.8 kg, P = 0.005) and a tendency for a loss of ASM (-0.1 +/- 0.6 kg, P = 0.20). Multiple regression modeling indicates greater rates of LSM loss in men. Body weight in men at follow-up did not change significantly (-0.5 +/- 3.0 kg, P = 0.44) and fat mass increased (+1.2 +/- 2.4 kg, P = 0.03). Body weight and fat mass in women were nonsignificantly reduced (-0.8 +/- 3.9 kg, P = 0.15 and -0.8 +/- 3.5 kg, P = 0.12). These observations suggest that sarcopenia is a progressive process, particularly in elderly men, and occurs even in healthy independently living older adults who may not manifest weight loss.
Article
Peak power declines more precipitously than strength with advancing age and is a reliable measure of impairment and a strong predictor of functional performance. We tested the hypothesis that a high-velocity resistance-training program (HI) would increase muscle power more than a traditional low-velocity resistance-training program (LO). Randomized controlled trial. University-based human physiology laboratory. Thirty women with self-reported dis-ability (aged 73 + 1, body mass index 30.1 + 1.1 kg/mn). We conducted a randomized trial comparing changes in skeletal muscle power and strength after 16 weeks of HI or LO. Training was performed three times per week, and subjects completed three sets (8-10 repetitions) of leg press (LP) and knee extension (KE) exercises at 70% of the one-repetition maximum (IRM). One-repetition maximum (1 RM) and peak power for KE and LP. LP and KE relative training force and total work were similar between groups (P > .05). However, HI generated significantly higher power during training sessions than LO for LP (3.7-fold greater, P < .001) and KE (2.1-fold greater, P < .001). Although LP and KE 1RM muscle strength increased similarly in both groups asa result of the training (P < .001), LP peak power increased significantly more in HI than in LO (267 W vs 139 W, P < .001). Furthermore, HI resulted in a significantly greater improvement in LP power at 40%, 50%, 60%,70%, 80%, and 90% of the 1 RM than did LO (P <.05). HI improved 1RM strength similarly and was more effective in improving peak power than was traditional LO in older women. Improvements in lower extremity peak power may exert a greater influence on age-associated reductions in physical functioning than other exercise interventions.
Article
To evaluate a dynamic form of weighted vest exercise suitable for home use and designed to enhance muscle power, balance, and mobility. A single-blind, randomized, controlled trial. Outpatient exercise research facility situated within an academic long-term care center. Twenty-one community-dwelling women aged 70 and older with a Short Physical Performance Battery (SPPB) score between 4 and 10 (out of 12). Subjects were randomized into a progressive resistance-training program using weighted vests for resistance with exercises designed to be specific to mobility tasks and have a component performed at the fastest possible velocity (Increased Velocity Exercise Specific to Task (InVEST), n=11) or a control exercise group (control, n=10), which performed slow-velocity, low-resistance exercise. Both groups exercised three times a week for 12 weeks. Changes in muscle power, balance, and physical performance were compared. In comparison to control group, InVEST group manifested significant improvements (P<.05) in leg power across measurements obtained at 75% to 90% of the one-repetition maximum. Both groups demonstrated significant improvements in chair stand and SPPB score from baseline, and the InVEST group showed significant improvements in gait speed and chair stand from baseline (P<.05). InVEST produced significantly greater changes in chair stand time than control (P<.05). InVEST training appears be an effective means of enhancing leg power and chair rise in this population and is worthy of further investigation as a means of enhancing balance and mobility.
Article
To estimate the magnitude of small meaningful and substantial individual change in physical performance measures and evaluate their responsiveness. Secondary data analyses using distribution- and anchor-based methods to determine meaningful change. Secondary analysis of data from an observational study and clinical trials of community-dwelling older people and subacute stroke survivors. Older adults with mobility disabilities in a strength training trial (n=100), subacute stroke survivors in an intervention trial (n=100), and a prospective cohort of community-dwelling older people (n=492). Gait speed, Short Physical Performance Battery (SPPB), 6-minute-walk distance (6MWD), and self-reported mobility. Most small meaningful change estimates ranged from 0.04 to 0.06 m/s for gait speed, 0.27 to 0.55 points for SPPB, and 19 to 22 m for 6MWD. Most substantial change estimates ranged from 0.08 to 0.14 m/s for gait speed, 0.99 to 1.34 points for SPPB, and 47 to 49 m for 6MWD. Based on responsiveness indices, per-group sample sizes for clinical trials ranged from 13 to 42 for substantial change and 71 to 161 for small meaningful change. Best initial estimates of small meaningful change are near 0.05 m/s for gait speed, 0.5 points for SPPB, and 20 m for 6MWD and of substantial change are near 0.10 m/s for gait speed, 1.0 point for SPPB, and 50 m for 6MWD. For clinical use, substantial change in these measures and small change in gait speed and 6MWD, but not SPPB, are detectable. For research use, these measures yield feasible sample sizes for detecting meaningful change.
Article
There is continued uncertainty regarding the strength of association between performance-based and self-report measures of physical functioning, and of their relationship to self-efficacy and health-related quality of life (HRQoL). This study assessed the inter-relationships between such measures, and the predictors of 'physical' aspects of HRQoL in frail older patients. We used statistical models to determine the predictors of 'physical' HRQoL, according to the physical component summary score and the physical functioning domain of the 36-item short form (SF-36) questionnaire. Patients were recruited from hospitals in Australia and New Zealand and followed up in their homes. Two hundred and forty-three frail older patients. Physical functioning was assessed using three performance-based measures (Timed Up and Go Test, gait speed and the Berg Balance Scale) and five self-report measures, including the modified falls self-efficacy scale, at three and six months after registration. A moderate association (r = 0.48-0.55) was found between each of the performance-based and self-report measures, including the SF-36 physical component summary score. Multiple linear regression analyses showed that the performance-based measures and falls self-efficacy predicted 33% of the SF-36 physical component summary score. Falls self-efficacy was the single highest predictor of both the SF-36 physical component summary score and SF-36 physical functioning domain. A curvilinear relationship was found between the SF-36 physical functioning domain and two variables: falls self-efficacy and the Berg Balance Scale. Although performance-based and self-report measures provide complementary but distinct measures of physical function, psychosocial factors such as self-efficacy have a strong influence on the HRQoL of frail older people.
Article
This study evaluated to what extent dual-energy X-ray absorptiometry (DXA) and two types of bioimpedance analysis (BIA) yield similar results for body fat mass (FM) in men and women with different levels of obesity and physical activity (PA). The study population consisted of 37-81-year-old Finnish people (82 men and 86 women). FM% was estimated using DXA (GE Lunar Prodigy) and two BIA devices (InBody (720) and Tanita BC 418 MA). Subjects were divided into normal, overweight, and obese groups on the basis of clinical cutoff points of BMI, and into low PA (LPA) and high PA (HPA) groups. Agreement between the devices was calculated by using the Bland-Altman analysis. Compared to DXA, both BIA devices provided on average 2-6% lower values for FM% in normal BMI men, in women in all BMI categories, and in both genders in both HPA and LPA groups. In obese men, the differences were smaller. The two BIA devices provided similar means for groups. Differences between the two BIA devices with increasing FM% were a result of the InBody (720) not including age in their algorithm for estimating body composition. BIA methods provided systematically lower values for FM than DXA. However, the differences depend on gender and body weight status pointing out the importance of considering these when identifying people with excess FM.
Measuring higher level physical function in wellfunctioning older adults: expanding familiar approaches in the health ABC study
Health ABC Study Group, 2001. Measuring higher level physical function in wellfunctioning older adults: expanding familiar approaches in the health ABC study. J. Gerontol. A Biol. Sci. Med. Sci. 56 (10), M644-M649.
Quantitation of resistance training using the session rating of perceived exertion method
  • T W Sweet
  • C Foster
  • M R Mcguigan
  • G Brice
Sweet, T.W., Foster, C., McGuigan, M.R., Brice, G., 2004. Quantitation of resistance training using the session rating of perceived exertion method. J. Strength Cond. Res./National Strength & Conditioning Association 18 (4), 796-802 (doi:14153 [pii]).
Office of disease prevention and health promotion
U.S. Department of Health and Human Services, 2015. Office of disease prevention and health promotion. Healthy People 2020 (Washington, DC. Retrieved from http:// www.healthypeople.gov/2020/topics-objectives/topic/older-adults/objectives).
The Next four Decades, the Older Population in the United States
  • G K Vincent
  • V A Velkoff
Vincent, G.K., Velkoff, V.A., 2010. The Next four Decades, the Older Population in the United States: 2010 to 2050. (U.S. Census Bureau) (Washington, DC).
The older population
  • C Werner
Werner, C., 2010. The older population. (Retrieved from http://www.census.gov/prod/ cen2010/briefs/c2010br-09.pdf).