Functional Capacity In Older Adults Research Articles

Resistance Exercise to Prevent and Manage Sarcopenia and Dynapenia.

For well over twenty centuries the muscle wasting (sarcopenia) and weakness (dynapenia) that occurs with old age has been a predominant concern of mankind. Exercise has long been suggested as a treatment to combat sarcopenia and dynapenia, as it exerts effects on both the nervous and muscular systems that are critical to positive physiological and functional adaptations (e.g., enhanced muscle strength). For more than two decades scientists have recognized the profound role that progressive resistance exercise training can have on increasing muscle strength, muscle size and functional capacity in older adults. In this review article we discuss how resistance exercise training can be used in the management and prevention of sarcopenia and dynapenia. We first provide an overview of the evidence for this notion and highlight certain critical factors- namely exercise intensity, volume and progression- that are key to optimizing the resistance exercise prescription. We then highlight how many, if not most, of the commonly prescribed exercise programs for seniors are not the 'best practices', and subsequently present easy-to-read guidelines for a well-rounded resistance exercise training program designed for the management and prevention of sarcopenia and dynapenia, including example training programs for the beginner through the advanced senior resistance exerciser. These guidelines have been written for the academician as well as the student and health care provider across a variety of disciplines, including those in the long term care industry, such as wellness instructors or activity directors.

Effects of eccentric-focused and conventional resistance training on strength and functional capacity of older adults.

The aim of the study was to assess the effect of eccentric training using a constant load with longer exposure time at the eccentric phase on knee extensor muscle strength and functional capacity of elderly subjects in comparison with a conventional resistance training program. Twenty-six healthy elderly women (age = 67 ± 6 years) were randomly assigned to an eccentric-focused training group (ETG; n = 13) or a conventional training group (CTG; n = 13). Subjects underwent 12 weeks of resistance training twice a week. For the ETG, concentric and eccentric phases were performed using 1.5 and 4.5 s, respectively, while for CTG, each phase lasted 1.5 s. Maximum dynamic strength was assessed by the one-repetition maximum (1RM) test in the leg press and knee extension exercises, and for functional capacity, subjects performed specific tests (6-m walk test, timed up-and-go test, stair-climbing test, and chair-rising test). Both groups improved knee extension 1RM (24-26 %; p = 0.021), timed up-and-go test (11-16 %; p < 0.001), 6-m walk test (9-12 %; p = 0.004), stair-climbing test (8-13 %; p = 0.007), and chair-rising test (15-16 %; p < 0.001), but there was no significant difference between groups. In conclusion, the strategy of increasing the exposure time at the eccentric phase of movement using the same training volume and intensity does not promote different adaptations in strength or functional capacity compared to conventional resistance training in elderly woman.

Role of Fatigue on the Effectiveness of a Physical Activity Intervention Aimed at Preventing Mobility Disability

While physical activity (PA) is known to preserve mobility and functional capacity in older adults, greater self-reported fatigue is associated with slower gait speed and poorer mobility. The potential impact of initial fatigue levels in mitigating the effects of a physical activity intervention on major mobility disability (MMD) outcomes has yet to be explored. PURPOSE: To examine the impact of a PA intervention on the risk of MMD by baseline (BL) fatigue status in older adults at risk for mobility disability. METHODS: The Lifestyle Interventions and Independence for Elders (LIFE) Study was a randomized clinical trial of a structured, moderate-intensity PA program (mean duration=2.6 years) consisting primarily of walking compared to a successful aging health education (SA) program in 1635 older adults, mean age 78.9±5.2 years. Self-reported fatigue was assessed using the Trait version of the Exercise-Induced Feelings Inventory (EFI-T), a 6-item scale with each item scored 0 (none of the time) to 5 (all of the time). A total score was calculated by averaging the items and the median split was used to define BL fatigue status: higher fatigue ≥2 (N=876) and lower fatigue <2 (N=755). A usual-paced 400m walk was conducted every 6 months; MMD was defined as the loss of ability to walk the 400m within 15 min. Cox proportional hazard models were used for the analysis of MMD in the PA vs. SA groups according to baseline fatigue status. RESULTS: Time to walk 400m at BL was slower for those with higher fatigue (521.0±113.3 sec) compared to lower fatigue (494.6±112.8 sec), p<0.0001. Participants with higher BL fatigue who were randomized to the PA program had a 26% lower risk of MMD compared to those who self-reported higher BL fatigue in SA (hazard ratio [HR] 0.74 [95% CI, 0.59-0.92], p=0.006). For those with lower BL fatigue, there was no difference between intervention programs on MMD (HR 0.88 [95% CI, 0.66-1.17], p=0.39); p-value for BL fatigue by intervention interaction: 0.24. Results did not change after adjustment for BL 400m walk time. CONCLUSION: A long-term moderate intensity PA intervention may be particularly effective in preserving mobility in older adults at risk for MMD who self-reported higher levels of initial fatigue. Supported by U01AG22376 from the NIH.

Parámetros funcionales y su relación con velocidad de marcha en adultos mayores de la comunidad chilenos

Introduction: Gait speed is a test to measure functional capacity in older adults. Nevertheless, the factors influencing this variable are not well described in South American populations.Objective: To determine the relationship between usual and maximal walking speed and functional parameters among Chilean community-dwelling older adults.Materials and methods: An observational, descriptive and cross-sectional study including 69 older adults was conducted. The usual and maximal gait speeds were associated with body composition (body mass index), upper limbs muscle strength (arm curl-ups), lower limbs muscle strength (30 seconds sit-to-stand test), global function (Barthel index), ankle flexibility (range of motion), dynamic balance (timed Up &amp; Go test) and aerobic capacity (2 minutes walking test).Results: The ankle flexibility, lower limbs strength and aerobic capacity influenced the maximal speed (R2=0.65; p &lt;0.001), while the usual speed was influenced by upper limbs and lower limbs strength and by the aerobic capacity (R2= 0.51; p &lt;0.001).Conclusion: The usual and maximal gait speeds are mostly influenced by the lower limbs muscle strength plus aerobic capacity.

Functional parameters and their association with gait speed in Chilean community-dwelling older adults

Gait speed is a test to measure functional capacity in older adults. Nevertheless, the factors influencing this variable are not well described in South American populations. To determine the relationship between usual and maximal walking speed and functional parameters among Chilean community-dwelling older adults. An observational, descriptive and cross-sectional study including 69 older adults was conducted. The usual and maximal gait speeds were associated with body composition (body mass index), upper limbs muscle strength (arm curl-ups), lower limbs muscle strength (30 seconds sit-to-stand test), global function (Barthel index), ankle flexibility (range of motion), dynamic balance (timed Up & Go test) and aerobic capacity (2 minutes walking test). The ankle flexibility, lower limbs strength and aerobic capacity influenced the maximal speed (R2 =0.65; p <0.001), while the usual speed was influenced by upper limbs and lower limbs strength and by the aerobic capacity (R2 = 0.51; p <0.001). The usual and maximal gait speeds are mostly influenced by the lower limbs muscle strength plus aerobic capacity.

Relationship between Nutritional Status and Functional Capacity for Older People

Functional capacity is the condition of an individual living independently and the lack of it for preparing and eating food, which is a factor that can result in malnutrition and deserves the attention of professionals and his family members. Then, the aim of this work was to evaluate the relationship between nutritional status and functional capacity for older adults using anthropometric measures and questionnaires for activities of daily and instrumental living. It was an epidemiological cross-sectional study using a representative sample of older adults selected from a previous study about quality of life in a Botucatu city, Sao Paulo. Brazil. The sample size was calculated considering 95% of reliability and 5% of error margin, resulting from a total of 365 individuals of both sexes but only 361 of them completed the protocol. Data included sociodemographic and morbidities questionnaires, activities of daily and instrumental living (ADL and IADL) and an-thropometric variables. 62.6% of the older were women, 44.68% were hypertensive, 28.81% were diabetic and 15.51% had hypercholesterolemia. 94.24% and 92.42% of the older were fully independent for ADL and IADL, respectively. Associations between ADL with marital status and schooling were found as well as with IADL. Also, it was found association with IADL and heart disease. Regarding anthropometry most of measures when compared men and women were significant. No significant association was found between nutritional status and ADL. A logistic regression model was fitted considering ADL as a response variable showed BMI as a protection factor and WC as a risk factor for dependence. For IADL, heart disease was a risk factor for dependence. In conclusion, low weight and increased waist circumference have influence in a functional capacity of older adults according to the activities daily living (ADL) and heart disease for IADL.

Development of the Japan Science and Technology Agency Index of Competence to Assess Functional Capacity in Older Adults: Conceptual Definitions and Preliminary Items.

Improvement in the health of older people and changes in their lifestyles necessitate a scale that can better measure their competence at a higher level. This study describes the development process of the Japan Science and Technology Agency Index of Competence (JST-IC) by (a) refining conceptual definitions and developing preliminary items and (b) examining the basic properties of the items. Participants were 1,253 septuagenarians (539 men and 714 women) living in communities, who were asked to judge whether they were independent via 88 items. To examine the basic properties of the preliminary items, five different analyses were conducted. Thirty-four items were considered as inappropriate (6 overlapped between the analyses): (a) 9 due to very high or low ratios of responders who answered “yes,” (b) 4 due to gender or regional differences, (c) 5 due to their weak association with health status, (d) 9 due to low communalities in factor analysis, and (e) 13 due to redundancy of meaning with other items. Conceptual definitions and preliminary items were developed, and the basic properties of the items were examined to create the JST-IC. The next step would be to screen the remaining 54 items to create the final version of the scale.

Changes in functional capacity in older adults living alone: a three-year longitudinal study in a rural area of Japan.

The purposes of this research were to clarify three-year changes in functional capacity and to investigate related physical health, psychological/mental health, and social health factors in older adults living alone in a rural area of Japan. Home visit interviews were conducted in 2000 (the baseline survey: n = 128) and in 2003 (the follow-up survey: n = 101) with older adults living alone in a town in Ishikawa prefecture. Seventy nine subjects were analyzed using logistic regression analysis at the follow-up survey. Of these 79 subjects, 40 persons had scores for functional capacity decreased by one or more points, the "Lowered" group (50.6%), while 27 persons were "Unchanged" (34.2%), and 12 persons were "Improved" (15.2%). Factors at the baseline survey were compared between the "Lowered" group and the "Unchanged/Improved" group. Significant factors that caused a decreased functional capacity were age (75 years old and over), no participation in social activities, and contact with friends/neighbors over the phone less than once a week. This research has shown that participation in social activities and contact with friends/neighbors maintain a higher functional capacity in older adults living alone.

Video game training enhances functional capacity in older adults

Video game training enhances functional capacity in older adults

Interrelated factors favoring physical performance and activity in older adults from the NuAge cohort study

ObjectivesContribute evidence towards the complex interrelationships of body composition, physical performance and physical activity (PA) in an older population to assist in decisions for maintaining functional capacity in older adults. DesignThis is a cross-sectional analysis of an existing dataset in which a literature-supported model linking together the variables of interest is tested using path analysis. A proposed model with age, sex, energy intake and chronic diseases as predictors associated with body composition components, while the latter associated with physical performance and with PA acting both as a predictor and as an outcome of physical performance. ParticipantsA sample of 847, community dwellers, non-diabetic older men and women from the Quebec Longitudinal Study on Nutrition and Successful Aging (NuAge Study). MeasurementsPhysical performance tests were reduced to two indices: strength and mobility. Muscle mass index (MMI; kg/height2) and % body fat were derived from DXA and bioimpedance analysis (BIA). PA was assessed by the Physical Activity Scale for the Elderly (PASE) and energy intakes were calculated from 24-hour food recalls. Data from the NuAge dataset served to test the relationships. The proposed model was evaluated using indices of fit. ResultsSignificant associations were found for MMI and % body fat with mobility (β −0.11 and −0.02, respectively), and for MMI with strength (β=0.60). PA was associated with MMI (β=0.02) and negatively with % body fat (β=−0.16), while mobility associated with PA (β=0.65). Our hypothesized model, with some paths added, fit the data: chi-square=4.64, root mean square error of approximation (RMSEA)=0. ConclusionsPA has desirable associations with body composition in older adults and mobility is associated with PA. These results stress the importance of taking into account the prior level of mobility when recommending PA for this age group. This model could explain in part the complex interrelationships that occur with aging and the potential factors that could be targeted to assist older individuals in maintaining functional capacity.

Resistance Training Strategies for the Clinician: Focus on the Novice Exerciser

Resistance Training Strategies for the Clinician: Focus on the Novice Exerciser

A Prospective Study of Frailty in Nephrology-Referred Patients With CKD

Frailty is a construct developed to characterize a state of reduced functional capacity in older adults. However, there are limited data describing the prevalence or consequences of frailty in middle-aged patients with chronic kidney disease (CKD). Observational study. 336 non-dialysis-dependent patients with stages 1-4 CKD with estimated glomerular filtration rate (eGFR) <90 mL/min/1.73 m(2) (by the CKD-EPI [CKD Epidemiology Collaboration] serum creatinine-based equation) or evidence of microalbuminuria enrolled in the Seattle Kidney Study, a clinic-based cohort study. Findings were compared with community-dwelling older adults in the Cardiovascular Health Study. Prevalence and determinants of frailty in addition to its association with the combined outcome of all-cause mortality or renal replacement therapy. We defined frailty according to established criteria as 3 or more of the following characteristics: slow gait, weakness, unintentional weight loss, exhaustion, and low physical activity. We estimated kidney function using serum cystatin C concentrations (eGFR(cys)) to minimize confounding due to relationships of serum creatinine levels with muscle mass and frailty. The mean age of the study population was 59 years and mean eGFR(cys) was 51 mL/min/1.73 m(2). The prevalence of frailty (14.0%) was twice that of the much older non-CKD reference population (P < 0.01). The most common frailty components were physical inactivity and exhaustion. After adjustment including diabetes, eGFR(cys) categories of <30 and 30-44 mL/min/1.73 m(2) were associated with a 2.8- (95% CI, 1.3-6.3) and 2.1 (95% CI, 1.0-4.7)-fold greater prevalence of frailty compared with GFR(cys) ≥60 mL/min/1.73 m(2). There were 63 events during a median 987 days of follow-up. After adjustment, the frailty phenotype was associated with an estimated 2.5 (95% CI, 1.4-4.4)-fold greater risk of death or dialysis therapy. Cross-sectional study design obscures inference regarding temporal relationships between CKD and frailty. Frailty is relatively common in middle-aged patients with CKD and is associated with lower eGFR(cys) and increased risk of death or dialysis therapy.

Inclusão digital e capacidade funcional de idosos residentes em Florianópolis, Santa Catarina, Brasil (EpiFloripa 2009-2010)

To study the relationship between digital inclusion, represented by the exchange of online messages, and functional capacity of older adults living in Florianópolis, Santa Catarina, Brazil. Data were from EpiFloripa Idoso, a cross-sectional household-based survey conducted between 2009 and 2010 with older adults (60+ years). Functional capacity was represented by the inability / difficulty to perform basic / instrumental activities of daily living, and formed the outcome variable called functional dependence. The main independent variable was self-reported ability to send and receive online messages using the computer. Prevalence ratios (PR) and 95% confidence intervals (95%CI) were estimated with multivariable Poisson regression models. The sample consisted of 1,656 older adults between 60 and 102 years old with a mean age of 70.39 years (SD = 7.79). Older adults who could send and receive online messages without difficulty demonstrated a significant lower prevalence of moderate / severe functional dependence (PR = 0.61; 95%CI: 0.40 - 0.94) after adjustment for demographic, socioeconomic, health and behavioral factors. The exchange of online messages has a strong association with functional independence. The causality of this association cannot be determined. Studies support the hypothesis that the exchange of online messages and functional independence have a bidirectional, additive and synergistic association. Longitudinal studies could elucidate the mechanisms involved in this association, in order to support digital inclusion policies for older adults, and to identify the profile of older adults who would benefit the most from digital inclusion.

Health Behaviors as Predictors for Declines in Higher-Level Functional Capacity in Older Adults: The Ohasama Study

To determine the characteristics of health behaviors related to higher-level functional decline in older community-dwelling adults. Prospective. Ohasama Town, Japan. One thousand fifty residents (mean age: 67.5) free of functional decline at baseline. Health behaviors including smoking status, alcohol consumption, frequency of exercise, sleep duration, dietary habits (supplement use, breakfast, late-night snacking, eating regularly, and eating out), and self-rated health were obtained from a self-administered questionnaire at baseline. Higher-level functional decline was examined using the subscales of the Tokyo Metropolitan Institute of Gerontology Index of Competence. During the 7-year follow-up, 27.5% of eligible participants reported decline in higher-level functional capacity. After adjustment for putative confounding factors, health behaviors that were significant predictors for declines in higher-level functional capacity at the 7-year follow-up were current smoking (odds ratio (OR) = 1.58, 95% confidence interval (CI) = 1.06-2.36), sleep duration of 9 hours or longer (OR = 2.15, 95% CI = 1.49-3.11), and poor self-rated health (OR = 1.93, 95% CI = 1.40-2.67). Several modifiable health behaviors contribute to higher-level functional decline.

Aptidão funcional de idosas praticantes de atividades físicas DOI:10.5007/1980-0037.2010v12n2p106

Aging is a natural and progressive process and physical activities have been indi-cated as a possibility to minimize its impact and, especially, to maintain the functional capacity of older adults for a longer period of time. The objective of the present study was to analyze modifications in the General Functional Fitness Index (GFFI) in older adults participating in a physical activity program for a period of 10 months and to associate the results with different age strata, duration of participation in the program and modifications in physical fitness. The study was conducted on 225 older women (mean age: 69.26, sd=5.685), participating in the Physical Activity and Folk Dance Program for The Elderly of the Sports Center, Universidade Federal de Santa Catarina. Descriptive statistics, Student t-test and analysis of variance (ANOVA) were used for analysis of the data. A significant difference (p&lt; 0.01) in GFFI and in the variables agility/balance and coordination (p&lt; 0.01) was observed between March and December 2005. Strength (p=0.323), resistance (p=0,946) and flexibility (p=0.722) did not differ significantly during the period analyzed. In addition, the group performing physical activity for more than 10 years and the group older than 80 years presented the best GFFI in the assessments. Physical activity for older adults might be an important factor to improve and/or maintain functional fitness during the process of aging.

Serum 25-hydroxyvitamin D concentration is associated with functional capacity in older adults with heart failure

Vitamin D is a fat-soluble hormone necessary for calcium homeostasis. Recently, studies have demonstrated that vitamin D may be important to the health of the cardiovascular system. Adults ≥ 50 years of age with heart failure were recruited for assessment of serum 25-hydroxyvitamin D (25OHD) concentrations. Cardiopulmonary exercise testing was used to assess functional capacity. Proximal muscle strength was evaluated with a Biodex isokinetic dynamometer [corrected] (Biodex, Shirley, NY), and health status was assessed with the Kansas City Cardiomyopathy Questionnaire. Univariate associations between physical performance and health status measures and 25OHD followed by a linear regression model were used to study associations, adjusting for other potential explanatory variables. Forty adults 67.8 ± 10.9 years of age (55% women and 57.5% African American) with mean ejection fraction 40% were analyzed (New York Heart Association class II in 70% and class III in 30%). Comorbidities included 77.5% hypertension and 47.5% diabetes. The mean 25OHD concentration was 18.5 ± 9.1 ng/mL, and mean peak Vo₂, 14 ± 4 mL/kg/min. In univariate regression analysis, 25OHD was positively associated with peak Vo₂ (P = .045). Multivariable regression analysis sustained positive association between 25OHD and peak Vo₂ (P = .044) after adjusting for age, race, and respiratory exchange ratio (adjusted R² = 0.32). Association between proximal muscle strength with the 25OHD concentration was not significant. The Kansas City Cardiomyopathy Questionnaire physical limitation domain score was negatively associated with 25OHD (P = .04) but was not sustained in multivariable analysis. 25-Hydroxyvitamin D may be an important marker or modulator of functional capacity in patients with heart failure. Randomized controlled trials are needed to assess the effect of vitamin D repletion on functional performance.

Can Isometric Knee Extensor Torque from Hand-held Dynamometry Predict Physical Function in Overweight Older Adults?

PURPOSE: Reduced muscular strength is associated with declines in functional capacity in older adults, and more field tests need to be developed in order to predict physical function in those who are at risk of sarcopenia- and obesity-related disability. The relationship between isometric knee extensor (KE) torque, handgrip strength (HGS) and tests of lower-extremity physical function was investigated in overweight and obese, community-dwelling older adults. METHODS: Overweight and obese (BMI = 33.4 ± 0.4 kg/m2), community-dwelling older (age = 68.9 ± 0.6 years) men and women (n = 108) underwent assessments of isometric KE torque, HGS, and completed two different measures of physical function. Maximal isometric KE torque was measured via hand-held dynamometry on the dominant leg and peak HGS values for the dominant hand were obtained using a hand-held dynamometer. Physical function was evaluated by the timed up-and-go test (TUG) and the short physical performance battery (SPPB). Individual subcomponents of the SPPB include a four-meter walk, quantitative assessments of balance, and a timed five chair stand test. The TUG measures the duration required to walk a short distance and provides an indication of functional mobility in older adults. A Spearman"s rank correlation coefficient analysis was conducted to investigate the association between performance on muscular function assessments and physical function tests. RESULTS: Maximal isometric KE torque was weakly but significantly correlated with peak HGS (+0.24, p=0.01). Peak HGS was significantly associated with total score on the SPPB (+0.20, p=0.04). Additionally, there was a significant inverse association between maximal HGS and time required to complete the TUG (-0.22, p=0.02). Interestingly, maximal isometric KE torque was not significantly associated with indices of lower-extremity physical function such as the TUG (-0.01, p=0.92) or the SPPB (+0.06, p=0.49). CONCLUSION: Although isometric KE torque from hand-held dynamometry is associated with HGS in overweight and obese, community-dwelling older adults, it may not adequately predict global measures of physical function. Peak HGS may have a better capacity to predict performance on measures of lower-extremity physical function in overweight and obese older adults.

Maximum Daily 6 Minutes of Activity: An Index of Functional Capacity Derived from Actigraphy and Its Application to Older Adults with Heart Failure

To compare the correlation between the maximum 6 minutes of daily activity (M6min) and standard measures of functional capacity in older adults with heart failure (HF) with that in younger subjects and its prognostic utility. Prospective, cohort study. Tertiary care, academic HF center. Sixty, ambulatory, adults, New York Heart Association (NYHA) Class I to III, stratified into young (50.9 +/- 9.4) and older cohorts (76.8 +/- 8.0). Correlation between M6min and measures of functional capacity (6-minute walk test; 6MWT) and peak oxygen consumption (VO(2)) according to cardiopulmonary exercise testing in a subset of subjects. Survival analysis was employed to evaluate the association between M6min and adverse events. Adherence to actigraphy was high (90%) and did not differ according to age. The correlation between M6min and 6MWT was higher in subjects aged 65 and older than in those younger than 65 (correlation coefficient (r=0.702, P<.001 vs r=0.490, P=.002). M6min was also significantly associated with peak VO(2) (r=0.612, P=.006). During the study, 26 events occurred (2 deaths, 10 hospitalizations, 8 emergency department visits, and 6 intercurrent illnesses). The M6min was significantly associated with subsequent events (hazard ratio=2.728, 95% confidence interval=1.10-6.77, P=.03), independent of age, sex, ejection fraction, NYHA class, brain natriuretic peptide, and 6MWT. The high adherence to actigraphy and association with standard measures of functional capacity and independent association with subsequent morbid events suggest that it may be useful for monitoring older adults with HF.

Effects of a Thoracic Mobility and Respiratory Exercise Program on Pulmonary Function and Functional Capacity in Older Adults

The purposes of this study were to describe a home exercise program (HEP) consisting of respiratory exercise and stretching thoracic muscles and to determine how regular participation in this program affected pulmonary function, chest wall excursion, physical function, and quality of life in community-dwelling older adults. Thirty-seven volunteers (mean age 80.5 years) participated in a twice daily HEP for 6 weeks. Twenty-two subjects completed the program. Pulmonary function, chest wall excursion (CWE), the 6-minute walk test (6MWT), the physical performance test (PPT), and RAND SF-36 quality of life survey (SF-36) were administered before and after the exercise program. Increases in CWE, 6MWT, and PPT were statistically significant. In conclusion, community-dwelling older adults participating in a 6-week stretching and respiratory exercise program demonstrated improved CWE and function.

Enrichment Effects on Adult Cognitive Development: Can the Functional Capacity of Older Adults Be Preserved and Enhanced?

Enrichment Effects on Adult Cognitive Development: Can the Functional Capacity of Older Adults Be Preserved and Enhanced?