Exercise Programs For Older Adults Research Articles

Clinically Meaningful Changes In Mobility After An Exercise Program For Older Adults

Aging is associated with a progressive decline in muscle strength and mass, eventually leading to reduced functional ability and disability. Regular physical activity can slow this inevitable decline and promote physical wellbeing, improve physical function and reduce risk of chronic diseases in older adults. However, meaningful improvements in physical function for individuals in response to a training stimulus are often missed when only group effects are considered. PURPOSE: to examine interindividual variation in changes in functional ability in response to a 10-week exercise intervention designed to improve physical function in older adults. METHODS: 97 older adults (age= 72.7 yrs+7.9); BMI=32.3+7.2) completed the 10-week Physical Activity for Seniors for Life (PALS) group exercise and lifestyle behavior change program. 6MW (distance covered in 6 minutes), and UGS (meters/second (m/s) to walk 6 m distance) were measured before and after the exercise program. RESULTS: There was a significant (p<.05) improvement in 6mw and UGS for the group (m=60.2 meters and 0.1045 m/s respectively). For 6mw, 27% did not improve more than 20 meters (>20 meters is small meaningful change), 23% improved between 20 and 50 meters, and 50% improved more than 50 meters (>50 meters is substantial meaningful change). For UGS 38% showed less than 0.05 m/s improvement (0.05 m/s is small meaningful change), 12% improved between 0.05 and 0.1 m/s, and 47% improved more than 0.1 m/s (0.1 m/s is substantial meaningful change). CONCLUSIONS: Consideration of individual variability is important in establishing the clinical meaningfulness of improvements in physical function in response to exercise programs designed for older adults.

Home-based Self-managed Older Adult Exercise Program Improves Physical Activity Status And Sleep Quality

Home-based Self-managed Older Adult Exercise Program Improves Physical Activity Status And Sleep Quality

COVID-19 Pandemic and Beyond: Considerations and Costs of Telehealth Exercise Programs for Older Adults With Functional Impairments Living at Home-Lessons Learned From a Pilot Case Study.

ObjectiveThe purpose of this study was to describe the process and cost of delivering a physical therapist–guided synchronous telehealth exercise program appropriate for older adults with functional limitations. Such programs may help alleviate some of the detrimental impacts of social distancing and quarantine on older adults at-risk of decline.MethodsData were derived from the feasibility arm of a parent study, which piloted the telehealth program for 36 sessions with 1 participant. The steps involved in each phase (ie, development, delivery) were documented, along with participant and program provider considerations for each step. Time-driven activity-based costing was used to track all costs over the course of the study. Costs were categorized as program development or delivery and estimated per session and per participant.ResultsA list of the steps and the participant and provider considerations involved in developing and delivering a synchronous telehealth exercise program for older adults with functional impairments was developed. Resources used, fixed and variable costs, per-session cost estimates, and total cost per person were reported. Two potential measures of the “value proposition” of this type of intervention were also reported. Per-session cost of $158 appeared to be a feasible business case, especially if the physical therapist to trained assistant personnel mix could be improved.ConclusionsThe findings provide insight into the process and costs of developing and delivering telehealth exercise programs for older adults with functional impairments. The information presented may provide a “blue print” for developing and implementing new telehealth programs or for transitioning in-person services to telehealth delivery during periods of social distancing and quarantine.ImpactAs movement experts, physical therapists are uniquely positioned to play an important role in the current COVID-19 pandemic and to help individuals who are at risk of functional decline during periods of social distancing and quarantine. Lessons learned from this study’s experience can provide guidance on the process and cost of developing and delivering a telehealth exercise program for older adults with functional impairments. The findings also can inform new telehealth programs, as well as assist in transitioning in-person care to a telehealth format in response to the COVID-19 pandemic.

Training With Wii Balance Board for Dynamic Balance in Older Adults

Background and Purpose: Age-related muscle strength deterioration and decreased ability to react appropriately and regain balance after unexpected sudden disturbances and deficit they have in the use of responsible mechanisms to control the dynamic stability in response to a disturbance are important intrinsic risk factors for the fall. The main objective of this study is to verify the impact on the dynamic balance, through the Limits of Stability test, of a physical exercise program in older adults using the Nintendo Wii console. Methods: The sample consisted of a total of 12 patients. Pre and posttreatment measurements and assessments were carried out at the Laboratory of Motion Analysis, Biomechanics, Ergonomics and Motor Control (LAMBECOM) in the Faculty of Health Sciences of the Rey Juan Carlos University. Results and Conclusions: The results of this study show improvements in the scores of all the variables analyzed by Limits of Stability: RT, MVL, EPE, MXE and DCL. The results obtained seem to determine that the protocol used through training with the Nintendo Wii and its Wii Fit video game produced clinical improvements in postural control and dynamic balance and a positive impact on quality of life.

The Study of Health-Related Fitness Normative Scores for Nepalese Older Adults.

Physical fitness tests are important to maintain and promote the health status of people. The purpose of this study was to develop health-related fitness evaluation norms according to the age and gender of Nepalese older adults. One thousand nine subjects (449 males, 560 females) above 60 years, residing in 19 wards (rural and urban) of Dhangadhi Sub-Metropolitan City participated in this study. The test included the PAR-Q (Physical Activity Readiness Questionnaire), social aspects questionnaire, blood pressure test, height, weight, BMI (body mass index), percent body fat, and four physical fitness components (grip strength, 1-minute sit-to-stand, sit and reach, and 2-minute step tests). Mean, SD, and fitness evaluation norms for each component were obtained after the main test and statistical analyses. This study showed higher BMI and percent body fat in female age groups than in male age groups. Grip strength, relative grip strength, sit-to-stand, and 2-minute steps scores were better in male age groups than in female age groups, but in contrast, flexibility was better in female age groups. This study may help the related sectors to assess physical fitness, identify fitness levels, and develop appropriate physical activities or exercise programs for older adults based on age.

Influence of exercise on cognitive processing of older woman during dual-task balance: sixteen case reports

BACKGROUND: Older adults require special attention during cognitive-motor tasks since automatic postural control is reduced.&#x0D; AIM: To analyze the effect of physical exercise on dual-task processing of healthy older women performing standing balance.&#x0D; METHOD: Sixteen healthy older women were assessed in a quiet standing position with eyes open/closed (single-task, EO, and EC) and with a cognitive task (dual-task, DT) using a Wii Balance Board. All individuals performed training (aerobic, strength, and virtual reality exercises) at moderate effort. Center of pressure (CoP) anteroposterior and mediolateral displacement were analyzed over time pre- and post-training. The Wilcoxon test was used to compare pre- and post-training.&#x0D; RESULTS: Greater variability in CoP was observed pre- compared to post-training. In the DT, there was a significance decrease in post-training variability compared to pre-training (p&lt;0.01).&#x0D; CONCLUSION: Physical exercise programs for older adults may contribute to simultaneously improving motor-cognitive performances, associated with improvement in the divided attention.

Effects of a Multicomponent Exercise Program in Older Adults with Non-Small-Cell Lung Cancer during Adjuvant/Palliative Treatment: An Intervention Study.

Clinical intervention studies support the efficacy and safety of exercise programs as a treatment modality for non-small-cell lung cancer (NSCLC) during adjuvant/palliative treatment, but the effectiveness of real-world oncogeriatric services is yet to be established. We aimed to examine the effects of a 10-week structured and individualized multicomponent exercise program on physical/cognitive functioning and mental wellness in elderly patients with NSCLC under adjuvant therapy or palliative treatment. A non-randomized, opportunistic control, longitudinal-design trial was conducted on 26 patients with NSCLC stage I–IV. Of 34 eligible participants, 21 were allocated into two groups: (i) control group (n = 7) received usual medical care; and (ii) intervention group (n =19) received multicomponent program sessions, including endurance, strength, balance, coordination and stretching exercises. Tests included the Short Physical Performance Battery (SPPB), 5-m habitual Gait Velocity Test (GVT), Timed Up & Go Test (TUG), 6-Min Walk Test (6MWT), independence of activities in daily living (IADL), muscular performance, cognitive function, and quality of life, which were measured at baseline and after 10 weeks of the program. Results revealed a significant group×time interaction for SPPB (p = 0.004), 5-m GVT (p = 0.036), TUG (p = 0.007), and muscular performance (chest and leg power; p < 0.001). Similarly, significant changes were observed between groups for cognitive functioning (p = 0.021) and quality of life for EUROQoL 5D (p = 0.006). Our findings confirm that a multicomponent exercise program improves measures of physical/cognitive functioning and quality of life in the elderly with NSCLC under adjuvant therapy or palliative treatment. This is an interesting and important study that adds to our current body of knowledge on the safety of exercise interventions, especially in the elderly with solid tumors.

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.

Changes in plantar pressure and spatiotemporal parameters during gait in older adults after two different training programs

BackgroundImproving gait is in exercise programs for older adults (OAs) but little is known about how different gait-training approaches affect spatiotemporal parameters and plantar pressure distributions in OAs. High plantar pressures are linked to tissue injury risk, ulceration, and pain in OAs, but no studies have yet compared how they affect podobarometric variables. Research questionThe effect of changing plantar pressure on absolute and mean maximum pressure, the pressure-time integral, stride time, stance time, and gait speed in OAs following either a multicomponent training program (EG) or interval-walking training (WG). MethodsComfortable gait speed, strength (seat-to-stand test), and plantar pressure (Pedar-X mobile in-shoe system), were evaluated in 23 OAs (EG: n = 12, 7 female, 71.58 ± 4.56 years; WG: n = 11, 6 female, 69.64 ± 3.56 years), by dividing the plantar area into 9 regions. ResultsAfter 14 weeks, the maximum pressure in medial and central metatarsus areas in the dominant leg were reduced in the EG (p = 0.01 &p = 0.04, respectively), but increased in the non-dominant leg lateral heel in the WG (p = 0.03). The mean maximum pressure also increased in the WG in medial heel in the dominant leg (p = 0.02) and lateral heel in the non-dominant leg (p = 0.03). The overall pressure-time integral reduced in the whole plantar area in both legs in both groups. WG reduced stride time (dominant: p = 0.01; non-dominant: p = 0.01) and stance time (dominant: p < 0.005; non-dominant: p < 0.005). Gait speed did not change in any group. As expected, lower limb strength improved after both exercise programs (EG: p = 0.02; WG: p = 0.01). SignificanceAlthough these training interventions were short, they indicate the importance of exercise types. Our results suggest that OAs might benefit from periodized training, especially when multicomponent programs are introduced prior to the walking goals. Future, larger studies should explore situations in which special populations with specific foot problems might benefit from these interventions.

A Novel Square-Stepping Exercise Program for Older Adults (StepIt): Rationale and Implications for Falls Prevention.

The ability to effectively execute compensatory steps is critical for preventing accidental falls, and consequently stepping training is an essential ingredient of fall prevention programs. In this paper, we propose a concept for stepping training that aims to maximize training effects by taking into account recent research evidence and a precise dosing of training ingredients. The concept addresses motor as well as cognitive falls-related aspects, it is suitable for individual as well as group based training, and it does not require costly equipment. Theory and evidence behind all of the training principles is reviewed, and an example of an exercise protocol is described in detail. Participants are presented with stepping patterns which they have to memorize and implement on a mat. In order to enable investigation of dose-response effects, the difficulty level systematically and gradually increases session by session based on four principles: execution speed, pattern complexity, pattern length and execution in dual-/multi-tasking conditions. The presented concept can be used as a framework for the development of further prevention and/or rehabilitation stepping exercise programs. Further studies using this exercise regimen or modified versions of it are encouraged.

Rapid Transition to Telehealth Group Exercise and Functional Assessments in Response to COVID-19.

Exercise is critical for health maintenance in late life. The COVID-19 shelter in place and social distancing orders resulted in wide-scale interruptions of exercise therapies, placing older adults at risk for the consequences of decreased mobilization. The purpose of this paper is to describe rapid transition of the Gerofit facility-based group exercise program to telehealth delivery. This Gerofit-to-Home (GTH) program continued with group-based synchronous exercise classes that ranged from 1 to 24 Veterans per class and 1 to 9 classes offered per week in the different locations. Three hundred and eight of 1149 (27%) Veterans active in the Gerofit facility-based programs made the transition to the telehealth delivered classes. Participants’ physical performance testing continued remotely as scheduled with comparisons between most recent facility-based and remote testing suggesting that participants retained physical function. Detailed protocols for remote physical performance testing and sample exercise routines are described. Translation to remote delivery of exercise programs for older adults could mitigate negative health effects.

It's Not Just Physical: Exercise Physiologist-Led Exercise Program Promotes Functional and Psychosocial Health Outcomes in Aged Care.

Regular physical activity has multiple benefits for older adults, including improved physical, cognitive, and psychosocial health. This exploratory study investigated the benefits of a 12-week exercise program for older adults (n = 11 control and n = 13 intervention) living in a residential aged care facility in Perth, Western Australia. The program, prescribed and delivered by an accredited exercise physiologist, aimed to maintain or improve participants' physical capacity. It comprised one-on-one exercise sessions (1hr × 2days/week × 12 weeks), involving a components-approach intervention. Physical performance measures (balance, strength, flexibility, and mobility) were assessed preintervention and postintervention. Qualitative interviews postintervention with residents participating in the exercise intervention, and with family members, staff, and research team members, explored barriers and enablers to participation and perceived psychosocial outcomes. Findings indicate the program provided physical benefits and enhanced social engagement for participants, illustrating the value of providing exercise physiology services in the aged care sector.

Personalized Exercise Programs for Older Adults - a Digital User-friendly Application

Personalized Exercise Programs for Older Adults - a Digital User-friendly Application

Predictors of Improvement in Physical Function in Older Adults in an Evidence-Based Physical Activity Program (EnhanceFitness).

Declines in strength, flexibility, and balance in older adults can lead to injuries and loss of independence and are particularly common in those of greater age and in worse health. EnhanceFitness (EF) is a nationally disseminated, evidence-based group exercise program for older adults that has been shown to improve function through cardiovascular, strength, flexibility, and balance exercises. This article examines changes in, and predictors of, participant physical function from baseline through 2 program cycles of EF as measured by 3 physical function tests: arm curls, chair stands, and 8-foot up-and-go. We analyzed data on participants who attended at least 2 consecutive 16-week program cycles between January 2005 and June 2016. We ran 3 random-effects linear regression models, 1 for each physical function test, and accounted for missing data and clustering by class site. Independent variables included attendance, demographics, and health status. A total of 7483 participants completed baseline and 2 sets of follow-up physical function tests. For all 3 physical function tests, participants showed some degree of improved physical function at each follow-up, and greater program attendance predicted clinically significant improvements. Some participants had less improvement: females, those less active at baseline, older than 75 years, not married or partnered, or in fair or poor health, those who had experienced at least 1 fall, and those with a disability. EnhanceFitness program providers may need to implement additional measures to support the participants who could benefit most from EF, such as targeting messaging, coordinating with referring providers to emphasize attendance and general activity in specific participants, and offering additional support to groups who show less improvement during classes. The evidence presented here may inform clinical decision making for older adult patients and increase health care provider confidence in EF and similar exercise programs, thereby providing a mechanism to maintain and continue functional gains made in clinical or rehabilitation settings.

257 Participants’ Experience of a Novel Group Exercise Program: Results from the DEFRAIL (Diet and Exercise for Frailty) Study Pilot

Abstract Background DEFRAIL (Diet and Exercise for Frailty) is a translational study examining the effect of an eight-week multicomponent group exercise program and protein supplementation on frailty in older adults. As part of the development of this novel intervention, a four-week pilot was carried out to assess participants’ experience of the program, with a view to optimising the final format. Methods Inclusion in the DEFRAIL study requires a candidate to be deemed frail as per the Fried criteria. During the initial stages of recruitment for DEFRAIL, any individual who was identified as pre-frail was offered the opportunity to participate in the pilot trial (11 x 1-hour group sessions at a local sporting facility). Following its conclusion, a telephone interview using a standardised questionnaire was conducted on all participants to assess various aspects of their experience. Results Of 9 participants recruited for the pilot, 7 completed the four-week program (One participant failed to attend any sessions due to difficulties with transport and one participant withdrew after the first week, reporting excessive fatigue as the main issue). Amongst these 7 individuals, attendance was 90.9%. The only other adverse events recorded were delayed-onset muscle soreness (DOMS) in 4 out of 7 and aggravation of a pre-existing joint injury in one individual (neither of which prevented participation in subsequent classes). All attendees reporting enjoying the program with additional feedback obtained via the questionnaire regarding the timing, duration, frequency and intensity of classes, in addition to identifying potential barriers or enablers to participation. Conclusion This pilot of a novel exercise program for older adults was enjoyed and well-tolerated by pre-frail older adults. Participant feedback, both during the pilot and through a standardised questionnaire following completion, has had a meaningful impact on the final version of the exercise program that will be used for frail older adults in the DEFRAIL intervention.

Walking People - Aruku-hito, Community-based Group Exercise Program For Older Adults: Expanding The Reach

Walking People - Aruku-hito, Community-based Group Exercise Program For Older Adults: Expanding The Reach

Multi-modal Exercise Program in Older Adults

Multi-modal Exercise Program in Older Adults

Feasibility and preliminary efficacy of Ai Chi aquatic exercise training in Hong Kong's older adults with risk of falling: Design and methodology of a randomized controlled trial.

Falls in older adults are a major global public health concern. Group exercise could mitigate fall risk but the traditional land-based group exercise may not be always suitable for older adults at risk of falling, especially for those with musculoskeletal problems. Ai Chi aquatic exercise program could provide a safe and low-impact exercise training for older adults. However, the feasibility and efficacy of the program has not been well-investigated. The objective of this study is to investigate the feasibility and efficacy of the Ai Chi aquatic exercise program, compared to the land-based exercise program for older adults with moderate to high risk of falling. Forty community-dwelling older adults aged 65 or above with moderate to high fall risk will be recruited. They will be randomly allocated in the Ai Chi Aquatic Exercise Group (intervention) or the Land-based Exercise Group (active control) receiving 16 sessions (8 weeks) of specific exercise training. Feasibility of both exercise groups will be examined by recruitment, adherence, retention, feedback, subjective exercise experiences and satisfaction. Preliminary efficacy will be determined by whether physical and psychological fall risk factors could be mitigated. Physical fall risk assessment will include tests for flexibility, muscle strength, gait and balance. Psychological fall risk will be evaluated by preliminary cognitive function, anxiety level, level of depression and fear of falling. The results could establish a solid foundation for worldwide development of a feasible, safe and effective Ai Chi aquatic exercise program for prevention of falls in older adults with risk of falling.

Trunk exercise training improves muscle size, strength, and function in older adults: A randomized controlled trial.

The aim of this study was to assess the effectiveness of a multimodal exercise program to increase trunk muscle morphology and strength in older individuals, and their associated changes in functional ability. Using a single-blinded parallel-group randomized controlled trial design, 64 older adults (≥60years) were randomly allocated to a 12-week exercise program comprising walking and balance exercises with or without trunk strengthening/motor control exercises; followed by a 6-week walking-only program (detraining; 32 per group). Trunk muscle morphology (ultrasound imaging), strength (isokinetic dynamometer), and functional ability and balance (6-Minute Walk Test; 30second Chair Stand Test; Sitting and Rising Test; Berg Balance Scale, Multi-Directional Reach Test; Timed Up and Go; Four Step Square Test) were the primary outcome measures. Sixty-four older adults (mean [SD]; age: 69.8 [7.5]years; 59.4% female) were randomized into two exercise groups. Trunk training relative to walking-balance training increased (mean difference [95% CI]) the size of the rectus abdominis (2.08 [1.29, 2.89]cm2 ), lumbar multifidus (L4/L5:0.39 [0.16, 0.61]cm; L5/S1:0.31 [0.07, 0.55]cm), and the lateral abdominal musculature (0.63 [0.40, 0.85]cm); and increased trunk flexion (29.8 [4.40, 55.31]N), extension (37.71 [15.17, 60.25]N), and lateral flexion (52.30 [36.57, 68.02]N) strength. Trunk training relative to walking-balance training improved 30-second Chair Stand Test (5.90 [3.39, 8.42] repetitions), Sitting and Rising Test (1.23 [0.24, 2.23] points), Forward Reach Test (4.20 [1.89, 6.51]cm), Backward Reach Test (2.42 [0.33, 4.52]cm), and Timed Up and Go Test (-0.76 [-1.40, -0.13]seconds). Detraining led to some declines but all outcomes remained significantly improved when compared to pre-training. These findings support the inclusion of trunk strengthening/motor control exercises as part of a multimodal exercise program for older adults.

What Types of Physical Function Predict Program Adherence in Older Adults?

The aims of this study were to describe participants' demographic characteristics by adherence levels and to examine the association between participants' baseline physical function and their adherence to an evidence-based group exercise program. A prospective exploratory study (N = 36,373). Participants' physical function was assessed using 30-second chair-stand, arm-curl, and 8-foot up-and-go tests. Adherence was calculated as the proportion of attended sessions over offered sessions. Participants' mean adherence was 52%. Older male, Asian/Pacific Islander race, and Washington State residents with fewer chronic conditions showed higher adherence. Multinomial logistic regression showed the baseline 30-second chair-stand, arm-curl, and 8-foot up-and-go tests significantly predict adherence levels after controlling for demographics. Stronger upper- and lower-extremity strength and better walking balance and mobility are associated with higher adherence to exercise programs in older adults. The results underscored the importance of offering classes at various physical function levels while considering participants' individual needs.