Effectiveness of a group exercise program in a long-term care facility: a randomized pilot trial.
Baum EE, Jarjoura D, Polen AE, Faur D, Rutecki G.
Northeastern Ohio Universities College of Medicine, Affiliated Hospitals at Canton, Canton, Ohio, USA. J Am Med Dir Assoc. 2003 Mar-Apr;4(2):74-80.
Objective: The purpose of this pilot was to determine whether a strength and flexibility program in frail long-term care facility (LTC) residents would result in improved function. p. Design: A prospective, randomized, controlled, semicrossover trial was designed with participants assigned either to group exercise (EX) or recreational therapy ©. In the EX group, the intervention continued for 1 year. In the C group, recreation continued for 6 months; these controls were then crossed over to the same exercise intervention as the EX group and followed for an additional 6 months. Functional outcomes were measured at baseline and 3, 6, 9, and 12 months for both groups.
Setting: A LTC facility, which included both assisted living (AL) and nursing home (NH) residents.
Participants: Twenty frail residents (5 from NH, 15 from AL) aged 75 to 99 years at one LTC facility.
Interventions: After random group assignment, the EX group met 1 hour three times per week. An exercise physiologist and LTC staff conducted sessions which included seated range of motion (ROM) exercises and strength training using simple equipment such as elastic resistance bands (therabands) and soft weights. The C group met three times per week and participated in activities such as painting during the first 6 months, before crossing over to exercise.
Methods: Objective measures of physical and cognitive function were obtained at baseline and 3, 6, 9, and 12 months using the timed get-up-and-go test (TUG), Berg balance scale, physical performance test (PPT), and mini-mental status exam (MMSE). Because we were interested in the impact of exercise on multiple endpoints and to protect the type I error rate, a global hypothesis test was used.
Results: There was a significant overall impact across the four measures of the exercise intervention (P = 0.013). Exercise benefit as indicated by the difference between exercise and control conditions showed exercise decreased TUG by 18 seconds, which represents an effect size (in standard deviation units) of 0.50, increased PPT scores by 1.3, with effect size = 0.40, increased Berg scores by 4.8, with effect size of 0.32, and increased MMSE by 3.1, with effect size = 0.54. Except for the Berg, 90% confidence intervals on these exercise effects excluded 0.
Conclusion: Frail elderly in a LTC facility were able to participate and benefit from a strength training program. The program was delivered with low-cost equipment by an exercise physiologist and LTC staff. The advantage of such a program is that it provides recreational and therapeutic benefits.
Obese, older adults with knee osteoarthritis: weight loss, exercise, and quality of life.
Rejeski WJ, Focht BC, Messier SP, Morgan T, Pahor M, Penninx B.
Department of Health and Exercise Science, Wake Forest University,
Winston-Salem, North Carolina 27109, USA. firstname.lastname@example.org
Health Psychol 2002 Sep;21(5):419-26
This study examined the effects of dietary weight loss and exercise on the health-related quality of life (HRQL) of overweight and obese, older adults with knee osteoarthritis. A total of 316 older men and women with documented evidence of knee osteoarthritis were randomly assigned to 1 of 4 18-month interventions: dietary weight loss, exercise, dietary weight loss and exercise, or healthy lifestyle control. Measures included the SF-36 Health Survey and satisfaction with body function and appearance. Results revealed that the combined diet and exercise intervention had the most consistent, positive effect on HRQL compared with the control group; however, findings were restricted to measures of physical health or psychological outcomes that are related to the physical self.
Oxygen-uptake (VO2) kinetics and functional mobility performance in impaired older adults.
Alexander NB, Dengel DR, Olson RJ, Krajewski KM.
The Geriatric Research, Education and Clinical Center, Veterans Affairs Ann Arbor Health Care System, and Division of Geriatric Medicine, Department of Internal Medicine, The University of Michigan, Ann Arbor, 48109-0926, USA. email@example.com J Gerontol A Biol Sci Med Sci. 2003 Aug;58(8):734-9.
Background: Measures of maximal oxygen uptake (VO(2max)) are limited in disabled older adults, and measures of submaximal oxygen uptake (VO(2)) may better predict functional mobility limitations. These measures may include oxygen-uptake kinetics at the onset of submaximal exercise or during recovery. We sought to determine whether the lag in oxygen uptake at the beginning of exercise (oxygen deficit) and excess oxygen uptake above rest following exercise (excess postexercise oxygen consumption) (a) predict physical performance in impaired older adults with decreased aerobic function, and (b) predict physical performance better than peak VO(2).
Methods: Two groups of community-dwelling volunteers aged 65 or older were recruited according to their performance on a maximal graded exercise test. Using the Social Security Administration criterion of disability of a peak VO(2) <=”” min=”” (impaired,=”” n=”20,” mean=”” +=”” -=”” sem=”” age=”” 82=”” 1=”” years)=”” with=”” unimpaired=””> 18 (Unimpaired, n = 21, mean +/- SEM age 76 +/- 1 years).
Results: The mean +/- SEM peak VO(2) was 58% lower in the Impaired (14 +/- 1 ml/kg/min) than the Unimpaired (24 +/- 1 ml/kg/min) adults. The time constant for oxygen deficit, tc(deficit), was more than twice as high in the Impaired than the Unimpaired (p <.05), and the time constant for excess postexercise oxygen consumption, tc(EPOC), tended to be higher in the Impaired than the Unimpaired (by 43%, p =.09). Measures of submaximal oxygen-uptake kinetics were as strong or more strongly predictive of functional mobility performance than peak VO(2) in both Unimpaired and Impaired older adults. The major predictor of functional performance for the Unimpaired was a measure of oxygen deficit accruing during exercise (tc(deficit)), and for the Impaired, it was a measure of oxygen debt during recovery, tc(EPOC).
Conclusion: Measurement of submaximal oxygen-uptake kinetics may provide a more practical and relevant assessment of deconditioning in frail older adults, and may eventually supplant maximal (peak) oxygen uptake as a predictor of functional disability in older adults.
The 6-minute walk test in mobility-limited elders: what is being measured?
Bean JF, Kiely DK, Leveille SG, Herman S, Huynh C, Fielding R, Frontera W.
Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA. firstname.lastname@example.org J Gerontol A Biol Sci Med Sci. 2002 Nov;57(11):M751-6.
Background: The 6-minute walk (6mw) is a well-established measure of aerobic capacity in elders with cardiorespiratory and peripheral vascular disease and may be an accurate measure of functional performance in healthy elders. In mobility-limited elders, a population at risk for disability, impairments in strength and power are predictive of performance-based measures of function. Though commonly utilized as an outcome measure among otherwise healthy mobility-limited elders, it is not clear whether the 6mw best represents a measure of functional limitation, aerobic capacity, or both.
Methods: We hypothesized that the 6mw would be strongly representative of performance-based measures of function being determined by impairments in muscle strength and power. We performed a cross-sectional analysis of 45 community-dwelling elders with mild to moderate mobility limitations.
Results: The 6mw was strongly associated with established functional measures (r =.61-.83; p <.001), but was poorly associated with indirect measures of aerobic capacity (r <.25; p >.05). Multivariate linear regression models demonstrated that impairments in leg strength and power, especially those at the knee and ankle, were predictive of 6mw performance.
Conclusion: These findings emphasize the 6mw as a measure of functional limitation among mobility-limited elders without cardiorespiratory or peripheral vascular disease.