Effect of a training programme for pensioners on condition and muscular strength

A hypothesis for a possible synergy between ghrelin and exercise in patients with cachexia: Biochemical and physiological bases

This article reviews the biochemical and physiological observations underpinning the synergism between ghrelin and ghrelin agonists with exercise, especially progressive resistance training that has been shown to increase muscle mass. The synergy of ghrelin agonists and physical exercise could be beneficial in conditions where muscle wasting is present, such as that found in patients with advanced cancer. The principal mechanism that controls muscle anabolism following the activation of the ghrelin receptor in the central nervous system involves the release of growth hormone/insulin-like growth factor-1 (GH/IGF-1). GH/IGF-1 axis has a dual pathway of action on muscle growth: (a) a direct action on muscle, bone and fat tissue and (b) an indirect action via the production of both muscle-restricted mIGF-1 and anti-cachectic cytokines. Progressive resistance training is a potent inducer of the secretion the muscle-restricted IGF-1 (mIGF-1) that enhances protein synthesis, increases lean body mass and eventually leads to the improvement of muscle strength. Thus, the combination of ghrelin administration with progressive resistance training may serve to circumvent ghrelin resistance and further reduce muscle wasting, which are commonly associated with cachexia.

Effects of low-intensity, elastic band resistance exercise combined with blood flow restriction on muscle activation

We examined the effects of blood flow-restricted, low-intensity resistance exercise (termed kaatsu) using an elastic band for resistance on muscle activation. Nine men performed triceps extension and biceps flexion exercises (four sets respectively) using an elastic band for resistance with blood flow restriction (BFR) or CON (unrestricted blood flow). During a BFR session, subjects wore pressure cuffs inflated to 170-260 mmHg on the proximal region of both arms. Surface electromyography (EMG) was recorded from the triceps brachii and biceps brachii muscles, and mean integrated EMG (iEMG) was analyzed. Blood lactate concentration was obtained before (Pre) and immediately after two exercises (Post). During triceps extension and biceps flexion exercises, muscle activation increased progressively (P < 0.05) under BFR (46% and 69%, respectively) but not under CON (12% and 23%, respectively). Blood lactate concentration at Post was higher (P < 0.05) under BFR than under CON (3.6 and 2.1 mmol/L, respectively). Blood lactate concentration at Post was significantly correlated with increased iEMG in both triceps extension (r = 0.65, P < 0.01) and biceps flexion exercises (r = 0.52, P < 0.05). We conclude that kaatsu training using elastic bands for resistance enhances muscle activation and may be an effective method to promote muscle hypertrophy in older adults or patients with a low level of activity.

Comparison of Histochemical, Biochemical and Contractile Properties of Triceps Surae of Trained Aged Subjects

L'étude avait pour but de comparer les propriétés contractiles, histochimiques et biochimiques du muscle triceps sural de 13 sujets mâles âgés de 63 à 76 ayant suivi un entrâinement aérobique. Une stimulation électrique fut appliquée au muscle triceps sural des sujets afin de déterminer les paramètres de secousse musculaire élémentaire, de tétanisation et de fatigue. Ces tests ont permis de calculer la tension de secousse musculaire (Pt), la tension TPT, le demi-temps de relaxation (1/2RT), les tensions tétaniques à 10(Po10), 20(Po20) et 50(Po50) Hz et un indice de fatigue (FI). Des échantillons du faisceau externe des muscles jumeaux du triceps furent prélevés par biopsie par aspiration. Une partie de chaque échantillon fut soumise à un examen histochimique afin de mesurer la myosine ATPasique (pH 4,30, 4,58 et 10,00) et la NADH-tétrazolium réductase et de pouvoir ainsi déterminer les zones fibreuses. Le reste de l'échantillon fut analysé afin de déceler l'activité enzymatique des déhydrogénase succinique et phosphofructokinase. D'importantes corrélations furent établies entre les zones fibreuses (ST et FI) et Po10/Po50 et FI. Par contre, pour aucun des paramètres histochimiques, on n'a relevé de lien significatif entre la Pt, la 172RT et le MVC. L'activité des SDH et PFK n'était corrélative à aucun paramètre histochimique ou psychologique. La fait de faire régulièrement des exercices d'endurance ne semble pas freiner le déclin des propriétés contractiles propres au vieillissement. Les activités enzymatiques régulatrices de substrat (PKF) et celles de marqueur (SDH) des muscles squelettiques sont plus faibles chez les personnes âgées que les sujets plus jeunes, et ce, en dépit du fait que les sujets s'adonnent à des exercices aérobiques.

Physical activity and muscle training in the elderly

Most elderly people have some kind of regular daily activity, usually closely connected to their daily habits. A six-graded scale for classification of physical activity is presented. Persons with a low physical activity also usually perceive their physical strain as rather light or moderate. There is a reduction with age in muscle volume, muscle strength, and aerobic capacity which are rather parallel. From a muscular point of view there are only moderate qualitative changes up to the ages around 70; at higher ages there will be a tendency to more marked changes in muscle structure. The maximal aerobic power as well as muscle strength can be increased by physical training also in the elderly. At least up to the ages around 70 there will be an adaptation in muscle structure and enzymatic capacity. In very well-trained 70-year-old men high levels of oxidative enzymes are found together with high maximal aerobic power capacity. A positive attitude should be taken towards physical exercise for prevention and rehabilitation also in the elderly.

Functional vs. strength training in disabled elderly outpatients

OBJECTIVE

To determine whether high-intensity functional training (FT) or strength training (ST) better enables impairment, disability, and functional gains among disabled community-dwelling elders.

DESIGN

Randomized, blinded, prospective clinical trial in a large, tertiary care outpatient rehabilitation department. Fifteen elders (62-85 yrs old) referred for physical therapy with one or more impairments, including lower-limb arthritis, participated in 6 wks of FT (weekly outpatient and three to five times per week of home practice in rapid and correct execution of locomotor activities of daily living, including gait, stepping, and sit to stand) or progressive resistive ST using elastic bands with intensity, therapist contact, and home practice similar to those of FT.

RESULTS

Both groups significantly improved their combined lower-extremity strength (hip abduction, ankle dorsiflexion, knee flexion, ankle plantarflexion, and knee extension) (P = 0.003), but no statistical difference between the ST and FT group gains (P = 0.203) was found. Subjects in both interventions improved their gait speed, but the FT group improved more than the ST group (P = 0.001). During chair rise, the FT group improved their maximum knee torque more than the ST group (P = 0.033), indicating that they employed a more controlled and efficient movement strategy.

CONCLUSIONS

These data suggest that an intensive FT intervention results in strength improvements of comparable magnitude as those attained from ST and that FT also confers greater improvements in dynamic balance control and coordination while performing daily life tasks.

Effects of Muscle Strength Training and Testosterone in Frail Elderly Males

PURPOSE

Determine the independent and combined effects of progressive resistance muscle strength training (PRMST) and testosterone on strength, muscle mass, and function in hypogonadal elderly male recuperative care patients.

METHODS

Between 1999 and 2004, 71 subjects (mean age 78.2 +/- 6.4 yr, 86% white) were enrolled. After baseline one-repetition maximum (1RM) strength testing and then randomization to one of four treatment groups (low-resistance (20% of the 1RM) exercises and weekly injections of either 100 mg of testosterone enanthate or placebo or high-intensity PRMST (> or =80% 1RM) and weekly injections), each subject received training and injections for 12 wk.

RESULTS

Ten subjects withdrew from the study before its completion. Based on intent-to-treat analyses, strength improved in all groups, but was greater with high-intensity PRMST compared with low-resistance exercise (e.g., leg press, (mean +/- SE), 28 +/- 4 vs 13 +/- 4%, P = 0.009). Although testosterone led to significantly greater increases in midthigh cross-sectional muscle area compared with placebo (7.9 +/- 1.3 vs 2.4 +/- 1.4%, P = 0.005), it produced only a nonsignificant trend toward greater strength gains (e.g., leg press 25 +/- 4 vs 16 +/- 4%, P = 0.144). Change in aggregate functional performance score (the sum of 4 functional performance test scores) did not differ between the four intervention groups nor with high-intensity PRMST compared with low-resistance exercise (7 +/- 5 vs 15 +/- 5%, P = 0.263). There was not a significant interaction between exercise and testosterone for any outcome.

CONCLUSION

High-intensity PRMST is as safe and well tolerated as a similarly structured low-resistance exercise regimen for very frail elderly patients, but produces greater muscle strength improvements. The addition of testosterone leads to greater muscle size and a trend toward greater strength but did not produce a synergistic interaction with exercise. Neither intervention had a significant effect on functional performance.

LUTEINIZING HORMONE-RELEASING HORMONE AGONIST EFFECTS ON SKELETAL MUSCLE: HOW HORMONAL THERAPY IN PROSTATE CANCER AFFECTS MUSCULAR STRENGTH

PURPOSE

Since the discovery of Huggins in 1941 demonstrating the androgen dependence of prostate cancer cells, the use of pharmacological therapies to decrease systemic androgen concentrations has been one of the main treatment options for prostate cancer. Despite their efficacy luteinizing hormone releasing hormone agonists (LHRHas) have a number of side effects, of which many have not been fully investigated in humans. This review focuses on the effects of LHRHas on skeletal muscle in 3 main areas, namely effects at the androgen receptor, at the neuromuscular junction and on skeletal muscle myofibers. Since prostate cancer is predominantly a disease of elderly individuals, the aging effects of LHRHa therapy on skeletal muscle are magnified and of clinical importance.

MATERIALS AND METHODS

A comprehensive MEDLINE search was performed of pertinent studies in the literature relating to the use of LHRHa and skeletal muscle.

RESULTS

LHRHas affect 3 primary sites within the skeletal muscle system, namely androgen receptor, the neuromuscular junction and second messenger systems, including insulin-like growth factor-1. All sites have been demonstrated to lead to a decrease in isokinetic exercise strength in large muscle groups.

CONCLUSIONS

The musculoskeletal effects of LHRHas for the treatment of prostate cancer should be counteracted via a program of exercise strength training to decrease the morbidity associated with skeletal muscle weakness.

Trajectories of leg strength and gait speed among sedentary older adults: longitudinal pattern of dose response

BACKGROUND

Current theory about how an older adult's leg strength influences walking speed is based primarily on nonlinear patterns of association observed in cross-sectional data. Compared with adults with normal or high levels of leg muscle strength, weak older adults are thought to have a greater capacity for functional change in response to changes in lower extremity strength. Longitudinal data, however, have not been applied to study this putative pattern of dose response.

METHODS

Three repeated measures of leg strength, gait speed, and covariates were evaluated in a cohort of 134 sedentary, community-dwelling male and female participants (aged >64 years) of a randomized exercise intervention. Empirical Bayes methods were used to evaluate the association between trajectories of strength and gait speed during the course of the study.

RESULTS

We observed a potentially clinically important, positive linear association between strength change and gait speed change. Each additional unit increase in the monthly rate of strength change increased the rate of gait speed change by 0.29 meters/minute/month (95% CI [confidence interval] = 0.03, 0.55 m/min/mo). Absolute change in walking velocity due to strength changes in the cohort ranged from a gain of approximately 15 m/min to a loss of approximately 13 m/min over the 9-month period (changes of -18% to +20% relative to a normal walking speed of 72 m/min).

CONCLUSIONS

In this cohort, change in functional walking speed depended more on the rate of strength change observed than on the amount of muscle weakness present at baseline. These results have important implications for screening and intervention programs designed to change functional walking ability among sedentary older adults.

Systematic Review of Progressive Resistance Strength Training in Older Adults

BACKGROUND

The aim of this systematic review was to quantify the effectiveness of progressive resistance strength training (PRT) to reduce physical disability in older people.

METHODS

Randomized controlled trials were identified from searches of relevant databases and study reference lists and contacts with researchers. Two reviewers independently screened the trials for eligibility, rated their quality, and extracted data. Only randomized controlled trials utilizing PRT as the primary intervention in participants, whose group mean age was 60 years or older, were included. Data were pooled using fixed or random effect models to produce weighted mean differences (WMD) and 95% confidence intervals (CI). Standardized mean differences (SMD) were calculated when different units of measurement were used for the outcome of interest.

RESULTS

62 trials (n = 3674) compared PRT with a control group. 14 trials had data available to allow pooling of disability outcomes. Most trials were of poor quality. PRT showed a strong positive effect on strength, although there was significant heterogeneity (41 trials [n = 1955], SMD 0.68; 95% confidence interval [CI] 0.52, 0.84). A modest effect was found on some measures of functional limitations such as gait speed (14 trials [n = 798], WMD 0.07 meters per second; 95% CI 0.04, 0.09). No evidence of an effect was found for physical disability (10 trials [n = 722], SMD 0.01; 95% CI -0.14, 0.16). Adverse events were poorly investigated, but occurred in most studies where they were defined and prospectively monitored.

CONCLUSIONS

PRT results in improvements to muscle strength and some aspects of functional limitation, such as gait speed, in older adults. However, based on current data, the effect of PRT on physical disability remains unclear. Further, due to the poor reporting of adverse events in trials, it is difficult to evaluate the risks associated with PRT.

Training with the International Space Station Interim Resistive Exercise Device

A unique, interim elastomer-based resistive exercise device (iRED) is being used on the International Space Station.

PURPOSE

This study characterized iRED training responses in a 1-g environment by: 1) determining whether 16 wk of high-intensity training with iRED produces increases in muscle strength and volume and bone mineral density (BMD), 2) comparing training responses with iRED to free weights, and 3) comparing iRED training responses at two training volumes.

METHODS

Twenty-eight untrained men were assigned to four groups of seven subjects each: a no exercise control group (CON), an iRED group who trained with three sets/exercise (iRED3), a free-weight group (FW) who trained with three sets/exercise, and an iRED group who trained with six sets/exercise (iRED6). Training exercises included squat (SQ), heel raise (HR), and dead lift (DL) exercises, 3 d.wk(-1) for 16 wk.

RESULTS

For CON, no changes occurred pre- to posttraining. For iRED3, increases (P< or =0.05) in one-repetition maximum (1-RM) strength (SQ 21 +/- 4%, HR 17 +/- 4%, DL 29 +/- 5%), leg lean mass (3.1 +/- 0.5%) by dual energy x-ray absorptiometry (DXA), and thigh (4.5 +/- 0.9%) and calf (5.9 +/- 0.7%) muscle volume (by magnetic resonance imaging) occurred after training with no changes in BMD (DXA). For FW, increases in 1-RM strength (SQ 22 +/- 5%, HR 24 +/- 3%, DL 41 +/- 7%), whole body (3.0 +/- 1.1%) and leg lean mass (5.4 +/- 1.2%), thigh (9.2 +/- 1.3%) and calf (4.2 +/- 1.0%) muscle volumes, and lumbar BMD (4.2 +/- 0.7%) occurred after training. For iRED6, all responses were similar to iRED3.

CONCLUSION

High-intensity training with the iRED produced muscle responses similar to FW but was not effective in stimulating bone. Bed rest and spaceflight studies are needed to evaluate the effectiveness of the iRED to prevent microgravity deconditioning.

Effects of dumbbell and elastic band training on physical function in older inner-city African-American women

Providing inner-city minorities with inexpensive exercise programs may be a means of reducing frailty and maintaining independent lifestyles in this population. To determine the efficacy of such a program, 22 African-American women aged 62-94 years were recruited from a senior center in the Wichita urban community. Sixteen women (age = 74.8 +/- 8.8 yr) participated in exercise training (3 days per week for 4 weeks) and 6 women (age = 74.7 +/- 4.5 yr) served as controls. Training consisted of chair-based exercises using elastic resistance bands (upper and lower body) and dumbbells (upper body). Elastic band training improved (p < 0.05) lower body strength (30-second chair stand, time for 5 stands) by approximately 20% and the combination of bands and dumbbell training improved upper body strength (30-second dumbbell curl) by 24%. Grip strength improved by 5%. Up-&-Go performance improved by 10% although balance and mobility exercises were not a fundamental element of the training program. Upper and lower body flexibility did not change. Changes were not observed for any variable in the control group. This study suggests that exercising with equipment that costs only a few dollars per participant improves upper and lower body fitness in older African-American women who live in an urban setting.

Progressive resistance strength training for physical disability in older people

BACKGROUND

Muscle weakness in old age, is associated with physical disability and an increased risk of falls. Progressive resistance strength (PRT) training exercises (i.e. movements performed against a specific external force that is regularly increased during training) are designed to increase strength in older people.

OBJECTIVES

To assess the effect of PRT on measures of physical disability, functional limitation and impairment in older people, and identify adverse events.

SEARCH STRATEGY

We searched the Cochrane Musculoskeletal Injuries Group specialized register (to August 2002), CENTRAL/CCTR (The Cochrane Library Issue 2, 2002), MEDLINE (1966 to February 1, 2002), EMBASE (1980 to February 1, 2002), CINAHL (1982 to February 1, 2002), Sports Discus (1948 to February 1, 2002), PEDro - The Physiotherapy Evidence Database (accessed February 1, 2002) and Digital Dissertations (accessed February 1, 2002). We also searched reference lists of articles, reviewed conference abstracts and contacted authors.

SELECTION CRITERIA

Randomised trials of PRT alone for older people (i.e. mean age of 60 or over) were included.

DATA COLLECTION AND ANALYSIS

Two reviewers independently assessed trial quality and extracted data. Weighted mean differences (WMD) were obtained using fixed or random effect models as appropriate. When measures with different units were pooled, standardised mean differences (SMD) were calculated. Relative risks were calculated for dichotomous outcomes.

MAIN RESULTS

Sixty-six trials with 3783 participants were included. Most studies were small and of poor quality. PRT had a large positive effect on strength (41 trials, 1955 participants), but there was statistical heterogeneity that was not explained by differences in study quality, participant characteristics or the exercise program. Some functional limitation measures showed modest improvements (i.e. gait speed, 14 trials, 798 participants, WMD 0.07 m/s, 95% CI 0.04 to 0.09). However, there was no evidence that PRT had an effect on physical disability when activity measures or health related quality of life measures (HRQOL) were assessed (10 trials, 798 participants, SMD 0.01, 95% CI -0.14 to 0.16 ). Adverse events were poorly recorded, but musculoskeletal injuries were detected in most of the studies that prospectively defined and monitored these events.

REVIEWER'S CONCLUSIONS

PRT appears to be an effective intervention to increase strength in older people and has a positive effect on some functional limitations. However, the effect of this intervention on more substantive outcomes such as measures of disability or HRQOL remains unclear. It is difficult to determine the balance of risks and benefits of PRT because adverse events have generally been poorly collected and recorded.

Resistance training alters torque-velocity relation of elbow flexors in elderly men

PURPOSE

The aim of the study was to compare in vivo dynamic muscle characteristics (torque-velocity relation and maximal contraction velocity) of sedentary young subjects with elderly men before and after training.

METHODS

Elbow flexion maximal isometric (Tmax) and dynamic torque at velocities between 100 degrees.s-1 and 600 degrees.s-1 were measured, from which maximal contraction velocity was estimated (eVmax). These parameters were obtained from 18 young sedentary subjects (Y) and from 23 healthy sedentary elderly (mean age 63 yr) men (E) before (PRE), after 13 wk (MID), and 26 wk (POST) of moderate intensity resistance training (30RM) of the elbow flexor muscles.

RESULTS

Y and E before training had similar Tmax, but mean dynamic torque over all velocities was 49.1% higher in Y compared with E. After 13 wk of training TmaxE increased by 8.2% and mean dynamic torque increased by 61.2%, with a velocity dependent gain. For eVmaxE an increase of 21.8% was observed. The second 13-wk training period did not induce further increases.

CONCLUSION

The results of the present study demonstrate that, after moderate intensity resistance training of healthy elderly men, maximal contraction velocity of elbow flexors (eVmax), estimated from the torque-velocity curve, increased to values observed for sedentary young men.

Effects of low-impact, moderate-intensity exercise training with and without wrist weights on functional capacities and mood states in older adults

This study examined the effects of low-impact, moderate-intensity exercise training with and without wrist weights (0.68 kg.wrist-1) on functional capacities and mood states in older adults (age 68.6 +/- 5.6, mean +/- SD). Twenty-three senior citizens residing in the community were randomly assigned to wrist weight (WW; n = 12) and no-wrist weight (NW; n = 11) exercise groups while 11 matched subjects served as non-exercise controls (NE). Exercise training was performed for 10 weeks, 3 days/week, for 60 min/session and consisted of low-impact aerobic dance (50-70% of maximal heart rate) combined with exercises to promote muscular fitness, flexibility, and balance. Before and after the intervention, each participant's aerobic fitness, muscular strength, flexibility, static and dynamic balance, skinfold thickness, and psychological mood states were assessed under standardized testing conditions. Exercise training resulted in significant improvements in peak oxygen uptake, lower extremity muscle strength, and psychological vigor (p < 0.05) but did not affect other fitness components (p > 0.05). There were no differences between the WW and NW exercise groups for any of the same variables studied (p > 0.05). No significant pre- to post-test changes were found for the NE control group (p > 0.05). It is concluded that 10 weeks of low-impact, moderate-intensity exercise training of the type that can be considered well-rounded in nature provides a sufficient stimulus to augment aerobic fitness, beneficially affects leg strength, and increases feelings of vigor in older adults. The present observations indicate that the use of light wrist weights has no beneficial or adverse effects on the measured training outcomes.

Temporal and biomechanical characteristics of oropharyngeal swallow in younger and older men

As the U.S. population ages, there is increasing need for data on the effects of aging in healthy elderly individuals over age 80. This investigation compared the swallowing ability of 8 healthy younger men between the ages of 21 and 29 and 8 healthy older men between the ages of 80 and 94 during two swallows each of 1 ml and 10 ml liquid. Videofluoroscopic studies of these swallows were analyzed to confirm the absence of swallowing disorders. Biomechanical analysis of each swallow was completed, from which data on temporal, range of motion, and coordination characteristics of the oropharyngeal swallow were taken. Position of the larynx at rest, length of neck, and pattern of hyoid bone movement were also compared between the two groups. None of the younger or older men exhibited any swallowing disorders. The C2 to C4 distance of older men was significantly shorter than that of younger men, and laryngeal position at rest was lower than in younger men but not significantly so. Older men had a significantly longer pharyngeal delay than younger men and significantly faster onset of posterior pharyngeal wall movement in relation to first cricopharyngeal opening. The older men exhibited significantly reduced maximum vertical and anterior hyoid movement as compared to the younger men even when accounting for the difference in C2 to C4 distance in older men. These data support the hypothesis of reduced muscular reserve in the swallows of older men as compared to younger men. Older men also exhibited less width of cricopharyngeal opening than younger men at 10 ml volume, indicating less upper esophageal sphincter flexibility in the swallows of older men. The potential for exercise to improve reserve is discussed. Significant changes in extent of hyoid elevation and duration of cricopharyngeal opening were seen as liquid bolus volume increased.

Tai Chi Chuan to improve muscular strength and endurance in elderly individuals: a pilot study

OBJECTIVE

To evaluate the training effect of a Tai Chi Chuan (TCC) program on knee extensor muscular strength and endurance in elderly individuals.

DESIGN

Before-after trial.

SETTING

Community setting.

PARTICIPANTS

Forty-one community dwelling subjects aged 61.1 +/- 9.8 years undertook a TCC program. Nine dropped out during the study. Pretraining and posttraining measurements were obtained from 15 men and 17 women.

INTERVENTION

Subjects participated in a 6-month TCC program. Each session consisted of 20 minutes of warm-up, 24 minutes of structured TCC training, and 10 minutes of cool-down exercises.

MAIN OUTCOME MEASURES

Peak torque of dominant and nondominant knee extensors was tested at speeds of 60 degrees , 180 degrees , and 240 degrees/sec concentrically and eccentrically. Muscular endurance of the knee extensor was tested at the speed of 180 degrees /sec.

RESULTS

In the group of men, concentric knee extensor peak torque increased by 15.1% to 20.0% and eccentric peak torque increased by 15.1% to 23.7%. The group of women also showed increases, ranging from 13.5% to 21.8% in concentric peak torque, and 18.3% to 23.8% in eccentric peak torque. In addition, the knee extensor endurance ratio increased by 9.6% to 18.8% in the men and 10.1% to 14.6% in the women.

CONCLUSION

TCC training may enhance muscular strength and endurance of knee extensors in elderly individuals.

Sarcopenia and decreased muscle strength in the elderly woman: resistance training as a safe and effective intervention

A principle component of age-related weakness and frailty in women is sarcopenia. This decrease in skeletal muscle mass is a progressive syndrome that will affect the quality of life for elderly women by decreasing the ability to perform many activities of daily living. Strength training is known to be an effective means of increasing muscular strength and size in many populations, and can be utilized successfully to significantly improve muscle strength, muscle mass and functional mobility in elderly women up to the age of 96 years. Such exercise can minimize the syndrome of physical frailty due to decreased muscle mass and strength. Any rehabilitation or exercise program for the elderly woman would benefit from the inclusion of such a training regime.

Balance control, flexibility, and cardiorespiratory fitness among older Tai Chi practitioners

BACKGROUND

Tai Chi Chuan (TTC) exercise has beneficial effects on the components of physical condition and can produce a substantial reduction in the risk of multiple falls. Previous studies have shown that short term TCC exercise did not improve the scores in the single leg stance test with eyes closed and the sit and reach test. There has apparently been no research into the effects of TCC on total body rotation flexibility and heart rate responses at rest and after a three minute step test.

METHODS

In this cross sectional study, 28 male TCC practitioners with an average age of 67.5 years old and 13.2 years of TCC exercise experience were recruited to form the TCC group. Another 30 sedentary men aged 66.2 were selected to serve as the control group. Measurements included resting heart rate, left and right single leg stance with eyes closed, modified sit and reach test, total body rotation test (left and right), and a three minute step test.

RESULTS

Compared with the sedentary group, the TCC group had significantly better scores in resting heart rate, three minute step test heart rate, modified sit and reach, total body rotation test on both right and left side (p < 0.01), and both right and left leg standing with eyes closed (p < 0.05). According to the American Fitness Standards, the TCC group attained the 90th percentile rank for sit and reach and total body rotation test, right and left.

CONCLUSION

Long term regular TCC exercise has favourable effects on the promotion of balance control, flexibility, and cardiovascular fitness in older adults.

Disability in older adults. 2: Physical activity as prevention

In this 2nd article in the series on older adults (persons aged > or = 65 years), the role of physical activity in preventing disability associated with aging in the absence of specific illnesses is discussed, and different types of activities and the measures of outcome are described. Evidence for physical activity as a prevention measure is restricted to primary and secondary prevention because the application of physical activity for tertiary prevention of disability is limited. Chronic disease is considered in the context of its influence on disability only when physical activity offers some potential benefit to elderly persons.

Home-based leg strengthening for older adults initiated through private practice

BACKGROUND

Leg strength correlates with functional ability in the frail elderly, many of whom can be reached through a private practice setting. The purpose of this study was to demonstrate the feasibility of physician-prescribed, home-based, clinic-monitored, high-intensity leg-strengthening treatment among elderly patients with a variety of medical problems.

METHODS

Twenty-two elderly patients with a variety of chronic medical conditions were invited to participate during regularly scheduled office visits if they had difficulty rising from a chair and an unsteady, cautious gait (age 85.1 +/- 5.7, 14 female). Physical therapists (PT) instructed patients to lift ankle weights at home, three times per week. Patients visited PT five times over a 12-week period. Weights were increased at each visit.

RESULTS

Patients' one-repetition maximum increased (right leg 13 to 21 lb, P = 0.00; left leg 15 to 22 lb, P = 0.00). Patients also improved in habitual (18 to 12 s, P = 0.01) and tandem (38 to 26 s, P = 0.00) 20-foot walking times and sit-to-stand time (5 to 3 s, P = 0.01).

CONCLUSION

The primary care physician can initiate a home-based leg-strengthening program that is practical for and well tolerated by the frail elderly.

Is lower extremity strength gain associated with improvement in physical performance and disability in frail, community-dwelling elders?

BACKGROUND

Strength loss is strongly associated with functional decline and is reversible with exercise. The effect of increased strength on function has not been clearly established. The purpose of this study was to determine whether strength gain is associated with improvement in physical performance and disability.

METHODS

One hundred functionally impaired community-dwelling men and women (77.6 +/- 7.6 yrs) were tested at baseline and outcome for lower extremity strength, physical performance, and disability. After random group assignment, exercise participants received strengthening exercises in their homes three times a week for 10 weeks while control subjects continued their normal activities. Using multiple regression techniques, the relationship between strength gain and improvement in physical performance and disability was assessed, controlling for age, depression, and baseline strength.

RESULTS

A significant impact of strength gain on mobility skills (p = .0009) was found. The impact of strength gain on chair rise performance was significant in participants who were more impaired (p = .04). Strength gain was associated with gain in gait speed (p = .02) and in falls efficacy (p = .05), but not with other balance, endurance, or disability measures.

CONCLUSIONS

Lower extremity strength gain is associated with gains in chair rise performance, gait speed, and in mobility tasks such as gait, transfers, stooping, and stair climbing, but not with improved endurance, balance, or disability. Strength gain is also associated with improvement in confidence in mobility. Factors that may influence the ability of strength gain to affect function are initial level of frailty and specificity of exercise. These results support the idea that strength training is an intervention that can potentially improve physical health status in many frail elders.

Ageing and physiological functions

In youth, most physiological functions have generous spare capacity. Even in health, however, increasing age is characterized by progressive erosion of these 'safety margins'. Examples include the decline of bone mass (towards a threshold for likelihood of fracture), of glomerular filtration rate (towards a threshold for susceptibility to clinical renal failure), of renal tubular function (towards a threshold for clinically important susceptibility to dehydration), of hepatic function (towards a threshold for accumulation following conventional 'young adult' doses of common medications), or of lower limb explosive power (towards thresholds for impaired functional mobility). Increasing age is also characterized by a rising prevalence of chronic pathologies, complicating attempts to determine the rate or the mechanism of the age-related decline in a physiological function. Nevertheless, it is clear that in many organs the loss of function is largely attributable to the loss of functioning cells, even in the absence of overt disease. This apparently fundamental aspect of ageing remains poorly understood.

A home-based exercise program for nondisabled older adults

OBJECTIVES

This paper describes a videotaped, home-based, strength training program, titled Strong-for-Life and reports on its effectiveness in improving muscle strength, psychological well-being, and health status in a sample of older persons.

DESIGN AND SETTING

We enrolled 102 nondisabled, community-dwelling older people aged 66 to 87, identified from the Medicare beneficiary list, into a randomized, controlled trial.

MEASUREMENTS

Effectiveness was based on change in isokinetic upper and lower extremity muscle strength, psychologic well-being, and health status.

RESULTS

Results revealed several statistically significant short-term benefits after 12 to 15 weeks of exercise, especially for men. Younger older adults demonstrated a 10% improvement in knee extensor strength relative to control subjects. Older male exercisers achieved significant differences relative to controls in perceived anger, tension, and overall social functioning. Male exercisers, in general, achieved significant improvement in perceived vigor. Women did not report psychological benefits following participation in the program.

CONCLUSION

Study results reveal that the Strong for Life program, designed to be widely disseminated to the nondisabled older population, has many short-term positive benefits.

Different kinds of services and informal support in the daily life activities in a community-based elderly population

As part of the well-known population study of 70-year olds in Gothenburg, 1239 persons at the age of 70 were invited to participate in an extensive investigation and Inter-Vention program of the Elderly in Gothenburg (IVEG). The probands were examined at the ages of 70, 73 and 76 years. The purpose of this study is to describe different kinds of services and informal support in the daily life activities among three large groups of people in their seventies. A cross-sectional study design was chosen in order to get as large groups as possible. A home call was made by an experienced occupational therapist, who interviewed and observed the probands' performance in the daily life activities. The probands and their relatives were asked about the extent of different services and informal support. Personal and home assistance care given by relatives almost doubled between the age of 70 and 76 years. Help organized by the Social Welfare Services only increased marginally. Of the personal activities of daily living (ADL), getting in/out of a bathtub was the activity that caused most problems. The most common walking aid was a stick or a crutch, while use of a wheelchair was quite uncommon. Between the age of 70 and 76 years, the use of the Handicap Transport Service more than doubled. This study shows that at the age of about 73 years the elderly should be offered formal support, such as the supply of assistive devices. What is noteworthy is that the help from relatives and friends increased much more than the help from the Social Welfare Services between the age of 70 and 76 years. At present, relatives and friends assist the elderly in their homes to a large extent, and frequently. Relatives are doing an important job for their elderly and for society, and should be given every possible kind of public support and relief in order to have the strength to continue.

Implementing a Structured Exercise Program for Frail Nursing Home Residents with Dementia: Issues and Challenges

This pilot study evaluated (a) the feasibility of a group exercise program in an institutionalized population with dementia; (b) the effects of such a program on physical performance measures; and (c) the potential additional effects of vitamin D supplementation on gait and muscle strength. Nursing home residents (N= 25) with chronic dementia and mobility impairments attended a thrice weekly exercise class for 8 weeks. They were randomly assigned to receive either a vitamin D supplement or no supplement throughout the program. Between-group differences in the effectiveness of the exercise intervention were analyzed. Pre-to-post changes were also assessed for both groups combined. In postexercise comparisons of both groups, knee extensor torque at 0°/sec declined by 18.6% while performance of 1-RM for hip extension increased by 16.1%. Balance also improved. Although vitamin D levels increased significantly in the supplement group, the two groups did not differ in their response to the exercise intervention.

Efficacy of a home-based training program for older adults using elastic tubing

The purpose of this study was to investigate the efficacy of, and the adherence to, a 12-week home-based progressive resistance training program for older adults utilizing elastic tubing. Sixty-two adults (mean age, 71.2 years) qualified to participate in the study. Subjects were randomly assigned to either the exercise (E) (n = 31) or non-exercise (NE) group (n = 31). Pre- and post-testing included isokinetic (1.05 rad.s-1) concentric/eccentric knee extension/flexion strength testing and flexibility measures of the hip, knee, and ankle. The E group trained three times per week, performing one to three sets of 10-12 repetitions for each of 12 resistance exercises. The exercises involved muscles of both the lower and upper body. Within the E group, 25 of the 31 subjects (80.6%) completed the study. Of the E subjects completing the study adherence to the three training sessions per week was 90% (range 72%-100%). Training resistances used during workouts increased significantly with the average estimated increase being 82% (P < 0.001). The E group also demonstrated significant (P < 0.05) increases in isokinetic eccentric knee extension (12%) and flexion (10%) strength. No other significant changes were observed between E and NE groups. These results suggest that home-based resistance training programs utilizing elastic tubing can serve as a practical and effective means of eliciting strength gains in adults over the age of 65.

Physical activity program for older persons: effect on balance, strength, neuromuscular control, and reaction time

Regular exercise has been recommended to improve balance, strength, and coordination in older persons. In this study, 44 persons, aged 50 to 75 years (mean 62.4 yrs) underwent assessments of quadriceps strength, reaction time, neuromuscular control, and body sway on two occasions before beginning a 10-week exercise program. The subjects were retested for the same measures at the end of the program. The mean number of classes attended for the 40 subjects who were retested was 16.2 (range 11 to 19). On completion of the program, the subjects showed improved performance in the tests of quadriceps strength, reaction time, body sway on a firm surface with the eyes closed, and a compliant surface with the eyes open and closed. In contrast, a group of nonexercisers showed no improvements in any of the test measures. These results suggest that exercise may play a role in improving a number of sensorimotor systems that contribute to stability in older persons.

Serum hormones and strength development during strength training in middle-aged and elderly males and females

Effects of a 12-week progressive strength training period on serum concentrations of testosterone, cortisol and sex-hormone-binding globulin (SHBG) as well as on strength development of the leg extensor muscles were investigated in nine middle-aged males (M50; range 44-57 years) and in nine middle-aged females (F50; range 43-54 years) as well as in 10 elderly males (M70; range 64-73 years) and in 11 elderly females (F70; range 66-73 years). Substantial increases took place in maximal isometric strength during the 12-week training period both in M50 (from 2834 +/- 452 to 3941 +/- 772 N; P < 0.001) and in F50 (from 2627 +/- 725 to 3488 +/- 1017 N; P < 0.001) as well as in M70 (from 2591 +/- 736 to 3075 +/- 845 N; P < 0.01) and in F70 (from 1816 +/- 427 to 2483 +/- 408 N; P < 0.001). The relative increases in strength during the 12-week training period did not differ significantly between the groups. However, during the last 4 weeks of the training none of the groups demonstrated further increases in strength but it actually decreased in F50 (P < 0.05), M70 (P < 0.01) and in F70 (P < 0.05). No systematic changes were observed during the training in the mean concentrations of serum total testosterone, free testosterone, cortisol, and SHBG, nor in testosterone/cortisol and testosterone/SHBG ratios. However, the individual levels of serum testosterone and testosterone/cortisol ratio and the individual changes in strength during the last four most intensive training weeks of the 12-week period were in significant positive linear correlation in F70 (r = 0.57; P < 0.05) and in M70 (r = 0.61; P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of walking, jogging and cycling on strength, flexibility, speed and balance in 60- to 72-year olds

The effects of a moderate intensity endurance training program on strength, speed of muscle contraction, balance, gait and flexibility were assessed in fifty 60- to 72-year-old men and women who had just completed a 3-month program of flexibility and strengthening exercise. Subjects trained for approximately 45 minutes/day, 4.1 days a week, for one year. Before and after the endurance exercise program, exercise participants underwent isometric and dynamic strength testing (Cybex II), standing balance tests, a gait examination, lower extremity flexibility testing, and a fatigue test for the quadriceps femoris muscle group. Fifteen control subjects who did not exercise were tested at the same time periods as exercise subjects. Gains made during the low intensity strengthening and flexibility program in strength, range of motion and quadriceps endurance were maintained throughout the year of endurance exercise training. Additional significant improvements in speed of muscular contraction, walking velocity and standing balance occurred with the program of moderate intensity endurance training which produced a 24% increase in VO2max for men and a 21% increase for women. These results provide additional evidence that older adults are able to improve their functional capacity in response to exercise training.

An epidemiological study of falls in older community-dwelling women: the Randwick falls and fractures study

Seven hundred and four women aged between 65 and 99 years (mean age 74.6 years), who were randomly selected from the community, took part in a study to determine whether health and lifestyle factors were associated with falls. In the 12 months before the survey, 66.1 per cent of the subjects experienced no falls, 19.7 per cent fell once and 14.2 per cent fell on two or more occasions. The proportion of women who fell outside the home decreased with age, with a corresponding increase in the proportion who fell inside the home on a level surface. The most common causes of falls reported were trips, slips and loss of balance. Some (27 per cent) suffered injuries as a result of a fall, and the proportion suffering injuries increased with age. Those who rated their health and balance as impaired, those with a limitation in activities of daily living, those receiving community services, those taking psychoactive drugs, and those taking four or more drugs had significantly more falls. On the other hand, those taking part in planned exercise and those active for seven or more hours per week had fewer falls. Smoking and alcohol consumption were not significantly associated with falls. Stepwise logistic regression analysis revealed poor vision, inactivity and subjective fall risk as variables that were independently and significantly associated with falling. These findings highlight possible intervention strategies for reducing falls risk in older people.

Balance, reaction time, and muscle strength in exercising and nonexercising older women: a pilot study

Twenty-one women, aged 57 to 75 years, who had been taking part in exercise programs for periods of 12 months or more underwent tests of muscle strength, reaction time, proprioception, and body sway. The performance of these women in the tests was compared with 21 women of the same age who were not taking part in any organized physical activity and were not exercising more than 30 minutes a day. The women who had been taking part in the exercise program performed significantly better in the tests of quadriceps strength, reaction time, and sway on a compliant surface than the nonexercising women. The exercisers also had lower body mass index scores. These pilot results suggest that exercise may play a role in improving a number of sensori-motor systems that contribute to stability, and that exercise of this nature may help prevent falls in older women.

Effects of a low intensity exercise program on selected physical performance characteristics of 60- to 71-year olds

The effects of a low intensity exercise program on strength, flexibility, balance, gait and muscular endurance were determined in sixty-two 60- to 71-year-old men and women. Subjects exercised for 1 hour daily 5 days a week for 3 months. Before and after the exercise program, each participant underwent lower extremity range of motion (ROM) determinations, isometric and dynamic strength testing (Cybex) of the knee and ankle musculature, standing balance tests, a gait examination and a fatigue test for the quadriceps. Thirteen control subjects who did not exercise also were tested at two time periods, 3 months apart. Significant improvements in strength occurred for exercise subjects, particularly at the fastest speed settings on the Cybex. ROM measures of the hip and trunk, and standing balance times improved, but no change in endurance or gait parameters was found. With the exception of muscular endurance, no changes were observed among the controls. Exercise subjects frequently reported improvements in functional capacity and activities of daily living. These results suggest that a low intensity exercise program can improve strength, balance and flexibility in sedentary healthy older people.

Dental health and functional ageing. A study of 70-year-old people

Functional ageing, including dental health, was studied in the gerontological population study in Gothenburg. This study was based on three 70-yr-old cohorts, born in 1901-2, 1906-7, and 1911-12 (n = 1380). The Eichner index was used as a measurement of deterioration in dental state and dental functional impairment. This impairment was significantly associated with a lower capacity in cognition, visual ability, hearing ability, lung volume, heart volume, muscle strength, and bone mineral content as well as a lower self-assessment of health. A multiple regression model showed that an index of seven functional capacities was the most predictive factor for dental status independent of confounding factors such as socioeconomic factors, tobacco smoking, and the most incapacitating diseases. These associations were more marked in men and the survival rate between 70 and 79 years of age was higher among men with a well preserved dental state of the age of 70. The co-variation between impairment in dental function and other functional variables and survival indicate a common functional ageing.

Dual-photon absorptiometry for determination of bone mineral content in the calcaneus with correction for fat

A portable dual-photon absorptiometry system for the determination of the bone mineral content BMC in vivo in the calcaneal bone is described. With knowledge of the total thickness of the heel at the measuring point the BMC can be corrected for fat and lean soft tissue. The system is capable of measuring the BMC in the heel bone with a precision of 1.2% in vitro and 1.8% in vivo at an absorbed dose to the skin of 0.2 mSv.

Effects of age and regular exercise on muscle strength and endurance

Twenty male and 20 female non-professional tennis players were classified into two different age groups (n = 10 per group): young active men (30.4 +/- 3.3 years), young active women (27.5 +/- 4.3 years), elderly active men (64.4 +/- 3.7 years), and elderly active women (65.3 +/- 4.5 years). These individuals were matched (n = 10 per group) according to sex, age, height and mass to sedentary individuals of the same socio-economical background: young sedentary men (29.2 +/- 3.4 years), young sedentary women (25.6 +/- 4.4 years), elderly sedentary men (65.2 +/- 3.2 years) and elderly sedentary women (65.6 +/- 4.4 years). An isokinetic dynamometer was used to measure the strength of the knee extensors and flexors (two separate occasions) and the endurance of the extensors. Vastus lateralis electromyogram (EMG) was measured concomitantly. Significant sex, age and exercise effects (P less than 0.001) were observed for peak torque of both muscle groups. The effect of age on extensor strength was more pronounced at high speeds where men were also able to generate larger relative torques than women. No age or sex effects were noted for muscle endurance. However, muscles of active individuals demonstrated a greater resistance to fatigue than those of sedentary individuals. In conclusion, men were found to be stronger than women, age was associated with a decrease in muscle strength, but not of muscle endurance, and tennis players were stronger and had muscles that were more resistant to fatigue than their sedentary pairs in both age groups.(ABSTRACT TRUNCATED AT 250 WORDS)