Associations between muscle strength,spirometric pulmonary function and mobility in healthy older adults

Pathological obstruction in lungs leads to severe decreases in muscle strength and mobility in patients suffering from chronic obstructive pulmonary disease. The purpose of this study was to investigate the interdependency between muscle strength, spirometric pulmonary functions and mobility outcomes in healthy older men and women, where skeletal muscle and pulmonary function decline without interference of overt disease. A total of 135 69- to 81-year-old participants were recruited into the cross-sectional study, which was performed as a part of European study MyoAge. Full, partial and no mediation models were constructed to assess the interdependency between muscle strength (handgrip strength, knee extension torque, lower extremity muscle power), spirometric pulmonary function (FVC, FEV₁ and FEF50) and mobility (6-min walk and Timed Up and Go tests). The models were adjusted for age, sex, total fat mass, body height and site of enrolment. Partial mediation models, indicating both direct and pulmonary function mediated associations between muscle strength and mobility, fitted best to the data. Greater handgrip strength was significantly associated with higher FVC, FEV1 and FEF50 (p < 0.05). Greater muscle power was significantly associated with better performance in mobility tests. Results suggest that decline in mobility with aging may be caused by decreases in both muscle strength and power but also mediated through decreases in spirometric pulmonary function. Future longitudinal studies are warranted to better understand how loss of function and mass of the respiratory muscles will affect pulmonary function among older people and how these changes are linked to mobility decline.     

Disparate effects of improving aerobic exercise capacity and quality of life after cardiac rehabilitation in young and elderly coronary patients

PURPOSE: Although cardiopulmonary exercise variables predict prognosis, functional capacity, and quality of life (QoL) in patients with coronary artery disease (CAD), these variables have not been assessed fully before and after exercise training in elderly with CAD. Therefore, the purpose of this study was to determine the impact of formal Phase II cardiac rehabilitation and exercise training programs on cardiopulmonary variables and QoL in elderly and younger CAD patients. METHODS: The authors analyzed consecutive patients before and after Phase II cardiac rehabilitation and exercise training programs, and compared exercise cardiopulmonary data and data from validated questionnaires assessing QoL (MOS SF-36) and function in 125 younger patients (< 55 years; mean 48 +/- 6 years) and 57 elderly (> 70 years; mean 78 +/- 3 years). RESULTS: At baseline, elderly patients had lower estimated aerobic exercise capacity (-27%; P < 0.001), peak oxygen consumption (VO2) (-19%; P < 0.01), and anaerobic threshold (-10%; P < 0.05), as well as total function scores (-11%; P < 0.01) and total QoL scores (-5%; P = 0.06). Commonly used prediction equations greatly overestimated aerobic exercise capacity compared with precise measurements using cardiopulmonary testing both before (+23% and +12% in younger and elderly patients, respectively) and after the exercise training programs (+51% and +31% in younger and elderly patients, respectively), and more so in younger compared with older patients. After rehabilitation, the elderly had significant improvements in estimated aerobic exercise capacity (+32%; P < 0.0001), peak VO2 (+13%; P < 0.0001), anaerobic threshold (+11%; P = 0.03), total function scores (+27%; P < 0.0001), and total QoL scores (+20%; P < 0.0001). Although younger patients had greater improvements in estimated aerobic exercise capacity (+44% versus +32%; P = 0.08), peak VO2 (+18% versus +13%; P < 0.01), and anaerobic threshold (+17% versus +11%; P = 0.07), the elderly had statistically greater improvements in both function scores (+27% versus +20%; P = 0.02), and total QoL scores (+20% versus +14%; P = 0.03). CONCLUSIONS: These data confirm the benefits of precisely determining aerobic exercise capacity by cardiopulmonary function, especially to determine the benefits of an exercise training program. In addition, these data using cardiopulmonary exercise tests and validated assessments of quality of life demonstrate the disparate effects of cardiac rehabilitation programs on improvements in aerobic exercise capacity and QoL in young and elderly with CAD.     

Cross-cultural validation of the Falls Efficacy Scale International (FES-I) using self-report and interview-based questionnaires among Persian-speaking elderly adults

FES-I has been designed to assess fear of falling (FoF). The purpose of this study was to establish the Persian-language version of the FES-I and to assess its psychometric properties under different modes of administration: self-report and interview-based. Participants included 191 elderly people aged over 60 who were mostly community dwelling. With an interval of 14 days, 97 volunteers completed the questionnaire in the retest session. To evaluate the construct validity, we assessed the ability of the FES-I to discriminate people based on gender, level of education, number of falls and FoF. The correlation with the Short Form of Health Survey (SF-36), Timed Up and Go (TUG) and Functional Reach Test (FRT) was also determined to test validity. Internal consistency was excellent in both self-report (0.93) and interview (0.92) versions. All intra-class correlations (ICCs) were above 0.70 with the highest reliability obtained for the condition where the interview based FES-I was used in both test and retest sessions. The strength of correlation between the FES-I and TUG varied based on mode of administration: moderate for interview and high for self-report mode. The FES-I had a higher correlation with the SF-36 subscales of physical health than subscales of mental health. The FES-I had the ability to discriminate the participants based on gender, educational level, and number of falls and FoF. In conclusion, both interview and self-report versions of the FES-I demonstrated acceptable measurement properties to assess FoF in Iranian elderly persons.     

Cross-cultural validation of the Falls Efficacy Scale International (FES-I) using self-report and interview-based questionnaires among Persian-speaking elderly adults

FES-I has been designed to assess fear of falling (FoF). The purpose of this study was to establish the Persian-language version of the FES-I and to assess its psychometric properties under different modes of administration: self-report and interview-based. Participants included 191 elderly people aged over 60 who were mostly community dwelling. With an interval of 14 days, 97 volunteers completed the questionnaire in the retest session. To evaluate the construct validity, we assessed the ability of the FES-I to discriminate people based on gender, level of education, number of falls and FoF. The correlation with the Short Form of Health Survey (SF-36), Timed Up and Go (TUG) and Functional Reach Test (FRT) was also determined to test validity. Internal consistency was excellent in both self-report (0.93) and interview (0.92) versions. All intra-class correlations (ICCs) were above 0.70 with the highest reliability obtained for the condition where the interview based FES-I was used in both test and retest sessions. The strength of correlation between the FES-I and TUG varied based on mode of administration: moderate for interview and high for self-report mode. The FES-I had a higher correlation with the SF-36 subscales of physical health than subscales of mental health. The FES-I had the ability to discriminate the participants based on gender, educational level, and number of falls and FoF. In conclusion, both interview and self-report versions of the FES-I demonstrated acceptable measurement properties to assess FoF in Iranian elderly persons.     

The effects of eyeball exercise on balance ability and falls efficacy of the elderly who have experienced a fall: A single-blind,randomized controlled trial

PurposeThe purpose of this study was to investigate the effects of eyeball exercise on balance and fall efficacy of the elderly who have experienced a fall.Material and methodsSubjects were randomly assigned to the eyeball exercise group (n = 30) or functional exercise group (n = 31). All subjects received 30 sessions for 10 weeks. To identify the effects on balance, static and dynamic balance were measured using the center of pressure (CoP) measurement equipment and Timed Up and Go Test (TUGT) respectively. Fall efficacy was evaluated using the modified efficacy scale (MFES). The outcome measurements were performed before and after the 10 weeks training period.ResultsAfter 10 weeks, static balance, dynamic balance, and fall efficacy were significantly improved in both groups. Also, there were significant differences in the outcome measures between both groups (p < 0.05).ConclusionsThese results indicate that eyeball exercise is beneficial to improve the fall efficacy as well as the balance of the elderly compared with functional exercise. Eyeball exercise would be useful to improve balance and fall efficacy of the elderly who have experienced a fall.     

Lower limb power rehabilitation (LLPR) using interactive video game for improvement of balance function in older people

Declined balance functions have adverse effects on elderly population. Lower limbs muscle power training is currently an emerging concept in rehabilitation on individuals with decreased balance and mobility. In this prospective, controlled study, we used a human-computer interactive video-game-based rehabilitation device (LLPR) for training of lower limb muscle power in the elderly. Forty (aged>65years) individuals were recruited from the community. Twenty participants in the exercise group received 30-min training, twice a week, using the LLPR system. The LLPR system allows participants to perform fast speed sit-to-stand (STS) movements. Twenty age-matched participants in the control group performed slow speed STS movements, as well as strengthening and balance exercises, with the same frequency and duration. The results were compared after 12 sessions (6weeks) of training. The mechanical and time parameters during STS movement were measured using the LLPR system. Modified falls efficacy scale (MFES), Tinetti Performance-Oriented Mobility Assessment (POMA), function reach test, five times sit to stand (FTSS) and Timed Up and Go (TUG) were administered to participants as clinical assessments. Results showed that in the exercise group, all the mechanical and time parameters showed significant improvement. In control group, only the maximal vertical ground reaction force (MVGRF) improved significantly. For clinical assessments (balance, mobility, and self-confidence), exercise group showed significantly better scores. The STS movements in video-game-based training mimic real life situations which may help to transfer the training effects into daily activities. The effectiveness of lower limb muscle training is worthy of further investigation.     

Short-term, light- to moderate-intensity exercise training improves leg muscle strength in the oldest old: a randomized controlled trial

OBJECTIVES: To assess the effects of an 8‐week exercise training program with a special focus on light‐ to moderate‐intensity resistance exercises (30–70% of one repetition maximum, 1RM) and a subsequent 4‐week training cessation period (detraining) on muscle strength and functional capacity in participants aged 90 and older. DESIGN: Randomized controlled trial performed during March to September 2009. SETTING: Geriatric nursing home. PARTICIPANTS: Forty nonagenarians (90–97) were randomly assigned to an intervention or control group (16 women and 4 men per group). INTERVENTION: Eight‐week muscle strength exercise intervention focused on lower limb strength exercises of light to moderate intensity. MEASUREMENTS: Primary outcome: 1RM leg press. Secondary outcomes: handgrip strength, 8‐m walk test, 4‐step stairs test, Timed Up and Go test, and number of falls. RESULTS: A significant group by time interaction effect (P=.02) was observed only for the 1RM leg press. In the intervention group, 1RM leg press increased significantly with training by 10.6 kg [95% confidence interval (CI)=4.1–17.1 kg; P=.01]. Except for the mean group number of falls, which were 1.2 falls fewer per participant in the intervention group (95% CI=0.0–3.0; P=.03), no significant training effect on the secondary outcome measures was found. CONCLUSION: Exercise training, even of short duration and light to moderate intensity, can increase muscle strength while decreasing fall risk in nonagenarians.     

Safety and feasibility of symptom-limited cardiopulmonary exercise test using the modified Naughton protocol in children with cerebral palsy: An observational study

Variables derived from the cardiopulmonary exercise test (CPX) provide objective information regarding the exercise capacity of children with cerebral palsy (CP), which can be used as the basis for exercise recommendations. Performing maximal CPX might not be appropriate, safe, or practical for children with CP. In the present study, the safety and feasibility of symptom-limited CPX using the modified Naughton protocol, a submaximal protocol, were investigated in children with CP, Gross Motor Function Classification System (GMFCS) level I or II. The present study included 40 children aged 6 to 12 years with CP who underwent symptom-limited CPX. CPX was performed to measure cardiopulmonary fitness using a treadmill with a modified Naughton protocol. Motor capacity was assessed using the Gross Motor Function Measure (GMFM), Pediatric Balance Scale (PBS), Timed Up and Go (TUG) test, and 6-minute walk test. Thirty-seven children with CP successfully completed testing without any adverse events during or immediately after CPX (dropout rate 7.5%). The reason for test termination was dyspnea (51.4%) or leg fatigue (48.6%). Based on the respiratory exchange ratio (RER), 21 of 37 (56.8%) children chose premature termination. The relationship between the reason for test termination and RER was not statistically significant (Spearman rho = 0.082, P = .631). CPX exercise time was strongly correlated with GMFM (Spearman rho = 0.714) and moderate correlation with PBS (Spearman rho = 0.690) and TUG (Spearman rho = 0.537). Peak oxygen uptake during CPX showed a weak correlation with GMFM and a moderate correlation with PBS. This study revealed that symptom-limited CPX using the modified Naughton protocol was safe and feasible for children with CP and GMFCS level I or II.     

The efficacy of counseling and progressive resistance home-exercises on adherence, health-related quality of life and function after discharge from a geriatric day-hospital

Loss of function and low exercise adherence is common among older people after hospitalization. The aim of this randomized-controlled trial was to evaluate the effects of a combined counseling- and exercise program on changes in health-related quality of life (HRQL) and physical function in patients attending a day hospital and continuing exercise at home. The exercise program consisted of counseling, balance- and progressive resistance training and support from the physical therapist at Geriatric Day-Hospital (GDH) and home for the Intervention-group. The Control-group received counseling, balance-training and support from the physical therapist. The sample was recruited from a GDH in Norway. 108 participants were randomized into the Intervention group (IT) (n=53) or the Control group (CT) (n=55). After 3 months 77 participants were tested. The intention to treat analysis showed that the program had significant benefits in terms of Health Related Quality of Life, measured by SF-36, on the domains vitality and bodily pain, in favor of the IT-group who performed the combined resistance exercises and balance program. All participants increased their scores on physical function, measured by Berg Balance Scale, Timed Up and Go, 5 times Sit-to-Stand, 6Min Walk Test and Activities Balance Confidence Scale, no group differences. Both groups were adherent to the home exercise program The results show that it is possible to facilitate older people to increase their HRQL, physical function and level of physical activity through counseling, exercise and support from physical therapists.     

Prevalence of lower extremity pain and its association with functionality and quality of life in elderly women in Australia

OBJECTIVE: To determine the prevalence of self-reported lower extremity pain and the impact on functionality and quality of life in a population based study of elderly women in Western Australia. METHODS: One thousand four hundred eighty-six women, 6.2% of 24,800 women aged over 70 in Perth, were recruited. An index of relative socioeconomic disadvantage (SES) was derived from postcode. Self-reported lower extremity pain at the hip, knee, and foot was collected by questionnaire. The frequency of lower extremity pain was classified into 5 groups. Mobility was measured by the Timed Up and Go Test (TUG). Quality of life was measured using the Medical Outcome Study Short Form 36 (SF-36) summary statistics: physical and mental component scores (PCS and MCS). RESULTS: The prevalence of women reporting any hip, knee, and foot pain was 39%, 52%, and 34% respectively. Fourteen percent experienced pain at all sites whereas 28% had no pain. There was no age difference between the various pain groups. Women with more pain were heavier and had higher BMI scores. At all lower limb sites, women with more frequent pain had reduced mobility and lower quality of life as measured by TUG, PCS, and MCS. For the TUG test, significant determinants in stepwise regression were age, BMI, knee and hip pain. For the SF-36 PCS, significant predictors were age, SES, BMI, and foot, knee, and hip pain. For the SF-36 MCS, SES and foot pain were significant predictors. CONCLUSIONS: Our results confirm the high prevalence of lower extremity pain in elderly women in Australia. Lower extremity pain significantly reduced both physical and mental aspects of the quality of life as well as mobility. In view of the availability of effective interventions to reduce joint pain, more aggressive intervention in the most disabled is indicated.     

Three-month follow up of patients discharged from a geriatric day hospital

OBJECTIVE: To determine if mobility and functional status of patients attending a geriatric day hospital are maintained three months after discharge. DESIGN: Prospective, before-after, quasi-experimental design. PARTICIPANTS: Community-dwelling elderly referred for comprehensive geriatric assessment and multidisciplinary management. METHODS: All patients who attended a geriatric day hospital for at least 5 visits and discharged between 1 August, 1999 and 1 March, 2000 were eligible (n = 41). Measurements were performed at admission, discharge and three months post-discharge. Data were analyzed using one way repeated measures ANOVA for parametric data and the Friedman-Chi square test for non-parametric data. OUTCOME MEASURES: Barthel Index, Timed Up and Go Test, Berg Balance Scale, Mini-Mental Status Examination, Geriatric Depression Scale. RESULTS: From admission to discharge, significant improvements were seen in Timed Up and Go Test, Berg Balance Scale, and Geriatric Depression Scale (all P相似文献   

Investigation of effectiveness of reformer pilates in individuals with fibromyalgia: A randomized controlled trial

Introduction and objectivesFibromyalgia (FM) is a chronic condition characterized by widespread pain, sleep disorder, fatigue, other somatic symptoms. Clinical pilates method is therapeutic modality that can be used in improving the symptoms. The aim of this study was to investigate the effectiveness of reformer pilates exercises in individuals with FM and to compare with home mat pilates.Material and methodsTwenty-eight women (age mean = 45.61 ± 10.31) diagnosed with FM were included in this study. Participants were randomly divided into two groups as reformer pilates group (n = 14) and home mat pilates group (n = 14). Reformer and home mat pilates exercises were given 2 times a week for 6 weeks. The number of painful regions with Pain Location Inventory (PLI), clinical status with Fibromyalgia Impact Questionnaire (FIQ), lower extremity muscle strength with Chair Stand Test, functional mobility with The Timed Up and Go Test (TUG), biopsychosocial status with Cognitive Exercise Therapy Approach-Biopsychosocial Questionnaire (BETY-BQ) and quality of life with Short Form-36 (SF-36) were evaluated. All evaluations were assessed before and after treatment.ResultsThere was a significant difference in FIQ and chair stand test in reformer pilates group, while in PLI, FIQ, BETY-BQ vs. SF-36 Physical Component in home group (p < 0.05) compared with baseline. There were no statistical differences between the groups in terms of delta value (p > 0.05).ConclusionsReformer pilates exercises had positive effects on clinical status and muscle strength while home mat pilates exercises had positive effects on the number of painful regions, clinical status, biopsychosocial status and physical component quality of life.Clinical trial registration number NCT04218630.     

Effects of a group-based exercise program on the physical performance,muscle strength and quality of life in older women

This study was aimed at determining the effect of a group-based exercise program on the physical performance, muscle strength and quality of life (QoL) in older women. Twenty women performed an exercise program for 8 weeks, at the rehabilitation unit. Outcome measures included a 4-m and 20-m walk test, a 6-min walk test, stair climbing and chair rise time, timed up and go test, isokinetic muscle testing of the knee and ankle, and the short form-36 (SF-36) and geriatric depression scale (GDS) questionnaires. The mean age of the study group was 70.3 ± 6.5 years. After the completion of the exercise program, all of the physical performance tests and the SF-36 scores for the participants showed statistically significant improvements (p < 0.05). In the isokinetic evaluations, most of angular velocities showed a significant increase in the peak torque (PT) values for knee extension and flexion, and for ankle plantar flexion (p < 0.05). We concluded that this exercise program, when applied to older women, resulted in improved physical performance, increased muscle strength measured in both the knee and ankle, and improvement in the scores, estimating the QoL. We have shown that this exercise program is both effective and reliable for this age group of women.     

Relevance of balance measurement tools and balance training for fall prevention in older adults

Approximately one in three older people fall each year owing to gait/balance disorder/weakness, the second leading cause of falls in older adults. This review evaluates the capability of different balance measurement tools to predict falls in the elderly, which are used routinely for assessing balance impairment. Balance measurement tools reviewed are the Timed Up and Go test, Berg Balance Scale, Tinetti Performance Oriented Mobility Assessment, Functional Reach Test, Clinical Test of Sensory Integration for Balance, and the postural sway measurements or center of pressure. The effect of balance training on the postural control mechanism and its efficacy in fall prevention in older adults were also reviewed. The current evidence is not conclusive enough to favor existing balance measurement tools and balance training implemented for fall prevention in older adults.     

Potential benefits of environmental volunteering programs of the health of older adults: a pilot study

PurposeTo study the effects of participating in a 12-week environmental volunteering program on the physical performance of older adults across different age groupsMaterials and MethodsWe conducted a pretest–posttest pilot study with a single group. The intervention consisted of twice-weekly recycling activities and once-weekly rehabilitation exercise at community-based care centers. The recycling activities of the environmental volunteering program included sorting and handling paper products, plastics, and metals; disposing electronic products; and sorting clothes. The rehabilitation exercise program comprised a 90-min course for special needs and 30 min of health education. The evaluation tools were the handgrip strength, five-times-sit-to-stand test, sit-and-reach test, Timed Up and Go (TUG) test and usual and fast gait speeds.ResultsIn total, 45 participants completed the program. After the program, the participants showed significantly great improvements compared to baseline in all outcome measures. We further divided these participants into two age subgroups [65–75 years (n = 31) and >75 years (n = 14)]. The 65–75-year subgroup only showed significant improvements in handgrip strength, TUG and usual gait speed. However, the >75-year subgroup showed significant improvements in all outcome measures.ConclusionsThis innovative environmental volunteering program conducted in a local Taiwanese community can be a sustainable and feasible model to improve physical performance in the participants, the subgroup aged >75 years in particular. It also provides a potential avenue for researchers and policymakers to address environmental and aging-related issues.     

Quality of Life,Dyspnea, and Functional Exercise Capacity Following a First Episode of Pulmonary Embolism: Results of the ELOPE Cohort Study

Background

We aimed to evaluate health-related quality of life (QOL), dyspnea, and functional exercise capacity during the year following the diagnosis of a first episode of pulmonary embolism.

Stroke: a randomized trial of exercise or relaxation

OBJECTIVES: To determine the feasibility and effect of exercise training after stroke. DESIGN: Randomized exploratory trial comparing exercise training (including progressive endurance and resistance training) with relaxation (attention control). SETTING: Interventions were performed in a rehabilitation hospital. PARTICIPANTS: Sixty-six independently ambulatory patients (mean age 72, 36 men) without significant dysphasia, confusion, or medical contraindications to exercise training who had completed their usual rehabilitation and had been discharged from hospital. INTERVENTION: Both interventions were held three times a week for 12 weeks. Up to seven patients attended each session. MEASUREMENTS: The Functional Independence Measure; Nottingham Extended Activities of Daily Living; Rivermead Mobility Index; functional reach; sit-to-stand; elderly mobility score; timed up-and-go; Medical Outcomes Study 36-Item Short Form Questionnaire, version 2 (SF-36); Hospital Anxiety and Depression Score; aspects of physical fitness (comfortable walking speed, walking economy, and explosive leg extensor power) were measured at baseline, immediately after interventions (3 months), and 7 months after baseline. RESULTS: The median number of intervention sessions attended was 36 (interquartile range (IQR) 30.00-36.75) for exercise and 36 (IQR 30.50-37.00) for relaxation. Adherence to the individual exercises ranged from 94% to 99%. At 3 months, role-physical (an item in SF-36), timed up-and-go, and walking economy were significantly better in the exercise group (analysis of covariance). At 7 months, role-physical was the only significant difference between groups. CONCLUSION: Exercise training for ambulatory stroke patients was feasible and led to significantly greater benefits in aspects of physical function and perceived effect of physical health on daily life.     

Self-monitored versus supervised walking programs for older adults

Walking is an effective, well accepted, inexpensive, and functional intervention. This study compared the outcomes and changes in walking behavior of self-monitored (SM) and supervised (SU) walking interventions for older adults.Participants were assigned to SM (n = 21) and SU (n = 21) walking groups according to their place of residence. Both groups exercised and wore a pedometer for 3 months.The outcome measures were step count, body mass index (BMI), and physical function. Two-way repeated-measure ANOVA and independent t tests were used to compare the intervention effects. We also plotted the trends and analyzed the walking steps weekly.Only BMI exhibited a group × time interaction. The pre-posttest differences showed knee extension muscle strength (KEMS) and Timed Up and Go test were significantly improved in the SM group, whereas BMI, KEMS, 30-s sit-to-stand, functional reach were significantly improved, but 5-m gait speed significantly slower in the SU group. For participants attending ≥50% of the sessions, those in the SM and SU groups had similar results for all variables, except for 2-min step (2MS) and daily walking step counts.Both self-monitored and supervised walking benefit older adults in most physical functions, especially lower-extremity performance, such as muscle strength, balance, and mobility. The effects of both programs do not differ significantly, except for BMI and 2MS (ie cardiopulmonary endurance). We recommend pedometer-assisted self-monitored walking for older adults because of its ability to cultivate exercise habits over the long term, whereas supervised walking to establish effective exercise intensity.     

Home‐based resistance training for older adults: A systematic review

Home‐based resistance exercise is commonly used for individuals who might not have access or the ability to use traditional resistance exercise. However, the extent to which home‐based resistance exercise can improve both strength and functional ability has not been investigated in healthy older individuals using a systematic analysis. The current article systematically reviewed the effectiveness of home‐based resistance exercise on strength and functional ability. Search engines included Academic Search Premier, CINAHL, PubMed, PsycINFO, MEDLINE, SPORTDiscus and Web of Science. A total of 649 articles were found using the key words “home‐based” and “strength” and “older” or “elderly”, with eight articles meeting the final criteria. The average age of the participants was 76 years, with the average duration of exercise training ranging from 8 weeks to 120 weeks. Of the eight studies, a significant increase in knee extension strength was found in five studies. Functional ability significantly improved in seven of the eight studies, with the average decrease in Timed Up & Go test being ?0.8 ± 0.5 s. Three studies included greater amounts of supervised visits compared with the other five studies (～51% vs ～7%). The more supervised studies had significant increases in strength and functional ability. Overall, home‐based resistance exercise can improve both strength and functional ability, but the improvements are generally small. The intensity of the exercises might not progress sufficiently enough to produce large improvements in strength as a result of less supervision or a lack of motivation to increase the intensity further. Geriatr Gerontol Int 2014; 14: 750–757.     

Footlift asymmetry during obstacle avoidance in high-risk elderly

OBJECTIVES: To test the hypothesis that vertical footlift asymmetries and low obstacle clearing distance during obstacle avoidance are characteristics of elderly people classified as high risk for falls. DESIGN: Controlled cross-sectional design with two conditions to cue selection of the foot-for-step initiation: sound cue and visual cue. SETTING: Senior independent living facilities. PARTICIPANTS: Eighteen community-dwelling elderly with a history of falling or prolonged Timed Up and Go score greater than 13.5 seconds, 16 elderly with no fall history and Timed Up & Go score of 13.5 seconds or less, and 15 younger subjects. MEASUREMENTS: Video kinematic analysis of bilateral footlift displacement and velocity using reflective markers as subjects stepped over foam obstacles scaled to a maximum tolerated height. RESULTS: High-risk elders contacted the obstacle more frequently and had significantly greater vertical footlift asymmetries adjusted for obstacle/subject height (mean+/-standard error asymmetry index for sound cue 3.25+/-0.42 cm, for visual cue 2.51+/-0.45 cm) than low-risk and younger subjects (P<.001). In low-risk elderly and younger subjects, the asymmetry index approached 0, which indicated symmetrical lower limb movements when stepping over the obstacles. CONCLUSION: High-risk elderly show a marked asymmetry in foot clearance while stepping over an obstacle, with the lag foot clearing the obstacle at a much lower distance than the lead foot. Possible mechanisms responsible for these findings (limited hip extension and deficits in executive cognitive function) are discussed.