Improved muscle strength and power in elderly exercising regularly

Can Age Influence Functional Tests Differently to Predict Falls in Nursing Home and Community-Dwelling Older Adults?

Aim: The aim of this cross-sectional study was to determine which functional tests are able to predict falls in nursing home residents (NHR) and community-dwelling (CDW) older adults grouped by age. Methods: Two hundred and fifty-two older adults were assessed in the following tests, Mini-Mental State Examination, anthropometric characteristics, fall history and functional tests. The participants were assigned to one of the following groups: Young Older Adults (YOA; 60-69 years, n = 102; 27.5% NHR), Old Older Adults (OOA; 70-79 years; n = 100; 23.5% NHR) and Very Older Adults (VOA, ≥80 years; n = 50; 52% NHR). Results: The five times sit-to-stand showed 1.41 odds to experience a fall in the NHR of the VOA. In the CDW, the handgrip strength score decreased the odds to fall occurrence (0.92 odds) in the YOA, while the low score in timed up and go test of the OOA showed 1.21 odds to experience a fall. Conclusions: Therefore, the five times sit-to-stand test can predict falls in NHR of VOA groups, while handgrip strength and timed up and go tests can predict falls in CDW of YOA and OOA groups, respectively.

Chair rise capacity and associated factors in older home-care clients

AIMS

The aim of this study was to investigate the ability of older home-care clients to perform the five times chair rise test and associated personal characteristics, nutritional status and functioning.

METHODS

The study sample included 267 home-care clients aged ≥75 years living in Eastern and Central Finland. The home-care clients were interviewed at home by home-care nurses, nutritionists and pharmacists. The collected data contained sociodemographic factors, functional ability (Barthel Index, IADL), cognitive functioning (MMSE), nutritional status (MNA), depressive symptoms (GDS-15), medical diagnoses and drug use. The primary outcome was the ability to perform the five times chair rise test.

RESULTS

Fifty-one per cent ( n=135) of the home-care clients were unable to complete the five times chair rise test. Twenty-three per cent ( n=64) of the home-care clients had good chair rise capacity (≤17 seconds). In a multivariate logistic regression analysis, fewer years of education (odds ratio [OR] = 1.11, 95% confidence interval [CI] 1.04-1.18), lower ADL (OR = 1.54, 95% CI 1.34-1.78) and low MNA scores (OR = 1.12, 95% CI 1.04-1.20) and a higher number of co-morbidities (OR = 1.21, 95% CI 1.02-1.43) were associated with inability to complete the five times chair rise test.

CONCLUSIONS

Poor functional mobility, which was associated with less education, a high number of co-morbidities and poor nutritional status, was common among older home-care clients. To maintain and to prevent further decline in functional mobility, physical training and nutritional services are needed. (NutOrMed, ClinicalTrials.gov Identifier: NCT02214758).

Electromyographic Pattern during Gait Initiation Differentiates Yoga Practitioners among Physically Active Older Subjects

During gait initiation, postural adjustments are needed to deal with balance and movement. With aging, gait initiation changes and reflects functional degradation of frailty individuals. However, physical activities have demonstrated beneficial effects of daily motor tasks. The aim of our study was to compare center of pressure (COP) displacement and ankle muscle co-activation during gait initiation in two physically active groups: a group of walkers (n = 12; mean age ± SD 72.6 ± 3.2 years) and a yoga group (n = 11; 71.5 ± 3.8 years). COP trajectory and electromyography of leg muscles were recorded simultaneously during five successive trials of gait initiation. Our main finding was that yoga practitioners had slower COP displacements (p < 0.01) and lower leg muscles % of coactivation (p < 0.01) in comparison with walkers. These parameters which characterized gait initiation control were correlated (r = 0.76; p < 0.01). Our results emphasize that lengthy ankle muscle co-activation and COP path in gait initiation differentiate yoga practitioners among physically active subjects.

[Motor skills and safety of patients with bi- or trimalleolar ankle injury : Comparison with healthy, active, age-matched control subjects]

OBJECTIVE

Do patients with bi- or trimalleolar ankle injury show differences in motor skills and safety in comparison with healthy, active, age-matched control subjects?

STUDY DESIGN

Prospective controlled cross-sectional study.

METHODS

Inclusion of 17 patients with bi- or trimalleolar ankle injury (mean 1.5 years postsurgery) and 23 healthy, active subjects of comparable age (fitness studio). Measurement instruments: motor test procedures and questionnaires.

RESULTS

Comparison of patients and control subjects by routine daily motor function: patients < controls with the "timed 'Up & Go' test" (TUG, p = 0.011), the chair rising test and a coordination test using a gymnastic hoop (CRT and GR p > 0.05), fear of falling: patients > controls (p = 0.003) and physical activity: patients < controls (p = 0.032).

CONCLUSION

There were no significant motor deficits in activities of daily life between the patients and controls, only tendencies; however, the patients showed definite limitations with an increased fear of falling and a reduced physical activity compared with the healthy control group. The resulting differences should be positively influenced by appropriate enhancement of training or participation in sports courses. The aim is to achieve a similar quality of life by a perception of safety and trust in one's own motor skills.

Correlations of psycho-physiological parameters influencing the physical fitness of aged women

Regular assessment of psycho-physiological parameters in aged subjects helps to clarify physical and mental conditions which are important in the prevention of health-endangering events to assure a healthy aging. Thirty older care female residents consented voluntarily to participate in the study. The somatic and psycho-physiological parameters recorded were handgrip force, disjunctive reaction time, balance control and whole body movement coordination, the electrocardiogram and heart rate variability. Significant correlations were found between (a) reaction time and balance control efficiency (r = -0.567, p < 0.009), (b) reaction time and movement coordination accuracy (r = -0.453, p < 0.045), (c) cardiac state and movement coordination accuracy (r = 0.545, p < 0.016), (d) cardiac stress and cardiac state (r = -0.495, p < 0.031), and (e) cardiac stress and force (r = -0.822, p < 0.045). In conclusion, for the aim of establishing basic battery tests for assessing psycho-physiological condition of physical fitness our results emphasize the importance of systematic physical activity, endurance and strength training supporting muscle force, balance control and whole-body movement coordination, in addition to improving the cardiac stress index level. The strong interrelation among these parameters allows the drawing of a more complete view regarding the health condition of aged individuals.

Effects of comprehensive health assessment and targeted intervention on chair rise capacity in active and inactive community-dwelling older people

BACKGROUND

Being able to rise from a chair is an important daily life activity that requires sufficient lower extremity muscle power and postural control.

OBJECTIVE

To assess the effects of an individually tailored intervention on the chair rise capacity of active and inactive community-dwelling older men and women.

METHODS

This study included a community-based sample of ≥75-year-olds who were randomized into intervention (n = 299) and control (n = 260) groups. The intervention started in 2004 and ended in December 2006; all the participants of the intervention group received individually targeted physical activity counseling annually and had an opportunity to participate in supervised strength and balance training once a week. Chair rise tests were conducted annually. The mixed model of linear regression was used for unadjusted measurements and age, and the Mini-Mental State Examination and functional comorbidity index adjusted comparisons of effects of the intervention.

RESULTS

The intervention improved the chair rise capacity in physically active women (adjusted mean difference -1.67 s, 95% confidence interval -3.21 to -0.13, p = 0.02). There was no improvement in inactive women or in men, regardless of their physical activity level.

CONCLUSION

Intervention showed a positive effect on the chair rise capacity of physically active community-dwelling older women.

Joint association of physical activity and body weight with subsequent physical and mental functioning: a follow-up study

Background

Physical inactivity and overweight are major threats to public health. However, it is not well understood to what extent physical activity might counteract the harmful effects of overweight on functioning. Thus, we examined the joint associations of leisure-time physical activity and body mass index (BMI) with subsequent physical and mental functioning over a follow-up of five to seven years.

Methods

The data were derived from the Helsinki Health Study, which is a cohort study among employees of the City of Helsinki, Finland. The baseline postal survey data were collected among 40-60-year-old employees in 2000–02 (n = 8960, response rate 67%), and the follow-up data in 2007 among all baseline survey respondents (n = 7332, response rate 83%). We divided the participants into six groups according to their amount of physical activity (inactive, moderately active and highly active) and their relative weight (normal weight and overweight). Highly active normal-weight participants were used as a reference group in all the analyses. Poor functioning was defined as the lowest quartile of the Short Form 36 (SF-36) health survey’s physical and mental component summaries, with the follow-up cut-off point also applied at baseline. We used logistic regression analysis adjusted for age, gender, baseline functioning, smoking, alcohol use, marital status, socioeconomic position and working conditions.

Results

At baseline 48% of the participants were overweight and 11% were inactive. After adjustments inactivity was associated with poor physical functioning at follow-up both among the normal-weight (OR 1.51, 95% CI 1.09-2.10) and overweight (OR 2.02, 95% CI 1.56-2.63) groups. Being overweight regardless of activity level was associated with poor physical functioning. Poor physical functioning was practically equally common among the highly active overweight group and the inactive normal-weight group. After adjustments, for mental functioning, only inactivity among the overweight was associated with poor mental functioning (OR 1.39, 95% CI 1.08-1.80).

Conclusions

Physical activity is likely to be beneficial for physical and mental functioning among both those with overweight and normal weight. However, maintaining normal weight is also important for good physical functioning. Therefore, efforts should be made to recommend people to engage in physical activity regardless of weight.

Differences in maximum upper and lower limb strength in older adults after a 12 week intense resistance training program

The purpose of this study was to identify differences in maximum strength after an intense strength training program, contrasting muscle groups from upper limbs versus lower limbs. The sample consisted of 10 healthy elderly males (age 73±6 years) with independent living. The training program lasted 12 weeks (3 × week, 50 to 80% of 1RM, 2–3 sets, 6 to 12 repetitions). Two muscle groups were analyzed: LOWER (sum of average values of three exercises for the lower limbs) and UPPER (sum of average values of four exercises for the upper limbs). Measurement of 1RM was performed at intervals of 4 weeks by direct methods. Repeated measures ANOVA identified significant differences in muscle groups (F=8.1, p=0.006), time (F=730.0 p=0.000) and also their interaction (F=4.4, p=0.014). The gains in 1RM values were higher for upper limbs. These results may suggest that the muscles of the lower limbs are elicited more frequently and therefore, have a smaller potential to gain strength at older age. The muscles of the upper limbs are in accelerated muscle atrophy and their trainability is probably higher.

Muscle power is related to tibial bone strength in older women

We enrolled 65 to 75 year-old community-dwelling women and measured muscle power, strength, physical activity using accelerometry and tibial bone strength using peripheral quantitative computed tomography (pQCT). Muscle power contributed 6.6% of the variance in the bone strength-strain index and 8.9% in the section modulus after accounting for age, height, weight, and physical activity; moderate to vigorous physical activity was related to muscle power in the lower extremity.

INTRODUCTION

Muscle power is associated with DXA measurements of bone mass, but it is not known whether muscle power is associated with bone strength. There are no reports of investigations that have tested the effect of muscle power on bone compartments using advanced imaging.

METHODS

We enrolled 74 community-dwelling women aged 65-75 years. We measured muscle power and strength of leg extension using Keiser air-pressure resistance equipment. All participants wore a waist-mounted Actigraph accelerometer to record physical activity. We used peripheral quantitative computed tomography (pQCT) to measure tibial mid-shaft (50% of the site) bone strength (strength-strain index, section modulus). We used Pearson correlations and multi-level linear regression to investigate the associations between muscle and bone.

RESULTS

Muscle power contributed 6.6% (p = 0.007) of the variance in the bone strength-strain index and 8.9% (p = 0.001) the variance in the section modulus in older women after accounting for age, height, weight, and physical activity. Moderate to vigorous physical activity was significantly related to muscle power in the lower extremity (r = 0.260; p = 0.041).

CONCLUSION

Muscle power significantly contributed to the variance in estimated bone strength. Whether power training will prove to be a more effective stimulus for bone strength than conventional strength training will require further studies.

A randomised controlled trial of the effectiveness of an exercise training program in patients recovering from severe acute respiratory syndrome

The aim of this study was to evaluate the effectiveness of an exercise training program on cardiorespiratory and musculoskeletal performance and health-related quality of life of patients who were recovering from severe acute respiratory syndrome (SARS). A 6-week supervised exercise training program was carried out in the physiotherapy department of a university teaching hospital. One hundred and thirty-three patients referred from a SARS Review Clinic solely for physiotherapy were included. Cardiorespiratory fitness (6-minute walk test, Chester Step Test for predicting VO_2max), musculoskeletal performance (isometric deltoid and gluteal muscles strength, handgrip strength, 1-minute curl-up and push-up tests) and health-related quality of life (SF-36) were measured and evaluated. Patients were assigned randomly to either a control group (standardised educational session about exercise rehabilitation) or an exercise group. After 6 weeks, significantly greater improvement was shown in the exercise group in the 6-minute walk test (77.4 m vs 20.7 m, p < 0.001), VO_2max (3.6 ml/kg/min vs 1 ml/kg/min, p = 0.04), and musculoskeletal performance (handgrip strength, curl-up and push-up tests, p < 0.05). Effects on health-related quality of life were not statistically significant. It was concluded that the exercise training program was effective in improving both the cardiorespiratory and musculoskeletal fitness in patients recovering from SARS. However, health-related quality of life was not affected by physical training.

Peak leg muscle power, peak VO2 and its correlates with physical activity in 57 to 70-year-old women

The two aims of this study were first to measure short-term muscle power (STMP) by means of a cycling force-velocity test (cycling peak power: CPP) and a vertical jump test (jumping peak performance: JPP) and second, to examine the relationships between physical activity (PA) level, peak oxygen uptake (peak VO2) and STMP in healthy elderly women. Twenty-three independent community-dwelling elderly women (mean age: 64+/-4.4) performed on separate days, a peak oxygen uptake test on cycle ergometer, a cycling force-velocity test and a vertical jump test. A questionnaire (QUANTAP) was used to assess lifespan exercise habits. Four indices expressed in kJ day(-1) kg(-1) were calculated. Two indices represented average past PA level: 1/quantity of habitual physical activity (QHPA), 2/quantity of sports activities (QSA). Two indices represented the actual PA level: 3/actual quantity of habitual physical activity (AQHPA), 4/actual quantity of sports activities (AQSA). CPP (6.3+/-1.2 W kg(-1)) was closely correlated to JPP (14.8+/-3.4 cm) (r=0.80, P<0.001). AQHPA and AQSA were only positively associated with peak VO2 (ml min(-1) kg(-1)) (r=0.49; r=0.50, P<0.05, respectively). Past PA level was not related to fitness measurements. Results show that in this population: (1) jumping peak performance was closely related to CPP measured in the laboratory; (2) the cardio-respiratory fitness was related to the actual habitual physical activity level; (3) only age and anthropometric variables explained the actual performances in multivariate analysis.

Serum Albumin and Muscle Strength: A Longitudinal Study in Older Men and Women

OBJECTIVES

To examine whether low serum albumin is associated with low muscle strength and future decline in muscle strength in community-dwelling older men and women.

DESIGN

Population-based cohort study.

SETTING

The Longitudinal Aging Study Amsterdam.

PARTICIPANTS

Six hundred seventy-six women and 644 men aged 65 to 88.

MEASUREMENTS

Serum albumin was determined at baseline. Muscle strength was assessed using grip strength at baseline, after 3 (n=1,009), and 6 (n=741) years. The outcomes were continuous baseline muscle strength, 3- and 6-year change in muscle strength, and a dichotomous indicator for substantial decline (a decrease if > or =1 standard deviations for women=11 kg, for men=12 kg) in muscle strength.

RESULTS

Mean serum albumin concentration+/-standard deviation was 45.0+/-3.3 g/L for women and 45.2+/-3.2 g/L for men. At baseline, adjusting for age, lifestyle factors, and chronic conditions, lower serum albumin was cross-sectionally associated with weaker muscle strength (P<.001) in women and men. After 3 years of follow-up, mean decline in muscle strength was -5.6+/-10.9 kg in women and -9.6+/-11.9 kg in men. After adjustment for potential confounders, lower serum albumin was associated with muscle strength decline over 3 years (P<.01) in women and men (beta=0.57, standard error (SE)=0.18; beta=0.37, SE=0.16, respectively). Lower serum albumin was also associated with substantial decline in muscle strength in women (per unit albumin (g/L) adjusted odds ratio (OR)=1.14, one-sided 95% confidence limit (CL)=1.07) and men (per unit albumin (g/L) adjusted OR=1.14, 95% CL=1.08). Similar but slightly weaker associations were found between serum albumin and 6-year change in muscle strength (P<.05).

CONCLUSION

These results suggest that low serum albumin, even within the normal range, is independently associated with weaker muscle strength and future decline in muscle strength in older women and men.

Outcome expectations that motivate physical activity among world senior games participants

This study validates a questionnaire which examines the role of selected outcome expectations from physical activity on motivating regular physical activity among a group of older adults. Data were obtained from a cross-sectional survey of 675 participants in the 2002 World Senior Games. Factor analysis identified four clusters among 14 outcome expectation items, which were labeled Recreation and Social, Physical Health, Mental Health, and Self-image. The percentage agreeing that the selected items motivated physical activity were calculated and ranked from 1 (high) to 14 (low). The average ranking in each of the four factors was 4.7 for Recreation and Social, 5.8 for Physical Health, 10.5 for Self-image, and 11.7 for Mental Health. The ranks of items did not significantly differ across categories of sex, age, marital status, education, smoking, alcohol drinking, and disease history. However, the ranking did significantly differ between individuals who considered themselves to be physically active versus sedentary. Physically active individuals were most likely to agree that recreational enjoyment or fun motivated physical activity, whereas sedentary individuals were most likely to agree that improving the quality of life motivated physical activity.

Effect of Age on Characteristics of Forward and Backward Gait at Preferred and Accelerated Walking Speed

BACKGROUND

Backward walking is used increasingly in rehabilitation programs to promote balance, strength, and aerobic conditioning. This study examines the effect of movement direction on the temporal-spatial gait characteristics of old versus young adults when progressing at a comfortable pace and as fast as possible.

METHODS

Participants included 40 old (mean age 77.7, standard deviation +/- 6.2) and 30 young volunteers (mean age 24.0, standard deviation +/- 2.3), who were independent walkers. Using a computer-based walkway system, participants were requested to walk forward and backward at a normal pace and as fast as possible. Analyses of variance and Tukey-Kramer tests were conducted to determine effects of age, movement direction, and acceleration of gait speed on various gait parameters.

RESULTS

Forward and backward walking of elderly persons is generally characterized by a lower velocity, cadence, stride length, and swing phase, accompanied by an increase in the double-support phase. Reversing from forward to backward walking presents a similar pattern in both age groups, with a decrease in gait velocity, stride length, and swing phase, an increase in the double-support phase, and no change in cadence. However, the decrease in stride length is significantly greater among elderly persons. In young persons, higher gait velocities are achieved by concurrent increases in stride length and cadence, regardless of movement direction. Ability of older persons to increase backward ambulation is limited and relies solely on increasing cadence.

CONCLUSIONS

Elderly persons demonstrate difficulties in walking backward, with stride length particularly affected. These difficulties must be considered when using backward ambulation for rehabilitation of elderly persons.

Effects of progressive strength training on the performance of the Functional Reach Test and the Timed Get-Up-and-Go Test in an elderly population from the rural north of Portugal

The purpose of this study was to examine the effect of an intensity progressive strength training program on the performance of two tests related to fall risk: the Functional Reach Test (FRT) and the Timed Get-Up-and-Go Test (TUG). Twenty subjects were randomly included in one experimental group (age 73 +/- 6 years old) and one control group (age 75 +/- 5 years old). Subjects from the experimental group participated in a strength-training program consisting of three sessions each week for a period of 14 consecutive weeks, from 50% to 80% of 1RM. A 2 (group: experimental vs. control) x 2 (pre-post: pre-test vs. post-test) repeated measures ANOVA was carried out on subjects in TUG and FRT performance. Mean FRT results from the pre-test were significantly lower than mean results from post-test. The two main effects were qualified by a significant group x pre-post interaction, F(1,18) = 39.23, P < 0.001, identifying markedly different performance profiles. Mean TUG results from the pre-test were significantly lower than mean results from post-test. The two main effects were qualified by a significant group x pre-post interaction, F(1,18) = 50.74, P < 0.001, again identifying markedly different performance profiles. Globally, the obtained results through our progressive strength-training program showed important improvements in functional task performance and in preventing falls.