Aerobic Function Research Articles

A25 The development of an evidence-based physical self-management rehabilitation programme for cancer survivors

Objective: This paper describes the development of a physical training programme for cancer patients. Four related but conceptually and empirically distinct physical problems are described: decreased aerobic capacity, decreased muscle strength, fatigue and impaired role physical functioning. The study aimed to identify the optimal content for an exercise programme that addresses these four physical problems, based on the highest level of evidence available. The study further aimed to review the evidence available on the delivery of the programmes. The final goal was to develop a programme in which content and delivery are based on the best available evidence. Methods: Literature searches (PUBMED and MEDLINE, to July 2006) on content looked for evidence about the efficacy of exercise on aerobic capacity, muscle strength, fatigue and impaired role physical functioning. Literature searches on delivery looked for self-management and/or selfefficacy enhancing techniques in relation to outcome, adherence to and/or adoption of a physically active lifestyle. Results: Evidence on the effectiveness of exercise in cancer patients varies and increases when moving from muscle strength (RCT level), fatigue and physical role functioning to aerobic capacity (all at the meta-analysis level). Effect sizes for aerobic capacity were moderate, while effect sizes for fatigue and physical role functioning were zero and/or small. Many of the studies have significant methodological shortcomings. There was some evidence (meta-analyses) that self-management programmes and self-efficacy enhancing programmes have beneficial effects on health outcomes in a variety of chronic diseases, on the quality of life in cancer patients, and on exercise adherence and later exercise behaviour. Conclusion: Limited data are available on the effectiveness of exercise for cancer patients. Although evidence supports the positive effects of exercise on exercise capacity during and after completion of cancer treatment, the effects for fatigue and role functioning are ambiguous. Evidence on the effectiveness of progressive exercise training on muscle strength is promising. In addition, some evidence supports the positive effects of self-management programmes and self-efficacy enhancing programmes on health outcomes, exercise adherence and later exercise behaviour. Practice Implications: The resulting programme was developed on the basis of the highest quality of evidence available regarding content and delivery. The content is based on information obtained from the present review, and on the recommendations of the American College of Sports Medicine. Potential advantages of the programme include: (a) tailored physical training towards focusing on the patient’s established problems and (b) delivery of the training as a self-management programme that might have beneficial effects on health outcome, exercise adherence and a longterm physically active lifestyle. # 2008 Elsevier Ireland Ltd. All rights reserved.

TITLE: Feasibility of the Nintendo Wii™ for Improving Aerobic Capacity and Cardio-respiratory Function to Enhance Community Engagement

TITLE: Feasibility of the Nintendo Wii™ for Improving Aerobic Capacity and Cardio-respiratory Function to Enhance Community Engagement

단기성 점진 부하 운동에 의한 피로유발이 동적 및 정적 자세안정성의 변화와 회복시간에 미치는 영향

The purpose of this study was to evaluate the effects of fatigue induced by short period of strenuous exercise performed on motor driven treadmill on postural control in healthy college aged male students. The design of this study was an longitudinal cross over design which implements the static and dynamic stability test to the same subjects giving 7 day interval. The subjects consist of 6 competitive gymnasts, 10 non-competitive recreational gymnasts, and 10 non-athletes. Participants completed BESS and SEBT test before maximal aerobic exercise on the treadmill using Bruce protocol. During the maximal aerobic test cardiorespiratory function was measured by Quark b2(Cosmed, USA) respiratory gas analyzer. After completion of aerobic test the participant repeated BESS and SEBT test in the separate session. The data collected were analyzed by SPSS statistical package using descriptive statistics, one way and two way repeated measure ANOVA with 0.05 significance level. The results showed that the knee extension and flexion peak torque were not statistically related to static and dynamic stability. Bone mineral density of non-dominant leg was also not related to static and dynamic stability. After fatigue error score of BESS test significantly increased but group difference did not exist within trial. The gymnasts and recreational gymnasts returned to baseline BESS score in 13 minutes after fatigue. However there was significant difference in SEBT test among the three group which means that gymnasts returned to baseline SEBT score faster than recreational gymnasts and non-athletes. In conclusion postural control was negatively affected after aerobic exercise protocols and the static postural control after fatigue does not respond to the length of previous athletic competition experience. However, dynamic postural control is affected by the length of previous athletic competition experience and elite gymnasts showed better recovery to baseline than the recreational gymnasts and non-athletes.

Exercise training from late middle age until senescence does not attenuate the declines in skeletal muscle aerobic function

We previously showed that 7 wk of treadmill exercise training in late-middle-aged rats can reverse the modest reductions in skeletal muscle aerobic function and enzyme activity relative to values in young adult rats (Exp Physiol 93: 863-871, 2008). The purpose of the present study was to determine whether extending this training program into senescence would attenuate the accelerated decline in the muscle aerobic machinery normally seen at this advanced age. For this purpose, 29-mo-old Fisher 344 Brown-Norway rats underwent 5 or 7 mo of treadmill exercise training. Training resulted in greater exercise capacity during an incremental treadmill exercise test and reduced percent body fat in 34- and 36-mo-old rats and improved survival. Despite these benefits at the whole body level, in situ muscle aerobic capacity and muscle mass were not greater in the trained groups at 34 mo or 36 mo of age. Similarly, the trained groups did not have higher activities of citrate synthase (CS) or Complex IV in homogenates of either the plantaris (fast twitch) or the soleus (slow twitch) muscles at either age. Finally, protein expression of CS (a marker of mitochondrial content) and peroxisome proliferator-activated receptor-gamma coactivator-1 (relating to the drive on mitochondrial biogenesis) were not higher in the trained groups. Therefore, although treadmill training from late middle age into senescence had significant benefits on running capacity, survival, and body fat, it did not prevent the declines in muscle mass, muscle aerobic capacity, or mitochondrial enzyme activities normally seen across this age, revealing a markedly diminished plasticity of the aerobic machinery in response to endurance exercise at advanced age.

Aerobic Conditioning for Team Sport Athletes

Team sport athletes require a high level of aerobic fitness in order to generate and maintain power output during repeated high-intensity efforts and to recover. Research to date suggests that these components can be increased by regularly performing aerobic conditioning. Traditional aerobic conditioning, with minimal changes of direction and no skill component, has been demonstrated to effectively increase aerobic function within a 4- to 10-week period in team sport players. More importantly, traditional aerobic conditioning methods have been shown to increase team sport performance substantially. Many team sports require the upkeep of both aerobic fitness and sport-specific skills during a lengthy competitive season. Classic team sport trainings have been shown to evoke marginal increases/decreases in aerobic fitness. In recent years, aerobic conditioning methods have been designed to allow adequate intensities to be achieved to induce improvements in aerobic fitness whilst incorporating movement-specific and skill-specific tasks, e.g. small-sided games and dribbling circuits. Such 'sport-specific' conditioning methods have been demonstrated to promote increases in aerobic fitness, though careful consideration of player skill levels, current fitness, player numbers, field dimensions, game rules and availability of player encouragement is required. Whilst different conditioning methods appear equivalent in their ability to improve fitness, whether sport-specific conditioning is superior to other methods at improving actual game performance statistics requires further research.

High rates of residual fatty acid oxidation during mild ischemia decrease cardiac work and efficiency

It is unknown what effects high levels of fatty acids have on energy metabolism and cardiac efficiency during milder forms of ischemia. To address this issue, isolated working rat hearts perfused with Krebs–Henseleit solution (5 mM glucose, 100 μU/mL insulin, and 0.4 (Normal Fat) or 1.2 mM palmitate (High Fat)) were subjected to 30 min of aerobic perfusion followed by 30 min of mild ischemia (39% reduction in coronary flow). Both groups had similar aerobic function and rates of glycolysis, however the High Fat group had elevated rates of palmitate oxidation (150%), and decreased rates of glucose oxidation (51%). Mild ischemia decreased cardiac work (56% versus 40%) and efficiency (29% versus 11%) further in High Fat hearts. Palmitate oxidation contributed a greater percent of acetyl-CoA production during mild ischemia in the High Fat group (81% versus 54%). During mild ischemia glycolysis remained at aerobic levels in the Normal Fat group, but was accelerated in the High Fat group. Triglyceride, glycogen and adenine nucleotide content did not differ at the end of mild ischemia, however glycogen turnover was double in the High Fat group (248%). Addition of the pyruvate dehydrogenase inhibitor dichloroacetate to the High Fat group resulted in a doubling of the rate of glucose oxidation and improved cardiac efficiency during mild ischemia. We demonstrate that fatty acid oxidation dominates as the main source of residual oxidative metabolism during mild ischemia, which is accompanied by suppressed cardiac function and efficiency in the presence of high fat.

Anatomic capillarization is elevated in the medial gastrocnemius muscle of mighty mini mice

House mice selectively bred for high voluntary wheel running display a mini-muscle (MM) phenotype wherein mass-specific mitochondrial enzyme activities are double that of normal, but muscle mass is reduced by half. In addition, mini-muscles are characterized by small muscle fibers in the superficial region of the plantaris and medial gastrocnemius muscles. To determine the structural alterations facilitating aerobic metabolism in these mini-muscles, cross-sections of the medial gastrocnemius muscle of normal (N; n = 6) and mini-muscle (MM; n = 6) mice were histo- and immunochemically labeled and analyzed for fiber size, capillarization, and fiber type. On the basis of the higher mitochondrial enzyme activities in muscles of MM mice, we hypothesized that they would have greater fiber capillarization in the medial gastrocnemius than N mice. Furthermore, we hypothesized that augmented capillarization in MM would principally be a function of the smaller fibers in the superficial aspect of this muscle. On average, MM had higher capillary-to-fiber ratio and higher capillary density. Binning fibers according to size revealed that it was primarily the normal-sized fibers of the MM that had higher capillarity. The small fibers seen in the superficial region of MM were distinct from N mice in that they had heterogeneous myofibrillar ATPase staining and patchy succinate dehydrogenase staining in the interior of the fibers. These results support the hypothesis that the MM have higher indexes of capillarity, caused primarily by greater capillary number around normally sized fibers. These alterations are consistent with the superior mass-specific aerobic function of these muscles.

Physical Fitness of Visually Impaired Adolescent Goalball Players

This study compared the physical fitness of 28 visually impaired goalball players (M=13 yr.) and a group of 27 less active age-matched adolescents. Physical characteristics (age, height, weight, sex) and visual acuity of the children were recorded. Body composition (Body Mass Index, skinfold thickness of triceps plus calf), musculoskeletal function (trunk-lift, curl-up, isometric push-up, shoulder-stretch tests) and aerobic function (1-mile run/walk test) were evaluated according to the Brockport Physical Fitness Test Battery. Also, anaerobic power was assessed by a vertical jump test. Physical fitness of visually impaired goalball players was higher than that of the more sedentary group (p<.05), except shoulder-stretch test values (p>.05). It was considered that directing visually impaired children to participation sports or recreational activities such as goalball has importance in improving their physical fitness.

Extremely short duration high intensity interval training substantially improves insulin action in young healthy males

BackgroundTraditional high volume aerobic exercise training reduces cardiovascular and metabolic disease risk but involves a substantial time commitment. Extremely low volume high-intensity interval training (HIT) has recently been demonstrated to produce improvements to aerobic function, but it is unknown whether HIT has the capacity to improve insulin action and hence glycemic control.MethodsSixteen young men (age: 21 ± 2 y; BMI: 23.7 ± 3.1 kg·m-2; VO2peak: 48 ± 9 ml·kg-1·min-1) performed 2 weeks of supervised HIT comprising of a total of 15 min of exercise (6 sessions; 4–6 × 30-s cycle sprints per session). Aerobic performance (250-kJ self-paced cycling time trial), and glucose, insulin and NEFA responses to a 75-g oral glucose load (oral glucose tolerance test; OGTT) were determined before and after training.ResultsFollowing 2 weeks of HIT, the area under the plasma glucose, insulin and NEFA concentration-time curves were all reduced (12%, 37%, 26% respectively, all P < 0.001). Fasting plasma insulin and glucose concentrations remained unchanged, but there was a tendency for reduced fasting plasma NEFA concentrations post-training (pre: 350 ± 36 v post: 290 ± 39 μmol·l-1, P = 0.058). Insulin sensitivity, as measured by the Cederholm index, was improved by 23% (P < 0.01), while aerobic cycling performance improved by ~6% (P < 0.01).ConclusionThe efficacy of a high intensity exercise protocol, involving only ~250 kcal of work each week, to substantially improve insulin action in young sedentary subjects is remarkable. This novel time-efficient training paradigm can be used as a strategy to reduce metabolic risk factors in young and middle aged sedentary populations who otherwise would not adhere to time consuming traditional aerobic exercise regimes.

Recommendations for the transfusion of red blood cells.

The transfusion of red cell concentrates (RCC) is indicated in order to achieve a fast increase in the supply of oxygen to the tissues, when the concentration of haemoglobin (Hb) is low and/or the oxygen carrying capacity is reduced, in the presence of inadequate physiological mechanisms of compensation (table I)1–14. Table I Mechanisms of adaptation to anaemia Tissue oxygenation depends on various factors - the concentration of Hb; - the saturation of Hb, which, in turn, depends on the O2 tension and the affinity of the Hb for O2; - the O2 requirement, that is, the volume of oxygen needed by the tissues to carry out their aerobic function. Clinical factors that affect the physiological mechanisms of adaptation to anaemia5–8,15–19 - a reduced increase in cardiac output: hypovolaemia, coronary artery disease, disorders of heart valves, congestive heart disease, negative inotropic drugs; - decreased capacity to increase the extraction of O2: acute respiratory distress syndrome (ARDS), sepsis, systemic inflammatory response syndrome (SIRS), traumatic ischaemia-reperfusion damage syndrome; - altered gas exchange: chronic obstructive pulmonary disease (COPD), ARDS; - increased consumption of O2: fever, pain, stress, sepsis, SIRS, hyperventilation syndromes. When there is an indication to correct anaemia, but the situation is not urgent, strategies other than transfusion are preferred, such as the use of haematopoietic drugs (iron, vitamin B12, folic acid, recombinant erythropoietin)5–8,20. In order to reduce perioperative bleeding, it is important to suspend treatment with platelet anti-aggregants, adapt/neutralise anticoagulant therapy and use drugs such as antifibrinolytics and desmopressin9,20–23. Autotransfusion, carried out according to the criteria set out in the appropriate pre-operative request schemes (maximum surgical blood order schedule -MSBOS), and surgical and anaesthetic techniques to limit blood loss are useful strategies for decreasing the use of homologous blood (Grade of recommendation: 1C+)5,6,13,14,20–24.

Ligand-enabled PtII–C(sp3) bond functionalization with dioxygen as a direct oxidant

This feature article summarizes the progress achieved in the field of aerobic functionalization of Pt(II) monoalkyl complexes in protic solvents, water and alcohols. These functionalization reactions are possible in the presence of tripodal semi-labile ligands such as di(2-pyridyl)methanesulfonate (dpms). The reactions include two subsequent transformations: (i) direct (mediatorless) oxidation of a Pt(II) monoalkyl or a Pt(II)-oxetane to produce a Pt(IV)(OH) alkyl or a Pt(IV)(OH)-oxetane, respectively, and (ii) reductive elimination from the Pt(IV) center of an oxygenated organic derivative with a new C-O bond such as alcohols (MeOH, HOC2H4OH), ethers (Me2O), or olefin (ethylene, cis-cyclooctene, norbornene) oxides. All the reactions are highly chemo- and stereoselective. Mechanisms of dioxygen activation with (dpms)Pt(II) alkyls and C-O reductive eliminations from a Pt(IV) center are discussed, including the direct C-O elimination of epoxides from Pt(IV) oxetanes previously undocumented for this metal. Modification of the "slow" Pt(II)-based systems led to the discovery of a "fast" dioxygenase-like acetoxylation of benzylic C-H bonds catalyzed by homogeneous Pd complexes with O2 as the sole oxidant.

Effect of Anodic Metabolic Function on Bioelectricity Generation and Substrate Degradation in Single Chambered Microbial Fuel Cell

Influence of anodic metabolic function viz., aerobic, anoxic and anaerobic on bioelectricity generation was evaluated in single chamber mediatorless microbial fuel cells (non-catalyzed graphite electrodes; open-air cathode) during wastewater treatment under similar operating conditions (pH 7; ambient temperature/pressure). Despite the fluctuations observed, aerobic metabolic function (379 mV; 538 mA/m2) documented higher power generation compared to anoxic (251 mV; 348 mA/m2) and anaerobic (265 mV; 211 mA/m2) operations. Relatively higher treatment efficiency was also evidenced in aerobic operation (COD removal efficiency; 77.68% (aerobic), 56.84% (anoxic), 48.68% (anaerobic)). Polarization behavior, bioelectrochemical analysis, sustainable resistance and cell potentials also supported the aerobic operation. Aerobic metabolic function showed potential to generate higher power and substrate degradation over the corresponding anoxic and anaerobic metabolic functions. The relative efficiency of power generation observed in aerobic microenvironment might be attributed to effective substrate oxidation and good biofilm growth observed on the anodic surface. Presence of lower dissolved oxygen concentration in anodic chamber due to the establishment of equilibrium between substrate oxidation and oxygen scavenging might also contributes positively to power generation in aerobic operation.

Editorial: promotion for physical activity in elderly

Aging considerations Aging is associated with decreases in aerobic capacity, cardiac function, and insulin sensitivity as well as alterations in myocardial substrate metabolism. Myocardial functional changes with cardiac complications in sedentary elderly include decline in maximum heart rate, stroke volume, and contractility, and an increase in peripheral vascular resistance. The changes in structure and function of the

Ex situ slurry phase bioremediation of chrysene contaminated soil with the function of metabolic function: Process evaluation by data enveloping analysis (DEA) and Taguchi design of experimental methodology (DOE)

Bioremediation of chrysene in soil matrix was evaluated in soil slurry phase bioreactor in conjugation with metabolic functions (aerobic, anoxic and anaerobic), microenvironment (single and mixed) conditions and nature of mixed consortia (native/resident mixed microflora and bioaugmented inoculum). Twelve experiments were operated independently in agitated-batch reactor keeping all other operating conditions constant (substrate loading rate – 0.084 g chrysene/kg soil-day; soil loading rate – 10 kg soil/m 3-day (3:25 soil water ratio); operating temperature – 35 ± 2° C). Data envelopment analysis (DEA) procedure was employed to analyze the performance of experimental variations in terms of chrysene degradation and pH. The efficacy of anoxic metabolism over the corresponding aerobic and anaerobic metabolic functions was documented. Aerobic metabolic function showed effective degradation capability under mixed microenvironment after augmentation with anaerobic inoculum. Anaerobic metabolic function showed lowest degradation potential. Application of bioaugmentation showed positive influence on the chrysene degradation rate. Design of experimental methodology (DOE) by Taguchi approach was applied to evaluate the effect of four selected factors (native soil microflora, microenvironment, metabolic function and bioaugmentation) on the chrysene degradation process. The optimized factors derived from analysis depicted the requirement of native soil microflora under anoxic metabolic function using mixed microenvironment after augmenting with anaerobic inoculum for achieving effective chrysene degradation efficacy.

Exercise training in late middle‐aged male Fischer 344 × Brown Norway F1‐hybrid rats improves skeletal muscle aerobic function

The Fischer 344 x Brown Norway F1-hybrid (F344BN) rat has become an increasingly popular and useful strain for studying age-related declines in skeletal muscle function because this strain lives long enough to experience significant declines in muscle mass. Since exercise is often considered a mechanism to combat age-related declines in muscle function, determining the utility of this strain of rat for studying the effects of exercise on the ageing process is necessary. The purpose of this study was to evaluate the plasticity of skeletal muscle aerobic function in late middle-aged male rats following 7 weeks of treadmill exercise training. Training consisted of 60 min per day, 5 days per week with velocity gradually increasing over the training period according to the capabilities of individual rats. The final 3 weeks involved 2 min high-intensity intervals to increase the training stimulus. We used in situ skeletal muscle aerobic metabolic responses and in vitro assessment of muscle mitochondrial oxidative capacity to describe the adaptations of aerobic function from the training. Training increased running endurance from 11.3 +/- 0.6 to 15.5 +/- 0.8 min, an improvement of approximately 60%. Similarly, distal hindlimb muscles from trained rats exhibited a higher maximal oxygen consumption in situ (23.2 +/- 1.3 versus 19.7 +/- 0.8 mumol min(-1) for trained versus sedentary rats, respectively) and greater citrate synthase and complex IV enzyme activities in gastrocnemius (29 and 19%, respectively) and plantaris muscles (24 and 28%, respectively) compared with age-matched sedentary control animals. Our results demonstrate that skeletal muscles from late middle-aged rats adapt to treadmill exercise by improving skeletal muscle aerobic function and mitochondrial enzyme activities. This rat strain seems suitable for further investigations using exercise as an intervention to combat ageing-related declines of skeletal muscle aerobic function.

Effects of Aging on Aerobic Function and Muscle Oxygenation

Effects of Aging on Aerobic Function and Muscle Oxygenation

Relationships Between Aerobic Fitness and Limbic Function in Military Men

Relationships Between Aerobic Fitness and Limbic Function in Military Men

Prolonged Exercise Training does not Preserve Mitochondrial Enzyme Activity in Senescent Rats

Skeletal muscle aerobic function (VO2max) and mitochondrial oxidative capacity decline with aging, particularly in senescence (SEN). Since exercise training improves muscle VO2max and oxidative capacity in young adult skeletal muscle, our objective was to determine if treadmill training from late middle age (LMA) into SEN would minimize the declines in skeletal muscle aerobic function and oxidative capacity seen in SEN. 62 male rats at late middle age (29 mo) were randomly separated into control and exercise groups. Exercise consisted of 60 m/day treadmill running, 5 d/week for 7 weeks and then decreased to 4 d/week for a total of 5 and 7 mo (until 34 and 36 mo of age respectively). Although running capacity was significantly higher in the trained groups (13% at 34 mo and 21% at 36 mo), muscle VO2max at matched muscle O2 delivery was not significantly greater in the trained groups compared to sedentary controls at either age. Similarly, citrate synthase and cytochrome oxidase activity in the plantaris, soleus and the heart muscle were not different in the trained vs the sedentary groups, suggesting no benefit of training for muscle oxidative capacity. The superior exercise capacity suggests a better overall level of function of the senescent rats; however, contrary to our hypothesis and prior observations in LMA rats, treadmill exercise training between LMA and SEN does not benefit muscle aerobic function or mitochondrial oxidative capacity.Supported by CIHR (AB, RT), CIHR Provincial Training Program in Bone and Joint Health (AB), AHFMR (RT) and NSERC (MT).

Aerobic capacity correlates to self-assessed physical function but not to overall disease activity or organ damage in women with systemic lupus erythematosus with low-to-moderate disease activity and organ damage

The present aim is to investigate the relationships between aerobic capacity and disease activity, organ damage, health-related quality of life (HRQL) and physical activity in 34 women with systemic lupus erythematosus (SLE) with low-to-moderate disease activity and organ damage. Mean age was 51 (SD 10) years, disease duration 17 (SD 11) years. Aerobic capacity (maximal oxygen uptake/VO2 max) was measured with a bicycle ergometer exercise test. Overall disease activity was assessed with Systemic Lupus Activity Measure (SLAM) and the modified Systemic Lupus Erythematosus-Disease Activity Index (modified SLE-DAI), overall organ damage with the Systemic Lupus International Collaboration Clinics/American College of Rheumatology-Damage Index, [SLICC/(ACR)-DI], HRQL with the 36-item Short-form health-survey (SF-36) and physical activity with a self-assessed question. The women who were low-to-moderately physically active had 89-92% (P < or = 0.001) of VO2 max predicted for sedentary women. Maximal oxygen uptake (L/min, mL/min/kg) correlated to SF-36 physical function (rs = 0.49, rs = 0.72) (P < or = 0.01), but not (rs < or = 0.25) to other HRQL scales, overall disease activity or organ damage or physical activity. The correlation between aerobic capacity and physical function and the absence of correlation between aerobic capacity and physical activity, suggest a possible disease-related factor behind the low aerobic capacity. However, with no correlation between aerobic capacity and overall disease activity and organ damage, low physical activity may contribute to the low aerobic capacity in our sample.

The Effects of Aerobic Training and Nutrition Education on Functional Performance in Low Socioeconomic Older Adults

To describe the population in terms of risk for disability and compare the effects of a walking intervention and nutrition education intervention on risk modification and functional performance in lower socioeconomic older adults using a randomized controlled study. Twenty-six community-dwelling older adults aged 60 and older were randomly assigned to a 16-week walking exercise group or a nutrition education control group. Peak aerobic capacity and physical function were measured at baseline and post intervention. Physical function was measured using the Medical Outcomes Study Short Form Health Survey Physical Function subscale, Short Physical Performance Battery, Physical Performance Test, and Continuous Scale Physical Functional Performance 10 item test (CS-PFP10). Eighty-five percent of the participants were at risk for preclinical disability of which 50% were at risk for moderate disability. The walking exercise group significantly improved in peak aerobic capacity (18.9%), physical function (25%) using the CS-PFP10 compared to the control group. These findings highlight the importance of physical activity and indicate that walking, a simple exercise that can be done without specialized exercise leader or equipment can significantly increase peak aerobic capacity and physical function in just 4 months.