Exercise Interventions For Older Adults Research Articles

The effects of exercise interventions on the inflammatory profile of older adults: A systematic review of the recent literature

Inflammageing - characterized by age-related chronic low-grade inflammation is considered to be positively influenced by physical exercises. The aim of this systematic review is to provide an update of the most recent literature regarding exercise effects on the inflammatory profile in older adults. This review is an update of an earlier published literature review and was performed according to the NICE guidelines. Databases PubMed and Web-of-Science were systematically searched by two independent authors screening for papers published since 2016. Effect sizes of outcome parameters related to the inflammatory profile were calculated where possible. Twenty-three articles were included. Resistance training (RT) was the most investigated type of exercise (13 articles: 8 in healthy, 1 in frail and 4 in older adults with a specific condition or disease). Aerobic training (AT) was investigated in 8 articles, including 5 studies in older adults with a specific disease or condition. Combined resistance & aerobic training (CT) was investigated in 7 articles: 3 were in healthy, 1 in frail and 3 in older adults with a specific condition or disease. 1 study investigated the effects of Tai Chi in older adults with mild cognitive impairment. In frail older subjects, IGF-1 - sole marker investigated - significantly increased after 8weeks RT and CT, whereas AT showed no significant effects compared to control. Most consistent exercise effects consisted in lowering of circulating levels of CRP, IL-6 and TNF-α; which seemed more prominent in healthy older adults compared to those with a specific disease or condition. None of the studies reported an exacerbation of inflammation following exercise and all studied exercise protocols were feasible and safe for older adults. Overall, significant anti-inflammatory effects of exercise in older persons were reported. Literature remains extremely scarce regarding the exercise-induced effects in frail older persons. Therefore, there is an urgent need for more studies focusing on the frail elderly. There is growing literature data on exercise interventions in older adults with a specific condition or disease; however, it appears more challenging to reduce inflammageing through exercise in these specific patient groups. Importantly, the exercise interventions performed in all studies appeared to be feasible and safe for older patients, thus the presence of a specific condition or disease should not be considered as a contra-indication to perform physical exercise.

Exercise interventions for older adults with Alzheimer\u2019s disease: a systematic review and meta-analysis protocol

BackgroundThe growing societal and economic impact of Alzheimer’s disease (AD) is further compounded by the present lack of disease-modifying interventions. Non-pharmacological intervention approaches, such as exercise, have the potential to be powerful approaches to improve or mitigate the symptoms of AD without added side effects or financial burden associated with drug therapies. Various forms and regiments of exercise (i.e., strength, aerobic, multicomponent) have been reported in the literature; however, conflicting evidence obscures clear interpretation of the value and impact of exercise as an intervention for older adults with AD. The primary objective of this review will be to evaluate the effects of exercise interventions for older adults with AD. In addition, this review will evaluate the evidence quality and synthesize the exercise training prescriptions for proper clinical practice guidelines and recommendations.MethodsThis systematic review and meta-analysis will be carried out by an interdisciplinary collective representing clinical and research stakeholders with diverse expertise related to neurodegenerative diseases and rehabilitation medicine. Literature sources will include the following: Embase, PsychINFO, OVID Medline, and Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily. Inclusion criteria are participants with late onset AD and structured exercise interventions with prescribed duration, frequency, and intensity. The primary outcome of this study will center on improved or sustained cognitive functioning. Secondary outcomes will include institutionalization-related outcomes, ability in activities of daily living, mood and emotional well-being, quality of life, morbidity, and mortality. Analysis procedures to include measurement of bias, data synthesis, sensitivity analysis, and assessment of heterogeneity are described in this protocol.DiscussionThis review is anticipated to yield clinically meaningful insight on the specific value of exercise for older adults with AD. Improved understanding of diverse exercise intervention approaches and their specific impact on various health- and function-related outcomes is expected to guide clinicians to more frequently and accurately prescribe meaningful interventions for those affected by AD.Systematic review registrationPROSPERO CRD42020175016.

Individual Differences in Response to Supervised Exercise Therapy for Peripheral Artery Disease.

Nonresponse to exercise has been extensively examined in young athletes but is seldom reported in studies of aerobic exercise interventions in older adults. This study examined the prevalence of nonresponse and poor response to exercise in functional and quality of life outcomes and response patterns between and among older adults undergoing 12-weeks of supervised exercise therapy for the management of peripheral artery disease (N = 44, mean age 72.3 years, 47.7% female). The prevalence of nonresponse (no change/decline in performance) in walking distance was 31.8%. The prevalence of poor response (lack of a clinically meaningful improvement) was 43.2%. Similar patterns of response were observed in both objective and patient-reported measures of physical function. All participants improved in at least one outcome; only two participants improved in all measured outcomes. Additional research should examine modifiable predictors of response to inform programming and maximize an individual's potential benefit from exercise therapy.

Mechanisms used to increase propulsive forces on a treadmill in older adults

Older adults typically demonstrate reductions in overground walking speeds and propulsive forces compared to young adults. These reductions in walking speeds are risk factors for negative health outcomes. Therefore, this study aimed to determine the effect of an adaptive speed treadmill controller on walking speed and propulsive forces in older adults, including the mechanisms and strategies underlying any change in propulsive force between conditions. Seventeen participants completed two treadmill conditions, one with a fixed comfortable walking speed and one with an adaptive speed controller. The adaptive speed treadmill controller utilized a set of inertial-force, gait parameters, and position-based controllers that respond to an instantaneous anterior inertial force. A biomechanical-based model previously developed for individuals post-stroke was implemented for older adults to determine the primary gait parameters that contributed to the change in propulsive forces when increasing speed. Participants walked at faster average speeds during the adaptive speed controller (1.20 m/s) compared to the fixed speed controller conditions (0.98 m/s); however, these speeds were not as fast as their overground speed (1.44 m/s). Although average trailing limb angle (TLA) (p < 0.001) and ankle moment (p = 0.020) increased when speed also increased between treadmill conditions, increasing TLA contributed more to the increased propulsive forces seen during faster treadmill speeds. Our findings show that older adults chose faster walking speeds and increased propulsive force when walking on an adaptive speed treadmill compared to a fixed speed treadmill, suggesting that an adaptive speed treadmill controller has the potential to be a beneficial alternative to current exercise interventions for older adults.

Effects of Aerobic and Resistance Exercise Interventions on Cognitive and Physiologic Adaptations for Older Adults with Mild Cognitive Impairment: A Systematic Review and Meta-Analysis of Randomized Control Trials.

(1) Background: The purpose of this meta-analysis is to investigate the effects of exercise intervention for older adults with mild cognitive impairment (MCI). (2) Methods: Databases including PubMed, Medline, and Cochrane were used to search for studies that reported effects of exercise for older adults with MCI and randomized controlled trials up to July 2020. Exercise interventions of all selected studies were summarized, and effect sizes of exercise interventions were calculated. (3) Results: A total of 14 studies, including 1178 older adults with MCI were included. Exercise participation in older adults with MCI improved cognitive functions (d = 0.88, 95% confidence interval [CI]; 0.10–1.65, p = 0.01; k = 5]) and handgrip strength (d = 0.62, 95% CI; 0.23–1.01, p = 0.00; k = 4) compared with control groups. Aerobic exercise or resistance exercise at moderate to vigorous levels for at least 150 min, 1 time/week, for 6 weeks was the minimum level to obtain beneficial effects from exercise for older adults with MCI. (4) Conclusions: Older adults with MCI who participated in exercise received beneficial effects, including improvement in cognitive functions and handgrip strength, but further studies to confirm the effects are needed.

The effectiveness of Tai Chi Chuan on fear of movement, prevention of falls, physical activity, and cognitive status in older adults with mild cognitive impairment: A randomized controlled trial.

This study aimed to investigate the effectiveness of Tai Chi Chuan (TCC) on fear of movement, prevention of falls, physical activity, and cognitive status in older adults with mild cognitive impairment. This controlled trial was conducted with 20 participants in the intervention group, and they did exercises for 35-40 min/session, twice a week for 12 weeks. The posttest scores of the scales indicated that the scores of cognitive adaptations, being observant, and changes in level subscales of the fall behavioral scale in the older adults who did Tai Chi exercise in the intervention group significantly increased (p < .01). The nursing home provider can safely manage TCC exercise interventions for older adults with MCI.

Comparative effectiveness of exercise interventions for preventing falls in older adults: A secondary analysis of a systematic review with network meta-analysis.

Systematic reviews have established that exercise reduces falls in older adults, however the most effective types of exercise are not known. This secondary analysis determined the comparative effectiveness of fall prevention exercise approaches. All fall prevention exercise interventions for older adults were identified from an existing search from inception until April 2017. Interventions were coded using a framework of 25 exercise types. Two reviewers independently screened studies, extracted data, and appraised risk of bias. Pairwise meta-analysis and network meta-analysis (NMA) were conducted. P-scores were used to rank exercise combinations. One hundred and sixty-nine studies were included. NMA was conducted on 73 studies (30,697 participants) for the outcome of number of fallers. The exercise combination ranked with the greatest likelihood of being most effective relative to no exercise was: anticipatory control, dynamic stability, functional stability limits, reactive control and flexibility (p-score=0.95). This exercise combination also significantly reduced number of fallers compared to 16 other combinations. No exercise combination had a significantly greater effect on reducing number of fallers more than this combination. This analysis identified components of effective fall prevention exercise. The results can inform evidence-informed exercise recommendations and be used to design effective programs.

Improvement in trunk kinematics after treadmill-based reactive balance training among older adults is strongly associated with trunk kinematics before training

Reactive balance training (RBT) is an emerging fall prevention exercise intervention for older adults. To better understand factors that influence improvements after RBT, the goal of this study was to identify key factors that strongly associate with training-induced improvements in reactive balance. This study is a secondary analysis of data from a prior study. Twenty-eight residents of senior housing facilities participated, including 14 RBT participants and 14 Tai Chi participants (controls). Before and one week after training, participants completed balance and mobility tests and a reactive balance test. Reactive balance was operationalized as the maximum trunk angle in response to standardized trip-like perturbations on a treadmill. Bivariate (Pearson) correlation was used to identify participant characteristics before RBT and measures of performance during RBT that associated with training-induced changes in maximum trunk angle. Maximum trunk angle before reactive balance training exhibited the strongest association with training-induced changes in maximum trunk angle among RBT participants (r2 = 0.84; p < .001), but not among Tai Chi participants (r2 = 0.17; p = .138). Measures of performance during RBT, based upon perturbation speed, also associated with RBT-induced improvements in maximum trunk angle. These results help clarify the characteristics of individuals who can benefit from RBT, and support the use of treadmill perturbation speed as a surrogate measure of training-induced improvements in trunk kinematics.

Changes in Gamma-aminobutyric Acid Concentrations in Sensorimotor Cortical Regions Following a 12-week Exercise Intervention in Older Adults

To determine if resting levels of GABA measured with magnetic resonance spectroscopy (MRS) change after a 12-week aerobic exercise intervention and if these changes are associated with improved motor learning.

Effectiveness of Multicomponent Exercise Interventions in Older Adults With Dementia: A Meta-Analysis.

Background and ObjectivesMulticomponent training (MT) combines aerobic, strength, postural, and balance exercises and may be a promising intervention strategy for dementia. This meta-analysis study aims to systematize evidence concerning the effectiveness of MT in physical fitness, cognition, and functionality on activities of daily living (ADL) in older adults with dementia and to identify moderation patterns regarding training variables.Research Design and Methods4 databases were systematically searched to locate potential trials through March 2019. A total of 2,312 records were identified and a final set of 17 manuscripts reviewed; of these, 6 satisfied all eligibility criteria.ResultsSamples sizes ranged from 27 to 170 participants; MT programs lasted between 4 weeks and 12 months, took place from a daily basis to twice a week, and sessions ranged from 30 to 60 min. The TESTEX scale was used to analyze the methodological quality, and the funnel plots to assess the risk of bias. This meta-analysis revealed that MT interventions benefit older adults with dementia regarding ADL performance (effect size = 0.313 [0.16–0.46]; p < .01), but the evidence was not sufficiently robust to determine the effectiveness of MT on cognitive function and physical fitness, particularly, on agility.Discussion and ImplicationsMT may be an important nonpharmacological strategy to enhance ADL functionality on older adults with dementia. Findings suggest that long-term interventions are more prevalent than high-frequency and longer duration exercise sessions. Further evidence is needed for acknowledging its benefits in specific cognitive abilities and physical fitness. This meta-analysis is registered in PROSPERO (no. CRD42020141545).

Exercise interventions for older adults: A systematic review of meta-analyses

BackgroundThe evidence concerning which physical exercise characteristics are most effective for older adults is fragmented. We aimed to characterize the extent of this diversity and inconsistency and identify future directions for research by undertaking a systematic review of meta-analyses of exercise interventions in older adults. MethodsWe searched the Cochrane Database of Systematic Reviews, PsycInfo, MEDLINE, Embase, CINAHL, AMED, SPORTDiscus, and Web of Science for articles that met the following criteria: (1) meta-analyses that synthesized measures of improvement (e.g., effect sizes) on any outcome identified in studies of exercise interventions; (2) participants in the studies meta-analyzed were adults aged 65+ or had a mean age of 70+; (3) meta-analyses that included studies of any type of exercise, including its duration, frequency, intensity, and mode of delivery; (4) interventions that included multiple components (e.g., exercise and cognitive stimulation), with effect sizes that were computed separately for the exercise component; and (5) meta-analyses that were published in any year or language. The characteristics of the reviews, of the interventions, and of the parameters improved through exercise were reported through narrative synthesis. Identification of the interventions linked to the largest improvements was carried out by identifying the highest values for improvement recorded across the reviews. The study included 56 meta-analyses that were heterogeneous in relation to population, sample size, settings, outcomes, and intervention characteristics. ResultsThe largest effect sizes for improvement were found for resistance training, meditative movement interventions, and exercise-based active videogames. ConclusionThe review identified important gaps in research, including a lack of studies investigating the benefits of group interventions, the characteristics of professionals delivering the interventions associated with better outcomes, and the impact of motivational strategies and of significant others (e.g., carers) on intervention delivery and outcomes.

Safety and Effectiveness of Long-Term Exercise Interventions in Older Adults: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Physical exercise is beneficial to reduce the risk of several conditions associated with advanced age, but to our knowledge, no previous study has examined the association of long-term exercise interventions (≥ 1year) with the occurrence of dropouts due to health issues and mortality, or the effectiveness of physical exercise versus usual primary care interventions on health-related outcomes in older adults (≥65 years old). To analyze the safety and effectiveness of long-term exercise interventions in older adults. We conducted a systematic review with meta-analysis examining the association of long-term exercise interventions (≥ 1year) with dropouts from the corresponding study due to health issues and mortality (primary endpoint), and the effects of these interventions on health-related outcomes (falls and fall-associated injuries, fractures, physical function, quality of life, and cognition) (secondary endpoints). Ninety-three RCTs and six secondary studies met the inclusion criteria and were included in the analyses (n = 28,523 participants, mean age 74.2years). No differences were found between the exercise and control groups for the risk of dropouts due to health issues (RR = 1.05, 95% CI 0.95-1.17) or mortality (RR = 0.93, 95% CI 0.83-1.04), although a lower mortality risk was observed in the former group when separately analyzing clinical populations (RR = 0.67, 95% CI 0.48-0.95). Exercise significantly reduced the number of falls and fall-associated injuries, and improved physical function and cognition. These results seemed independent of participants' baseline characteristics (age, physical function, and cognitive status) and exercise frequency. Long-term exercise training does not overall influence the risk of dropouts due to health issues or mortality in older adults, and results in a reduced mortality risk in clinical populations. Moreover, exercise reduces the number of falls and fall-associated injuries, and improves physical function and cognition in this population.

Feasibility and Effects on Muscle Function of an Exercise Program for Older Adults.

Study objective was to determine feasibility and compliance with a 3-month exercise intervention in older adults, and if peripheral quantitative computed tomography muscle measures and jumping mechanography could detect changes in muscle mass and function. A parallel group, nonblinded, pilot trial with individuals 70 yr or older randomized to control group of walking-only (WALK) or an intervention group of walking combined with exercises to improve balance and strength (W + EX). Both groups attended similar weekly nutrition education sessions. Body composition, muscle density, intramuscular adipose tissue area, and muscle function were assessed before and after the intervention using dual-energy x-ray, peripheral quantitative computed tomography, functional tests, and mechanography. Eighty-five (90%) of 94 individuals enrolled completed (41WALK, 44W + EX). Eighty-six percent of participants attended seven or more nutrition sessions, and log sheets, used to assess exercise compliance, were returned by 66% of participants, and of those, 88% logged activity on 50%+ days. Sixty-seven percent of participants stated that they increased activity levels, and 82% stated that they felt better overall. Both groups increased lean and lost fat mass, resulting in decreases in fat percentage (all, P < 0.05). Intramuscular adipose tissue area decreased and muscle density increased among WALK (P < 0.05 and P = 0.056, respectively) but were not different between groups. Improvement in force efficiency and chair-rise power were greater among W + EX group than WALK (5.9% ± 1.8% vs -1.2% ± 2.0% [P = 0.01] and 0.25 ± 0.19 W·kg and -0.37 ± 0.23 W·kg [P = 0.04], respectively). Differences in mechanography results became greater in a per-protocol analysis. A larger trial is feasible, and the program was well accepted. Both groups showed improvements, the program that included strength and balance lead to greater jump force efficiency and power than walking only. Whether these differences lead to differences in fall rates need to be determined in a larger trial.

Use it or lose it: a qualitative study of the maintenance of physical activity in older adults

BackgroundLack of physical activity (PA) is a recognised global public health problem, which is increasing in prevalence with a detrimental impact on the pattern of disease worldwide. In the UK, older adults comprise the most sedentary group, with only 57% of males and 52% of females aged 65–74 years and 43% of males and 21% of females aged 75–84 years meeting PA recommendations.PA confers multiple health benefits including increased stamina, muscle, bone and joint strength, increased independence and reduced risk of falls in old age. Despite benefits experienced during time-limited PA programmes, increased PA is not always continued. This study aimed to provide a better understanding of PA maintenance behaviours in older people.MethodsFace to face semi-structured interviews were conducted with adults who completed one of two strength and balance exercise programmes as part of the ProAct65+ trial: group (FaME) and home based (OTAGO) exercises. Five GP practices in Nottingham and Derby were recruited and invited people aged 65 years and older who met eligibility criteria. Interviews were conducted in participants’ homes. Interviews explored PA levels pre and post intervention, perceived health benefits, facilitators, barriers and use of technology for PA maintenance. The interviews were transcribed verbatim and analysed using framework analysis and the software NVivo10.ResultsFifteen participants from each intervention group were interviewed. The FaME group consisted of 10 females and 5 males, age range of 70–88 years. The OTAGO group consisted of 12 females and 3 males aged 72–95 years. Important themes identified were physical, social, psychological and environmental facilitators and barriers. These included increased physical autonomy, enjoyment, positive evaluation of the activity and physical benefits, importance of social interaction, positive feedback, development of behaviour considered normal or habitual, motivation and self-efficacy. Some participants used technologies not included in the original interventions, like pedometers and smart phones to motivate themselves.ConclusionsA range of modifiable factors influence continued participation in PA at the end of exercise programmes. The findings from this study will inform the commissioning and quality improvement of future PA programmes and development of an intervention to enhance continuation of PA after exercise interventions in older adults.

Does exercise-induced apelin affect sarcopenia? A systematic review and meta-analysis.

There have been a number of studies on the role of the novel protein apelin, identified in 1998, in improving muscular function and structure in various human organs, as well as on how it is involved in pathological processes. The aim of this systematic review and meta-analysis was to determine the effect of exercise on serum apelin levels to provide up-to-date data for the development of an exercise intervention for older adults. We searched for articles in PubMed, Ovid MEDLINE, and EMBASE from database inception to May 31, 2019. To conduct a meta-analysis of the primary outcome (serum apelin level), we analyzed intervention effect sizes of the differences between the exercise group and control groups for the primary outcome measure at post-treatment. The outcomes were analyzed using Hedge's statistic effect size (Zr) for weight mean difference (WMD) from various statistical results, including t, F, x2, and r. A heterogeneity test was conducted using Higgin's I2 statistic and Q statistics (p > 0.10) via a forest plot. A fixed-effect model was considered if Higgin's I2 was less than 50%. If heterogeneity was high (I2 > 50%), a random-effects model with a subgroup analysis or meta-regression was used. A meta-analysis using nine studies showed that exercise could increase serum apelin levels, which was beneficial for such metabolic diseases as diabetes. In the subgroup analysis, the 50-60-year-old group showed significant effects of exercise. However, the BMI (normal, overweight, and obesity) categories failed to show any difference in exercise-induced effect. Further studies are needed to clarify in greater detail the effect of resistance exercise on apelin levels, including data on frequency, type, intensity, and time of aerobic exercise, to compare their effects on sarcopenia and cognitive disorders.

Assessing the feasibility and impact of specially adapted exercise interventions, aimed at improving the multi-dimensional health and functional capacity of frail geriatric hospital inpatients: protocol for a feasibility study

BackgroundFrailty is a common and clinically significant condition in older adults, predominantly due to its association with adverse health outcomes such as hospitalisation, disability and mortality. Exercise interventions have been...

Older Veterans EmpoweRed To Use Regular Exercise (OVERTURE) II: Design and methods of a randomized controlled trial among older veterans with chronic health conditions

There are physical and mental health benefits associated with regular physical activity across the life span [1]; however, individuals are less likely to engage in regular physical activity with advancing age. Recent statistics from the Federal Interagency Forum on Aging Related-Statistics (FIFA-RS) [2] suggest that only 12% of adults 65 years and older engage in regular physical activity that meets the Federal guidelines for physical activity. The guidelines recommend that U.S. adults engage in at least 150 min of moderate-intensity aerobic activity weekly and two to three alternating days of muscle-strengthening activities [3,4]. The guidelines further recommend that older adults with chronic health conditions strive to be as physically active as possible. Among older adults, veterans represent a special population that may not be able to meet the Federal government's guidelines for physical activity. As a result of military service, older veterans who once were considered to be in optimal physical and mental condition as active duty service members, often live with multiple chronic conditions (MCCs) that may limit physical activity [5,6]. For example, older veterans receiving care through the Veterans Affairs (VA) often report a high degree of functional limitations and mental health issues [5,6], such as chronic knee and back pain [7], major depression [8], and post-traumatic stress disorder [8]. Consequentially, the presence of MCCs increases the risk for poor quality of life (QOL) [9,10] and wellbeing (WB) [11] and limits physical activity. In spite of the evidence that physical activity is beneficial to QOL [9] and WB [11], there is scant evidence in the research literature of exercise interventions for older adults with MCCs, specifically for older veterans. Older adults, regardless of veteran status, who have MCCs are often excluded from exercise interventions [12]. OVERTURE II endeavors to determine the feasibility of an exercise intervention that may promote QOL and WB among older veterans with MCCs.

Cost-Effectiveness of a Therapeutic Tai Ji Quan Fall Prevention Intervention for Older Adults at High Risk of Falling.

BackgroundData on the cost-effectiveness of proven fall prevention exercise interventions are limited. We aimed to establish the cost-effectiveness of Tai Ji Quan: Moving for Better Balance (TJQMBB) compared with a conventional exercise intervention for older adults at high risk of falling.MethodsWe conducted a trial-based cost-effectiveness analysis involving 670 older adults who had a history of falling or impaired mobility. Participants received one of three interventions—TJQMBB, multimodal exercise, or stretching exercise (control)—each of which was implemented twice weekly for 24 weeks. The primary cost-effectiveness measure was the incremental cost per additional fall prevented, comparing TJQMBB and multimodal exercise to Stretching and TJQMBB to multimodal exercise, with a secondary measure of incremental cost per additional quality-adjusted life-year (QALY) gained. The intervention was conducted between February 2015 and January 2018, and cost-effectiveness was estimated from a health care system perspective over a 6-month time horizon.ResultsThe total cost to deliver the TJQMBB intervention was $202,949 (an average of $906 per participant); for multimodal exercise, it was $223,849 ($1,004 per participant); and for Stretching, it was $210,468 ($903 per participant). Incremental cost-effectiveness ratios showed that the multimodal exercise was cost-effective ($850 per additional fall prevented; $27,614 per additional QALY gained) relative to Stretching; however, TJQMBB was the most economically dominant strategy (ie, having lower cost and being clinically more efficacious) compared with multimodal and stretching exercises with regard to cost per additional fall prevented and per additional QALY gained. TJQMBB had a 100% probability of being cost-effective, relative to Stretching, at a threshold of $500 per each additional fall prevented and $10,000 per additional QALY gained. Sensitivity analyses showed the robustness of the results when extreme cases, medical costs only, and missing data were considered.ConclusionsAmong community-dwelling older adults at high risk for falls, TJQMBB is a cost-effective means of reducing falls compared with conventional exercise approaches.Trial RegistrationClinicaltrials.gov (NCT02287740).

A Scoping Review of Physical Performance Outcome Measures Used in Exercise Interventions for Older Adults With Alzheimer Disease and Related Dementias.

There is growing evidence that exercise interventions can mitigate functional decline and reduce fall risk in older adults with Alzheimer disease and related dementias (ADRD). Although physical performance outcome measures have been successfully used in older adults without cognitive impairment, additional research is needed regarding their use with individuals who have ADRD, and who may have difficulty following instructions regarding performance of these measures. The purpose of this scoping review was to identify commonly used physical performance outcome measures, for exercise interventions, that are responsive and reliable in older adults with ADRD. Ultimately, we aimed to provide recommendations regarding the use of outcome measures for individuals with ADRD across several domains of physical performance. A scoping review was conducted to broadly assess physical performance outcome measures used in exercise interventions for older adults with ADRD. Exercise intervention studies that included at least 1 measure of physical performance were included. All physical performance outcome measures were abstracted, coded, and categorized into 5 domains of physical performance: fitness, functional mobility, gait, balance, and strength. Criteria for recommendations were based on (1) the frequency of use, (2) responsiveness, and (3) reliability. Frequency was determined by the number of studies that used the outcome measure per physical performance domain. Responsiveness was assessed via calculated effect size of the outcome measures across studies within physical performance domains. Reliability was evaluated via published studies of psychometric properties. A total of 20 physical performance outcome measures were extracted from 48 articles that met study inclusion criteria. The most frequently used outcome measures were the 6-minute walk test, Timed Up and Go, repeated chair stand tests, short-distance gait speed, the Berg Balance Scale, and isometric strength measures. These outcome measures demonstrated a small, medium, or large effect in at least 50% of the exercise intervention studies. Good to excellent reliability was reported in samples of older adults with mild to moderate dementia. Fitness, functional mobility, gait, balance, and strength represent important domains of physical performance for older adults. The 6-minute walk test, Timed Up and Go, repeated chair stand tests, short-distance gait speed, Berg Balance Scale, and isometric strength are recommended as commonly used and reliable physical performance outcome measures for exercise interventions in older adults with mild to moderate ADRD. Further research is needed on optimal measures for individuals with severe ADRD. The results of this review will aid clinicians and researchers in selecting reliable measures to evaluate physical performance outcomes in response to exercise interventions in older adults with ADRD.

Effects of 10-week walking and walking with home-based resistance training on muscle quality, muscle size, and physical functional tests in healthy older individuals

BackgroundOlder individuals have been shown to present muscle atrophy in conjunction with increased fat fraction in some muscles. The proportion of fat and connective tissue within the skeletal muscle can be estimated from axial B-mode ultrasound images using echo intensity (EI). EI was used to calculate the index of muscle quality. Walking, home-based weight-bearing resistance training, and its combinations are considered simple, easy, and practical exercise interventions for older adults. The purpose of this study was to quantify the effects of walking and walking with home-based resistance training on muscle quality of older individuals.MethodsThirty-one participants performed walking training only (W-group; 72 ± 5 years) and 33 participants performed walking and home-based resistance training (WR-group; 73 ± 6 years). This study was a non-randomized controlled trial with no control group. All participants were instructed to walk 2 or 3 sets per week for 10 weeks (one set: 30-min continuous walking). In addition, the WR-group performed home-based weight-bearing resistance training. EI was measured as a muscle quality index using axial B-mode ultrasound images of the rectus femoris and vastus lateralis of the mid-thigh. We further averaged these parameters to obtain the EI of the quadriceps femoris (QF). Participants further performed five functional tests: sit-ups, supine up, sit-to-stand, 5-m maximal walk, and 6-min walk.ResultsQF EI was significantly decreased in both groups after training (W-group 69.9 ± 7.4 a.u. to 61.7 ± 7.0 a.u., WR-group 64.0 ± 9.5 a.u. to 51.1 ± 10.0 a.u.; P < 0.05), suggesting improved muscle quality. QF EI was further decreased in the WR-group compared with the W-group. The sit-up test in both groups and the sit-to-stand and 5-m maximal walk tests in the W-group were significantly improved after training.ConclusionThese results suggest that training-induced stimulation is associated with a decrease in EI in some thigh regions. Furthermore, the addition of home-based resistance training to walking would be effective for a greater reduction of EI.