Exercise Prescription For Older Adults Research Articles

Effects of detraining on neuromuscular function and structural adaptations following once- or twice-weekly eccentric resistance training in older adults

BackgroundEccentric resistance training elicits greater preservation of training-induced muscular adaptations compared with other training modalities, however the detraining profiles of different training dosages remain unknown.AimsTo examine the detraining effects following once- or twice-weekly eccentric-specific resistance training in older adults.MethodsTwenty-one older adults (age = 70.5 ± 6.0 year) completed a 12-week detraining period following the 12-week eccentric training programmes with neuromuscular function and muscle structure assessed six (mid-detraining) and 12 (post-detraining) weeks following training cessation.ResultsFrom post-training to post-detraining, no significant regression of the training-induced improvements (collapsed group data reported) occurred in power (0%), strength (eccentric = 0%, isometric = 39%), or explosive strength over numerous epochs (0–32%), resulting in values that remained significantly greater than at pre-training. However, significant regression in the improvements in muscle thickness (91%) and fascicle angle (100%) occurred, resulting in values that were not significantly greater than pre-training.DiscussionThe limited regression in neuromuscular function following a 12-week detraining period has important implications for supporting eccentric exercise prescription in older adults who often face periods of inactivity. However, further work is required to develop an effective maintenance dosage strategy that preserves improvements in muscle structure.ConclusionsEccentric resistance training elicits improvements in the neuromuscular function of older adults, which are sustained for at least 12 weeks after eccentric training cessation.

Exercise instructors are not consistently implementing the strength component of the UK chief medical officers’ physical activity guidelines in their exercise prescription for older adults

Strength training recommendations have been embedded within the UK’s Chief Medical Officers’ physical activity guidelines since 2011. There is limited evidence that these recommendations are used by exercise instructors in the community to underpin strength training prescription in the older adult population. This study aimed to explore exercise instructors’ awareness and utilisation of the guidelines when prescribing strength training to older adults. Fifteen exercise instructors working with older adults in the UK participated in one online interview. A general inductive approach was conducted and thematic analysis allowed for major themes to be identified from the raw data. We found that most exercise instructors (n = 9), but not all (n = 6), were aware of the guidelines. Only one instructor (n = 1) had reportedly implemented the guidelines into their practice; other instructors reported that the guidelines were irrelevant. Instead, each of the instructors had their preferred sources of information that they relied on to underpin their exercise prescription, and each had their own interpretation of ‘evidence-based strength training.’ This individualised interpretation resulted in exceptionally varied prescription in the community and does not necessarily align with the progressive, evidence-based prescription known to build muscular strength. We suggest that (i) more detail on how to build muscular strength be embedded within the guidelines, (ii) a handbook on how to implement the guidelines be made available, (iii) theoretical and practical teaching materials and courses be updated, and/or (iv) a re-(education) of exercise instructors already in the field may be necessary to bring about a consistent, evidence-based strength prescription necessary for the best possible health and longevity outcomes for our ageing population.

Exercise Prescription for Older Adults.

Exercise Prescription for Older Adults.

Exercise to Improve Postural Stability in Older Adults with Alzheimer's Disease: A Systematic Review of Randomized Control Trials.

In this systematic review, we aim to synthesize published evidence on the effects of exercise in improving postural stability among older adults with Alzheimer’s Disease (AD). A systematic electronic literature search was undertaken in Pedro, Cochrane, MEDLINE, ProQuest, Science direct and Clinical trial databases involving human participants published from year 2000–2022. This search was updated in June 2022. The studies chosen were based on predetermined criteria. Data relating to the contents and parameters of exercise in persons with AD were gathered and analyzed. A total of 8 experimental studies met the inclusion criteria. Overall, the selected studies were of a medium quality. In these studies, information and physical exercises were used to improve postural stability in older adults with AD. The findings of the review suggest that performing combined strength, balance and executive function training can improve postural stability. However, we are unable to conclude the specific dose for specific type of exercise. More high-quality studies are required pertaining to exercise prescription for older adults with AD. Mostly, information and physical exercise were delivered via face-to-face sessions conducted by health professionals. The structure of exercises summarized in this review may be beneficial for older adults with AD to improve postural stability and as a result reduce falls.

A New Lens on Physical Activity Promotion: Can Technology Boost Exercise Prescription and Adherence?

Adherence to exercise prescription for older adults (OAs) is a significant problem and can have a detrimental effect on key health outcomes. Exercise adherence for OAs is a multifactorial problem encompassing many factors affecting adherence such as socioeconomic status, education, physical fitness, and mental and health status. Improving exercise adherence could have a significant impact on longevity, quality of life, and health care costs. This symposium brings multiple perspectives to closely examine promising technology approaches, both in the form of models and programs. We will also discuss gaps regarding adherence to physical activity (PA) and exercise prescription for OA and the application of current publicly available technologies to boost PA adherence and compliance accordingly to the U.S. Department of Health and Human Services national standards for promoting health and preventing disease. The symposium includes five novel presentations addressing several key factors related to successful implementation of technology approaches to exercise program delivery and adherence for OAs. In addition, we will have one presentation highlighting the key factors that impact exercise prescription, compliance, and adherence. The speakers will present and address important components related to technology use with the goal to increase older adult’s PA participation. The exercise programs will target key areas affecting older adult’s health such as cognitive function, falls, obesity, gender, environments, and self-efficacy. Technology user-usability perspective will be presented. Current challenges and recommendations for future research will be comprehensively discussed to properly address the exercise adherence and compliance needs of our OA populations.

Assisted Jumping in Healthy Older Adults: Optimizing High-Velocity Training Prescription.

Tufano, JJ, Vetrovsky, T, Stastny, P, Steffl, M, Malecek, J, and Omcirk, D. Assisted jumping in healthy older adults: optimizing high-velocity training prescription. J Strength Cond Res 36(6): 1518-1523, 2022-Because older adults benefit from power training, training strategies for athletes such as supramaximal velocity-assisted jumping could also be useful for older adults. However, optimizing-assisted exercise prescription in older adults remains uninvestigated. Therefore, the purpose of this study was to determine the effects of different bodyweight (BW) assistance levels on jumping force and velocity in healthy older adults. Twenty-three healthy older adults (67.6 ± 7.6 years, 167.0 ± 8.8 cm, 72.7 ± 14.3 kg, and 27.1 ± 6.9% body fat) performed 5 individual countermovement jumps at BW, 90, 80, 70, and 60% of BW. Jumps were performed on a force plate, which provided peak take-off force (TOF), flight time, and peak impact force. A linear position transducer measured peak concentric velocity (PV). The rating of perceived exertion (RPE) was also assessed after each condition. Take-off force was greater during BW than all other conditions, 90 and 80% were greater than 70 and 60%, but there were no differences between 80 and 90% or between 70 and 60%. The FT progressively increased at all assistance levels, and PV was faster for all assistance levels than BW, with no differences between assistance levels. Impact force was greater during BW than 80, 70, and 60% and was greater during 90% than 60%. The RPE was less than BW during all assistance conditions but was the least during 70%. Implementing assisted jumping between 70 and 80% of BW in older adults likely provides the ideal combination of force, velocity, and RPE.

All-Extremity Exercise Training Improves Arterial Stiffness in Older Adults.

The purpose of this randomized controlled trial was to compare the effect of all-extremity high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) on aortic pulse wave velocity (PWV) and carotid artery compliance in older adults. Forty-nine sedentary older adults (age = 64 ± 1 yr), free of overt major clinical disease, were randomized to HIIT (n = 17), MICT (n = 18), or nonexercise controls (CONT; n = 14). HIIT (4 × 4 min at 90% HRpeak interspersed with 3 × 3 min active recovery at 70% HRpeak) and isocaloric MICT (70% HRpeak) were performed on an all-extremity non-weight-bearing ergometer, 4 d·wk for 8 wk under supervision. Aortic (carotid to femoral PWV [cfPWV]) and common carotid artery compliance were assessed at pre- and postintervention. cfPWV improved by 0.5 m·s in MICT (P = 0.04) but did not significantly change in HIIT and CONT (P > 0.05). Carotid artery compliance improved by 0.03 mm·mm Hg in MICT (P = 0.001), but it remained unchanged in HIIT and CONT (P > 0.05). Improvements in arterial stiffness in response to MICT were not confounded by changes in aortic or brachial blood pressure, HR, body weight, total and abdominal adiposity, blood lipids, or aerobic fitness. All-extremity MICT, but not HIIT, improved central arterial stiffness in previously sedentary older adults free of major clinical disease. Our findings have important implications for aerobic exercise prescription in older adults.

Applying the Evidence for Exercise Prescription in Older Adults with Knee Osteoarthritis

Knee osteoarthritis (OA) is prevalent and disabling condition in older adults. Pain, weakness, instability, stiffness, and loss of mobility result in a reduction of physical, recreational, and social activities that impact an individual’s health, lifestyle, and societal role. Exercise is highly beneficial for the many body systems that are impacted indirectly by this disease as well as for improving quality of life. The purpose of this narrative review is to identify exercise options and dosage parameters to aid the clinician in assisting individuals with knee OA. These exercise options include cardiovascular training, resistance training, and balance or neuromuscular control training, which work to improve the cardiovascular and neuromuscular systems to improve function. The application of exercise by health care professionals is often dosed at levels which may not achieve optimal gains for the individual desiring to restore functional activities and improve recreational and social participation. Understanding the current literature on prescribing exercise for individuals with knee OA aids clinicians in obtaining better patient outcomes.

Coming of Age: Considerations in the Prescription of Exercise for Older Adults.

Older adults represent the fastest-growing age demographic of the population. Physiological changes associated with primary aging and concurrent chronic disease adversely impact functional capacity, health outcomes, and quality of life. For these reasons, there is a national emphasis for healthcare providers to improve the health, function, and quality of life of older adults to preserve independent living and psychological well-being. The benefits of regular physical activity or exercise with regard to aging and disease are indisputable, yet many clinicians do not prescribe exercise to older adults. This reluctance may be attributable to a lack of knowledge regarding appropriate exercise prescription for older adults in light of the potential risks and benefits of various doses and types of exercise. In addition, clinicians and patients may have concerns about potential health considerations relevant to older adults such as comprehensive pre-exercise screening and exercise-drug interactions. In light of this, the following review presents (1) guidelines for exercise prescription in older adults and modification of these guidelines for patients with the most common age-associated comorbidities; (2) recommendations for pre-exercise screening prior to initiating an exercise program in older adults; (3) considerations for older adults on one or more medications; and (4) common barriers to adopting and maintaining exercise in an older population. Our goal is to provide a framework that clinicians can follow when prescribing exercise in older adults while considering the unique characteristics and concerns present in this population.

All‐Extremity Aerobic Exercise Training Improves Carotid Artery Compliance in Older Adults

Advancing age is associated with decreased arterial compliance and increased arterial wall intima‐media thickness (IMT), both independent predictors of cardiovascular disease. Aerobic exercise training is a recognized strategy for reducing the risk of cardiovascular disease, however, optimal exercise prescription in older adults remains unknown. The purpose of this study was to examine the effect of all‐extremity aerobic exercise training on central and peripheral vascular structure and function in older adults. Twenty two sedentary older men and postmenopausal women (age 55 to 76 yrs, 64±1yrs; mean±SE), free of major clinical disease (e.g., diabetes, cardiovascular, renal and liver disease) were randomized to 8 weeks of all‐extremity aerobic exercise training (EX; n=12) or non‐exercise control condition (CON; n=10). Aerobic training was performed 4 days/week under supervision and consisted of 47 min of exercise on an air‐braked all‐extremity ergometer (Airdyne, Schwinn) at 70% of maximal heart rate. Central and peripheral vascular structure was assessed by measuring carotid and femoral artery diameter and IMT using high resolution ultrasonography. Vascular function was evaluated by calculating arterial compliance using simultaneous measures of diameter and pressure via applanation tonometry. In response to the exercise intervention, carotid artery compliance improved (EX: 0.12±0.01 vs. 0.14±0.02 mm2/mmHg, P=0.01 and CON: 0.12±0.02 vs. 0.12±0.02 mm2/mmHg, P=0.8; pre‐ vs. post‐intervention). However, carotid artery diameter (EX: 7.1±0.2 vs. 7.1±0.2 mm and CON: 6.8±0.2 vs. 6.8±0.2 mm; P>0.05) and IMT normalized for lumen diameter (EX: 0.09±0.005 vs. 0.08±0.003 and CON: 0.09±0.005 vs. 0.09±0.004; P>0.05) remained unchanged. Femoral artery compliance did not improve with the intervention (EX: 0.17±0.02 vs. 0.16±0.02 mm2/mmHg and CON: 0.17±0.03 vs. 0.14±0.03 mm2/mmHg; P>0.05). Similarly, femoral artery diameter (EX: 8.6±0.4 vs. 8.8±0.4 mm, and CON: 8.5±0.5 vs. 8.6±0.5 mm; P>0.05) and IMT/diameter (EX: 0.07±0.009 vs. 0.07±0.008 and CON: 0.09±0.009 vs. 0.08±0.008; P>0.05) did not change following the intervention. In conclusion, eight weeks of aerobic exercise training performed on an all‐extremity ergometer improves carotid artery compliance in healthy older adults. This finding may have important implications for reducing the risk of cardiovascular disease in older adults.

Promoting physical activity for elders with compromised function: the Lifestyle Interventions and Independence for Elders (LIFE) Study physical activity intervention

The Lifestyle Interventions and Independence for Elders (LIFE) Study is a Phase III randomized controlled clinical trial (Clinicaltrials.gov identifier: NCT01072500) that will provide definitive evidence regarding the effect of physical activity (PA) on major mobility disability in older adults (70–89 years old) who have compromised physical function. This paper describes the methods employed in the delivery of the LIFE Study PA intervention, providing insight into how we promoted adherence and monitored the fidelity of treatment. Data are presented on participants’ motives and self-perceptions at the onset of the trial along with accelerometry data on patterns of PA during exercise training. Prior to the onset of training, 31.4% of participants noted slight conflict with being able to meet the demands of the program and 6.4% indicated that the degree of conflict would be moderate. Accelerometry data collected during PA training revealed that the average intensity – 1,555 counts/minute for men and 1,237 counts/minute for women – was well below the cutoff point used to classify exercise as being of moderate intensity or higher for adults. Also, a sizable subgroup required one or more rest stops. These data illustrate that it is not feasible to have a single exercise prescription for older adults with compromised function. Moreover, the concept of what constitutes “moderate” exercise or an appropriate volume of work is dictated by the physical capacities of each individual and the level of comfort/stability in actually executing a specific prescription.

Impairment-targeted exercises for older adults with knee pain: protocol for a proof-of-principle study.

BackgroundExercise therapy for knee pain and osteoarthritis remains a key element of conservative treatment, recommended in clinical guidelines. Yet systematic reviews point to only modest benefits from exercise interventions.One reason for this might be that clinical trials tend to use a one-size-fits-all approach to exercise, effectively disregarding the details of their participants' clinical presentations. This uncontrolled before-after study (TargET-Knee-Pain) aims to test the principle that exercises targeted at the specific physical impairments of older adults with knee pain may be able to significantly improve those impairments. It is a first step towards testing the effectiveness of this more individually-tailored approach.Methods/DesignWe aim to recruit 60 participants from an existing observational cohort of community-dwelling older adults with knee pain. Participants will all have at least one of the three physical impairments of weak quadriceps, a reduced range of knee flexion and poor standing balance. Each participant will be asked to undertake a programme of exercises, targeted at their particular combination and degree of impairment(s), over the course of twelve weeks. The exercises will be taught and progressed by an experienced physiotherapist, with reference to a "menu" of agreed exercises for each of the impairments, over the course of six fortnightly home visits, alternating with six fortnightly telephone calls. Primary outcome measures will be isometric quadriceps strength, knee flexion range of motion, timed single-leg standing balance and the "Four Balance Test Scale" at 12 weeks. Key secondary outcome measures will be self-reported levels of pain, stiffness and difficulties with day-to-day functional tasks (WOMAC). Outcome measures will be taken at three time-points (baseline, six weeks and twelve weeks) by a study nurse blinded to the exercise status of the participants.DiscussionThis study (TargET-Knee-Pain) is the first step towards exploring whether an impairment-targeted approach to exercise prescription for older adults with knee pain may have sufficient efficacy to warrant further testing. If warranted, future randomised clinical trials may compare this approach with more traditional one-size-fits-all exercise approaches.Trial registrationCurrent Controlled Trials ISRCTN61638364.

Exercise prescription after fragility fracture in older adults: a scoping review

The purpose of this study is to identify and chart research literature on safety, efficacy, or effectiveness of exercise prescription following fracture in older adults. We conducted a systematic, research-user-informed, scoping review. The population of interest was adults aged ≥45years with any fracture. "Exercise prescription" included post-fracture therapeutic exercise, physical activity, or rehabilitation interventions. Eligible designs included knowledge synthesis studies, primary interventional studies, and observational studies. Trained reviewers independently evaluated citations for inclusion. A total of 9,415 citations were reviewed with 134 citations (119 unique studies) identified: 13 knowledge syntheses, 95 randomized or controlled clinical trials, and 11 "other" designs, representing 74 articles on lower extremity fractures, 34 on upper extremity, eight on vertebral, and three on mixed body region fractures. Exercise prescription characteristics were often missing or poorly described. Six general categories emerged describing exercise prescription characteristics: timing post-fracture, person prescribing, program design, functional focus, exercise script parameters, and co-interventions. Upper extremity and ankle fracture studies focused on fracture healing or structural impairment outcomes, whereas hip fracture studies focused more on activity limitation outcomes. The variety of different outcome measures used made pooling or comparison of outcomes difficult. There was insufficient information to identify evidence-informed parameters for safe and effective exercise prescription for older adults following fracture. Key gaps in the literature include limited numbers of studies on exercise prescription following vertebral fracture, poor delineation of effectiveness of different strategies for early post-fracture mobilization following upper extremity fracture, and inconsistent details of exercise prescription characteristics after lower extremity fracture.

Exercise and Physical Activity for Older Adults

The purpose of this Position Stand is to provide an overview of issues critical to understanding the importance of exercise and physical activity in older adult populations. The Position Stand is divided into three sections: Section 1 briefly reviews the structural and functional changes that characterize normal human aging, Section 2 considers the extent to which exercise and physical activity can influence the aging process, and Section 3 summarizes the benefits of both long-term exercise and physical activity and shorter-duration exercise programs on health and functional capacity. Although no amount of physical activity can stop the biological aging process, there is evidence that regular exercise can minimize the physiological effects of an otherwise sedentary lifestyle and increase active life expectancy by limiting the development and progression of chronic disease and disabling conditions. There is also emerging evidence for significant psychological and cognitive benefits accruing from regular exercise participation by older adults. Ideally, exercise prescription for older adults should include aerobic exercise, muscle strengthening exercises, and flexibility exercises. The evidence reviewed in this Position Stand is generally consistent with prior American College of Sports Medicine statements on the types and amounts of physical activity recommended for older adults as well as the recently published 2008 Physical Activity Guidelines for Americans. All older adults should engage in regular physical activity and avoid an inactive lifestyle.

Successful Aging: The Role of Physical Activity

Although no amount of physical activity can stop the aging process, a moderate amount of regular exercise can minimize the physiological effects of an otherwise sedentary lifestyle and increase active life expectancy by limiting the development and progression of chronic disease and disabling conditions. Ideally, exercise prescription for older adults should include aerobic, muscle strengthening, and flexibility exercises. In addition, individuals at risk for falling or mobility impairment should also perform specific exercises to improve balance. The intensity and duration of physical activity should be low at the outset for those who are highly deconditioned, are functionally limited, or have chronic conditions affecting their ability to perform physical tasks. Furthermore, the progression of activities should be individualized and tailored to tolerance and preference. Incorporating principles of behavioral change into the design and application of exercise and physical activity programs will increase the likelihood of an individual initiating and maintaining a regular program of exercise and/ or physical activity. Strategies for maintaining physical function and improving overall health of older adults with chronic conditions and disability are discussed. All older adults with and without disabilities should be encouraged to develop a personalized physical activity plan that meets their needs and personal preferences.

Influence of Self-Efficacy on the Functional Relationship Between Ratings of Perceived Exertion and Exercise Intensity

Rating of perceived exertion (RPE) has been consistently used as a subjective index of exercise intensity for both exercise testing and prescription. Little empirical efforts have been made to determine how psychological factors influence changes in RPE. This study examined the influence of self-efficacy expectations on changes in RPE as a function of exercise intensity. Participants were 193 sedentary older adults (mean age = 66.7 years) who completed an assessment of exercise self-efficacy and aerobic capacity. Analyses indicated that RPE during exercise changed in both a linear and a quadratic manner as intensity increased and that self-efficacy was a predictor of both patterns of change. Those high in self-efficacy maintained a constant rate of change in RPE as exercise intensity increased, whereas less efficacious participants exhibited a slower rate of change in RPE as a function of exercise intensity, with an initial gradual curve at lower intensity and a more dramatic trajectory at higher intensity. Results have important implications for using RPE for exercise prescription in older adults and suggest that exercise self-efficacy is implicated in patterns of RPE change.

Prescribing Exercise for Older Adults

To inform the development of educational programming designed to teach providers appropriate methods of exercise prescription for older adults, the authors conducted a survey of 177 physicians, physician assistants, and nurse practitioners (39% response rate). The survey was designed to better understand the prevalence of exercise prescriptions, attitudes, barriers, and educational needs of primary care practitioners toward older adults. Forty-seven percent of primary care providers report not prescribing exercise for older adults; 85% of the sample report having no formal training in exercise prescription. Practitioner attitudes were positive toward exercise, but were not predictive of their exercise prescribing behavior, which indicates that education efforts aimed at changing attitudes as a way of increasing exercise-prescribing behaviors would not be sufficient. In order to facilitate and reinforce practice changes to increase exercise-prescribing behaviors of primary care providers, results suggest the need for specific skill training on how to write an exercise prescription and motivate older adults to follow these prescriptions.

Declines in strength and balance in older adults with chronic knee pain: a 30-month longitudinal, observational study.

To document changes in lower extremity strength and balance over a 30-month period in older adults with chronic knee pain, and to identify relationships among these variables that may prove useful in designing a subsequent clinical intervention trial. This longitudinal, 30-month, observational study was designed to examine the association of physical, psychological, social, and environmental factors with severity and progression of physical disability caused by chronic knee pain. This article will focus on 2 physical measures: strength and dynamic balance. The participants were a cohort of 480 adults 65 years of age or older with chronic knee pain. Measurements included: 1) force platform dynamic balance measure of the center of pressure excursion during a forward and subsequent backward lean, 2) isokinetic strength measures of concentric and eccentric knee flexion and extension, and concentric ankle plantar flexion and dorsiflexion, and 3) body mass index and a knee pain scale to measure obesity and knee pain, respectively. A maximum-likelihood analysis revealed an overall significant decline in knee (P < 0.001) and ankle (P = 0.012) strength, and balance (P < 0.001) after a 30-month followup period. Participants with greater knee strength at baseline had less expected decline in balance at followup than their weaker counterparts (4.2% versus 7.7% for the 75th versus 25th percentiles of strength; P = 0.023). However, the absolute decline in balance over 30 months was similar regardless of baseline ankle strength. Adults age >or=65 years with chronic knee pain experience significant declines in balance and lower extremity strength over a 30-month period. Moreover, greater knee and ankle muscular strength is associated with better balance. Previous studies have shown that weight training is effective in improving balance in older adults with knee osteoarthritis. Taken together, these studies present a strong rationale for incorporating weight training into an exercise prescription for older adults with chronic knee pain.