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Effects of dance intervention on frailty among older adults
Abstract
Objective:
The aims of this study were to examine the effects of dance intervention on frailty in pre-frail and frail older persons.
Design:
This is a quasi-experimental, two-group trial.
Setting:
Older adults living nursing home.
Participants:
Participants aged ≥ 60 years with low physical activity (mean age was 81.8 years; 71 % were female) (N = 66).
Methods:
Participants allocated to the dance group attended 40 min dance sessions in a nursing home, three times a week for 12-weeks. Participants allocated to the control group maintained their normal daily activities. Assessments were conducted at baseline, 6 weeks, and 12 weeks by researchers blinded to the allocation. Frailty was measured based on Fried criteria. Estimates of frailty between groups over time were calculated using the generalized estimating equations (GEE) and mixed effects models.
Results:
The prevalence of frailty decreased over time in the dance group compared to the control group (P = 0.002). The mean frailty scores decreased 0.69 at 6 weeks and 1.06 at 12 weeks. Compared to the control group, the prevalence of slowness (p = 0.002), weakness (p = 0.005), and low physical activity (p < 0.001) significantly decreased in the dance group.
Conclusions:
Dance intervention may reduce the presence and severity of frailty in older adults. Slowness and low physical activity improve following 12 weeks of dance intervention.
... Dance can improve psychological aspects that can improve practice compliance so that the training objectives can be achieved. Dance has a multicomponent intervention that integrates physical functions, cognitive and social elements, which provides stimulation of balance, coordination, flexibility, and cardiorespiratory (Payne, 2003;Meng et al., 2020). Modified Javanese traditional dance is a dance based on Javanese dance movements with an intensity that is adjusted to the therapeutic target. ...
... One of the variables assessed was walking speed. there was a significant increase in the walking speed of the elderly after the intervention with p = 0.0002 (Meng et al., 2020). ...
Sarcopenia is one of the most common phenomena in the elderly. dancing is an alternative to physical therapy to overcome this. The purpose of this study was to see whether there was an effect of giving modified Javanese traditional dance on hand grip strength and walking speed in the elderly. Eleven participants alocated in one group, took part in this study, completed a twelve-week (36 sessions) modified Javanese traditional dance, 35 minutes each session, with moderate aerobic intensity. The outcome measures were hand grip strength as measured by hand dynamometer and walking speed as measured by ten meters walking test (10MWT). Measured before and after 12 weeks intervention. There was a statistically significant increase in hand grip strength (p=0,003) and walking speed (p=0,01) after 12 weeks of giving modified Javanese traditional dance. The results of the calculation of the mean effect size show large results for both hand grip strength (Cohen's D = 0.94) and walking speed (Cohen’s D = 0,88). Thus, the regular twelve-weeks of modified Javanese traditional dance can increase hand grip strength and walking speed ini healthy older adult.
... The modified traditional Javanese dance is an alternative aerobic exercise, which contains elements of a strong Indonesian tradition, so that it can increase the interest of the elderly for participating in exercise regularly. Dance is also reported more fun for the elderly, improves psychological aspects, integrates physical functions, cognitive and social elements, which provides stimulation of balance, coordination, flexibility, and cardiorespiratory function (Meng et al., 2020;Payne, 2003). ...
The aim of this study is to determine changes of cardiorespiratory fitness in elderly after giving modified Javanese traditional dance for 12 weeks. This study is a experimental study with pre and post-test randomized control group design. The subjects were the elderly woman over 60 years old in the Hargodedali nursing home, Surabaya, Indonesia. Subjects in the treatment group participated in the modified Javanese traditional dance for 12 weeks, 3 times per week with a duration of 35 minutes per session. The control group subjects did not attend the dance session. Six minutes walking test (6MWT) and VO2 max were measured before before treatment and 12 weeks after treatment was finished. There was a statistically significant increase in VO2 max value of the treatment group (p = 0.01). While in the control group there was a decrease in vo2 max, but not significant (p = 0.221). The effect size of the treatment group is 0.93. There is a significant difference in delta vo2max between the treatment and control groups (p=0.004). The effect size after treatment between groups is 1.4. The adherence of subject in this study is 95.3%. Thus, modified traditional Javanese dance increase VO2 max for elderly.
... In another intervention, after applying a dance programme for twelve weeks in older adults, the mean frailty scores decreased by 0.69 at six weeks and 1.06 at twelve weeks. In addition, slowness and weakness gradually decreased in the group dance compared to the control group [44]. In this way, frailty is reduced, and movement agility, essential for daily tasks and executive function, increases. ...
(1) Background: The regular practice of dancing benefits the physical condition, improving quality of life and minimising the adverse effects of ageing. Therefore, this review aims to evaluate the impact of dance programmes by quantifying different physical parameters of the lower body in older adults. (2) Methods: A systematic qualitative review in the English language (PubMed, Scopus, OvidSP, Cochrane and PEDro database) until mid-2020 considering the PRISMA guidelines and the PEDro quality criteria considering the following parameters of gait: stride length and width, speed. Physical parameters: flexion and dorsiflexion joint, muscle strength and range of motion were carried out. (3) Results: 9 studies with a population of 544 subjects from 5 continents and 6 types of dances were taken into account. The improvement of some parameters over others depended on the type of dance and the movements generated, having moderate positive effects on strength, agility, mobility and balance. (4) Conclusions: there is a general improvement in the functional capacity of the elderly through the practice of ballroom dancing, with specific improvement of each parameter depending on the type of dance.
Background
Physical frailty and cognitive impairment are prevalent globally, particularly in China, which is experiencing an unprecedented aging of its large population.Objectives
Examine the association between physical frailty and the level and rate of change of cognitive function, globally and by domain, among community-dwelling Chinese older adults, and quantify the mediation effects from activities of daily living (ADL) limitations and depressive symptoms.DesignLongitudinal.SettingChina Health and Retirement Longitudinal Study (2011–2018).Participants5,431 eligible adults aged ≥ 60 years with valid information on physical frailty.MeasurementsPhysical frailty, cognitive function, ADL limitations, and depressive symptoms were respectively assessed by frailty phenotypes, the Telephone Interview for Cognitive Status (episodic memory, executive function, and orientation), performance in six daily tasks, and the eight-item Center for Epidemiological Studies Depression Scale. Latent growth curve models were used to address the objectives.ResultsCompared to adults who were non-frail, those who were pre-frail (β = −0.06) and frail (β = −0.13) reported significantly worse global cognitive function and episodic memory (pre-frail: β = −0.05; frail: β = −0.14), executive function (pre-frail: β = −0.04, frail: β = −0.10), and orientation (pre-frail: β = −0.06; frail: β = −0.07) at baseline; those who were frail were more likely to experience faster decline in global cognitive function (β = 0.12) and episodic memory (β = 0.08). ADL limitations (β = −0.07) and depressive symptoms (β = −0.14) significantly mediated the association between physical frailty and the level of cognitive function, but not its rate of decline.Conclusions
Intervention strategies that help maintain cognitive function may benefit from early screening and assessment of physical frailty. For pre-frail and frail older Chinese adults, programs designed to help improve or maintain activities of daily living and reduce number of depressive symptoms may contribute to better cognitive performance.
Background
Depression and anxiety are two common mental disorders in older people. Studies have reported that depression is strongly associate with frailty, but few studies focus on anxiety disorder and comorbid two mental disorders. In this study, we aimed to identify associations between comorbid depressive and anxiety symptoms with frailty in older adults.
Methods
4,103 community-dwellings adults aged 60 and older from the baseline of the West China Health and Aging Trend (WCHAT) study were included. Frailty was measured by the Fried frailty phenotype criteria. The 15-item Geriatric Depression Scale (GDS-15) and 7-item Generalized Anxiety Disorder Scale (GAD-7) assessed for depressive and anxiety symptoms with a cut-off value of 5. Multinomial logistic regression was used to explore the association between different depressive and anxiety status and frailty.
Results
8.7% of old adults suffered comorbid depressive and anxiety symptoms in the present study. The prevalence of pre-frailty and frailty was 47.0% and 6.7%, respectively. After adjusting for covariates, individuals with comorbid depressive and anxiety symptoms had higher odds of being pre-frail (OR=1.86, 95% CI=1.41, 2.45) and frail (OR=7.03, 95% CI=4.48, 11.05) compared to those without depressive and anxiety symptoms. In the comorbidity group, those with severe comorbid symptoms also had higher prevalence of pre-frailty and frailty.
Limitations
Depressive and anxiety symptom assessments were based on screening tools.
Conclusions
This study suggested comorbid depressive and anxiety symptoms were associated with frailty among Chinese older adults. Further efforts to screen and target depression and anxiety comorbidity may be warranted.
Background:
Given the high costs associated with the care of those with Alzheimer's disease (AD) dementia, we examined the likely impact of a reduction in the rate of cognitive decline upon cost outcomes associated with this disease.
Methods:
Using the group of patients with mild AD dementia from the GERAS study, generalised linear modelling (GLM) was used to explore the relationship between change in cognition as measured using the Mini-Mental State Examination (MMSE) and UK overall costs (health care and social care costs, and total societal costs) associated with AD dementia.
Results:
A total of 200 patients with mild AD dementia were identified. Least squares mean (LSM) ± standard error (SE) reduction in MMSE score was 3.6 ± 0.4 points over 18 months. Using GLM it was possible to calculate that this worsening in cognition was associated with an 8.7% increase in total societal costs, equating to an increase of approximately £2200 per patient over an 18-month period. If the rate of decline in cognition was reduced by 30% or 50%, the associated savings in total societal costs over 18 months would be approximately £670 and £1100, respectively, of which only £110 and £180, respectively, could be attributed to a saving of health care costs.
Conclusion:
This study demonstrates that there are potential savings to be made in the care of patients with AD dementia through reducing the rate of cognitive decline. A reduction in wider societal costs is likely to be the main contributor to these potential savings, and need to be further evaluated when intervention costs and cost offsets can be measured.
Background:
Cognitive impairment is characterized by problems in thinking, memory, language, and judgment that are greater than cognitive changes in normal aging. Considering the unprecedented growth of the older adult population and the projected increase in the prevalence of cognitive impairment, it is imperative to find effective strategies to improve or maintain cognitive function in older adults. The objective of this review is to summarize the effects of dance versus any other control group on cognitive function, physical function, adverse events, and quality of life in older adults.
Method:
We will search the following databases MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) to identify the randomized controlled trials (RCTs) evaluating the effects of dance on cognitive function among older adults. Also, we will search http://apps.who.int/trialsearch , clinicaltrials.gov and conference abstracts to identify ongoing and unpublished studies. There will be no restrictions on language, date, or journal of publication. Reviewers will independently and in duplicate screen for eligible studies using pre-defined criteria. Data extraction from eligible studies will be performed independently and in duplicate. The Cochrane risk of bias tool will be used to assess the risk of bias of studies. Our primary outcome of interest is cognitive function, more specifically the executive function domain. We will include other domains as well such as processing speed and reaction time. Secondary outcomes of interest are physical function. The secondary outcomes also include adverse events including falls and quality of life. We will use Review Manager (RevMan 5.3) to pool the effect of dance for each outcome where possible. Results will be presented as relative risks along with 95% confidence intervals for dichotomous outcomes and as mean differences, or standardized mean differences along with 95% confidence intervals, for continuous outcomes. We will assess the certainty of the evidence using the GRADE approach and present findings in a Summary of Findings table.
Discussion:
This systematic review, to our best knowledge the first-ever, will synthesize the available evidence on the effects of dance on cognitive function among older people.
Systematic review registration:
PROSPERO CRD42017057138.
Background:
Many studies have highlighted the positive effects of dance in people with neurodegenerative diseases.
Objectives:
To explore the effects of International Ballroom Dancing on cognitive function in elders with amnestic mild cognitive impairment (aMCI).
Methods:
One-hundred twenty-nine elderly patients with aMCI diagnosis (mean age 66.8 ± 10.1 years) were randomly assigned into 2 groups: intervention group (IG, n = 66) and control group (CG, n = 63). The IG exercised systematically for 10 months, and both groups were submitted to extensive neuropsychological assessment prior and after the 10-month period.
Results:
According to the independent sample t test at the follow-up, significant differences between groups were found in benefit of the IG while the CG showed worse performance in the majority of neuropsychological tests. According to the Student t test, better performance is detected in IG in contrast with CG, which had worse performance almost in all scales.
Conclusion:
Dance may be an important nonpharmacological approach that can benefit cognitive functions.
Fall prevention exercise programs have been reported to be effective in minimizing falls in older adults. However, adherence and attrition in exercise programs remain a challenge. This study reviewed the evidence on how levels of adherence and attrition in fall prevention exercise programs may affect magnitude of effect of fall risk reduction in community-dwelling older adults. A systematic review and meta-analysis of randomized controlled trials on fall prevention exercise programs for community-dwelling older adults aged 65+ years published between 2005 and 2016 from six databases were undertaken. Twenty articles met inclusion criteria. Results showed that program adherence >80% may result in greater fall risk reduction compared to lower levels of adherence. A possible inverse relationship exists between attrition levels and effect sizes of fall prevention exercise programs. Future studies should properly report falls/fallers and a consensus on a standardized measure for reporting adherence to fall prevention exercise programs is recommended.
From animal research, it is known that combining physical activity with sensory enrichment has stronger and longer-lasting effects on the brain than either treatment alone. For humans dancing has been suggested to be analogous to such combined training. Here we assessed whether a newly designed dance training program that stresses the constant learning of new movement patterns is superior in terms of neuroplasticity to conventional fitness activities with repetitive exercises and whether extending the training duration has additional benefits.
Twenty-two healthy seniors (63-80 y) who had been randomly assigned to either a dance or a sport group completed the entire 18-month study. MRI, BDNF and neuropsychological tests were performed at baseline and after 6 and 18 months of intervention.
After 6 months, we found a significant increase in gray matter volume in the left precentral gyrus in the dancers compared to controls. This neuroplasticity effect may have been mediated by the increased BDNF plasma levels observed in the dancers. Regarding cognitive measures, both groups showed significant improvements in attention after 6 months and in verbal memory after 18 months. In addition, volume increases in the parahippocampal region were observed in the dancers after 18 months.
The results of our study suggest that participating in a long-term dance program that requires constant cognitive and motor learning is superior to engaging in repetitive physical exercises in inducing neuroplasticity in the brains of seniors. Therefore, dance is highly promising in its potential to counteract age-related gray matter decline.
Background
The prevention of falls among older people is a major public health challenge. Exercises that challenge balance are recognized as an efficacious fall prevention strategy. Given that small-scale trials have indicated that diverse dance styles can improve balance and gait of older adults, two of the strongest risk factors for falls in older people, this study aimed to determine whether social dance is effective in i) reducing the number of falls and ii) improving physical and cognitive fall-related risk factors.
Methods and Findings
A parallel two-arm cluster randomized controlled trial was undertaken in 23 self-care retirement villages (clusters) around Sydney, Australia. Eligible villages had to have an appropriate hall for dancing, house at least 60 residents, and not be currently offering dance as a village activity. Retirement villages were randomised using a computer generated randomisation method, constrained using minimisation. Eligible participants had to be a resident of the village, be able to walk at least 50 m, and agree to undergo physical and cognitive testing without cognitive impairment. Residents of intervention villages (12 clusters) were offered twice weekly one-hour social dancing classes (folk or ballroom dancing) over 12 mo (80 h in total). Programs were standardized across villages and were delivered by eight dance teachers. Participants in the control villages (11 clusters) were advised to continue with their regular activities. Main outcomes: falls during the 12 mo trial and Trail Making Tests. Secondary outcomes: The Physiological Performance Assessment (i.e., postural sway, proprioception, reaction time, leg strength) and the Short Physical Performance Battery; health-related physical and mental quality of life from the Short-Form 12 (SF-12) Survey. Data on falls were obtained from 522 of 530 (98%) randomised participants (mean age 78 y, 85% women) and 424 (80%) attended the 12-mo reassessment, which was lower among folk dance participants (71%) than ballroom dancing (82%) or control participants (82%, p = 0.04). Mean attendance at dance classes was 51%. During the period, 444 falls were recorded; there was no significant difference in fall rates between the control group (0.80 per person-year) and the dance group (1.03 per person-year). Using negative binomial regression with robust standard errors the adjusted Incidence Rate Ratio (IRR) was 1.19 (95% CI: 95% CI = 0.83, 1.71). In exploratory post hoc subgroup analysis, the rate of falls was higher among dance participants with a history of multiple falls (IRR = 2.02, 95% CI: 1.15, 3.54, p = 0.23 for interaction) and with the folk dance intervention (IRR = 1.68, 95% CI: 1.03, 2.73). There were no significant between-group differences in executive function test (TMT-B = 2.8 s, 95% CI: −6.2, 11.8). Intention to treat (ITT) analysis revealed no between-group differences at 12-mo follow-up in the secondary outcome measures, with the exception of postural sway, favouring the control group. Exploratory post hoc analysis by study completers and style indicated that ballroom dancing participants apparently improved their gait speed by 0.07 m/s relative to control participants (95% CI: 0.00, 0.14, p = 0.05). Study limitations included allocation to style based on logistical considerations rather than at random; insufficient power to detect differential impacts of different dance styles and smaller overall effects; variation of measurement conditions across villages; and no assessment of more complex balance tasks, which may be more sensitive to changes brought about by dancing.
Conclusions
Social dancing did not prevent falls or their associated risk factors among these retirement villages' residents. Modified dance programmes that contain "training elements" to better approximate structured exercise programs, targeted at low and high-risk participants, warrant investigation.
Trial Registration
The Australian New Zealand Clinical Trials Registry ACTRN12612000889853
Background:
Exercise, nutrition, and psychological interventions may all have positive impacts on frailty and sarcopenia. However, it is not known whether an integrated care programme with all three components can be beneficial and the intensity of such programme is also not certain. In this study, we aim to determine the effectiveness of two levels of integrated care on frailty and sarcopenia.
Methods:
A randomized control trial was conducted at two community hospitals in Taiwan. Older adults (65-79 years of age, N = 289) who scored ≥1 on the Cardiovascular Health Study Phenotypic Classification of Frailty (CHS_PCF) were enrolled in the trial. Low-level care (LLC) participants received a 2 h education course on frailty, sarcopenia, coping strategy, nutrition, and demonstration of study exercise programme. Educational multimedia material was distributed as reference for home practice with bi-monthly telephone follow-ups on adherences. High-level care (HLC) participants, in addition to LLC instructions, received six sessions of on-site problem solving therapy and 48 exercise sessions within 6 months. Brief nutrition consultation was also provided during the exercise sessions. Primary outcome was improvement of the CHS_PCF by at least one category (from pre-frail to robust, or from frail to pre-frail or robust) from baseline. Secondary outcomes included changes of individual frailty, and sarcopenia indicators. Assessments were done at 3, 6, and 12 months by trained research assistants blinded to randomization status. Intention-to-treat analysis was applied.
Results:
Mean age was 71.6 ± 4.3 years, with 53% females. For the entire cohort, improvement of primary outcome was 35% at 3 months, increased to 40% at 6 months, and remained stable at 39% at 12 months. Improvement rates were similar in both groups. Compared with the LLC group, HLC participants had greater improvements in the following indices: energy expenditure of walking, 5 m walking time, dominant hand grip strength, timed-up-and-go-test, and one-leg-stand time - mainly at 6 and 12 month assessments.
Conclusions:
The 6 month integrated care improved frailty and sarcopenia status among community-dwelling elders, with high-intensity training yielding greater improvements. Low-level care could be promoted as a basic intervention, while HLC could be reserved for those at high risk and with high motivation.
This research investigates the efficacy of dance intervention of moderate length (10-weeks, 45min/week) on a sample of old-old living in a residential care setting. The study focused on the effect of the intervention on aspects of cognitive functioning (short-term memory, executive functioning). Also, changes in general self-efficacy and life satisfaction were investigated. Twenty-four older adults (mean age M=80.8), with no cognitive impairments, participated in the study. Participants were randomly assigned to two programs: the experimental group attended the dance intervention, while the active control group was involved in an alternative (non-dance) program. A pretest, posttest and follow-up measurement was conducted. A 2x3 mixed design ANOVA revealed benefit in short-term memory and executive functioning for the trained group, but not for the active control, and this benefit was maintained at the five months follow-up. These results suggest that training procedures, based on dance, could improve cognitive functioning in old-old.
Background:
Frailty can be an important clinical target to reduce rates of disability.
Objective:
To ascertain if a supervised-facility multicomponent exercise program (MEP) when performed by frail older persons can reverse frailty and improve functionality; cognitive, emotional, and social networking; as well as biological biomarkers of frailty, when compared with a controlled population that received no training.
Design:
This is an interventional, controlled, simple randomized study. Researchers responsible for data gathering were blinded for this study.
Setting:
Participants from 2 primary rural care centers (Sollana and Carcaixent) of the same health department in Spain were enrolled in the study between December 2013 and September 2014.
Patients:
We randomized a volunteer sample of 100 men and women who were sedentary, with a gait speed lower than 0.8 meters per second and frail (met at least 3 of the frailty phenotype criteria).
Interventions:
Participants were randomized to a supervised-facility MEP (n = 51, age = 79.5, SD 3.9) that included proprioception, aerobic, strength, and stretching exercises for 65 minutes, 5 days per week, 24 weeks, or to a control group (n = 49, age = 80.3, SD 3.7). The intervention was performed by 8 experienced physiotherapists or nurses. Protein-calorie and vitamin D supplementation were controlled in both groups.
Results:
Our MEP reverses frailty (number needed to treat to recover robustness in subjects with attendance to ≥50% of the training sessions was 3.2) and improves functional measurements: Barthel (trained group 91.6 SD 8.0 vs 82.0 SD 11.0 control group), Lawton and Brody (trained group 6.9 SD 0.9 vs 5.7 SD 2.0 control group), Tinetti (trained group 24.5 SD 4.4 vs 21.7 SD 4.5 control group), Short Physical Performance Battery (trained group 9.5 SD 1.8 vs 7.1 SD 2.8 control group), and physical performance test (trained group 23.5 SD 5.9 vs 16.5 SD 5.1 control group) as well as cognitive, emotional, and social networking determinations: Mini-Mental State Examination (trained group 28.9 SD 3.9 vs 25.9 SD 7.3 control group), geriatric depression scale from Yesavage (trained group 2.3 SD 2.2 vs 3.2 SD 2.0 control group), EuroQol quality-of-life scale (trained group 8.2 SD 1.6 vs 7.6 SD 1.3 control group), and Duke social support (trained group 48.5 SD 9.3 vs 41.2 SD 8.5 control group). This program is unique in that it leads to a decrease in the number of visits to primary care physician (trained group 1.3 SD 1.4 vs 2.4 SD 2.9 control group) and to a significant improvement in frailty biomarkers.
Conclusions:
We have designed a multicomponent exercise intervention that reverses frailty and improves cognition, emotional, and social networking in a controlled population of community-dwelling frail older adults.
Trial registration:
ClinicalTrials.gov. Identifier: NCT02331459.
Background: A physically active lifestyle has the potential to prevent cognitive decline and dementia, yet the optimal type of physical activity/exercise remains unclear. Dance is of special interest as it complex sensorimotor rhythmic activity with additional cognitive, social, and affective dimensions.
Objectives: To determine whether dance benefits executive function more than walking, an activity that is simple and functional.
Methods: Two-arm randomized controlled trial among community-dwelling older adults. The intervention group received 1 h of ballroom dancing twice weekly over 8 months (~69 sessions) in local community dance studios. The control group received a combination of a home walking program with a pedometer and optional biweekly group-based walking in local community park to facilitate socialization.
Main outcomes: Executive function tests: processing speed and task shift by the Trail Making Tests, response inhibition by the Stroop Color-Word Test, working memory by the Digit Span Backwards test, immediate and delayed verbal recall by the Rey Auditory Verbal Learning Test, and visuospatial recall by the Brief Visuospatial Memory Test (BVST).
Results: One hundred and fifteen adults (mean 69.5 years, SD 6.4) completed baseline and delayed baseline (3 weeks apart) before being randomized to either dance (n = 60) or walking (n = 55). Of those randomized, 79 (68%) completed the follow-up measurements (32 weeks from baseline). In the dance group only, “non-completers” had significantly lower baseline scores on all executive function tests than those who completed the full program. Intention-to-treat analyses showed no group effect. In a random effects model including participants who completed all measurements, adjusted for baseline score and covariates (age, education, estimated verbal intelligence, and community), a between-group effect in favor of dance was noted only for BVST total learning (Cohen’s D Effect size 0.29, p = 0.07) and delayed recall (Cohen’s D Effect size = 0.34, p = 0.06).
Conclusion: The superior potential of dance over walking on executive functions of cognitively healthy and active older adults was not supported. Dance improved one of the cognitive domains (spatial memory) important for learning dance. Controlled trials targeting inactive older adults and of a higher dose may produce stronger effects, particularly for novice dancers.
Trial registration: Australian and New Zealand Clinical Trials Register (ACTRN12613000782730).
The beneficial effects of exercise have been well recognized for over half a century. Dr Jeremy Morris' pioneering studies in the fifties showed a striking difference in cardiovascular disease between the drivers and conductors on the double-decker buses in London. These studies sparked off a vast amount of research on the effects of exercise in health, and the general consensus is that exercise contributes to improved outcomes and treatment for several diseases including osteoporosis, diabetes, depression, and atherosclerosis. Evidence of the beneficial effects of exercise is reviewed here. One way of highlighting the impact of exercise on disease is to consider it from the perspective of good practice. However, the intensity, duration, frequency (dosage), and counter indications of the exercise should be taken into consideration to individually tailor the exercise programme. An important case of the beneficial effect of exercise is that of ageing. Ageing is characterized by a loss of homeostatic mechanisms, on many occasions leading to the development of frailty, hence frailty is one of the major geriatric syndromes and exercise is very useful to mitigate, or at least delay it. Since exercise is so effective in reducing frailty, we would like to propose that exercise be considered as a supplement to other treatments. People all over the world have been taking nutritional supplements in the hopes of improving their health. We would like to think of exercise as a physiological supplement not only for treating diseases, but also for improving healthy ageing. This article is protected by copyright. All rights reserved.
Background: Depression is a chronic condition that results in considerable disability, and particularly in later life, severely impacts the life quality of the individual with this condition. The first aim of this review article was to summarize, synthesize, and evaluate the research base concerning the use of dance-based exercises on health status, in general, and secondly, specifically for reducing depressive symptoms, in older adults. A third was to provide directives for professionals who work or are likely to work with this population in the future. Methods: All English language peer reviewed publications detailing the efficacy of dance therapy as an intervention strategy for older people in general, and specifically for minimizing depression and dependence among the elderly were analyzed. Key words: dance therapy and depression were included. Databases used were Academic Search Complete, Cinahl, PubMed, Scopus, PsycINFO, and Web of Science. Results: Collectively, this data reveal dance therapy may be useful as a rehabilitation strategy for older adults, in general, as well as for elders with varying degrees of depression, regardless of strategy employed. Conclusions: Although more research is needed, older individuals with or without chronic depression or depressive symptoms can benefit emotionally from dance based exercise participation. Geriatric clinicians can expect this form of exercise will also heighten the life quality of the older individual with depression or subclinical depression.
Background:
The course of cognitive aging has demonstrated substantial heterogeneity. This study attempted to identify distinctive cognitive trajectories and examine their relationship with burdens of disability, hospitalization, and nursing home admission.
Methods:
Seven hundred and fifty-four community-living persons aged 70 years or older in the Yale Precipitating Events Project were assessed with the Mini-Mental State Examination every 18 months for up to 108 months. A group-based trajectory model was used to determine cognitive aging trajectories while adjusting for age, sex, and education. Cumulative burden of disabilities, hospitalizations, and nursing home admissions over 141 months associated with the cognitive trajectories were evaluated using a generalized estimating equation Poisson model.
Results:
Five distinct cognitive trajectories were identified, with about a third of participants starting with high baseline cognitive function and demonstrating No decline during the follow-up period. The remaining participants diverged with Minimal (prevalence 41%), Moderate (16%), Progressive (8%), and Rapid (3%) cognitive decline. Participants with No decline incurred the lowest incidence rates (per 1,000 person-months) of disability in activities of daily living (ADL; 75, 95% confidence intervals: 60-95) and instrumental ADL (492, 453-535), hospitalization (29, 26-33) and nursing home admission (18, 12-27), whereas participants on the Rapid trajectory experienced the greatest burden of ADL disability (612, 595-758) and those on the Progressive trajectory had the highest nursing home admission (363, 292-451).
Conclusions:
Community-living older persons follow distinct cognitive aging trajectories and experience increasing burdens of disability, hospitalization, and nursing home placement as they age, with greater burdens for those on a declining cognitive trajectory.
Objectives
To determine the efficacy of adapted tango for improving mobility, motor–cognitive function, and gait; to determine whether former dance experience was associated with improvements; and to evaluate participant satisfaction, changes in depression, and quality of life.DesignQuasi-experimental, two-group, repeated-measures preintervention, postintervention, and 3-month postintervention study.SettingDiverse senior independent living communities in an urban metropolitan area.ParticipantsIndividuals aged 59 to 95 (73% aged 80 and older; 31% nonwhite, 72% female) (N = 74).InterventionParticipants were assigned to 20 sessions of 90-minute tango (n = 62) or health education (n = 12) classes over 12 weeks.MeasurementsMobility, motor–cognitive function, gait, cognition, and psychosocial function were evaluated before, immediately after, and 3 months after the intervention. Two (groups) by two (before and after) repeated-measures analyses of variance with post hoc comparisons were used to evaluate differences in primary analyses. Secondary analyses from immediately after to 3 months after were used to examine the data for retention of any gains.ResultsForty-four tango and 10 education participants completed 20 sessions. Significant group by time interactions revealed that tango improved mobility (P = .006), backward and fast gait speeds (P < .001), and motor–cognitive function (P = .03). Education improved depression (P = .001). No relationship was noted between previous dance experience and improvements. Gains were maintained 3 months after the intervention.Conclusion
Adapted tango may improve mobility, gait and motor–cognitive function more than health education classes in older adults. Further research is necessary to confirm these findings.
It is important to establish whether frailty among older individuals is reversible with nutritional, physical or cognitive interventions, singly or in combination. We compared the effects of 6-month duration interventions with nutritional supplementation, physical training, cognitive training, and combination treatment versus control in reducing frailty among community-dwelling pre-frail and frail older persons.
We conducted a parallel group, randomized controlled trial in community-living pre-frail and frail old adults in Singapore. The participants' mean age was 70.0 years, and 61.4% (n=151) were female. Five different 6-month interventions included nutritional supplementation (N=49), cognitive training (N=50), physical training (N=48), combination treatment (N=49) and usual care control (N=50). Frailty score, body mass index, knee extension strength, gait speed, energy/vitality, and physical activity levels and secondary outcomes (activities of daily living dependency, hospitalization and falls) were assessed at 0 month, 3 month, 6 month and 12 month.
Frailty score and status over 12 months were reduced in all groups, including control (15%), but were significantly higher (35.6% to 47.8%) in the nutritional (OR=2.98), cognition (OR=2.89) and physical (OR=4.05) and combination (OR=5.00) intervention groups. Beneficial effects were observed at 3 month and 6 month, and persisted at 12 month. Improvements in physical frailty domains (associated with interventions) were most evident for knee strength (physical, cognitive and combination treatment), physical activity (nutritional intervention), gait speed (physical intervention), and energy (combination intervention). There were no major differences with respect to the small numbers of secondary outcomes.
Physical, nutritional and cognitive interventional approaches were effective in reversing frailty among community-living older persons.
Copyright © 2015 Elsevier Inc. All rights reserved.
The purpose of the present study was to provide basic data to identify which types of exercise promote health of older adults. To this end, this study investigated how exercise affects frailty, depression, and cognitive functions in older adults. Frailty, depression, and cognitive function assessed in the exercise participants, 164 older adult women. Results revealed that participants' frailty and depression varied according to exercise participation time and frequency. In particular, dancing was more effective than other types of exercise in reducing frailty and depression. Exercise duration and frequency did not influence cognitive function, but results indicated that table tennis exerted a greater influence on cognitive function than other types of exercise did. In addition, cognitive function differed according to the degree of frailty participants displayed.
Objective:
To evaluate the effect of a dance-based therapy on depressive symptoms among institutionalized older adults.
Design:
Randomized controlled trial.
Setting:
Nursing homes.
Participants:
Older adults (60 years or older) permanently living in a nursing home.
Intervention:
Exercise Dance for Seniors (EXDASE) Program designed for the use in long-term care settings performed once a week for 60 minutes for 3 months.
Measurements:
Baseline measures included sociodemographic characteristics, ability to perform basic as well as instrumental activities of daily living, basic mobility, self-rated health, and cognitive status. Outcome measures were collected before and after the intervention and included assessment of depressive symptoms using the geriatric depression scale (GDS).
Results:
Comparison of participants with MMSE of 15 or higher showed that GDS scores in the intervention group significantly improved (P = .005), whereas the control group had a trend of further worsening of depressive symptoms (P = .081). GLM analysis documented highly statistically significant effect of dance therapy (P = .001) that was not influenced by controlling for intake of antidepressants and nursing home location. Dance therapy may have decreased depressive symptoms even in participants with MMSE lower than 15 and resulted in more discontinuations and fewer prescriptions of antidepressants in the intervention group than in the control group.
Conclusion:
This study provides evidence that dance-based exercise can reduce the amount of depressive symptoms in nursing home residents. In general, this form of exercise seems to be very suitable and beneficial for this population.
Traumatic brain injury (TBI) is one of the common causes of disability in physical, psychological, and social domains of functioning leading to poor quality of life. TBI leads to impairment in sensory, motor, language, and emotional processing, and also in cognitive functions such as attention, information processing, executive functions, and memory. Cognitive impairment plays a central role in functional recovery in TBI. Innovative methods such as music therapy to alleviate cognitive impairments have been investigated recently. The role of music in cognitive rehabilitation is evolving, based on newer findings emerging from the fields of neuromusicology and music cognition. Research findings from these fields have contributed significantly to our understanding of music perception and cognition, and its neural underpinnings. From a neuroscientific perspective, indulging in music is considered as one of the best cognitive exercises. With "plasticity" as its veritable nature, brain engages in producing music indulging an array of cognitive functions and the product, the music, in turn permits restoration and alters brain functions. With scientific findings as its basis, "neurologic music therapy" (NMT) has been developed as a systematic treatment method to improve sensorimotor, language, and cognitive domains of functioning via music. A preliminary study examining the effect of NMT in cognitive rehabilitation has reported promising results in improving executive functions along with improvement in emotional adjustment and decreasing depression and anxiety following TBI. The potential usage of music-based cognitive rehabilitation therapy in various clinical conditions including TBI is yet to be fully explored. There is a need for systematic research studies to bridge the gap between increasing theoretical understanding of usage of music in cognitive rehabilitation and application of the same in a heterogeneous condition such as TBI.
Frailty is a common and important geriatric syndrome characterized by age-associated declines in physiologic reserve and function across multiorgan systems, leading to increased vulnerability for adverse health outcomes. Two major frailty models have been described in the literature. The frailty phenotype defines frailty as a distinct clinical syndrome meeting three or more of five phenotypic criteria: weakness, slowness, low level of physical activity, self-reported exhaustion, and unintentional weight loss. The frailty index defines frailty as cumulative deficits identified in a comprehensive geriatric assessment. Significant progress has recently been made in understanding the pathogenesis of frailty. Chronic inflammation is likely a key pathophysiologic process that contributes to the frailty syndrome directly and indirectly through other intermediate physiologic systems, such as the musculoskeletal, endocrine, and hematologic systems. The complex multifactorial etiologies of frailty also include obesity and specific diseases. Major clinical applications include risk assessment and stratification. This can be applied to the elderly population in the community and in a variety of care settings. Frailty may also be useful for risk assessment in surgical patients and those with cardiovascular diseases, cancer, or human immunodeficiency virus infection, as well as for assessment of vaccine effectiveness in older adults. Currently, exercise and comprehensive geriatric interdisciplinary assessment and treatment are key interventions for frailty. As understanding of the biologic basis and complexity of frailty further improves, more effective and targeted interventional strategies and innovative geriatric-care models will likely be developed.
The prefrontal cortex and medial temporal lobe are particularly vulnerable to the effects of aging. The disconnection between them is suggested to be an important cause of cognitive decline in normal aging. Here, using multimodal intervention training, we investigated the functional plasticity in resting-state connectivity of these two regions in older adults. The multimodal intervention, comprised of cognitive training, Tai Chi exercise, and group counseling, was conducted to explore the regional connectivity changes in the default-mode network, as well as changes in prefrontal-based voxel-wise connectivity in the whole brain. Results showed that the intervention selectively affected resting-state functional connectivity between the medial prefrontal cortex and medial temporal lobe. Moreover, the strength of resting-state functional connectivity between these regions correlated with individual cognitive performance. Our results suggest that multimodal intervention could postpone the effects of aging and improve the function of the regions that are most heavily influenced by aging, as well as play an important role in preserving the brain and cognition during old age.
The superior temporal sulcus (STS) and gyrus (STG) are commonly identified to be functionally relevant for multisensory integration of audiovisual (AV) stimuli. However, most neuroimaging studies on AV integration used stimuli of short duration in explicit evaluative tasks. Importantly though, many of our AV experiences are of a long duration and ambiguous. It is unclear if the enhanced activity in audio, visual, and AV brain areas would also be synchronised over time across subjects when they are exposed to such multisensory stimuli. We used intersubject correlation to investigate which brain areas are synchronised across novices for uni- and multisensory versions of a 6-min 26-s recording of an unfamiliar, unedited Indian dance recording (Bharatanatyam). In Bharatanatyam, music and dance are choreographed together in a highly intermodal-dependent manner. Activity in the middle and posterior STG was significantly correlated between subjects and showed also significant enhancement for AV integration when the functional magnetic resonance signals were contrasted against each other using a general linear model conjunction analysis. These results extend previous studies by showing an intermediate step of synchronisation for novices: while there was a consensus across subjects' brain activity in areas relevant for unisensory processing and AV integration of related audio and visual stimuli, we found no evidence for synchronisation of higher level cognitive processes, suggesting these were idiosyncratic.
Metabolic syndrome is associated with an increased risk of cognitive impairment. The purpose of this prospective pilot study was to examine the effects of dance exercise on cognitive function in elderly patients with metabolic syndrome. The participants included 38 elderly metabolic syndrome patients with normal cognitive function (26 exercise group and 12 control group). The exercise group performed dance exercise twice a week for 6 months. Cognitive function was assessed in all participants using the Korean version of the Consortium to Establish a Registry for Alzheimer's disease (CERAD-K). Repeatedmeasures ANCOVA was used to assess the effect of dance exercise on cognitive function and cardiometabolic risk factors. Compared with the control group, the exercise group significantly improved in verbal fluency (p = 0.048), word list delayed recall (p = 0.038), word list recognition (p = 0.007), and total CERAD-K score (p = 0.037). However, no significance difference was found in body mass index, blood pressure, waist circumference, fasting plasma glucose, triglyceride, and HDL cholesterol between groups over the 6-month period. In the present study, six months of dance exercise improved cognitive function in older adults with metabolic syndrome. Thus, dance exercise may reduce the risk for cognitive disorders in elderly people with metabolic syndrome. ©Journal of Sports Science and Medicine.
The aim of this study was to determine the effects of dancing activity based on different dance styles, in groups as well as with a partner, on mobility performance, quality of life and social engagement in a sample of older adults. One hundred and sixty-three older adults (mean age, 70 years; SD = 4 years) participated in a supervised dancing activity programme for 16 weeks. The dancing activity included different dance routines and was progressive in terms of motor complexity. Data on mobility, health-related quality of life and social engagement were collected before and after a 16-week training period. Significant improvements in mobility, quality of life and social engagement were noted in single as well as dual-task performance after the intervention. Our results emphasise the benefit of a 16-week dance training on multidimensional features, including physical and psychosocial domains, which are important for successful ageing.
Physical exercise is one of the most effective non-pharmacological interventions aimed to improve mobility and independence in older persons. The effect of physical exercise and the most effective type of exercise in frail older persons remain undefined. This systematic review examines the effectiveness of physical exercise on frail older persons. Seven databases were search for randomized control trials which assessed the effect of exercise on participants who were identified as being frail using specific and validated criteria. Nine articles were reviewed from eight studies, from which seven used a validated definition of frailty. Based on the articles analyzed in our systematic review, the evidence suggests that exercise has a positive effect on various measures used to determine frailty including cognition, physical functioning, and psychological wellbeing. Some studies revealed that exercise may prevent or delay the onset of frailty which can enhance quality of life in older adults. Despite the evidence for exercise interventions in frail older adults, it appears that there is no clear guidance regarding the most effective program variables. The reviewed studies were generally long in duration (≥6 months) with sessions lasting around 60 minutes performed three or more times per week, including multicomponent exercises. In conclusion, although exercise interventions appear to be effective in managing the various components of frailty and preventing/delaying the onset of frailty, the most effective exercise program in this population remains unidentified.
Introduction:
Increased physical activity (PA) is a crucial factor in the prevention of physical deterioration, and resistance training (RT) is also a common and effective intervention for older adults. However, the effects of PA as an adjunct to RT on frailty status remains unclear; therefore, we clarified the effect of a PA intervention with feedback, as an adjunct to resistance strength training, on the physical and mental outcomes of frail older adults.
Materials and methods:
We employed a randomized controlled trial. Community-dwelling frail older adults in Japan were recruited to participate. Forty-one participants (mean age 81.5) were randomly assigned to engage in a resistance training with PA (RPA group) or RT group for six months. Frailty status and frailty scores, which were measured according to the Cardiovascular Health Study criteria-muscle strength, mobility, instrumental activities of daily living, and health-related quality of life-were assessed.
Results:
Participants in the RPA group exhibited a significant increase in light-intensity PA, the number of steps taken daily (p < 0.05), and lower-limb muscle strength (p < 0.05) and a significant decrease in frailty scores. However, pre- and postintervention frailty status, instrumental activities of daily living, and health-related quality of life did not differ significantly.
Conclusions:
Implementation of a PA intervention as an adjunct to RT is feasible, as it reduced frailty scores and increased lower-limb muscle strength and mobility in older adults with frailty symptoms.
Objective:
To test the hypothesis that a long-term, structured cognitive leisure activity program is more effective than a health education program at reducing the risk of further cognitive decline in older adults with mild cognitive impairment syndrome (MCI), a high risk for dementia.
Design:
A 3-arm, single-blind randomized controlled trial.
Setting:
Community.
Participants:
A total of 201 Japanese adults with MCI (mean age: 76.0 years, 52% women).
Interventions:
Participants were randomized into 1 of 2 cognitive leisure activity programs (60 minutes weekly for 40 weeks): dance (n = 67) and playing musical instruments (n = 67), or a health education control group (n = 67).
Measurements:
Primary outcomes were memory function changes at 40 weeks. Secondary outcomes included changes in Mini-Mental State Examination and nonmemory domain (Trail Making Tests A and B) scores.
Results:
At 40 weeks, the dance group showed improved memory recall scores compared with controls [mean change (SD): dance group 0.73 (1.9) vs controls 0.01 (1.9); P = .011], whereas the music group did not show an improvement compared with controls (P = .123). Both dance [mean change (SD): 0.29 (2.6); P = .026] and music groups [mean change (SD): 0.46 (2.1); P = .008] showed improved Mini-Mental State Examination scores compared with controls [mean change (SD): -0.36 (2.3)]. No difference in the nonmemory cognitive tests was observed.
Conclusions:
Long-term cognitive leisure activity programs involving dance or playing musical instruments resulted in improvements in memory and general cognitive function compared with a health education program in older adults with MCI.
Trial registration:
UMIN-CTR UMIN000014261.
Objectives
The aim of this study was to examine the effects of a home-based and volunteer-administered physical training and nutritional intervention program compared with social support intervention on nutritional and frailty status in prefrail and frail community-dwelling older persons.
Design
This was a randomized controlled trial in which community-dwelling persons (mean age = 83 years) were recruited and randomly assigned to the physical training and nutritional intervention group (PTN, n = 39) and the social support group (SoSu, n = 41). The study was conducted by trained lay nonprofessionals.
Setting
The community-dwelling older persons in both groups were visited twice a week by trained nonprofessional volunteers (buddies) in Vienna, Austria.
Participants
Eighty prefrail and frail adults aged 65 years or older.
Intervention
In the PTN group, both the buddies and older persons performed 6 strength exercises within a circuit training session and discussed nutrition-related aspects. The active control group (SoSu) had the opportunity to perform cognitive training in addition to the social contact.
Measurements
Outcome measures as nutritional (Mini Nutritional Assessment long form [MNA-LF]) and frailty status (Frailty Instrument for Primary Care of the Survey of Health, Ageing and Retirement in Europe [SHARE-FI]) were obtained at baseline and after 12 weeks.
Results
Significant improvements in the MNA-LF score (1.54 points, 95% confidence interval [CI] 0.51–2.56; P = .004) and the SHARE-FI score (−0.71 discrete factor score values, 95% CI −1.07, −0.35; P < .001) were observed in the PTN group after 12 weeks. In both groups, the prevalence of impaired nutritional status and frailty decreased significantly over time. The prevalence of impaired nutritional status decreased by 25% in the PTN group and by 23% in the SoSu group. Moreover, the prevalence of frailty decreased by 17% in the PTN group and by 16% in the SoSu group. The presence of impaired nutritional status at baseline was independently associated with greater changes in the nutritional (adjusted odds ratio [OR] 3.18, 95% CI 1.26–7.98; P = .014) and frailty status (adjusted OR 3.16, 95% CI 1.01–9.93; P = .049) after 12 weeks.
Conclusion
The results indicate that a home-based physical training, nutritional, and social support intervention conducted by nonprofessionals is feasible and can help to tackle malnutrition and frailty in older persons living at home. Furthermore, social support alone also can result in improvement. In particular, older adults with impaired nutritional status at baseline can benefit more from the intervention. Such a home visit program might also have the potential to prevent future health risks and could allay isolation and loneliness.
Keywords
Older persons; frailty; malnutrition; exercise; nutrition; home visits
The authors declare no conflicts of interest.
The study was funded by a grant (Life Sciences Call 2012) from the Vienna Science and Technology Fund (reference number LS12–039) from March 2013 to August 2016. This is a noncommercial fund, which had no role in the design and conduct of the study; the collection, analysis, and interpretation of data; in the preparation of the manuscript; or in the review or approval of the manuscript.
DAVENPORT, M.H., D.B. HOGAN, G.A. ESKES, R.S. LONGMAN, and M.J. POULIN. Cerebrovascular reserve: the link between fitness and cognitive function? Exerc. Sport Sci. Rev., Vol. 40, No. 3, pp.:153-158,2012. Better physical fitness in later life is associated positively with cognitive functioning. Novel data suggest that this association is mediated, in part, by increases in brain perfusion and the ability of cerebral blood vessels to respond to demand. This review presents evidence on the beneficial effects of exercise on cerebrovascular and cognitive health with aging and explores potential underlying vascular-related mechanisms.
The recent availability of longitudinal data on the possible association of different lifestyles with dementia and Alzheimer's disease (AD) allow some preliminary conclusions on this topic. This review systematically analyses the published longitudinal studies exploring the effect of social network, physical leisure, and non-physical activity on cognition and dementia and then summarises the current evidence taking into account the limitations of the studies and the biological plausibility. For all three lifestyle components (social, mental, and physical), a beneficial effect on cognition and a protective effect against dementia are suggested. The three components seem to have common pathways, rather than specific mechanisms, which might converge within three major aetiological hypotheses for dementia and AD: the cognitive reserve hypothesis, the vascular hypothesis, and the stress hypothesis. Taking into account the accumulated evidence and the biological plausibility of these hypotheses, we conclude that an active and socially integrated lifestyle in late life protects against dementia and AD. Further research is necessary to better define the mechanisms of these associations and better delineate preventive and therapeutic strategies.
An active lifestyle can improve various aspects of the life quality in older adults. Regardless of the age, each person is capable for some type of physical activity. Ageing is not a limitation factor for an active lifestyle and for the inclusion of older adults in organized dancing activities. In introduction, the paper presents the current knowledge about the role of the dance in human life in the ontological and anthropological sense, and also describes the dance functions in the older adult age. In the central part, the paper shows the results of a qualitative research based on in-depth interviews conducted with 10 retirees who were involved in dancing activities in the Association of Pensioners New Brestje. The goal of the research is to achieve a better understanding of the older adults' experiences in dancing activities, and to gain insight into their attitudes and expectations from their participation in organized dancing activities. The results show that retirees who are actively engaged in dancing activities usually have a positive experience in practicing dancing in earlier periods of their life. The participants described experience with the dance as a constructive way of their adaption to changed life circumstances connected with the loss of their previous roles (at work, in the family). The results show that the participation of older adults in dancing activities improves their social inclusion, life satisfaction, self-confidence, physical condition and feeling of acceptance and support from the environment. The participants emphasize the high level of motivation of their engagement in dancing activities, because they recognize this activity as a good way to maintain a homeostatic balance in their life, to enrich their inner life, to fulfil leisure time with cheerful and calming activity which brings strength to cope with everyday problems. Through participating in dancing activities, the older adults expect to maintain health and physical activity, to strengthen their relationships within the peer group, and to gain therapeutic effects for mental health improvement and support for constructive coping with difficulties. Health problems and structural factor associated with the lack of an adequate supply to provide dancing activities in the community are recognised by the participants as barriers for their engagement in organized dancing activities.
Frailty is a condition of increased vulnerability to cope with stressors, predisposing to the development of disability in basic and instrumental activities of daily living, falling, institutionalization and finally death. It is characterized by the loss of functional reserve in multiple domains resulting in a reduced tolerance to common external stresses. The pathogenetic steps conducting to frailty are not completely clear, but there is increasing evidence of a crucial role of insulin resistance and systemic inflammation in the development of frailty, disability, and related medical conditions. These two conditions may act directly, through a negative impact on homeostatic regulation and cross-systems compensation, or indirectly, by the effect of several diseases strongly related to frailty. Therefore, counteracting insulin resistance and systemic inflammation could be a powerful way to prevent the development of frailty and/or of its adverse outcomes. In this framework, diet and physical exercise may represent two important weapons in the prevention of frailty; indeed, current literature supports the effectiveness of a correct lifestyle based on a healthy diet (Mediterranean type diet) and regular physical exercise on frailty primary prevention. Studies on secondary prevention of frailty suggest that multi-component and resistance training, together with adequate energy and protein intake, might be helpful although data are still lacking. The efficacy of dietary supplementation in secondary prevention of frailty, albeit promising, remains to be confirmed in large clinical trials.
Controversy exists as to whether supplementation with the antioxidants vitamin E and vitamin C blocks adaptation to exercise. Exercise is a first-line means to treat obesity and its complications. While diet-induced obesity alters mitochondrial function and induces insulin resistance (IR), no data exist as to whether supplementation with vitamin E and vitamin C modify responses to exercise in pre-existing obesity. We tested the hypothesis that dietary supplementation with vitamin E (0.4 g α-tocopherol acetate/kg) and vitamin C (0.5 g/kg) blocks exercise-induced improvements on IR and mitochondrial content in obese rats maintained on a high-fat (45% fat energy (en)) diet. Diet-induced obese, sedentary rats had a 2-fold higher homeostasis model assessment of insulin resistance and larger insulin area under the curve following glucose tolerances test than rats fed a low-fat (10% fat en) diet. Exercising (12 weeks at 5 times per week in a motorized wheel) of obese rats normalized IR indices, an effect not modified by vitamin E and vitamin C. Vitamin E and vitamin C supplementation with exercise elevated mtDNA content in adipose and skeletal muscle to a greater extent (20%) than exercise alone in a depot-specific manner. On the other hand, vitamin C and vitamin E decreased exercise-induced increases in mitochondrial protein content for complex I (40%) and nicotinamide nucleotide transhydrogenase (35%) in a muscle-dependent manner. These data indicate that vitamin E and vitamin C supplementation in obese rodents does not modify exercise-induced improvements in insulin sensitivity but that changes in mitochondrial biogenesis and mitochondrial protein expression may be modified by antioxidant supplementation.
Objectives: The purpose of this study was to evaluate the effects of creative dance on physical fitness and life satisfaction in older women.
Methods: A total of 57 women (65–80 years old) were randomized to either an experimental group or a control group. The experimental group participated in a supervised creative dance program for 24 weeks. Physical fitness (strength, aerobic endurance, flexibility, motor ability/dynamic balance, and body composition) and life satisfaction were assessed pre- and posttreatment (at 12 and 24 weeks) by the Senior Fitness Test and the Life Satisfaction scale, respectively.
Results: After the intervention, the experimental group had better physical fitness and life satisfaction when compared with the control group.
Conclusion: Creative dance has a positive effect in different dimensions of functioning and has the potential to contribute to healthy aging. This could be related to the integrated mobilization of physical, cognitive, and social skills promoted by creative dance.
Background:
The frailty syndrome is as a well-established condition of risk for disability. Aim of the study is to explore whether a physical activity (PA) intervention can reduce prevalence and severity of frailty in a community-dwelling elders at risk of disability.
Methods:
Exploratory analyses from the Lifestyle Interventions and Independence for Elders pilot, a randomized controlled trial enrolling 424 community-dwelling persons (mean age=76.8 years) with sedentary lifestyle and at risk of mobility disability. Participants were randomized to a 12-month PA intervention versus a successful aging education group. The frailty phenotype (ie, ≥3 of the following defining criteria: involuntary weight loss, exhaustion, sedentary behavior, slow gait speed, poor handgrip strength) was measured at baseline, 6 months, and 12 months. Repeated measures generalized linear models were conducted.
Results:
A significant (p = .01) difference in frailty prevalence was observed at 12 months in the PA intervention group (10.0%; 95% confidence interval = 6.5%, 15.1%), relative to the successful aging group (19.1%; 95% confidence interval = 13.9%,15.6%). Over follow-up, in comparison to successful aging participants, the mean number of frailty criteria in the PA group was notably reduced for younger subjects, blacks, participants with frailty, and those with multimorbidity. Among the frailty criteria, the sedentary behavior was the one most affected by the intervention.
Conclusions:
Regular PA may reduce frailty, especially in individuals at higher risk of disability. Future studies should be aimed at testing the possible benefits produced by multidomain interventions on frailty.
Introduction:
Deficits of balance or postural control in persons of advanced age are one of the factors that influence the risk of falling. The most appropriate treatment approaches and their benefits are still unknown.
Objective:
The aim of this article is to systematically review the scientific literature to identify the therapeutic effects of dancing as a physical exercise modality on balance, flexibility, gait, muscle strength and physical performance in older adults.
Methods:
A systematic search of Pubmed, Cochrane Library Plus, PEDro, Science Direct, Dialnet and Academic Search Complete using the search terms "dance", "older", "dance therapy", "elderly", "balance", "gait" and "motor skills". The eligibility criteria were: studies written in English and Spanish, published from January 2000 to January 2013, studies which analyzed the effects of dance (ballroom dance and/or dance based exercise) in older adults over 60 years of age with no disabling disease and included the following variables of study: balance, gait, risk of falls, strength, functionality, flexibility and quality of life.
Results:
123 articles were found in the literature. A final selection of seven articles was used for the present manuscript. Although the selected studies showed positive effects on the risk of falling related to factors (balance, gait and dynamic mobility, strength and physical performance), there were some aspects of the studies such as the methodological quality, the small sample size, the lack of homogeneity in relation to the variables and the measurement tools, and the existing diversity regarding the study design and the type of dance, that do not enable us to confirm that dance has significant benefits on these factors based on the scientific evidence.
Objectives
It has been suggested that exercise improves cognitive function and increases cerebral volume even in older people. However, the relation between cognitive function and brain volume is unclear. We evaluated the longitudinal change of cognitive function and gray matter volume due to mild-intensity exercise over 2 years, and the residual effects 6 months post-exercise.Methods
Subjects were 110 healthy older individuals over 65 years old in Tone town, Ibaraki prefecture. Seventy-five participants were voluntarily enrolled in the exercise group. A mild-intensity calisthenics regimen, which consisted of home-based and club-based programs for as long as 2 years, was employed as the intervention for the exercise group.ResultsThe exercise group showed significant improvement in attentional shift over the course of the observation period including a 6-month follow-up. Neuroimaging analysis revealed the significant preservation of bilateral prefrontal volume in the exercise group with small-volume corrections, although this effect faded after intervention. Furthermore, the longitudinal changes in attentional shift and memory were positively correlated with the prefrontal volumetric changes.Conclusion
Our results suggest that mild-intensity exercise could prevent prefrontal volume reduction due to aging and impede cognitive decline. Copyright © 2014 John Wiley & Sons, Ltd.
to test the effect of a 16-week multimodal exercise program on neurocognitive and physical functioning and brain-derived neurotrophic factor (BDNF).
a single-blinded, parallel-group randomised controlled trial.Settings: university campus and community-based halls.
forty-nine women aged 65 to 75 years, with no cognitive impairment and not undertaking more than 1 h of formal exercise training per week.Methods: the intervention group attended a 60-min multimodal class twice each week which included cardiovascular, strength and motor fitness training. The primary outcome was neurocognitive functioning and secondary outcomes were physical functioning and plasma levels of BDNF.Results: twenty-five participants were randomised to the intervention group and 24 to the control group. One control participant withdrew before follow-up data collection. The intervention group performed significantly better than the control group at follow-up (when controlled for baseline) in the Trail Making test A and B, the California Older Adult Stroop test (Word, Interference and Total scores), Controlled Oral Word Association test and the Timed Up-and-Go test, Six-Minute Walk test, One-Legged Stance test and plasma BDNF.Conclusion: this multimodal exercise program resulted in neurocognitive and physical performance improvements and increased levels of plasma BDNF, in older women, when compared with controls. This RCT provides evidence that a multimodal exercise intervention can achieve larger effect sizes than those generally resulting from single modality interventions. Increases in BDNF levels imply neurogenesis may be a component of the mechanism underpinning the cognitive improvements associated with multimodal exercise.Trial registration: Australian and New Zealand Clinical Trial Registration Number: ANZCTR12612000451808.
This randomized controlled trial examined the effects of multicomponent training on muscle power output, muscle mass, and muscle tissue attenuation; the risk of falls; and functional outcomes in frail nonagenarians. Twenty-four elderly (91.9 ± 4.1 years old) were randomized into intervention or control group. The intervention group performed a twice-weekly, 12-week multicomponent exercise program composed of muscle power training (8-10 repetitions, 40-60 % of the one-repetition maximum) combined with balance and gait retraining. Strength and power tests were performed on the upper and lower limbs. Gait velocity was assessed using the 5-m habitual gait and the time-up-and-go (TUG) tests with and without dual-task performance. Balance was assessed using the FICSIT-4 tests. The ability to rise from a chair test was assessed, and data on the incidence and risk of falls were assessed using questionnaires. Functional status was assessed before measurements with the Barthel Index. Midthigh lower extremity muscle mass and muscle fat infiltration were assessed using computed tomography. The intervention group showed significantly improved TUG with single and dual tasks, rise from a chair and balance performance (P < 0.01), and a reduced incidence of falls. In addition, the intervention group showed enhanced muscle power and strength (P < 0.01). Moreover, there were significant increases in the total and high-density muscle cross-sectional area in the intervention group. The control group significantly reduced strength and functional outcomes. Routine multicomponent exercise intervention should be prescribed to nonagenarians because overall physical outcomes are improved in this population.
This study documented feasibility and immediate effects of a dance intervention two times per week for 12 weeks on depression, physical function, and disability in older, underserved adults. The one-group, pretest/post-test study recruited a convenience sample of 40 participants from a federally subsidized apartment complex located in an economically depressed, inner-city neighborhood. Depression, physical function and disability were measured at baseline and 12 weeks. Average age was 63 years (SD=7.9), 92% were female, and 75% were African American. At baseline participants reported increased depression (M=20.0, SD=12.4), decreased physical function (M=56.6, SD=10.9), and increased disability limitations (M=65.7, SD=14.9). At posttest, paired t-tests showed that the dance intervention significantly decreased depression (t=6.11, p<.001) and disability (t=- 2.70, p=.014) and significantly increased physical function (t=-2.74, p=.013). The results indicate that the 12-week dance intervention may be an effective adjunct therapy to improve depression, disability, and physical function in underserved adults.
The CES-D scale is a short self-report scale designed to measure depressive symptomatology in the general population. The items of the scale are symptoms associated with depression which have been used in previously validated longer scales. The new scale was tested in household interview surveys and in psychiatric settings. It was found to have very high internal consistency and adequate test- retest repeatability. Validity was established by pat terns of correlations with other self-report measures, by correlations with clinical ratings of depression, and by relationships with other variables which support its construct validity. Reliability, validity, and factor structure were similar across a wide variety of demographic characteristics in the general population samples tested. The scale should be a useful tool for epidemiologic studies of de pression.
Frailty is a clinical state in which there is an increase in an individual's vulnerability for developing increased dependency and/or mortality when exposed to a stressor. Frailty can occur as the result of a range of diseases and medical conditions. A consensus group consisting of delegates from 6 major international, European, and US societies created 4 major consensus points on a specific form of frailty: physical frailty. 1. Physical frailty is an important medical syndrome. The group defined physical frailty as "a medical syndrome with multiple causes and contributors that is characterized by diminished strength, endurance, and reduced physiologic function that increases an individual's vulnerability for developing increased dependency and/or death." 2. Physical frailty can potentially be prevented or treated with specific modalities, such as exercise, protein-calorie supplementation, vitamin D, and reduction of polypharmacy. 3. Simple, rapid screening tests have been developed and validated, such as the simple FRAIL scale, to allow physicians to objectively recognize frail persons. 4. For the purposes of optimally managing individuals with physical frailty, all persons older than 70 years and all individuals with significant weight loss (>= 5%) due to chronic disease should be screened for frailty. Copyright (c) 2013 - American Medical Directors Association, Inc.