Acute effects of walking at moderate normobaric hypoxia on gait and balance performance in healthy community-dwelling seniors: A randomized controlled crossover study

BackgroundHiking at moderate altitude is a popular outdoor activity in seniors. Acute exercise or altitude can diminish balance performance. Thus, the present study examined the combined effects of altitude and walking on static and dynamic balance.MethodsThirty-six healthy seniors (age: 62 (SD: 4) y; BMI: 25 (5) kg/m²) were examined on three days. Firstly, walking velocity was determined at 85% of the first ventilatory threshold (VT₁). Therefore, a ramp walking test on a treadmill was completed. On day two or three, a 40-minute treadmill walk under sea level or normobaric hypoxia (2600m) was performed using a random, double-blind study design. Balance performance was assessed on a force-plate during single leg stance with eyes open (SLEO, 10 s on a force-plate) immediately before and after walking. Spatio-temporal gait characteristics were collected during walking at 5 and 35 min.ResultsCondition × time interaction effects were not found for either parameter (0.13 < p < 0.60; 0.007< η_p² < 0.07). Only time effects were observed for cadence (−1.5%, p < 0.001, η_p² = 0.29), stride time (+2.3%, p = 0.007, η_p² = 0.28), and temporal gait variability (+22.6%, p = 0.01, η_p² = 0.16). A moderate time × condition effect was observed for postural sway during SLEO (p = 0.04, η_p² = 0.11). Subseqent post hoc testing revealed difference between hypoxia and normoxia at 35 min (p = 0.01) and between 5 and 35 min testing during hypoxia and normoxia (both p < 0.001).ConclusionAlterations of cadence, stride time, and temporal gait variability might be attributed to fatigue-induced changes of temporal gait adjustments. Normobaric hypoxia did not acutely impair gait patterns. We assume that demanding postural standing tasks that require more central control may be affected to a greater extent by altitude exposure.     

Effectiveness of exercise with or without thermal therapy for community-dwelling elderly Japanese women with non-specific knee pain: A randomized controlled trial

Knee pain is a common health problem in the elderly population, for which non-invasive treatments are recommended as a first line treatment in the management of knee pain. A randomized controlled trial was conducted to determine the effects of exercise with or without thermal therapy in community-dwelling elderly women with chronic knee pain. Women over 75 years of age with knee pain (n = 150) were randomly assigned into four groups; exercise (Ex) and heat/steam generating sheet (HSGS) (n = 38), Ex (n = 37), HSGS (n = 38), or health education (HE) (n = 37). The Ex group attended a 60-min comprehensive training program twice a week for 3-months. The HSGS group placed two sheets on the knee for five hours per day. Functional fitness, visual analog scale (VAS), and Japanese knee osteoarthritis measure (JKOM) were assessed at baseline and post-intervention. The results showed VAS improvements in the Ex + HSGS and HSGS groups. Total JKOM score, muscle strength, and functional mobility significantly improved in the Ex + HSGS group compared with the HE group. The odds ratio (OR) for VAS and functional mobility improvement was more than eight times as great in the Ex + HSGS group (OR = 8.60, 95% confidence interval (CI) = 2.82–32.73) compared with the education group. Ex or HSGS alone were insufficient in enhancing functional fitness or improving pain and quality of life. The combined effects of both Ex and heat therapy seems to have an added benefit of decreasing pain, improving physical function and increasing quality of life. Trial Registration Number: JMA-IIA00110.     

Effectiveness of exercise with or without thermal therapy for community-dwelling elderly Japanese women with non-specific knee pain: A randomized controlled trial

Knee pain is a common health problem in the elderly population, for which non-invasive treatments are recommended as a first line treatment in the management of knee pain. A randomized controlled trial was conducted to determine the effects of exercise with or without thermal therapy in community-dwelling elderly women with chronic knee pain. Women over 75 years of age with knee pain (n = 150) were randomly assigned into four groups; exercise (Ex) and heat/steam generating sheet (HSGS) (n = 38), Ex (n = 37), HSGS (n = 38), or health education (HE) (n = 37). The Ex group attended a 60-min comprehensive training program twice a week for 3-months. The HSGS group placed two sheets on the knee for five hours per day. Functional fitness, visual analog scale (VAS), and Japanese knee osteoarthritis measure (JKOM) were assessed at baseline and post-intervention. The results showed VAS improvements in the Ex + HSGS and HSGS groups. Total JKOM score, muscle strength, and functional mobility significantly improved in the Ex + HSGS group compared with the HE group. The odds ratio (OR) for VAS and functional mobility improvement was more than eight times as great in the Ex + HSGS group (OR = 8.60, 95% confidence interval (CI) = 2.82–32.73) compared with the education group. Ex or HSGS alone were insufficient in enhancing functional fitness or improving pain and quality of life. The combined effects of both Ex and heat therapy seems to have an added benefit of decreasing pain, improving physical function and increasing quality of life. Trial Registration Number: JMA-IIA00110.     

Effects of exercise and tea catechins on muscle mass,strength and walking ability in community‐dwelling elderly Japanese sarcopenic women: A randomized controlled trial

Aim: To investigate the effects of exercise and/or tea catechin supplementation on muscle mass, strength and walking ability in elderly Japanese women with sarcopenia. Methods: A total of 128 women aged over 75 years were defined as sarcopenic and randomly assigned into four groups: exercise and tea catechin supplementation (n = 32), exercise (n = 32), tea catechin supplementation (n = 32) or health education (n = 32). The exercise group attended a 60‐min comprehensive training program twice a week and the tea catechin supplementation group ingested 350 mL of a tea beverage fortified with catechin daily for 3 months. Body composition was determined by bioelectrical impedance analysis. Interview data and functional fitness measurements, such as muscle strength, balance and walking ability, were collected at baseline and after the 3‐month intervention. Results: There were significant group × time interactions observed in timed up & go (P < 0.001), usual walking speed (P = 0.007) and maximum walking speed (P < 0.001). The exercise + catechin group showed a significant effect (odds ratio 3.61, 95% confidence interval 1.05–13.66) for changes in the combined variables of leg muscle mass and usual walking speed compared with the health education group. Conclusions: The combination of exercise and tea catechin supplementation had a beneficial effect on physical function measured by walking ability and muscle mass. Geriatr Gerontol Int 2013; 13: 458–465 .     

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.     

The effects of a three-month exercise programme on neuropsychological function in elderly institutionalized women: a randomized controlled trial

This randomized controlled trial examined the effect of a 3-month exercise programme on neuropsychological function in a population of very elderly institutionalized women. Baseline neuropsychological testing was performed, and following 3 months of exercise or control intervention, subjects were retested 3-7 days after the completion of the study period. Apart from the Word Fluency Test, there was no significant improvement in any of the neuropsychological test scores. This study may not have shown any significant improvement in neuropsychological function because our exercise programme was too light to improve aerobic fitness, or because neuropsychological tests were repeated 3-7 days after exercise was completed and any acute effects of exercise may have disappeared by that time.     

Effect of different types of exercise on postural balance in elderly women: A randomized controlled trial

Different types of exercise are indicated for the elderly to prevent functional capacity limitations due to aging and reduce the risk of falls. This study aimed to evaluate the effect of three different exercises (mini-trampoline, MT; aquatic gymnastics, AG and general floor gymnastics, GG) on postural balance in elderly women. Seventy-four physically independent elderly women, mean age 69 ± 4 years, were randomly assigned to three intervention groups: (1) MT (n = 23), (2) AG (n = 28), and (3) GG (n = 23). Each group performed physical training, including cardiorespiratory, muscular strength and endurance, flexibility and sensory-motor exercises for 12 weeks. To determine the effects on each intervention group, five postural balance tasks were performed on a force platform (BIOMEC 400): the two-legged stand with eyes open (TLEO) and two-legged stand with eyes closed (TLEC); the semi-tandem stand with eyes open (STEO) and semi-tandem stand with eyes closed (STEC) and the one-legged stand. Three trials were performed for each task (with 30 s of rest between them) and the mean was used to compute balance parameters such as center of pressure (COP) sway movements. All modalities investigated such as the MT, AG and GG were significantly (P < 0.05) efficient in improving the postural balance of elderly women after 12 weeks of training. These results provide further evidence concerning exercise and balance for promoting health in elderly women.     

A randomized trial comparing Tai Chi with and without cognitive-behavioral intervention (CBI) to reduce fear of falling in community-dwelling elderly people

The aim of this randomized trial was to compare the effects of Tai Chi with and without CBI on a primary outcome of reducing the fear of falling, and on secondary outcomes including encouraging better social engagement, improving self-perceived personal wellbeing, and achieving better mobility among elderly people with fear of falling. One hundred and twenty-two community-dwelling elderly people aged ≥65 were randomly assigned to either a Tai Chi or a Tai Chi plus CBI group. Participants’ level of fear of falling, physical mobility, self-perceived personal wellbeing and social participation were compared before and after completing the 8-week intervention and then at a 2-month follow-up. The findings showed that Tai Chi both with and without CBI had a similar effect on reducing elderly people's fear of falling, but only Tai Chi plus CBI had a positive effect on participants’ self-perceived personal wellbeing. Tai Chi both with and without CBI had no effect on participants’ self-perceived social participation and mobility. Apart from a slight improvement in participants’ self-perceived personal wellbeing, other outcome effects were similar for Tai Chi with and without CBI. This finding raises a question about the additive effects of combined intervention over Tai Chi alone in reducing elderly people's fear of falling. In view of the higher demand for resources and manpower to implement a combined intervention, further study is still required to confirm the potential additional benefits of this combined intervention prior to recommending it to community services.     

Effectiveness of multidimensional exercises for the treatment of stress urinary incontinence in elderly community-dwelling Japanese women: a randomized, controlled, crossover trial

OBJECTIVES: To evaluate the effectiveness of pelvic floor muscle (PFM) and fitness exercises in reducing urine leakage in elderly women with stress urinary incontinence (UI).
DESIGN: Randomized, crossover, follow-up trial.
SETTING: Urban community in Japan.
PARTICIPANTS: Seventy women aged 70 and older who reported urine leakage one or more times per month; 35 were randomly assigned to intervention and the other 35 to control.
INTERVENTION: The intervention group attended an exercise class aimed at enhancing PFMs and fitness. Duration of the exercise was 60 minutes per session twice a week for 3 months. After 3 months of exercise, the intervention group was followed for 1 year.
MEASUREMENTS: Body mass index (BMI), urine leakage, walking speed, and muscle strength were measured at baseline, after the intervention, and at follow-up.
RESULTS: In the intervention group, maximum walking speed and adductor muscle strength increased significantly after the intervention; there were no significant changes in the control group. After 3 months of exercise, 54.5% of the intervention group and 9.4% of the control group reported being continent. Within the cured group of UI, a significantly higher proportion had decreased their BMI at 3 months ( P =.03) and increased walking speed at 3 ( P =.04) and 12 ( P =.047) months.
CONCLUSION: Decrease in BMI and increase in walking speed may contribute to the treatment of UI, although the data do not support a positive correlation between strengthening of adductor muscle and improvement of UI, which needs more research.     

The effects of multidimensional exercise on functional decline, urinary incontinence, and fear of falling in community-dwelling elderly women with multiple symptoms of geriatric syndrome: A randomized controlled and 6-month follow-up trial

This study assessed the effects of multidimensional exercises on functional decline, urinary incontinence, and fear of falling in community-dwelling Japanese elderly women with multiple symptoms of geriatric syndrome (MSGS). Sixty-one participants were randomly assigned either to an intervention (n = 31) or to a control group (n = 30). For 3-month period, the intervention group received multidimensional exercise, twice a week, aiming to increase the muscle strength, walking ability, and pelvic floor muscle (PFM). Outcome variables were measured at baseline, and after intervention and follow-up. The functional decline of the intervention group decreased from 50.0% at baseline to 16.7% after intervention and follow-up (Q = 16.67, p < 0.001). For urinary incontinence, the intervention group decreased from 66.7% at baseline to 23.3% after intervention and 40.0% at follow-up (Q = 13.56, p = 0.001), whereas the control group showed no improvement. Intervention group showed greater and significant decrease in the score of MSGS compared to control group (F = 12.66, p = 0.001). Within the subjects that showed improvement to normal status of MSGS, a significantly higher proportion demonstrated increased maximum walking speed at follow-up (Q = 6.50, p = 0.039). These results suggest that multidimensional exercise is an effective strategy for reducing geriatric syndromes in elderly population. An increase in walking ability may contribute to the improvement of MSGS.     

The effects of plantar perception training on balance and falls efficacy of the elderly with a history of falls: A single-blind,randomized controlled trial

PurposeThe purpose of this study was to identify the effects of plantar perception training using a hardness discrimination task on balance and falls efficacy of the elderly who have experienced a fall.Materials and methodsSixty-two elderly persons 65 years of age or older were randomly allocated to the experimental group (n = 31) or the control group (n = 31). The experimental group performed a hardness discrimination task using five different levels of hardness of sponge mats, while the control group performed the same task except that they were not asked to discriminate hardness levels of sponge mats. All subjects performed 10 sessions for two weeks. Outcome measures were conducted using center of pressure (CoP) sway in the standing position, the Timed Up and Go (TUG) test, and falls efficacy scale (FES) to measure balance and falls efficacy.ResultsThere were no significant differences in general characteristics between both groups (p > .05). After 10 sessions, plantar perception was significantly improved in the experimental group (F = 101.18, p < .001). Additionally, changes in CoP sway with eye closed and TUG test were significantly different (p < .05) between the experimental group (CoP sway with eye closed, −208.32 ± 74.89; TUG test, −1.91 ± 0.72) and the control group (CoP sway with eye closed, −14.55 ± 35.44; TUG test, −1.31 ± 0.75).ConclusionsThese results showed that plantar perception training might be beneficial to improve falls efficacy as well as balance of the elderly.     

An evidence-based walking program among older people with knee osteoarthritis: the PEP (participant exercise preference) pilot randomized controlled trial

Knee osteoarthritis is a common joint problem leading to an increase of pain and a loss of function in older individuals. The main objective of this study was to evaluate if a participant who was randomly assigned to his preferred group improved his adherence to an effective walking program compared to a participant who did not receive his preferred group. This was a 9-month pilot randomized clinical trial, based on a patient treatment preferences design. The 69 eligible participants had a diagnosis of knee osteoarthritis. Participants were randomized to one of two groups: a supervised community-based or unsupervised walking program, based on the Ottawa Panel guidelines. At 6 months, participants who expressed a preference, either for the supervised or unsupervised program, and who were assigned to their preferred choice of program showed significantly higher adherence to walking sessions (supervised 60.7 ± 12.3%, P < 0.0001; unsupervised 43.1 ± 12.1%, P = 0.03), compared to the participants who did not obtain their preferred choice of program. After 9 months, significant improvements were shown according to the level of stiffness evaluated with the WOMAC (P = 0.01) and the functional status assessed with the Timed Up and GO Test (P = 0.04), among the adherent participants who obtained their preference, as compared to those who did not receive their preference. We show this approach promotes long-term adherence to a community-based walking program, while ensuring the maintenance of clinical benefits of walking, among older adults susceptible to avoid or not properly engage in physical activity.     

Six weeks of combined aerobic and resistance exercise using outdoor exercise machines improves fitness,insulin resistance,and chemerin in the Korean elderly: A pilot randomized controlled trial

BackgroundThe aim of this study was to investigate the effect of a six-week-long exercise program using outdoor exercise equipment on fitness, insulin resistance and adipocytokines among Korean elderly.MethodsA total of 47 participants were randomized into one of the following three groups; control, resistance exercise or combined exercise (aerobic and resistance exercise). The resistance exercise group completed three resistance types of exercise. The combined exercise group completed five exercises, including three resistance types of exercise and two aerobic types of exercise. Participants’ body composition, fitness level, homeostasis model assessment of insulin resistance (HOMA-IR), and adipocytokines were measured at baseline and at the end of six weeks.ResultsAfter six weeks of exercise training, participants in the combined exercise group exhibited significant reduction in insulin, HOMA-IR and chemerin levels, while significant reduction was observed in HOMA-IR only in the resistance exercise group compared with the control group. Meanwhile, six weeks of exercise training, whether resistance exercise alone or combined, significantly improved upper body muscular strength/endurance and physical function compared to the control group.ConclusionsSix weeks of combined exercise using outdoor exercise equipment was effective in improving fitness, HOMA-IR, circulating chemerin levels, and other known risk factors of chronic diseases.     

The effects of breaking sedentary time with different intensity exercise bouts on energy metabolism: A randomized cross-over controlled trial

Background and aimsBreaking up sedentary periods, particularly with light activity, increases total energy expenditure (EE), and helps provide better glycemic control. However, the effects of activities of various intensities to interrupt prolonged sedentary time are unclear. The purpose of the present study was to examine potential differences in glycemic control and EE from breaking up sedentary time with short exercise bouts of different intensities.Methods and resultsNine overweight/obesity young men underwent whole body indirect calorimetry at 19:00 on day 1 and stayed overnight. After awakening on day 2, they performed short duration jogging every 30 min over 8 h (16-time bouts in total) under 3 different conditions with the same running distance: (1) lactate threshold (LT) for 2 min, (2) 60% LT for 200 s, and (3) onset of blood lactate accumulation (OBLA) for 75 s. The 24-h EE and interstitial glucose concentration (from 8:00 to 19:00 on day 2) was continuously measured throughout the trials. The standard deviation during intervention and indexes of postprandial of the interstitial glucose concentration was significantly lower at LT and OBLA than at 60% LT (p < 0.05). The 24-h EE was not significantly different among conditions, but EE at OBLA during intervention was slightly but significantly higher than at 60% LT and LT.ConclusionBreaking up sedentary time with short-duration jogging at LT and with OBLA intensities may have better glycemic control and increased use of carbohydrate as a fuel, while short-duration a jogging at OBLA intensity may increase EE.Trial registrationUMIN000041361.     

妊娠期肝内胆汁淤积症女性使用熊去氧胆酸治疗与安慰剂比较:一项随机对照试验

【据《Lancet》2019 年9 月报道】题:妊娠期肝内胆汁淤积症女性使用熊去氧胆酸治疗与安慰剂比较:一项随机对照试验(作者Chappell LC 等)妊娠期肝内胆汁淤积症的特征是产妇瘙痒和血清胆汁酸浓度升高,与死产、早产和新生儿入院率增加有关。熊去氧胆酸是被广泛应用的治疗方法,但是没有充分的证据基础。     

The effects of helium-hyperoxia on 6-min walking distance in COPD: a randomized, controlled trial

BACKGROUND: We hypothesized that breathing helium-hyperoxia (HeO2) would significantly improve 6-min walking test (6MWT) distance in COPD subjects. METHODS: This was a blinded, randomized crossover study. At visit 1, we assessed pulmonary function, exercise capacity, and 6MWT distance. Visits 2 and 3 consisted of four 6MWTs in which the following different inspired gases were used: room air (RA) by mask; 100% O2 by mask (mask O2); 100% O2 by nasal prongs (nasal O2); and 70% He/30% O2 by mask (HeO2). Walking distance, shortness of breath, leg fatigue, O2 saturation, and heart rate (HR) were assessed. RESULTS: Sixteen COPD subjects participated (mean FEV(1)/FVC ratio [+/- SD], 48 +/- 8%; mean FEV1, 55 +/- 13% predicted). Subjects walked farther when breathing HeO2 (564 m) compared to RA (497 m; p < 0.001), mask O2 (520 m; p < 0.001), or nasal O2 (528 m; p < 0.001). Despite the increased distance walked while breathing HeO2, there was no increase in shortness of breath or leg fatigue. There was desaturation when breathing RA (8%; p < 0.001) and nasal O2 (5%; p < 0.001), which was reduced when breathing HeO2 (3%; difference not significant) and mask O(2) (0%; difference not significant). There were no significant differences in HR in the four 6MWTs. CONCLUSIONS: The use of HeO2 increased 6MWT distance in COPD subjects more than either mask O2 or nasal O2 compared to RA. The increased walking distance was not associated with increased shortness of breath or leg fatigue. The results suggest that clinical benefit would be obtained by administering HeO2 during exercise, which may have significant clinical implications for the management of COPD patients.