Exercise In Elderly Patients Research Articles

BENEFÍCIOS DO TREINAMENTO RESISTIDO EM IDOSOS COM ALZHEIMER: REVISÃO NARRATIVA DE LITERATURA

Introdução: Com o crescente aumento da população de idosos cresce também as doenças neurológicas degenerativas, como a Doença de Alzheimer (DA). A DA acarreta declínios cognitivos, déficit de equilíbrio, perdas na força muscular e nas funções físicas, resultando em perda de qualidade de vida. Sabe-se atualmente que o exercício físico, na modalidade resistido, é uma intervenção que ameniza as perdas cognitivas e motoras no processo de envelhecimento. Objetivo: Verificar os possíveis benefícios do treinamento resistido em idosos com DA. Materiais e Métodos: Revisão narrativa de literatura, com busca nas bases de dados: Pubmed, Lilacs, e Bireme, com as palavras “strenght exercise”, “exercise training”, “resistance training”, “strength training” e “muscle strength associados a “Alzheimer”. Resultados: Foram encontrados 241 artigos, dos quais foram selecionados 10. Para as variáveis: Atividade de Vida Diária, Atividades Instrumentais de Vida Diária e Qualidade de Vida ainda são inconclusivos os benefícios do treinamento resistido. O treinamento combinado, contendo exercícios de força, caminhada, flexibilidade equilíbrio e agilidade, apresenta benefícios para o aumento na força muscular, melhoras no equilíbrio, função cognitiva e função física (capacidade de caminhar, subir e descer escadas, sentar e levantar) em idosos com DA. Conclusão: Estudos mais confiáveis, com metodologia sistemática e avaliação de risco de viés, precisam ser realizados para afirmar os benefícios descritos e padronizar intensidade, duração, volume de exercícios resistidos em idosos com DA.

COPD患者の運動に対する分岐鎖アミノ酸（BCAA）の効果

COPD患者の運動に対する分岐鎖アミノ酸（BCAA）の効果

Circuit weight training or walking exercise in elderly patients with medicated diabetes and hypertension

Circuit weight training or walking exercise in elderly patients with medicated diabetes and hypertension

Distractive Auditory Stimuli Alleviate the Perception of Dyspnea Induced by Low-Intensity Exercise in Elderly Subjects With COPD.

Although recent studies have shown that distractive auditory stimuli (DAS) in the form of music increase adherence to exercise in subjects with COPD, the effect of DAS on dyspnea induced by low-intensity, constant-load exercise in elderly patients with COPD has not been elucidated. Therefore, the purpose of this study was to investigate the effect of DAS on the perception of dyspnea induced by low-intensity, constant-load exercise in elderly subjects with COPD. We enrolled 16 male out-patients with COPD. Subjects completed cycling exercises with and without DAS at 40% maximum oxygen consumption. They were asked to rate their perception of dyspnea using the modified Borg scale every 3 min during exercise and every 1 min during the recovery period. Dyspnea perception during low-intensity exercise showed a significant correlation between the exercise condition (DAS and control) and exercise duration (P = .04). Exercise-induced dyspnea perception under the DAS condition was significantly lower than that under the control condition from 18 min after the start of exercise to 3 min after the end of exercise (18, 20, 21, 22, and 23 min, P = .01, P < .001, P = .009, P = .006, and P = .006, respectively). However, oxygen consumption and ventilation in response to low-intensity exercise did not significantly differ in the DAS and control conditions (P = .39 and .14, respectively) Our results suggest that DAS is a non-pharmacologic therapy that can be used to reduce the dyspneic sensation in elderly patients with COPD.

Exercise in Elderly Patients with Chronic Heart Failure in Primary Care: Effects on Physical Capacity and Health-Related Quality of Life

Chronic heart failure (CHF) limits exercise capacity which influences physical fitness and health-related quality of life (HRQoL). The aim was to determine the effects on physical capacity and HRQoL of an exercise programme in elderly patients with CHF in primary care. An exercise intervention was conducted as a prospective, longitudinal and controlled clinical study in primary care in elderly patients with CHF. Endurance exercise and resistance training were conducted as group-training at the primary care centre and as home training. Follow-up on physical capacity and HRQoL was done at 3, 6 and 12months. Exercise significantly improved muscle endurance in the intervention group (n=29, mean age 76.2years) compared to the control group (n=31, mean age 74.4years) at all follow-ups except for shoulder flexion right at 12months (shoulder abduction p=0.006, p=0.048, p=0.029; shoulder flexion right p=0.002, p=0.032, p=0.585; shoulder flexion left p=0.000, p=0.046, p=0.004). Six minute walk test improved in the intervention group at 3months (p=0.013) compared to the control group. HRQoL measured by EQ5D-VAS significantly improved in the intervention group at 3 and 12months (p=0.016 and p=0.034) and SF-36, general health (p=0.048) and physical component scale (p=0.026) significantly improved at 3months compared to the control group. This study shows that exercise conducted in groups in primary care and in the patients' homes could be used in elderly patients with CHF. The combination of endurance exercise and resistance training has positive effects on physical capacity. However, the minor effects in HRQoL need further verification in a study with a larger study population.

19 Exercise in elderly patients with chronic heart failure in primary care; effects on physical capacity and health-related quality of life

19 Exercise in elderly patients with chronic heart failure in primary care; effects on physical capacity and health-related quality of life

19 Oral Exercise in elderly patients with chronic heart failure in primary care; effects on physical capacity and health-related quality of life

19 Oral Exercise in elderly patients with chronic heart failure in primary care; effects on physical capacity and health-related quality of life

PC-FACS

PC-FACS

Caudal blockade shortens the time to walking exercise in elderly patients following low back surgery

We conducted a randomized, double-blinded study to test our hypothesis that caudal blockade as preemptive analgesia for low back surgery might accelerate time to walking exercise following surgery and reduce postoperative analgesics, thereby attaining faster recovery of cognitive function. Our study included 51 elderly patients >70 years with American Society of Anesthesiologists (ASA) physical status 1-3, who underwent lumbosacral surgery under general anesthesia. After anesthetic induction and tracheal intubation, patients in the study group (group B) were injected with simple 0.5% bupivacaine [10 ml x height (m)] as a caudal block 15 min before surgical incision, whereas patients in the control group (group C) received normal saline. After surgery, patients had access to intravenous patient-administered analgesia (IV PCA), fentanyl, for postoperative pain relief. We assessed Mini-Mental State Examination (MMSE) scores before and after the surgery, values of visual analog scale (VAS) for postoperative analgesic status, fentanyl consumption during and for 3 days after surgery, and time to begin walking exercise after surgery. VAS value of group B patients was significantly lower than those in group C throughout the postoperative 48-h period (p < 0.005), and group B patients began walking exercise significantly earlier than those in group C [mean +/- standard deviation (SD) 70.2 (14.3) in group C, and 61.9 (7.6) in group B; p = 0.0133]. Cognitive function level was higher in group B than in group C patients 24 h after operation. Caudal blockade as preemptive analgesia shortened the time to start walking exercise after surgery and accelerated recovery of postoperative cognitive function.

One-Year Adherence to Exercise in Elderly Patients Receiving Postacute Inpatient Rehabilitation After Cardiac Surgery

Promoting an active lifestyle through an appropriate physical exercise prescription is one of the major targets of cardiac rehabilitation. However, information on the effectiveness of cardiac rehabilitation in promoting lifestyle changes in elderly patients is still scant. In 131 patients over the age of 65 yrs (86 men, and 45 women, mean age 75 yrs +/- 6 SD) who have attended postacute inpatient cardiac rehabilitation after cardiac surgery, we tested the 1-yr adherence to the physical exercise prescription received at the end of the cardiac rehabilitation by using a questionnaire on physical activity and the 6-min walk test. All of the 36 patients who reported an active lifestyle and 49 of the 95 patients who reported a sedentary lifestyle in the year preceding the cardiac operation reported at least 1 hr/day on 5 days each week of light regular physical activity in the year after the cardiac rehabilitation. Further, the distance walked at the follow-up 6-min walk test was significantly related to the physical activity score gathered from the questionnaire. Our data show that 65% of the elderly patients who have attended postacute inpatient cardiac rehabilitation after cardiac surgery are still capable of recovering or even increasing their regular physical activity and of maintaining these favorable lifestyle changes at least for 1 yr.

The study on exercise safety among elderly diabetes patients

0bjective To observe effects and safety of exercise in elderly patients with diabetes mellitus in order to offer the guideline for the diabetic education about exercise.Methods We designed the five sport prescriptions about the different intensity and evaluated the effect of exercise training on plasma glucose, heart rate.blood pressure and a consumption of the difie,rent exercises.Twentv patients with diabetes mellitus in elderly individuals were evaluated before and after zero hour,4 hours,and 12 hours while exercises were over. And we followed up the effects after 12 weeks.Results The level of glucose in different sport time and in different exercise prescriptions showed significant(P 0.05).After the 1 2 weeks following,the level of plasma glucose,ltbAlc,albumin in urine,triglyeeride,cholesterol,low density lipoprotein and blood pressure decreased(P 0.05).Conclusions It is effecfive and safe to carry out individual exercise prescriptions among elderly patients with diabetes mellitus. Key words: Elderly patients with diabetes mellitus; Sport safety; Exercise prescription

Maximum oxygen uptake at peak exercise in elderly patients with coronary artery disease and preserved left ventricular function: The role of inflammation on top of tissue Doppler–derived systolic and diastolic function

Several studies have shown that longitudinal systolic function and left ventricular filling pressures, as assessed with tissue Doppler imaging, predict exercise capacity.The aim of this study was to evaluate whether natriuretic peptides and inflammatory parameters can independently predict maximum oxygen uptake at peak exercise (VO2max) on top of tissue Doppler imaging-derived markers.We evaluated 142 patients (age 70 +/- 6 years, 77% men) with known or suspected coronary artery disease and a preserved left ventricular ejection fraction (> or = 50%). All patients underwent bicycle spiroergometry, and N-terminal pro-B-type natriuretic peptide levels were determined. Cytokines (IL-6 and soluble tumor necrosis factor receptors 1 and 2) and high-sensitivity C-reactive protein were measured as inflammatory markers. Tissue Doppler imaging was applied to evaluate peak long axis systolic velocities (Sm) and early mitral annulus velocities (E'). Ratio of early transmitral flow (E) to E' was assessed as marker of left ventricular filling. Analysis of variance, comparing VO2max quartiles, was used to determine univariate predictors and linear regression to determine multivariate VO2max predictors.Average VO2max was 18.5 +/- 5.7 mL/kg per minute (range 6-36.6). Compared with the highest quartile, patients with low VO2max were more frequently women (P < .0001). N-terminal pro-B-type natriuretic peptide and cytokine levels were significantly higher in the lower VO2max categories. Longitudinal myocardial velocities increased, and E/E' decreased along with increasing VO2max. In multivariate linear regression analysis, VO2max was independently predicted by sex, glucose, Sm, E/E', and cytokine levels.Maximum oxygen uptake at peak exercise in patients with known or suspected coronary artery disease and preserved systolic function was independently predicted by inflammatory makers on top of tissue Doppler-derived systolic and diastolic function.

Echocardiography as a Noninvasive Swan-Ganz Catheter

Diwan and co-investigators report in this issue of Circulation that the interval between onset of mitral E and annular early diastolic velocity (Ea) by tissue Doppler, TE−Ea, can be used to estimate left ventricular (LV) filling pressure in patients with mitral valve disease.1 Garcia and colleagues were the first to report that the onset of Ea occurred 7.5±3.5 ms after peak mitral inflow velocity in 7 patients with restrictive cardiomyopathy, whereas Ea started 22±19 ms earlier than did E in the normal group.2 Subsequently, TE−Ea has been shown to correlate with the time constant of LV relaxation (τ) demonstrated by Hasegawa and associates in their elegant animal experiment.3 With worsening of heart failure by rapid pacing, Ea progressively decreased in velocity and delayed in onset. Mitral E occurred coincidently with the termination of the early diastolic left arterial (LA) and LV pressure gradient at baseline and all stages of heart failure. In contrast, with increasing heart failure, Ea was progressively delayed after LA to LV pressure crossover, and TE−Ea was related to τ. Rivas-Gotz, Nagueh, and their associates also demonstrated that TE−Ea was prolonged after constriction of the circumflex coronary artery in dogs.4 In patients with heart failure, LV myocardial relaxation and compliance are decreased. See p 3281 Although LV filling is initiated and enhanced by augmentable myocardial relaxation in healthy individuals, it is driven by high filling pressure in patients with heart failure because myocardial relaxation remains reduced, not being sensitive to preload. Myocardial relaxation also affects the isovolumic relaxation time (IVRT). As relaxation becomes abnormal, LV pressure falls more slowly and the opening of the mitral valve is delayed, resulting in a longer IVRT. IVRT, however, becomes shorter as LA pressure increases; hence, IVRT∝τ/LA pressure. Because TE−Ea∝τ, …

Comprehensive geriatric assessment and treatment of elderly diabetic patients

Because of diversities of physical, mental, and psychological functions as well as clinical and social backgrounds, comprehensive geriatric assessment (CGA) is of great importance in treating elderly diabetic patients. We addressed three issues as to functions important for the CGA. First, we assessed several domains of cognitive function in 213 elderly diabetic patients. Attention and visual memory in diabetic patients without vascular disease were impaired compared with non-diabetic controls after adjusting for age and sex using analysis of covariance. Multivariate analysis revealed that age, hyperglycemia, and the presence of cerebral infarction were independent determinants for the impairment of attention in the diabetic patients. The results suggest that glucose control is important for the maintenance of cognitive function in elderly diabetic patients. Secondly, we assessed positive well-being as a measure of psychological function using a PGC morale scale in 197 elderly diabetic patients without cerebrovascular disease at baseline and examined whether the low well-being affect the development of cerebrovascular disease in a 3-year longitudinal study. The results indicate that low well-being was an independent risk factor for cerebrovascular disease after adjusting conventional risk factors in elderly diabetic patients. Thirdly, as a physical function, we assessed 5-m walking speed for both usual and maximum walking in 64 diabetic patients. The walking speed decreased with age and correlated significantly with the knee extension power and functional reach. The result suggests that muscle-strength exercise and balance training as well as endurance exercises are necessary to improve age-related decreases in walking speed and for effective exercise in elderly patients. From a gerontological point of view, new strategies of elderly diabetes treatment including muscle strength exercise and psychological approaches should be established to improve physical, mental, psychological, and social functions as assessed by the CGA.

Lifting strategy and stability in strength-impaired elders.

Ninety-six subjects underwent biomechanical analysis of freestyle box lifting. To relate lifting strategy to lower extremity muscle strength and postural stability in functionally limited elders. Back pain and postural instability in elders is rampant and poorly understood. Much of the literature on lifting relates to young subjects. Lifting strategy for 91 functionally limited elders was classified by timing of peak power in the back and knee joints. Isometric hip and knee extensor strength and postural stability were compared among strategy classifications. Postural stability was analyzed by measuring center of gravity (CG) displacement during lifting. Three lift strategy groups were established: back-lift, or back dominant strategy (BDS); leg-lift, or leg dominant strategy (LDS); and leg-dominant back-first mixed strategy (LDB). Subjects with relatively strong hip and knee extensors used leg dominant strategy; subjects with relatively strong knee, but weak hip, extensors used leg-dominant back-first mixed strategy; and subjects with weak hip and knee extensors used back dominant strategy. Leg dominant strategy and leg-dominant back-first mixed strategy engendered less center of gravity displacement and thus were posturally more stable than the back dominant strategy. Subjects apparently chose their lift strategy based on their hip and knee extensor strength. Weaker elders using a less stable back dominant strategy could be susceptible to falls and subsequent long bone and vertebral body fractures. Clinicians could identify at-risk elders by muscle testing. Beyond emphasizing strength and endurance exercise in elderly patients, weak elders should be taught to use a leg dominant lifting strategy, or if they are not physically able, to use a combined back/leg strategy.

Acute Effects of α- and β-Adrenoceptor Blockade on Plasma Atrial Natriuretic Peptides during Exercise in Elderly Patients with Mild Hypertension

In a randomized study in 26 elderly patients with mild essential hypertension, acute effects of alpha- and beta-adrenoceptor blockade on plasma ANP levels were examined at rest and during ergometric exercise. Plasma ANP level and LVEF were measured before and after administration of prazosin (an alpha 1-adrenergic blocker), atenolol (a cardioselective beta-adrenergic blocker), or carteolol (a nonselective beta-adrenergic blocker). Plasma ANP level was increased by exercise. Carteolol and atenolol increased plasma ANP levels at rest and during exercise, but the effect of atenolol was not statistically significant. Prazosin significantly suppressed the ANP values at rest and during exercise. The LVEF was increased by prazosin and decreased by beta-blockers, especially by carteolol. Multivariate regression analysis showed that LVEF was the most significant predictor of the plasma ANP level at maximal exercise; the resting blood pressure and heart rate were not predictors of this value. The results showed that single administrations of an alpha-blocker and a nonselective beta-blocker had opposite effects on the plasma ANP level both at rest and during exercise in elderly patients with mild essential hypertension. The observed difference in the ANP response seems to be related to changes in left ventricular function rather than changes in blood pressure or heart rate.

Hormonal supply during physical exercise in elderly patients with ischemic heart disease.

30 males, suffering from ischemic heart disease (IHD), and stable exertional angina pectoris, whose age ranged from 60 to 74 years and also 15 apparently healthy volunteers of the same age participated in the study. The IHD patients' blood displayed increased basal levels of adrenocorticotropic hormone (ACTH), cortisol, and met-enkephalins. During graded physical exercise two types of hormonal system response were established: in the first group of patients the plasma ACTH and cortisol levels were seen to rise at maximal threshold load, while in the second group the content of the above hormones declined. The first group of patients showed a less economical hemodynamic response to standard loading in comparison to the second group. A relation was found between changes in hemodynamic system and function of pituitary-adrenal system in elderly IHD patients during physical exercise. Inadequate ACTH and cortisol increase in the course of effects of stress contributed to IHD aggravation in old age, along with reduced tolerance to physical exercise. beta-Adrenoblocker, propranolol, influenced both types of hormonal response, thereby diminishing their shifts in physical stress.

Scintigraphic left ventricular function during exercise in elderly patients with coronary artery disease.

Left ventricular performance at rest and during supine symptom-limited exercise was determined by radionuclide ventriculography (RNV) in 65 subjects of the age of 65 years or older. Eleven subjects had no evidence of coronary artery disease (CAD) by history or submaximal stress ECG. In this control group left ventricular ejection fraction (LV-EF) increased from 0.62 +/- 0.09 (mean +/- SD) to 0.69 +/- 0.08 with a further increase in regional wall motion. There were 10 patients with a history of hypertension or atypical angina without infarction. Left ventricular ejection fraction (LVEF) at rest was 0.65 +/- 0.11 and showed no significant increase during exercise (mean exercise tolerance: 73 +/- 33W). Nineteen patients had an anterior infarction. LVEF at rest was 0.44 +/- 0.16 and as a group showed no change during exercise (mean exercise tolerance: 70 +/- 23W). Only two of 19 patients showed an increase of LVEF greater than 0.10. There were 19 patients with inferior infarction. LVEF at rest was 0.49 +/- 0.08 and showed also no significant change during exercise (mean exercise tolerance: 80 +/- 25W). Four of 19 patients showed an increase of LVEF in response to exercise. The five patients with two or more infarctions showed a markedly decreased resting LVEF of 0.28 +/- 0.11 with a further decline (0.22 +/- 0.09) during exercise (mean exercise tolerance: 45 +/- 32W). Therefore, age by itself does not significantly impair left ventricular ejection fraction at rest and during exercise. RNV appears as a valuable method in evaluating left ventricular performance of older patients with a similar response to exercise as in younger persons without or with comparable disease.

Renin and angiotensin responses to posture and exercise in elderly patients with heart failure.

Activation of the renin-angiotensin system may in part be responsible for the abnormally increased vascular tone which occurs in heart failure; it has also been suggested that this system's responsiveness may diminish with age. We investigated the effects of posture and upright exercise on renin, angiotensin II, aldosterone and catecholamines in 8 patients over 65 years and in 10 patients under 65 years, all of whom had congestive heart failure. Samples were taken supine, after 5 min standing in the upright posture, and after exercise. Exercise time was similar between the two groups [5 X 3 +/- 1 X 9 min (mean +/- SD) in the younger group, compared with 5 X 2 +/- 3 X 4 min in the older group]. Resting renin and angiotensin II were similar and rose on standing with a further increase during exercise; there were no statistically significant differences between the groups. However, aldosterone rose during exercise only in the younger group, while increases in plasma noradrenaline were greater in the elderly. This study implies that the efficacy of angiotensin converting enzyme inhibitors is likely to be maintained in the elderly patient with heart failure.

How safe is exercise in elderly-patients?

How safe is exercise in elderly-patients?