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Walking With a Rollator and the Level of Physical Intensity in Adults 75 Years of Age or Older
Abstract
To determine whether walking with a rollator by persons 75 years of age or older is of sufficient intensity to improve aerobic fitness.
A cross-sectional cohort study.
University movement laboratory.
Fifteen subjects 75 years of age or older (mean age, 83.7 y) who could only walk by using a rollator.
Not applicable.
During 6 minutes of self-paced treadmill walking using a rollator at a mean walking speed of 0.6 m/s, oxygen uptake (Vo2), carbon dioxide production, and heart rate were determined. Respiratory exchange ratio (RER) and energy expenditure were calculated. The energy expenditure was expressed as the number of metabolic equivalents (METS), the percentage of estimated maximal Vo2 (Vo2max), the percentage of estimated Vo2max reserve, and the percentage of estimated maximal heart rate.
Mean Vo2 was .718 L/min. Mean RER was .93 (95% confidence interval [CI], .89-.97). Thirteen participants showed an RER below 1.0, which indicates a negligible contribution of anaerobic expenditure. Walking with a rollator required a mean of 2.8 (95% CI, 2.4-3.2) METS, 71.9% of Vo2max (95% CI, 65.2%-78.6%), 50.5% (95% CI, 39.4%-61.5%) of Vo2 reserve, and 75.2% (95% CI, 67.6%-82.8%) of estimated maximal heart rate.
For people 75 years of age or older, walking with a rollator is an activity of moderate to high level of intensity, with the capacity of improving aerobic fitness.
... Participants were excluded from the study if they were younger than 70 years, not able to walk short distances with or without a walking aid or suffering from a cognitive impairment (MMSE < 23). Participants' medical history showed comorbidities that were representative of the general population of this age [527] . Fifteen participants used a β-blocker during their participation in this study, and three participants used other heart rate reducing medication (amiodaron, flecainide). ...
... The mean intensity of the 30 minutes session of chair-assisted exercises was calculated and expressed as meanVo 2 (mL/min) and meanVo 2 per kilogram of body weight (mL/min/kg). To estimate whether oxygen uptake was of at least moderate intensity, it was recalculated as a percentage of participants' estimatedVo 2 max by the same method as a comparable study for people aged 55 to 86 years [527] . TheVo 2 max regression equations for men were: HRmax (beats/minute) = 220 − age (8.5) ...
... The chair-assisted exercises of this study meet the intensity criterion for healthy aging [522] . The intensity of chair-assisted exercises is comparable to the intensity of walking in older people [527] . It is known that walking may increase cognition, in particular executive functions [65] . ...
... Five of the studies reported on findings from studies using 15 subjects or less. [20][21][22][23][24] The remaining studies reported on samples sizes ranging from 26 up to 60 25-31 apart from two, one which had 90 subjects, 32 and another 158 subjects. 33 The CASP critical appraisal tools for case control studies were used for four studies, 20,24,26,32 the cohort tool was used for 10, 19,[21][22][23]25,[28][29][30][31]33 economic evaluation tool for one 18 and RCT tool for one. ...
... [20][21][22][23][24] The remaining studies reported on samples sizes ranging from 26 up to 60 25-31 apart from two, one which had 90 subjects, 32 and another 158 subjects. 33 The CASP critical appraisal tools for case control studies were used for four studies, 20,24,26,32 the cohort tool was used for 10, 19,[21][22][23]25,[28][29][30][31]33 economic evaluation tool for one 18 and RCT tool for one. 27 Information in regards to study design, CASP tools used and quality scores for the studies is given in Table 4. ...
... 24,31,32 Three studies used the term rollator or walker but did not give any further description as to the actual type. 19,21,27 Five of the studies included compared different types of frames with others. 20,22,24,26,31 Outcomes from the use of different types of frames were reported in terms of gait parameters and physiological effects using a range of different measures (Table 3). ...
Background: The purpose of this paper is to systematically review the evidence for the provision of walking frames to improve mobility for older people. Objectives: To investigate the types of frames used and the processes involved in prescribing frames, and to determine the effects of using a frame. Methods: The AMED, CINAHL, Embase, and MEDLINE Electronic databases were searched using key terms between 1990 and January 2011. Research papers reporting outcomes about the effectiveness of walking frames in relation to mobility for older people were eligible for inclusion. Sixteen papers were included under the criteria applied, representing 17% of the studies identified. A range of study designs was included. Double-blind review was carried out and quality assessment conducted using CASP critical appraisal tools. Synthesis of literature was carried out on a narrative basis through the development of themes in relation to types of frames, user’s perspective, falls prevention, effects on gait and balance, and physiological effects. Results: The evidence reviewed is largely of poor quality. Users obtain walking frames from many sources. The evidence reviewed neither proves nor disproves their effectiveness in the prevention of falls. Walking frame use does have an effect on gait patterns and some physiological outcomes. The effect on posture and balance remains unclear. Conclusions: A need for clinical guidelines in relation to provision of walking frames has been identified. The therapeutic use of walking frames to improve physical fitness merits further research as well as longer-term studies to evaluate the effects over time.
... Many elderly people report that walkers are difficult to use [3,4]. A major difficulty is that the metabolic cost of ambulation with a walker is greatly elevated [5][6][7][8][9] combined with the diminished aerobic capacity associated with aging [10][11][12][13][14]. In this study, we quantified the major reasons why walker-assisted gait is so expensive. ...
... We hypothesized that: (1) at a fixed speed, walking with a 4F walker is metabolically more expensive that walking unassisted or with a 4W or 2W walker and (2) the greater cost of using a 4F walker is due to the slow walking speed, the step-to gait pattern, and the repeated lifting the walker. We tested these hypotheses on healthy, young subjects because people who are elderly or who have disabilities would be unable to sustain their locomotion long enough to obtain steady-state metabolic rate data [8]. ...
... We did not investigate the effects of walkers on an elderly or disabled population who need the assistance of walkers to ambulate. It would be difficult to conduct such a study because the diminished aerobic capacity of such subjects would preclude sustainable, steady-state metabolic rates [8]. Nevertheless, the general mechanisms that we have quantified likely apply to elderly or disabled individuals. ...
... Prevention of cognitive decline reflecting a continuum of cognitive changes ranging from within the spectrum of normal ageing to mild cognitive impairment (MCI) and cognitive impairment with dementia[1] among the rising numbers of elderly has become widely acknowledged as a major public health issue worldwide. Cognitive functions are particularly vulnerable to ageing and are crucial for independent living.[2] Cognitive decline due to dementia is a leading cause of admission to nursing homes in Sweden and worldwide, with a high level of dependency in activities of daily living (ADL).[3][4] ...
... The results do not preclude the possibility that introduced modifications in activity might change the course of cognitive performance later in the life span [60] – High123456 decline was lower for both men and women with a high frequency of visual contact with relatives and community social integra- tion Engagement with friends seemed to be protective for cognitive decline in women but not men Formal participation in social activities (church, social centre for elderly people, group membership, and park) has protective effects against cognitive decline It was concluded that social integration, frequent contact with family and friends, and playing an important role with significant others have beneficial effects in maintaining cognitive function in later life [71] There were significantly decreased odds ratios for the number of confidants, sports activities, and cultural activities at age 30, at age 50, and at 10 years before data collection When all the psychosocial network factors were included simultaneously in the logistic regression model, these factors remained statistically significant , indicating independent effects ...
Objective:
A systematic literature review was conducted to characterise the current state of knowledge concerning the definition, categorisation, and operationalisation of leisure activity in studies examining its possible role in preventing later-life cognitive decline. Following PRISMA guidelines for a systematic review, the study examined peer-reviewed empirical research publications focused on leisure activity, cognitive decline, and prevention.
Methods:
Searches in the PubMed/Medline reSEARCH, CINHAL, Ovid MEDLINE, Embase, Web of Science, PsychoINFO, Proquest ERIC Proquest, the Cochrane library, and PsycARTICLES databases for the years 2000 to 2011 identified 52 publications for inclusion.
Results:
The results are discussed and based on these findings are further interpreted using the Model of Human Occupation, which focuses on key factors identified in the review that are salient to associations between participation in leisure activities and prevention of dementia.
Conclusions:
While the findings support a growing consensus that participation in leisure activities might significantly contribute to prevention of dementia, it also identifies major hindrances to progress. Important limitations detected include a lack of theoretical underpinnings, and little consensus and standardisation in the measured key variables. The study reinforces the critical need to overcome these limitations to enable health care professionals (e.g. occupational therapists) to make evidence-based recommendations for increased participation in activities as a means of promoting health and preventing cognitive decline.
... The practical translation of this finding is that any form of aid might thus increase physical activity in this very advanced and disabled population [38] [39]. Indeed, improvement of the metabolic work would parallel the individual's reserve in heart rate and oxygen consumption, directly linked with any positive change in the aerobic activity [38]. ...
... The practical translation of this finding is that any form of aid might thus increase physical activity in this very advanced and disabled population [38] [39]. Indeed, improvement of the metabolic work would parallel the individual's reserve in heart rate and oxygen consumption, directly linked with any positive change in the aerobic activity [38]. Notwithstanding, this result only leads to hypothesize a bio-enzymatic adaptation at the skeletal muscle level, since our study was not designed as physiologic. ...
Measurements of Energy Expenditure (EE) at rest (REE) and during physical activities are increasing in interest in chronic patients. In this study we aimed at evaluating the validity/reliability of the SenseWear®Armband (SWA) device in terms of REE and EE during assisted walking in Chronic Respiratory Failure (CRF) patients receiving long-term oxygen therapy (LTOT).
In a two-phase prospective protocol we studied 40 severe patients and 35 age-matched healthy controls. In phase-1 we determined the validity and repeatability of REE measured by SWA (REEa) in comparison with standard calorimetry (REEc). In phase-2 we then assessed EE and Metabolic Equivalents-METs by SWA during the 6-minute walking test while breathing oxygen in both assisted (Aid) or unassisted (No-Aid) modalities. When compared with REEc, REEa was slightly lower in patients (1351±169 vs 1413±194 kcal/day respectively, p<0.05), and less repeatable than in healthy controls (0.14 and 0.43 coefficient respectively). COPD patients with CRF patients reported a significant gain with Aid as compared with No-Aid modality in terms of meters walked, perceived symptoms and EE.
SWA provides a feasible and valid method to assess the energy expenditure in CRF patients on LTOT, and it shows that aided walking results in a substantial energy saving in this population.
... Mobilität ist ein zentraler Faktor für den Erhalt der Selbstständigkeit [1,4] und Lebensqualität [9]. Diesbezügliche Verluste infolge altersbedingter Abbauprozesse und Erkrankungen können mithilfe eines Rollators ausgeglichen [16,24,26] und verlorene Fähigkeiten sogar wiederhergestellt werden [5,6,26,27]. Nutzungsvoraussetzungen sind motorische Kompetenzen wie Kraft und Gleichgewicht, das Wissen über die Handhabung [2,18,25] und die Akzeptanz des Hilfsmittels [26]. ...
Background
The number of older people with mobility impairments using wheeled walkers is increasing; however, the handling of these walking aids is often ineffective. Moreover, age-associated functional loss, environmental demands and fear of falling may additionally challenge mobility. The new training program “Active and safe with wheeled walkers” aims to enhance skills and to improve mobility. The present pilot study was carried out to assess the feasibility of the training as well as to identify training effects and methodological insights for further research.
Material and methods
The study was carried out with 28 wheeled walker users (age 68–91 years) in assisted living facilities using a pre-post design. Of the participants 13 persons were trained for 10 weeks (90 min, twice a week) and 15 persons served as a control group. Data were collected on functional mobility, hand strength, leg strength, balance, walker handling and fear of falling.
Results
The drop-out rate for the training was 38 % due to health concerns (n = 2), lack of time (n = 1) and changes in health status independent of training (n = 3). Medium to large effects were detected. Data regarding the recruitment strategy and the acceptance of individual exercises are available.
Conclusion
The results indicate a good feasibility and effectiveness of the training. The simple accessibility of the training was conducive for the regular participation. The everyday relevance of the results and the lack of comparable interventions suggest that further research efforts be carried out. Recruitment strategies, training requirements and data collection methods need to be optimized.
... Rollators are four-wheeled walkers commonly used in clinical practice in many patient groups (Gupta et al., 2006; Chee et al., 2013; Eggermont et al., 2006; Smith et al., 2012). The specific aims of rollator use vary depending on the patient diagnosis. ...
... Een activiteit die veel wordt uitgevoerd door verzorgingshuisbewoners en daardoor mogelijk een geschikte interventie zou kunnen zijn is lopen, eventueel met een rollator. Onderzocht is wat het energieverbruik is van het uitvoeren van deze activiteit door ouderen (Eggermont et al., 2006a). Vijftien ouderen (gemiddelde leeftijd 84 jaar) liepen met hun rollator in hun eigen tempo op een loopband terwijl het zuurstofverbruik en de hartslag werden gemeten. ...
De vergrijzing van de populatie heeft geresulteerd in een grote toename van ouderen met dementie. De bestaande medicamenteuze
therapieën voor dementie richten zich op de behandeling van symptomen en een zoektocht naar nieuwe behandelwijzen is volop
gaande. Er is ook steeds meer aandacht voor activiteiten die het ontstaan en het verloop van dementie zouden kunnen vertragen.
Eén zo'n vorm van activiteit die vooral de laatste paar jaar veel aandacht heeft gekregen, is lichamelijke activiteit.
... However, these interventions were multi-dimensional (including bright light and improved sleep hygiene) precluding knowledge of which type of stimulation is (most) effective [7]. In the present study, a type of physical activity appropriate for older nursing-home residents with dementia, i.e. walking [8], was offered daily, to determine the effects on sleep disturbance, e.g. night-time restlessness, in persons with mild-to-moderate dementia. ...
Vorgestellt wird die Entwicklung eines Rollatormoduls zur sensorgestützten Haltungs- und Gangmustererkennung sowie zur Sturzprävention. Mit dem Ziel der Sturzprävention werden bei geriatrischen Patienten pathologische Gangmuster erfasst und durch ein geeignetes Interface an den Patienten rückgemeldet, sodass eine Haltungskorrektur erfolgen kann. Der Klassifikationsansatz zeigt eine gute Übereinstimmung mit der klinischen Ganganalyse. Die Evaluation möglicher Benutzerinterfaces zeigt, dass sich ein Rückmeldungssystem basierend auf einfachen Leuchtdioden, die in den Rollatorhandgriffen integriert werden, als praktikabel erweist. In einer klinischen Interventionsstudie wurde die Praktikabilität und Benutzerfreundlichkeit des Gesamtsystems überprüft. Dabei stand die Benutzerfreundlichkeit, erfasst durch den System Usability Score SUS für Patienten und Therapeuten im Vordergrund. Darüber hinaus wurden die Veränderungen der Gangparameterklassifikationen im Verlauf der Therapie geprüft sowie die Qualität der Korrekturrückmeldung des Systems durch die zuständigen Therapeuten bewertet. Insgesamt zeigt der Ansatz gutes Potenzial, das Gangbild von Rollatornutzern im Alltag zu verbessern.
Epidemiologisch onderzoek laat een sterke relatie zien tussen fysieke activiteit en cognitie. Bij ouderen zonder dementie hebben behandelprogramma’s bestaande uit fysieke activiteit een positief effect op het cognitieve functioneren en met name op de executieve functies. Bij ouderen mét dementie is echter slechts beperkt onderzoek gedaan waarin fysieke activiteit als behandeling wordt aangeboden. De onderzoeken die er zijn vertonen vaak methodologische beperkingen en de resultaten zijn niet consistent. Uit literatuuronderzoek blijkt een mogelijke verklaring voor de inconsistente uitkomsten. Het aanbieden van fysieke activiteit ter verbetering van de cognitie hoeft niet gunstig te zijn voor ouderen met dementie die lijden aan vasculaire ziekten zoals hypertensie en hart- en vaatziekten. Verondersteld wordt dat er bij aanwezigheid van vasculaire ziekten minder bloed naar de hersenen gaat tijdens fysieke inspanning. Deze veronderstelling dient nader onderzocht te worden.
Nils Levsen focuses on the international diffusion of product and service innovations for elderly users. In particular, the existence and location of lead markets is being investigated. Lead markets are characterized by their early adoption of innovations and their influence on design choice in a subsequent international diffusion process. Finally, two boundary conditions to the applicability of lead market theory are being identified and described.
Due to the ongoing aging process (e.g. one over 10 people in France is more than 75 years old); loss of autonomy has become a major public health issue. This socio-economical problem may be explained by the continuous need of acute information on the balance of elderly. In this manner, a deep analysis of ankle musculotendinous stiffness and posture may provide new insights on the neuromuscular mechanisms involved in maintaining upright stance, by means of appropriate biomechanical parameters. This work was funded by the National Research Agency (ANR-08-TECS MIRAS-009-04), and aimed at characterizing the elastic properties (i.e. musculotendinous stiffness) and balance in elderly subjects recovering their autonomy. Therefore, a global description of population profiles in a geriatric rehabilitation care unit was first carried out. Then to verify and improve the existing methods for ankle musculotendinous stiffness estimation ("Quick-Release" approach), a new method for the calculation foot inertial parameters was proposed and validated. Finally, a study of ankle stiffness and balance through a stabilometric approach was conducted on a sample of elderly patients. The results of this work proved to be useful in improving the methods for calculating ankle musculotendinous stiffness, while contributing to a better understanding of balance mechanisms in the elderly.
Individuals with Multiple Sclerosis commonly use assistive mobility devices, such as
rollators, to compensate for their mobility impairments. However, the effect of these devices on
their foot placement during gait has not been explored in the community. The objective of
experiment one was to develop and validate a tool that quantifies medio-lateral foot placement
characteristics during rollator use. In this study, a technique was developed for an instrumented
rollator (i.e. iWalker) and validated against a Vicon motion capture system in able-bodied young
adults. The two systems were in strong agreement. The objective of experiment two was to apply
this iWalker-based technique to individuals with Multiple Sclerosis to identify environmentrelated
foot placement changes. This study revealed that step width variability, but not step
width, can be influenced by certain outdoor environments. Therefore, environmental context is
important to consider when investigating user-device interactions and factors responsible for safe
mobility in this population.
Walking is particularly concerned by the effects of aging. Balance is often compromised, step is modified and the risk of falls increases. Consequentely, the physiotherapists propose the use of assistive device for walking very often during the reeducation of elderly people.
The aim of our study was to know the feeling of the elderly about these assistive device and the point of view of the physiotherapists about their practice (custom of use, choice, implementation…).
The results show that the assistive device, is not only a tool of reeducation, but often becomes a support for the locomotion.
Moreover, the help of walking has its limits and the adherence is different for each one. The help can be adopted by elderly with mechanisms associating compensation and adaptation or in opposite can be rejected.
Level of evidence:
4
Introduction:
The American College of Sports Medicine prescribes regular performance of at least moderate-intensity physical activity for healthy aging. This study examined whether 1 session of 30 min of chair-assisted exercises for the elderly meets this intensity criterion.
Method:
This cross-sectional study included 47 cognitively healthy volunteers (mean age 84 years). During the performance of 30 min of chair-assisted exercises the authors determined oxygen uptake (VO2), carbon dioxide production, heart rate (HR), and rating of perceived exertion (RPE). These measures were expressed as a percentage of the estimated maximal VO2 (VO2max) and the estimated maximal HR (HRmax) and estimated as metabolic equivalent units (METs).
Results:
Participants performed chair-assisted exercises at 61.0% ± 14.7% of VO2max, 67.6% ± 11.3% HRmax, 3.9 ± 0.9 METs, and 13.1 ± 2.1 RPE.
Conclusions:
The intensity of these chair-assisted exercises is at least moderate for older adults, which is necessary for healthy aging.
Scherder EJA, Eggermont LHP, Geuze RH, PhD, Vis J, Verkerke GJ: Quadriceps strength and executive functions in older women.
Objective: The aim of this study is to answer the question whether the strength of the knee extensor musculus quadriceps (m. quadriceps), in particular, is related to specific executive functions and whether this relationship is independent of aerobic fitness. The clinical relevance of this question is that the m. quadriceps can still be trained in older people and executive functions are the most vulnerable to processes of aging.
Design: In 41 cognitively intact older women, cognitive functioning was assessed by neuropsychological tests; isometric and isotonic quadriceps strength by the Quadrisotester and the 30-sec chair-stand test, respectively; and aerobic fitness by the 6-min walk test.
Results: A significant proportion of the total variance of the executive functions, attention/working memory and inhibition, were explained by isometric/isotonic knee extensor strength and aerobic fitness, respectively. Extensor muscle strength, aerobic fitness, or one or more interactions did not explain a significant proportion of the total variance of other cognitive functions.
Conclusions: These data suggest that in older women, quadriceps strength is associated with the executive function, attention/working memory, and that this effect is independent of aerobic fitness, which seems to be associated more strongly with inhibition, another executive function.
Aims. The goal of this brief review is to address studies examining the relationship between physical inactivity and pain in aging and dementia.
Background. A decrease in the level of physical activity is characteristic of older persons, both with and without dementia. Passive behaviour is often considered to be part of the apathy frequently observed in patients with dementia, although it could also be a sign of pain.
Design. Literature review.
Method. Searches were performed in PubMed and Embase. A total of 15 studies concerning the relationship between physical inactivity and pain in older persons with and without dementia were identified (older persons without dementia: 12; with dementia: 3).
Results. In older persons without dementia, a positive relationship between physical inactivity and pain has been demonstrated. In older persons with dementia, pain may cause physical inactivity and physical inactivity may cause pain.
Conclusions. In older persons, a positive relationship between physical inactivity and pain was demonstrated. More specifically, pain may cause physical inactivity. In older persons with dementia pain may cause physical inactivity and vice versa.
Relevance to clinical practice. Nurses’ awareness of physical inactivity as an indication of pain in older persons with and without dementia may reduce the risk of underdiagnosis and subsequent undertreatment of pain.
To elucidate whether a simple walking aid may improve physical performance in COPD patients with chronic respiratory insufficiency who usually carry their own heavy oxygen canister.
Randomized crossover trial.
Physiopathology laboratory of three rehabilitation centers.
We studied 60 stable COPD patients (mean age, 70.6 +/- 7.9 years; FEV(1), 44.8 +/- 14.3% of predicted [+/- SD]) with chronic respiratory insufficiency who randomly performed, on 2 consecutive days, a standardized 6-min walking test using two different modalities: a full-weight oxygen canister transported using a small wheeled cart and pulled by the patient (Aid modality) or full-weight oxygen canister carried on the patient's shoulder (No-Aid modality).
The distance walked, peak effort dyspnea, and leg fatigue scores as primary outcomes, and other cardiorespiratory parameters as secondary outcomes were recorded during both tests. A significant difference (p < 0.05) between the two tests occurred for all the measured outcomes in favor of the Aid modality. Most importantly, significant changes for distance (+ 43 m, p < 0.001), peak effort dyspnea (- 2.0 points, p < 0.001), leg fatigue (- 1.4 points, p < 0.001), as well as for mean and nadir oxygen saturation and heart rate with the Aid modality (but not with the No-Aid modality) were recorded in the subgroup of patients walking < 300 m at baseline.
This study suggests that a simple walking aid may be helpful in COPD patients receiving long-term oxygen therapy, particularly in those with lower residual exercise capacity.
This study aimed at assessing the profile of ambulation aid users among patients admitted for geriatric rehabilitation care.
Retrospective chart review.
Geriatric Rehabilitation Department of the Hôpital Albert Chenevier, Créteil, France.
The sample comprised 206 records of patients aged 65 or older with no previous use of assistive device before admission and length of stay longer than 7 days.
Ambulation levels were classified as independent ambulators (IA, reference category), ambulation aid users (AA), or nonambulatory patients (NA). we explored age, gender, purpose of initial admission, comorbidities, and past medical history as factors potentially associated with ambulation levels, using multinomial logistic regression.
The study population (mean age 84 years [6.1 standard deviation], 68.5 % women) comprised 110 IA (53.4% of the overall population), 72 AA (34.9%), and 24 NA (11.6%). Factors independently associated with AA use were the following: older age (odds ratio = 1.17; [95% confidence interval 1.09-1.25]), previous history of lower limb surgery (2.15; [1.0-4.73]), and admission for hip surgery (8.14; [2.60-25.53]). Factors independently associated with NA were the following: older age (1.12 [1.02-1.23]) and low Mini-Mental State Exam score (0.77 [0.70-0.85]). A borderline association was observed for visual impairment (3.36 [0.93-12.95]). Cardiac disease, respiratory disease, falls, and dementia were not associated with ambulation aid use.
History of lower-limb surgery, particularly recent hip surgery, and old age are the primary predictive factors of ambulation aid use in a geriatric rehabilitation hospital.
Nella prospettiva di un miglioramento della gestione quotidiana di presidi, il cammino assistito dall’uso di specifici carrellini dotati di ruote (portastroller) ha dimostrato, in pazienti BPCO in Ossigeno-Terapia Lungo Termine (OTLT), un miglioramento della performance fisica e della sintomatologia percepita. Tuttavia, ad oggi, nessun dato di consumo metabolico supporta questo miglioramento. Il SenseWear® Armband (SWA®), è un nuovo sistema portatile di rilevazione oggettiva del Consumo Energetico (EE), a riposo (come REE) o durante attività fisica, già stato validato in soggetti sani o affetti da alcune patologie croniche. In due giorni consecutivi e in sequenza randomizzata, abbiamo studiato 40 pazienti BPCO in OTLT domiciliare (65% maschi, età 71±7 anni con BMI 24±4 kg/m2) e 35 controlli sani (con analoghe caratteristiche antropometriche) al fine di: 1) determinare con misure di REE la validità del SWA® rispetto al dato rilevato con la Calorimetria Indiretta; 2) valutare se la modalità di cammino con portastroller (Modalità Assistita), rispetto a quella standard di trasporto a spalla dello stroller (NON-Assistita), sia più economica in termini di spesa energetica (EE, kcal/min ed Equivalenti metabolici METs, kcal/kg/h). Le misure di REE mediante Calorimetria indiretta e SWA® risultano essere significativamente differenti (rispettivamente 1413 vs 1351 kcal/day, p<0.05) nei pazienti (ma non nei controlli), e tra loro meno correlate rispetto ai controlli (Pearson r2 = 0.46 e r2 = 0.71 rispettivamente). Analoghi risultati si sono ottenuti per il confronto fra metodiche strumentali mediante l’analisi di Bland & Altman (coefficiente di correlazione di 0.14 nei pazienti e 0.43 nei sani). Nei pazienti studiati, il valore (rapportato ai metri percorsi) di EE (ΔEE/6MWT) e di METs (ΔMETs/6MWT) rilevati nel corso del test in Modalità Assistita si dimostrava inferiore rispetto a quelli rilevati nella modalità NON-Assistita (rispettivamente 0.081 vs 0.100 e 0.010 vs 0.013). Il nostro studio suggerisce che SWA® può essere una valida metodica di valutazione metabolica nella determinazione del REE in pazienti BPCO in OTLT domiciliare. Conferma inoltre che il cammino assistito dal portastroller, in questa tipologia di pazienti, conduce a un sostanziale risparmio energetico (ΔEE/6MWT e ΔMETs/6MWT).
Walking has proven to be beneficial for cognition in healthy sedentary older people. The aim of this study was to examine the effects of a walking intervention on cognition in older people with dementia.
97 older nursing home residents with moderate dementia (mean age 85.4 years; 79 female participants; mean Mini-Mental State Examination 17.7) were randomly allocated to the experimental or control condition. Participants assigned to the experimental condition walked for 30 min, 5 days a week, for 6 weeks. To control for personal communication, another group received social visits in the same frequency. Neuropsychological tests were assessed at baseline, directly after the 6 week intervention and again 6 weeks later. Apolipoprotein E (ApoE) genotype was determined.
Differences in cognition between both groups at the three assessments were calculated using a linear mixed model. Outcome measures included performance on tests that formed three domains: a memory domain, an executive function domain and a total cognition domain. Results indicate that there were no significant time x group interaction effects or any time x group x ApoE4 interaction effects.
Possible explanations for the lack of a beneficial effect of the walking programme on cognition could be the level of physical activation of the intervention or the high frequency of comorbid cardiovascular disease in the present population of older people with dementia.
ACSM Position Stand on The Recommended Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory and Muscular Fitness, and Flexibility in Adults. Med. Sci. Sports Exerc., Vol. 30, No. 6, pp. 975-991, 1998. The combination of frequency, intensity, and duration of chronic exercise has been found to be effective for producing a training effect. The interaction of these factors provide the overload stimulus. In general, the lower the stimulus the lower the training effect, and the greater the stimulus the greater the effect. As a result of specificity of training and the need for maintaining muscular strength and endurance, and flexibility of the major muscle groups, a well-rounded training program including aerobic and resistance training, and flexibility exercises is recommended. Although age in itself is not a limiting factor to exercise training, a more gradual approach in applying the prescription at older ages seems prudent. It has also been shown that aerobic endurance training of fewer than 2 d·wk-1, at less than 40-50% of V˙O2R, and for less than 10 min-1 is generally not a sufficient stimulus for developing and maintaining fitness in healthy adults. Even so, many health benefits from physical activity can be achieved at lower intensities of exercise if frequency and duration of training are increased appropriately. In this regard, physical activity can be accumulated through the day in shorter bouts of 10-min durations.
In the interpretation of this position stand, it must be recognized that the recommendations should be used in the context of participant's needs, goals, and initial abilities. In this regard, a sliding scale as to the amount of time allotted and intensity of effort should be carefully gauged for the cardiorespiratory, muscular strength and endurance, and flexibility components of the program. An appropriate warm-up and cool-down period, which would include flexibility exercises, is also recommended. The important factor is to design a program for the individual to provide the proper amount of physical activity to attain maximal benefit at the lowest risk. Emphasis should be placed on factors that result in permanent lifestyle change and encourage a lifetime of physical activity.
Nonweight-bearing ambulation with the aid of an assistive device is often prescribed in the clinical setting. Little is known about the oxygen cost, cardiovascular stress, and perception of effort of these devices when applied to the same sample of subjects. Therefore, the present study compared the oxygen cost, cardiovascular stress [measured by heart rate (HR), blood pressure (BP) responses, and rate pressure product (RPP)], and perception of effort [measured by ratings of perceived exertion (RPE)] of unassisted ambulation (UA), nonweight-bearing ambulation using axillary crutches (AC), a standard walker (SW), and a wheeled walker (WW). Nine female subjects ambulated at self-selected velocities for 7 minutes during each ambulation mode. Oxygen consumption, HR, BP, and RPEs were obtained. As expected, UA resulted in the lowest VO2 (11.2 +/- 1.4 ml/kg.min-1) and greatest velocity (1.24 +/- 0.27 m/sec). Results also indicated that AC ambulation resulted in lower oxygen consumption per meter (0.4 +/- 0.1 ml/kg.m-1) and greater velocity (0.74 +/- 0.18 m/sec) than either SW ambulation (0.6 +/- .1 ml/kg.-1, 0.39 +/- 0.09 m/sec) or WW ambulation (0.6 +/- .1 ml/kg.m-1, 0.40 +/- 0.12 m/sec) (p < .05). No differences were observed among assisted ambulation modes for HR, BP responses, RPP, or RPE values. Because patients typically ambulate for a set distance (rather than a set time) and because the oxygen cost per unit distance was lowest for AC, it is suggested that, when possible, AC should be prescribed for non-weight-bearing ambulation.
The purpose of this study was to quantify and compare cardiorespiratory demands imposed during unassisted ambulation and ambulation with various assistive devices in older adults.
Ten volunteers (3 male, 7 female) who were not dependent on assistive devices for ambulation, with a mean age 60.3 years (SD = 8.4, range = 50-74), participated.
Immediately after a 5-minute steady-state session with each of the assistive devices tested (standard walker, wheeled walker, and single-point cane), subjects ambulated for 2 minutes at a self-selected speed with each device and unassisted while selected cardiorespiratory and metabolic variables were monitored.
Ambulation with the use of a standard walker was shown to require 212% more oxygen per meter than unassisted ambulation and 104% more oxygen per meter than ambulation with a wheeled walker. Ambulation with a standard walker elicited 200% and 98% higher heart rate per meter as compared with unassisted ambulation and ambulation with a wheeled walker, respectively. No difference was detected for physiologic demands between unassisted ambulation and ambulation with a cane.
The decision to prescribe a wheeled walker versus a standard walker may be clinically important with patients who have impaired cardiorespiratory systems.
Physical activity programs in nursing homes typically consist of seated, range of motion (ROM) exercises, regardless of resident abilities. The Functional Fitness for Long-Term Care (FFLTC) Program was designed not only to maintain ROM, but also to improve strength, balance, flexibility, mobility, and function. In addition, it was tailored to meet the needs of both high and low mobility residents.
The feasibility and efficacy of the FFLTC Program were evaluated with 68 residents (mean age 80) from five institutions. Persons were classified as low or high mobility and randomized into either the FFLTC program or a seated ROM program. Classes were conducted in groups of 4 to 10 residents by trained facility staff for 45 minutes, three times per week. Assessments at baseline and 4 months consisted of mobility, balance, gait, flexibility, functional capacity, and several upper and lower extremity strength measures.
Attendance averaged 86% for the FFLTC and 79% for the ROM classes. Four months of exercise led to significant improvements in mobility (16%), balance (9%), flexibility (36%), knee (55%), and hip (12%) strength for the FFLTC group. Shoulder strength was the only improvement found for the ROM group. The ROM group significantly deteriorated in some areas, particularly hip strength, mobility, and functional ability.
Institutionalized seniors, even those who are physically frail, incontinent and/or have mild dementia, can respond positively to a challenging exercise program. The FFLTC program demonstrated clear benefits over typical, seated ROM exercises. Moreover, with minimal training, the program can be safely delivered at low cost by institutional staff and volunteers.
While the benefits of physical activity and exercise among older persons are becoming increasingly clear, the role of exercise stress testing and safety monitoring for older persons who want to start an exercise program is unclear. Current guidelines regarding exercise stress testing likely are not applicable to the majority of persons aged 75 years or older who are interested in restoring or enhancing their physical function through a program of physical activity and exercise. In addition to being expensive and of unproven benefit, the current policy of routine exercise stress testing potentially could deter many older persons from participating in an exercise program. Research is needed to investigate current physician practices, evaluate the risk of adverse cardiac events, determine the role of pharmacological stress testing, and measure and compare absolute and relative exercise intensities. To assist clinicians, we offer a set of recommendations regarding precautions that can be taken to minimize the risk of adverse cardiac events among previously sedentary older persons who do not have symptomatic cardiovascular disease and are interested in starting an exercise program. JAMA. 2000;284:342-349
To report the percentile distribution of Mini-Mental State Examination (MMSE) scores in older people by age, sex, and education level, estimated from longitudinal data, after correcting for loss due to dropout.
The Cambridge City over 75 Cohort is a population-based study of a cohort of 2106 subjects age 75 years and older at study entry followed up over 9 years. At each of the four waves, cognitive function was assessed using MMSE. Based on these data, the relationship between age and MMSE score was modeled. Percentile distributions by age, sex, and education level were provided using inverse probability weighting to correct for dropouts.
Performance on MMSE was related to age in men and women. In women, at age 75, MMSE score ranged from 21 (10th percentile) to 29 (90th percentile). At age 95, the range was 10 (10th percentile) to 27 (90th percentile). The upper end of MMSE distribution was slightly modified with age, whereas the lower end of the distribution was very sensitive to age effect. A similar pattern was observed in both sexes.
These findings provide norms for MMSE scores in subjects age 75 years and older from longitudinal population-based data. Such norms can be used as reference values to determine where an individual's score lies in relation to his or her age, sex, and education level.
This study determined the effectiveness of a 6-month program of regular exercises for the improvement of functional performance of the elderly living in a nursing home. The 40 subjects aged 60 to 99 who took part in this trial were assigned either to a comparative group or an exercise group. The following variables were measured: functional performance with the use of an obstacle course, a lower-limb function test, and a 6-minute walk test (gait velocity); isometric strength of the knee extensors; proprioception of the lower limbs; mental status through the Mini-Mental State Examination (MMSE); and depression symptoms with the use of the Geriatric Depression Scale (GDS). In the exercise group, 19 subjects completed the program and attended an average of 32 (68%) sessions. At the end of the trial, the exercise subjects showed significant performance improvement in quantitative and qualitative obstacle course scores, lower-limb function test, gait velocity test, knee extensors strength, and the GDS, while the nonexercise subjects showed significant decrease in qualitative obstacle course score, lower-limb function, gait velocity, MMSE, and the GDS.
The primary goal of the present study was to examine whether in the elderly with mild cognitive impairment (MCI), the effect of physical activity measured directly following treatment, was reflected in an improvement in cognitive functioning in general or in executive functions (EF) in particular. Secondly, this study aimed to compare the effectiveness of two types of intervention, with varying intensities: walking and hand/face exercises. Forty-three frail, advanced elderly subjects (mean age: 86) with MCI were randomly divided into three groups, namely, a walking group (n=15), a group performing hand and face exercises (n=13), and a control group (n=15). All subjects received individual treatment for 30 minutes a day, three times a week, for a period of six weeks. A neuropsychological test battery, administered directly after cessation of treatment, assessed cognitive functioning. The results show that although a (nearly) significant improvement in tasks appealing to EF was observed in both the walking group and the hand/face group compared to the control group, the results should be interpreted with caution. Firm conclusions about the effectiveness of mild physical activity on EF in the oldest old can only be drawn after studies with larger number of subjects.
Interventions to improve care for persons with chronic medical conditions often use quality of life (QOL) outcomes. These outcomes may be affected by coexisting (comorbid) chronic conditions as well as the index condition of interest. A subjective measure of comorbidity that incorporates an assessment of disease severity may be particularly useful for assessing comorbidity for these investigations.
A survey including a list of 25 common chronic conditions was administered to a population of HMO members age 65 or older. Disease burden (comorbidity) was defined as the number of self-identified comorbid conditions weighted by the degree (from 1 to 5) to which each interfered with their daily activities. We calculated sensitivities and specificities relative to chart review for each condition. We correlated self-reported disease burden, relative to two other well-known comorbidity measures (the Charlson Comorbidity Index and the RxRisk score) and chart review, with our primary and secondary QOL outcomes of interest: general health status, physical functioning, depression screen and self-efficacy.
156 respondents reported an average of 5.9 chronic conditions. Median sensitivity and specificity relative to chart review were 75% and 92% respectively. QOL outcomes correlated most strongly with disease burden, followed by number of conditions by chart review, the Charlson Comorbidity Index and the RxRisk score.
Self-report appears to provide a reasonable estimate of comorbidity. For certain QOL assessments, self-reported disease burden may provide a more accurate estimate of comorbidity than existing measures that use different methodologies, and that were originally validated against other outcomes. Investigators adjusting for comorbidity in studies using QOL outcomes may wish to consider using subjective comorbidity measures that incorporate disease severity.
Older individuals arc more likely than younger adults to exhibit symptoms of exercise intolerance at high work rates. The risks of maximal exercise in older adults increase proportionally as the number of health difficulties increase. In this study, the effects of health status, age, and gender on older adults’ ability to attain V̇O2max are examined. Sedentary volunteers (60 women, 45 men), mean age 67 ± 5 years (range 57-78 years), participated in graded maximal exercise tests on a combined arm and leg cycle ergometer. Subjects were classified into three groups based on test termination reason: attainment of V̇O2max (MAX), symptom-limited (SX), or EKG-limited (EKG). Sixty percent of men and 40% of women were classified as MAX, while 48% of women and 27% of men were characterized as SX. Thirteen percent of men and 12% of women had EKG-limited exercise tests. Those in the EKG group reported significantly more diagnoses than subjects in the MAX group (2.7 vs. 1.4. p < .05). The number of medications reporte...
While the benefits of physical activity and exercise among older persons
are becoming increasingly clear, the role of exercise stress testing and safety
monitoring for older persons who want to start an exercise program is unclear.
Current guidelines regarding exercise stress testing likely are not applicable
to the majority of persons aged 75 years or older who are interested in restoring
or enhancing their physical function through a program of physical activity
and exercise. In addition to being expensive and of unproven benefit, the
current policy of routine exercise stress testing potentially could deter
many older persons from participating in an exercise program. Research is
needed to investigate current physician practices, evaluate the risk of adverse
cardiac events, determine the role of pharmacological stress testing, and
measure and compare absolute and relative exercise intensities. To assist
clinicians, we offer a set of recommendations regarding precautions that can
be taken to minimize the risk of adverse cardiac events among previously sedentary
older persons who do not have symptomatic cardiovascular disease and are interested
in starting an exercise program.
Older individuals are more likely than younger adults to exhibit symptoms of exercise intolerance at high work rates. The risks of maximal exercise in older adults increase proportionally as the number of health difficulties increase. In this study, the effects of health status, age, and gender on older adults' ability to attain V̇O 2max are examined. Sedentary volunteers (60 women, 45 men), mean age 67 ± 5 years (range 57-78 years), participated in graded maximal exercise tests on a combined arm and leg cycle ergometer. Subjects were classified into three groups based on test termination reason: attainment of V̇O 2max (MAX), symptom-limited (SX), or EKG-limited (EKG). Sixty percent of men and 40% of women were classified as MAX, while 48% of women and 27% of men were characterized as SX. Thirteen percent of men and 12% of women had EKG-limited exercise tests. Those in the EKG group reported significantly more diagnoses than subjects in the MAX group (2.7 vs. 1.4, p < .05). The number of medications reported and age of the subjects did not differ across test termination categories.
Article abstract—Objective: To report the percentile distribution of Mini-Mental State Examination (MMSE) scores in older people by age, sex, and education level, estimated from longitudinal data, after correcting for loss due to dropout. Methods: The Cambridge City over 75 Cohort is a population-based study of a cohort of 2106 subjects age 75 years and older at study entry followed up over 9 years. At each of the four waves, cognitive function was assessed using MMSE. Based on these data, the relationship between age and MMSE score was modeled. Percentile distributions by age, sex, and education level were provided using inverse probability weighting to correct for dropouts. Results: Performance on MMSE was related to age in men and women. In women, at age 75, MMSE score ranged from 21 (10th percentile) to 29 (90th percentile). At age 95, the range was 10 (10th percentile) to 27 (90th percentile). The upper end of MMSE distribution was slightly modified with age, whereas the lower end of the distribution was very sensitive to age effect. A similar pattern was observed in both sexes. Conclusion: These findings provide norms for MMSE scores in subjects age 75 years and older from longitudinal population-based data. Such norms can be used as reference values to determine where an individual's score lies in relation to his or her age, sex, and education level. NEUROLOGY 2000;55:1609 -1613
It is the policy of the editors of the Journal of Cardiopulmonary Rehabilitation to keep its readers up to date with new policy statements and position stands from other professional organizations that are relevant to its readers. In 1978 the American College of Sports Medicine (ACSM) published a position stand entitled "The Recommended Quantity and Quality of Exercise for Developing and Maintaining Fitness in Healthy Adults'' which was later reprinted in JCR 1981;1;375-384. The revised position stand printed below was recently published by ACSM (Med Sci Sports Exerc 1990;22;265-274.) and replaces the 1978 statement. Although the statement is related to the healthy adult, its reference to the elderly, low fit, or obese person makes it relevant for wellness and cardiopulmonary rehabilitation programs. Of particular interest is the classification of intensity of exercise based on 20 to 60 minutes of endurance training (Table I). This classification system is valid and practical for use with patient populations as well as with elderly and low fit participants. An important addition to the present statement includes a resistance-training component to the training program. The importance of a well-rounded program is emphasized with the 8 to 10 exercises recommended to train the major muscle groups. The statement notes that such exercise is very specific. Thus, training the legs will have little or no effect on the arms, shoulders, or trunk. The editors believe that the new ACSM position stand is important to read because most health professions involved in rehabilitation treat a variety of patients, many of whom could benefit from this statement.
(C) Lippincott-Raven Publishers.
Over the past several years, editors Chuck Corbin, Bob Pangrazi, and Don Franks have commissioned a series of articles about vital physical fitness and activity topics for The President’s Council on Physical Fitness and Sports Research Digest. Now collected in two compact volumes, these texts are designed to introduce a new audience to the important and timely contributions of these renowned experts in the field. Perfect for classroom or personal use, these important volumes provide students and professionals alike the foundation for a better understanding of the many dimensions of physical fitness and activity. This second volume contains 21 articles on such topics as the economic benefits of physical activity, physical activity and youth, motivating physical activity, and physical activity for special populations.
Frailty is a state of reduced physiologic reserve associated with increased susceptibility to disability. Reduced physiologic capacity in neurologic control, mechanical performance, and energy metabolism are the major components of frailty. Although disease is an important cause of frailty, there is sufficient epidemiologic and experimental evidence to conclude that frailty is also due to the additive effects of low-grade physiologic loss resulting from a sedentary lifestyle and more rapid loss due to acute insults (illness, injuries, major life events) that result in periods of limited activity and bedrest. The pathogenesis of frailty involves a complicated interaction of factors that block recovery from rapid physiologic loss. To some extent, frailty is preventable. Approaches to prevention include (1) the periodic monitoring of key physiologic indicators of frailty, (2) the prevention of physiologic loss and acute and subacute episodes of physiologic loss, (3) the prediction of episodes of physiologic loss and the reduction of frailty prior to the loss, and (4) the removal of obstacles to recovery once physiologic loss has occurred.
The energy expenditure of level walking was measured in 260 normal male and female subjects walking around a 60.5m-circular outdoor track. Subjects were divided into four age groups (children, 6-12 years; teens; young adults, 20-59 years; and senior adults, 60-80 years). Oxygen consumption was measured with a modified Douglas Bag technique during the fourth and fifth minutes of each trial. Standard tables according to age and sex were derived for the average energy expenditure (rate of oxygen uptake, energy cost per meter, and heart rate) and for the gait characteristics (speed, cadence, stride length) at the subjects' customary slow, normal, and fast walking speeds. Statistical analysis was performed to determine the energy-speed relationship for the different age groups to derive normative tables for the rate of oxygen uptake throughout the range of customary walking velocities.
A coding scheme is presented for classifying physical activity by rate of energy expenditure, i.e., by intensity. Energy cost was established by a review of published and unpublished data. This coding scheme employs five digits that classify activity by purpose (i.e., sports, occupation, self-care), the specific type of activity, and its intensity as the ratio of work metabolic rate to resting metabolic rate (METs). Energy expenditure in kilocalories or kilocalories per kilogram body weight can be estimated for all activities, specific activities, or activity types. General use of this coding system would enhance the comparability of results across studies using self reports of physical activity.
In this paper, we consider the domain of executive functions (EFs) and their possible role in developmental psychopathologies. We first consider general theoretical and measurement issues involved in studying EFs and then review studies of EFs in four developmental psychopathologies: attention deficit hyperactivity disorder (ADHD), conduct disorder (CD), autism, and Tourette syndrome (TS).
Our review reveals that EF deficits are consistently found in both ADHD and autism but not in CD (without ADHD) or in TS. Moreover, both the severity and profile of EF deficits appears to differ across ADHD and autism. Molar EF deficits are more severe in the latter than the former. In the few studies of more specific EF tasks, there are impairments in motor inhibition in ADHD but not in autism, whereas there are impairments in verbal working memory in autism but not ADHD. We close with a discussion of implications for future research.
To determine the ownership and use of various assistive devices by older people living at home.
A random sample of 1405 elderly people aged 65 years and over, in three health authorities, were asked about ownership and use of a number of disability aids, spectacles and hearing aids.
74% of respondents owned one or more aid, 97% had spectacles and 16% a hearing aid. The most commonly owned assistive devices were a non-slip bath mat (50%), a walking stick (24%) and a bath rail (21%). Many severely disabled people, however, had no aids. For example, 75% had no stair rail, 68% had no lavatory rail and 46% had no non-slip bath mat. Most of the equipment owned was used. Walking frames and wheelchairs were used more by those over 75, as were all bathroom and lavatory appliances. Gender influenced the use of some aids, with more women using their walking frames and bathroom rails than men.
Our study confirms that ownership and use of aids varies with age, gender, living arrangements and disability. Very disabled people need but do not own certain basic and relatively inexpensive appliances. Community services currently aim to promote autonomy and independence in elderly people in the community. This may be facilitated and enhanced by provision of appropriate equipment and increasing awareness of the value of assistive devices among elderly people, informal carers and health- and social-care professionals. Knowledge of who owns and uses various items of equipment may help improve strategic planning.
The interplay of cardiovascular and cellular oxygen uptake determinants of aerobic performance and the system adaptations to training in different population samples are examined in order to describe the limitation. With VO2max, a central limitation following myocardial infarction and ageing is modified with training. Peripheral adaptations occur and stroke volume may be increased primarily through improved diastolic filling. In submaximal perturbations, control of the increase in O2 uptake at exercise onset (O2 kinetics) is most often under peripheral metabolic control, but in exceptions may also be limited by central factors. In young and old the peripheral machinery is matched to the growth (puberty) and loss (ageing) of muscle mass. Cardiac stroke volume capacity may adjust following the changes in muscle mass. Submaximal endurance is closely influenced by the anaerobic threshold (theta(an)) and peripheral factors of oxidative metabolism. Relative to VO2max, the theta(an) is low in children and high in older adults, perhaps reflecting a slow time course in full development and loss of peripheral adaptations. Remarkable increases in endurance performance are related to relatively small changes in the maximal capacity and the relative intensity of performance.
This study explores the effect of regular training on blood pressure, maximal oxygen uptake, maximal isometric muscle strength, and walking speed in the very old. A total of 55 community-dwelling women, 85-year-old, were enrolled in a training group (N = 22) or a control group (N = 33). These groups were reduced to 19 and 26 subjects, respectively, after the training period. Training was performed once a week over eight months, and consisted of various exercises with particular attention to movements important for everyday activities. Training reduced diastolic blood pressure (p < 0.05), and showed a similar trend for systolic blood pressure. Measurements of maximal oxygen uptake before the start of the training (15 mL min-1 kg-1) revealed a level close to the presumed limit for independent living (13 mL min-1 kg-1). Training improved VO2 max by 18% (p < 0.05), whereas the control group experienced a trend towards a reduction. Maximal isometric muscle strength of both the right and left leg showed a tendency to increase with training, but no significant changes were evident in the trunk flexor and extensor muscles. The training group showed a significant increase of 17% in maximal walking speed after the training period. However, one year later, without training, this improvement was reduced to 8% (p < 0.05). No major changes were observed in the control group for any of these parameters. This study demonstrates a maximal oxygen capacity in very old community-dwelling women close to a threshold level indicating dependency. Furthermore, 8 months of regular training appears to lower blood pressure, and to increase maximal oxygen uptake and maximal walking speed. This suggests that physical reactivation of the very old may reduce the risk for acquiring age-related diseases associated with an elevated blood pressure, and may improve parameters crucial for independence.
Sedentary behavior is an important risk factor for chronic disease morbidity and mortality in aging. However, there is a limited amount of information on the type and amount of activity needed to promote optimal health and function in older people. The purpose of this review is to describe the change in patterns of habitual physical activity in aging and the relationship of these changes to physical function and selected chronic diseases. We undertook a literature review of large population-based studies of physical activity in older people, and there is encouraging evidence that moderate levels of physical activity may provide protection from certain chronic diseases. Additionally, substantial health effects can be accrued independent of the fitness effects achieved through sustained vigorous activity. Thus, regular participation (i.e., 30 minutes/day on most days of the week) in activities of moderate intensity (such as walking, climbing stairs, biking, or yardwork/gardening), which increase accumulated daily energy expenditure and maintain muscular strength, but may not be of sufficient intensity for improving fitness, should be encouraged in older adults. Public policy should focus on ways of increasing volitional and lifestyle activity in older people, as well as on increasing the availability and accessibility of senior and community center programs for promoting physical activity throughout the life span.
Many features of aging suggest dysfunction in both frontal and subcortical regions. Connections between the two areas form a series of pathways that critically influence various aspects of cognition, motor control, affect, and as recently discovered, normal urinary function. Age-related changes in the structure and integrity of these circuits may be associated with cognitive impairment, mood disorders, loss of balance, falls, and urinary dysfunction. In addition, cardiovascular risk factors in elderly people are associated with the development of cerebral microangiopathic changes in both the periventricular white matter and basal ganglia. These lesions are common, usually unsuspected, and were previously believed to be clinically innocuous. However, increasing evidence supports a role for these lesions as a cause for both dysfunction in frontal-subcortical systems, and many clinical features of aging that account for substantial disability. Because this form of cerebrovascular disease is potentially preventable, interventions that address risk factors for the development of cerebral microangiopathy may go a long way in preventing disability for the next generation of elderly persons.
While limited research is available, evidence indicates that physical and mental activity influence the aging process. Human data show that executive functions of the type associated with frontal lobe and hippocampal regions of the brain may be selectively maintained or enhanced in humans with higher levels of fitness. Similarly enhanced performance is observed in aged animals exposed to elevated physical and mental demand and it appears that the vascular component of the brain response may be driven by physical activity whereas the neuronal component may reflect learning. Recent results have implicated neurogenesis, at least in the hippocampus, as a component of the brain response to exercise, with learning enhancing survival of these neurons. Non-neuronal tissues also respond to experience in the mature brain, indicating that the brain reflects both its recent and its longer history of experience. Preliminary measures of brain function hold promise of increased interaction between human and animal researchers and a better understanding of the substrates of experience effects on behavioral performance in aging.
The clinical course of Parkinson disease (PD) varies from patient to patient. A number of studies investigating predictors of prognosis in patients with PD have been performed.
To summarize evidence on predicting the rate of motor decline and increasing disability in early PD.
English-language and French-language literature cited in the MEDLINE database (1966-2002).
Cohort and case-control studies investigating associations between clinical features and subsequent motor impairment or disability were selected.
Study methods and results were abstracted by a single reviewer.
The results of 13 studies were summarized qualitatively. Study methods were highly variable, particularly regarding the choice of outcome measure. Baseline motor impairment and cognitive impairment are probable predictors of more rapid motor decline and disability. A lack of tremor at onset and older age both appear to be predictive of increasing disability, but conflicting results exist for their association with the rate of change of motor impairment. Family history of PD does not appear to be prognostically important. The prognostic value of many other factors studied is uncertain owing to conflicting or unconfirmed results.
Uncertainty remains about the prognostic importance of many baseline clinical features in PD. Greater baseline impairment, early cognitive disturbance, older age, and lack of tremor at onset appear to be adverse prognostic factors.
A theory is described which links cognitive changes observed in normal aging to an underlying decline in the function of the dopamine (DA) system projection to prefrontal cortex (PFC). The theory postulates that this neural mechanism is integral to the representation, maintenance and updating of context information, and as such impacts cognitive control across a wide range of cognitive domains, including working memory, attention, and inhibition. Behavioral and brain imaging data in support of the theory are discussed, which demonstrate selective impairments in context processing among healthy older adults associated with abnormal PFC activation. These findings highlight the utility of a computational approach to cognitive aging. Current directions for further refinement and validation of the model are outlined.
A meta-analytic study was conducted to examine the hypothesis that aerobic fitness training enhances the cognitive vitality of healthy but sedentary older adults. Eighteen intervention studies published between 1966 and 2001 were entered into the analysis. Several theoretically and practically important results were obtained. Most important fitness training was found to have robust but selective benefits for cognition, with the largest fitness-induced benefits occurring for executive-control processes. The magnitude of fitness effects on cognition was also moderated by a number of programmatic and methodological factors, including the length of the fitness-training intervention, the type of the intervention, the duration of training sessions, and the gender of the study participants. The results are discussed in terms of recent neuroscientific and psychological data that indicate cognitive and neural plasticity is maintained throughout the life span.
In epidemiological studies, estimation of total energy expenditure can only be carried out from using metabolic equivalent (MET) units calculated physical activity questionnaires, where 1 MET is generally assumed to be 3.5 ml/min/kg resting oxygen consumption (VO2 resting). Since the basal metabolic rate varies with age, the energy expenditure equivalent to 1 MET is likely to vary with age. The objective of this study was to determine the energy value for 1 MET in elderly Chinese people compared with younger subjects, using a cross-sectional study. The participants were 138 young adults (88 female, 50 male) aged 16-64 years and 70 elderly adults (35 female, 35 male) aged 65-89 years. VO2 resting was determined by indirect calorimetry (Deltatrac; Datex Division Instrumentraium Corp, Helsinki, Finland). The height and weight were measured. The body fat percentage and lean mass was estimated by body mass index, tricep and bicep skinfold thickness and Bio-impedance analysis. Both VO2 resting and VO2 resting/kg body weight were significantly lower in elderly than young subjects in both gender groups (P<0.01). The significant age difference in VO2 resting remained after adjustment for weight, height and lean mass in both the male group (P<0.001) and the female group (P<0.01). In conclusion, age had an independent effect on VO2 resting, independent of the change of body composition. The present study suggested that the assumption of 1 MET=3.5 ml/min/kg VO2 resting may over-estimate energy expenditure when apply to elderly people.
Physical activity may be associated with better cognition.
To investigate whether change in duration and intensity of physical activity is associated with 10-year cognitive decline in elderly men.
Data of 295 healthy survivors, born between 1900 and 1920, from the Finland, Italy, and the Netherlands Elderly (FINE) Study were used. From 1990 onward, physical activity was measured with a validated questionnaire for retired men and cognitive functioning with the Mini-Mental State Examination (maximum score 30 points).
The rates of cognitive decline did not differ among men with a high or low duration of activity at baseline. However, a decrease in activity duration of >60 min/day over 10 years resulted in a decline of 1.7 points (p < 0.0001). This decline was 2.6 times stronger than the decline of men who maintained their activity duration (p = 0.06). Men in the lowest intensity quartile at baseline had a 1.8 (p = 0.07) to 3.5 (p = 0.004) times stronger 10-year cognitive decline than those in the other quartiles. A decrease in intensity of physical activity of at least half a standard deviation was associated with a 3.6 times stronger decline than maintaining the level of intensity (p = 0.003).
Even in old age, participation in activities with at least a medium-low intensity may postpone cognitive decline. Moreover, a decrease in duration or intensity of physical activity results in a stronger cognitive decline than maintaining duration or intensity.
To determine whether cardiorespiratory fitness at baseline is associated with maintenance of cognitive function over 6 years or with level of cognitive function on tests performed 6 years later in a longitudinal study of healthy older people.
Prospective cohort.
Community-based study of noninstitutionalized adults aged 55 and older living in Sonoma, California.
Three hundred forty-nine cohort members without evidence of cardiovascular disease, musculoskeletal disability, or cognitive impairment at baseline.
Cardiorespiratory fitness measures were based on a standard treadmill exercise test protocol and included peak oxygen consumption (peak VO2), treadmill exercise duration, and oxygen uptake efficiency slope (OUES). Cognitive function was evaluated at baseline with a modified Mini-Mental State Examination (mMMSE) and after 6 years of follow-up with a detailed cognitive test battery that included the full MMSE, three tests of attention/executive function, two measures of verbal memory, and two tests of verbal fluency.
Participants with worse cardiorespiratory fitness at baseline experienced greater decline on the mMMSE over 6 years (mean mMMSE decline (95% confidence interval) by baseline peak VO2 tertile: lowest = -0.5 (-0.8 to -0.3), middle = -0.2 (-0.5-0.0), highest = 0.0 (-0.3-0.2), P =.002 for trend over tertiles). Participants with worse baseline cardiorespiratory fitness also performed worse on all cognitive tests conducted 6 years later. Results were similar for analyses based on peak VO2, treadmill exercise duration, and OUES. After adjustment for demographic and health-related covariates, measures of cardiorespiratory fitness were associated most strongly with measures of global cognitive function and attention/executive function.
Baseline measures of cardiorespiratory fitness are positively associated with preservation of cognitive function over a 6-year period and with levels of performance on cognitive tests conducted 6 years later in healthy older adults. High cardiorespiratory fitness may protect against cognitive dysfunction in older people.
Loss of balance and falling are critical concerns for older adults. Physical activity can improve balance and decrease the risk of falling. The purpose of this study was to evaluate a simple, low-cost exercise program for community-dwelling older adults. Sixteen senior adults were evaluated using the Senior Fitness Test for measures of functional strength, aerobic endurance, dynamic balance and agility, and flexibility. In addition, measures of height, weight, resting blood pressure, blood lipids, and cognitive function were obtained. Participants then attended a 10-week exercise class including stretching, strengthening, and balance-training exercises. At the completion of the program, significant improvements were observed in tests measuring dynamic balance and agility, lower and upper extremity strength, and upper extremity flexibility. The results indicate that exercise programs such as this are an effective, low-cost solution to improving health and factors that affect falling risk among older adults.
Rollators are used in order to make mobility possible for people with restricted walking ability. The use of rollators is increasing, but little is known about outcomes. The aim of this study was to investigate users' satisfaction with rollators.
A follow-up study was carried out in seven Danish municipalities. One month after they got their device, 89 users of rollators were interviewed by means of the QUEST 1.0. Three months after the first interview a second interview took place and data from the 64 users available for follow-up were analysed.
The users were satisfied with their rollators, and the frequency of use was high. However, many of the users were frail, and some of them were not fully satisfied in all respects. Women especially, users living alone and first time users were likely to be dissatisfied. The main problem identified was handling the rollator, and for several users the physical environment caused accessibility problems.
Rollators are valuable for the users and a relevant societal intervention. However, a better match between person and technology, enhanced user training and follow-up can improve the outcome of the intervention. Furthermore, better rollator design is called for, and buses and the outdoor environment need to be made more accessible.
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