Perturbation exercises during treadmill walking improve pelvic and trunk motion in older adults—A randomized control trial

BackgroundMost falls among older adults occur while walking. Pelvic and trunk motions are required to maintain stability during walking. We aimed to explore whether training that incorporates unexpected loss of balance during walking that evokes balance recovery reactions will improve pelvic, thorax, and trunk kinematics at different walking speeds.MethodsFifty-three community-dwelling older adults (age 80.1 ± 5.6 years) were randomly allocated to an intervention group (n = 27) or a control group (n = 26). Both groups received 24 training sessions over 3 months. The intervention group received unexpected perturbation of balance exercises during treadmill walking, while the control group performed treadmill walking only. The primary outcome measures were the pelvic, thorax, and trunk motion. The secondary outcome measures were stride times, length, and width.ResultsCompared to control, participation in the intervention program led to improvement in pelvic and trunk transverse rotations especially at participants’ preferred walking speed. No improvement where found in pelvic list while thorax transverse rotation improved in both groups.ConclusionsPelvic and trunk transverse motion, parameters previously reported to deteriorate during aging, associated with gait stability and a risk factor for falls, can be improved by gait training that includes unexpected loss of balance.     

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.     

Impact of using a pedometer on time spent walking in older adults with type 2 diabetes

PURPOSE: The purpose of this study was to investigate the impact of using a pedometer on time spent walking, in sedentary and overweight adults with type 2 diabetes participating in a coaching intervention. It was hypothesized that participants using a pedometer would spend more time walking than would nonpedometer participants. Method A sample of 57 men and women with a mean age of 62 years participated in a randomized controlled trial in a community setting. Participants were allocated to either a pedometer and coaching (intervention) group or a coaching-only (control) group. Coaching for both groups involved education, goal setting, and supportive/motivational strategies to increase time spent walking. The duration of the study was 6 months, with blood pressure, glycosylated hemoglobin, anthropometric, and fitness measurements assessed at baseline and at 3-month intervals. RESULTS: A repeated-measures analysis of variance indicated that the coaching-only group spent significantly more time walking than did the pedometer group. However, when an analysis of covariance with all the other variables as covariates was performed, group membership had no influence on time spent walking. Significant reductions in waist circumference and weight were achieved for both groups from baseline to 6 months. Cardiovascular fitness also increased significantly for both groups. CONCLUSION: The study demonstrated that previously sedentary older adults with type 2 diabetes, supported with a coaching intervention, were able to achieve the physical activity targets known to be beneficial to health. However, using a pedometer added no further benefit. Further research on the impact of specific coaching strategies in diabetes management is warranted.     

Effects of sensorimotor adaptation training on functional mobility in older adults

The goal of this study was to determine if prolonged exposure to perceptual-motor mismatch increased adaptability and retention of balance in older adults. Sixteen adults, aged 66 to 81 years, were randomized to one of two groups: either the control group (n=8) or the experimental group (n=8). Both groups first completed six trials of walking an obstacle course. Participants then trained twice a week for 4 weeks. In the training, the control group walked on a treadmill for 20 minutes while viewing a static visual scene and the experimental group walked on a treadmill for 20 minutes while viewing a rotating visual scene that provided a perceptual-motor mismatch. Following training, both groups were post-tested on the obstacle course. The experimental group moved faster through the obstacle course with fewer penalties. This training effect was retained for 4 weeks. Exposure to perceptual-motor mismatch induced an adaptive training effect that improved balance and locomotor control in older adults.     

Trail‐Walking Exercise and Fall Risk Factors in Community‐Dwelling Older Adults: Preliminary Results of a Randomized Controlled Trial

OBJECTIVES: To evaluate the effects of a trail‐walking exercise (TWE) program on the rate of falls in community‐dwelling older adults. DESIGN: Pilot randomized controlled trial (RCT). SETTING: This trial was conducted in Japan and involved community‐dwelling older adults as participants. PARTICIPANTS: Sixty participants randomized into a TWE group (n=30) and a walking (W) group (n=30). INTERVENTION: Exercise class combined with multicomponent trail walking program, versus exercise class combined with simple indoor walking program. MEASUREMENT: Measurement was based on the difference in fall rates between the TWE and W groups. RESULTS: Six months after the intervention, the incidence rate ratio (IRR) of falls for the TWE group compared with the W group was 0.20 (95% confidence interval (CI)=0.04–0.91); 12 months after the intervention, the IRR of falls for the TWE group compared with the W group was 0.45 (95% CI=0.16–1.77). CONCLUSION: The results of this pilot RCT suggest that the TWE program was more effective in improving locomotion and cognitive performance under trail‐walking task conditions than walking. In addition, participants who took part in the TWE demonstrated a decrease in the incidence rate of falls 6 months after trial completion. Further confirmation is needed, but this preliminary result may promote a new understanding of accidental falls in older adults.     

Effects of once weekly dual‐task training in older adults: A pilot randomized controlled trial

Aim: To compare single‐task and dual‐task training on obstacle avoidance, gait speed and balance in healthy community‐dwelling older adults. Methods: A total of 17 older adults (65–83 years) participated in a group circuit class, once weekly for 45 min for 4 weeks. The dual‐task group carried out cognitive activities simultaneously with gait and balance exercises. The single‐task training group carried out identical gait and balance activities without cognitive tasks. We assessed time to complete a 6‐m obstacle course under single‐task and three different dual‐task conditions (spontaneous speech, alphabet recitation and coin transfer), 25‐ft gait speed, Timed Up and Go, and the Activities‐specific Balance Confidence Scale. Results: Both groups showed significant improvement in gait speed and Timed Up and Go. In addition, the proportion of participants who achieved gait speed >1.0 m/s increased in both groups. There were no within‐ or between‐subjects differences in obstacle course performance under single or dual‐task conditions after the intervention. Conclusion: Once weekly group circuit training focusing on balance, gait and agility, with or without simultaneous cognitive tasks, resulted in significantly improved walking speed among older adults. Group‐format dual‐task training once per week did not improve walking time or dual‐task cost on an obstacle negotiation task. Geriatr Gerontol Int 2012; ??: ??–??.     

Physical activity combined with resistance training reduces symptoms of frailty in older adults: A randomized controlled trial

IntroductionIncreased physical activity (PA) is a crucial factor in the prevention of physical deterioration, and resistance training (RT) is also a common and effective intervention for older adults. However, the effects of PA as an adjunct to RT on frailty status remains unclear; therefore, we clarified the effect of a PA intervention with feedback, as an adjunct to resistance strength training, on the physical and mental outcomes of frail older adults.Materials and methodsWe employed a randomized controlled trial. Community-dwelling frail older adults in Japan were recruited to participate. Forty-one participants (mean age 81.5) were randomly assigned to engage in a resistance training with PA (RPA group) or RT group for six months. Frailty status and frailty scores, which were measured according to the Cardiovascular Health Study criteria—muscle strength, mobility, instrumental activities of daily living, and health-related quality of life—were assessed.ResultsParticipants in the RPA group exhibited a significant increase in light-intensity PA, the number of steps taken daily (p < 0.05), and lower-limb muscle strength (p < 0.05) and a significant decrease in frailty scores. However, pre- and postintervention frailty status, instrumental activities of daily living, and health-related quality of life did not differ significantly.ConclusionsImplementation of a PA intervention as an adjunct to RT is feasible, as it reduced frailty scores and increased lower-limb muscle strength and mobility in older adults with frailty symptoms.     

Effects of dual-task switch exercise on gait and gait initiation performance in older adults: preliminary results of a randomized controlled trial

Few studies have reported the effect of exercise intervention for improving postural control deficit in older adults at high risk of falling. We have developed a "Dual-task Switch Exercise (DSE)" program that focuses on gait initiation performance under the dual-task condition. The purpose of this study was to evaluate whether gait initiation performance could be improved by a specific exercise intervention. Eighteen participants were randomly assigned to either DSE or control groups. The DSE group received focused training to improve the ability to initiate movements quickly under the dual-task condition. The control group received steady-state walking training. After 30-min of seated training sessions, participants received 5-min individualized training sessions once a week for 24 weeks. In the pre- and post-training period, performance of the steady-state gait (10-m walking time) and gait initiation (reaction time, backward center of pressure (COP) displacement) were measured under the single- and dual-task conditions. The results of a randomized clinical trial showed that both groups showed improvement of steady-state walking time under the dual-task condition (main effect of time; p=0.018). However, DSE was more effective in improving both the reaction time and backward COP displacement during gait initiation under the dual-task condition than control (interaction effect of time×group; reaction time, p=0.015; COP displacement, p=0.011). There were no significant differences in steady-state gait and gait initiation performance under the single-task condition between pre- and post-training in both groups. Only the specific exercise intervention improved gait initiation performance under the dual-task condition.     

Impact of the fit and strong intervention on older adults with osteoarthritis

PURPOSE: This study assessed the impact of a low cost, multicomponent physical activity intervention for older adults with lower extremity osteoarthritis. DESIGN AND METHODS: A randomized controlled trial compared the effects of a facility-based multiple-component training program followed by home-based adherence (n = 80) to a wait list control group (n = 70). Assessments were conducted at baseline and at 2 and 6 months following randomization. The training program consisted of range of motion, resistance training, aerobic walking, and education-group problem solving regarding self-efficacy for exercise and exercise adherence. All training group participants developed individualized plans for posttraining adherence. RESULTS: Relative to the persons in the control group, individuals who participated in the exercise program experienced a statistically significant improvement in exercise efficacy, a 48.5% increase in exercise adherence, and a 13.3% increase in 6-min distance walk that were accompanied by significant decreases in lower extremity stiffness at 2 and 6 months. Program participants also experienced a significant decrease in lower extremity pain and a borderline significant improvement in efficacy to adhere to exercise over time at 6 months (p =.052). In contrast, persons in the control group deteriorated over time on the efficacy and adherence measures and showed no change on the other measures. No adverse health effects were encountered. IMPLICATIONS: These benefits indicate that this low-cost intervention may hold great promise as one of a growing number of public health intervention strategies for older adults in the United States with osteoarthritis.     

Multiple roads lead to Rome: combined high-intensity aerobic and strength training vs. gross motor activities leads to equivalent improvement in executive functions in a cohort of healthy older adults

The effects of physical activity on cognition in older adults have been extensively investigated in the last decade. Different interventions such as aerobic, strength, and gross motor training programs have resulted in improvements in cognitive functions. However, the mechanisms underlying the relationship between physical activity and cognition are still poorly understood. Recently, it was shown that acute bouts of exercise resulted in reduced executive control at higher relative exercise intensities. Considering that aging is characterized by a reduction in potential energy (V·O2 max − energy cost of walking), which leads to higher relative walking intensity for the same absolute speed, it could be argued that any intervention aimed at reducing the relative intensity of the locomotive task would improve executive control while walking. The objective of the present study was to determine the effects of a short-term (8 weeks) high-intensity strength and aerobic training program on executive functions (single and dual task) in a cohort of healthy older adults. Fifty-one participants were included and 47 (age, 70.7 ± 5.6) completed the study which compared the effects of three interventions: lower body strength + aerobic training (LBS-A), upper body strength + aerobic training (UBS-A), and gross motor activities (GMA). Training sessions were held 3 times every week. Both physical fitness (aerobic, neuromuscular, and body composition) and cognitive functions (RNG) during a dual task were assessed before and after the intervention. Even though the LBS-A and UBS-A interventions increased potential energy to a higher level (Effect size: LBS-A—moderate, UBS-A—small, GMA—trivial), all groups showed equivalent improvement in cognitive function, with inhibition being more sensitive to the intervention. These findings suggest that different exercise programs targeting physical fitness and/or gross motor skills may lead to equivalent improvement in cognition in healthy older adults. Such results call for further investigation of the multiple physiological pathways by which physical exercise can impact cognition in older adults.     

Exploring the Role of Virtual Reality to Support Clinical Diabetes Training—A Pilot Study

Background:It is estimated that 16 to 25% of patients in hospital have diabetes and 1 in 25 inpatients with Type 1 Diabetes develop diabetic ketoacidosis (DKA). It is vital that non-specialist doctors recognize and appropriately manage diabetes emergencies. Simulation training is increasingly being used in healthcare and virtual reality (VR) based educational resources is transforming medical education. This study aimed to evaluate the use of virtual reality to help non-specialist clinicians manage clinical scenarios related to diabetes.Methods:This pilot project, titled ‘DEVICE’ (Diabetes Emergencies: Virtual Interactive Clinical Education) was developed in collaboration with Oxford Medical Simulation. Fully interactive immersive VR scenarios were created to stimulate real life diabetes emergencies. Users then received personalized feedback and performance metrics. Feedback surveys were provided before and after the participation in the VR scenario. Kirkpatrick’s training evaluation model was used.Results:Thirty-nine participants from 2 hospitals in UK provided feedback up to 3 months after attending the VR education sessions. Overall feedback was extremely positive, and participants found this immersive teaching experience very helpful. After use of virtual reality scenarios, the mean trainee confidence in managing DKA (on an 8-point Likert scale) increased from 3.92 (3.38-4.47) 95% CI to 5.41 (4.79-6.03) 95% CI (statistically significant). The VR study demonstrates Kirkpatrick level 3 in the follow up survey.Conclusion:VR based training scenarios in this pilot project increased confidence in managing diabetes emergencies and demonstrated positive changes in their behavior. VR education is a safe, useful and a well-liked training tool for diabetes emergencies.     

Floor-rise strategy training in older adults

OBJECTIVES: To determine the effect of a 2-week (six-session) training intervention to improve the ability of disabled older adults to rise from the floor. DESIGN: Prospective intervention trial. SETTING: Congregate housing in Michigan. PARTICIPANTS: Subjects aged 65 and older who admitted to requiring assistance (such as from a person, equipment, or device) in performing at least one of the following mobility-related activities of daily living: transferring, walking, bathing, and toileting. INTERVENTION: Participants were randomly allocated to individual training (n = 17, mean age 81) in strategies to rise from the floor (using for example, certain key intermediate body positions) or a control chair-based flexibility intervention (n = 18, mean age 80). MEASUREMENTS: At baseline and postintervention, residents were queried regarding their rise difficulty (difficulty scale) and symptoms (symptoms scale) associated with the rise and were tested in their ability to perform timed floor-rise tasks. These tasks varied in starting position (supine vs all fours) and in use of a support to assist in rising (no support, use of an end table, use of a chair). RESULTS: Using baseline performance as the covariate, by analysis of covariance (ANCOVA), the training group showed a significant (P <.05) improvement in mean number of rise tasks completed (baseline mean 6.6, postintervention mean 7.3) versus essentially no improvement in the controls. Similarly, by ANCOVA, the training group (compared with controls) showed a significant (P <.05) improvement on the difficulty and symptoms scales. There was no intervention effect for rise time. CONCLUSIONS: A short-term, strategy-based intervention improved floor-rise ability and perceived difficulty and symptoms associated with the rise. This approach, focusing on key intermediate body positions, may be useful in training floor-rise skills, particularly in older adults at risk for falls.     

Knee strength maintained despite loss of lean body mass during weight loss in older obese adults with knee osteoarthritis

BACKGROUND: The effects of weight loss on muscle function in older adults have not been well studied. This study determined the effects of a 6-month weight-loss intervention on muscle strength and quality in older obese adults with knee osteoarthritis. METHODS: Participants were randomized to a weight loss (WL) (n = 44, 70 +/- 6 years) or weight stable (WS) (n = 43, 69 +/- 6 years) group. The WL intervention consisted of weekly educational meetings, a meal replacement diet, and a three-session-per-week structured exercise program to achieve 10%-12% weight loss. The WS intervention included bimonthly group meetings and newsletters. Body composition and knee extensor strength were measured at baseline and after intervention. RESULTS: The WL group decreased body weight, lean body mass, fat mass, and percent body fat (p <.001 for all). Concentric extension strength increased 25% in WL (p >.05), whereas eccentric extension decreased 6% in WS (p =.028). Concentric muscle quality (strength per kg body weight or lean body mass) increased in WL (p <.05), whereas eccentric muscle quality decreased in WS (p <.05). Changes in lean body mass and fat mass were inversely associated with changes in most muscle strength and quality measures (p <.05). Men and women did not differ in response to the intervention in knee strength outcomes. CONCLUSIONS: Hypocaloric dieting in combination with exercise training had beneficial effects on muscle strength/quality, despite loss of lean body mass in this sample of older men and women. Greater fat loss was associated with greater gains in muscle strength and quality. More studies are needed regarding the mechanisms by which loss of fat mass increases muscle strength and quality.     

Effects of long-term resistive training on mobility and strength in older adults with diabetes

BACKGROUND: Strength training has been shown to be beneficial in older adults. However, very little data exist on the effects of strength training in older diabetics. METHODS: 31 community-dwelling older adults with diabetes (mean age = 66.1 years) were randomly assigned to either an exercise (EX) or control (CO) group. The EX group trained the plantar flexors, knee extensors, knee flexors, hip extensors, and hip flexors muscle groups at 50%, 60%, and 70% of 1-repetition maximum, 2.6 days a week, for 24 months. Mobility tests included the timed up and go, 50-foot walk, and walking up and down 8 stairs. Strength and mobility for both groups were evaluated at 6-month intervals. RESULTS: There was a group and time effect as the EX group increased 31.4% (p <.001) in strength for all muscle groups after the first 6 months of training, and the strength gains were retained for the duration of the training intervention. There was also a group and time effect for mobility as performance increased 8.6% and 9.8% (p =.032 and p = 0.031) for the first 6 and 12 months, respectively, but decreased to 4.6% above baseline at the end of the intervention. There were essentially no changes from baseline strength or mobility values for the CO group. CONCLUSION: In conclusion, these data suggest that a moderate-intensity resistive-training program can improve mobility and strength for the duration of a 24-month intervention in older adults with diabetes, thus potentially reducing the rate of mobility loss during aging.     

Tai chi practice reduces movement force variability for seniors

BACKGROUND: The purpose of this study was to examine whether Tai Chi practice can reduce the inconsistency of arm movement force output in older adults. METHODS: Twenty seniors took part in the 8-week-long exercise intervention program (12 in Tai Chi practice, M = 79.3 years, SD = 2.4; and 8 in a locomotor activity group, walking or jogging, M = 79.5 years, SD = 1.9). Linear and curvilinear manual aiming movements were tested at the beginning (pretest), during 4th week (retest), and the end of the exercise program (post-test). The measure of vertical pressure on the surface of a tablet served as the dependent variable. RESULTS: The findings suggest that the Tai Chi participants significantly reduce more pressure variability than the participants in locomotor activity group after 8 weeks of practice. Additionally, seniors produced higher pressure variability in the curvilinear task than in the linear task. CONCLUSIONS: Evidence from this study proposes that Tai Chi practice may serve as a better real world exercise for reducing force variability in older adults' manual performance.     

Power training improves balance in healthy older adults

BACKGROUND: Age-related decline in muscle power may be an early indicator of balance deficits and fall risk, even in nonfrail adults. This study examined the dose-dependent effect of power training on balance performance in healthy older adults. METHODS: One hundred twelve community-dwelling healthy older adults (69 +/- 6 years) were randomized to 8-12 weeks of power training at 20% (LOW), 50% (MED), or 80% (HIGH) of maximal strength, or a nontraining control (CON) group. Participants trained twice weekly (five exercises; three sets of eight rapid concentric/slow eccentric repetitions) using pneumatic resistance machines. Balance, muscle performance (strength, power, endurance, contraction velocity), and body composition were measured. RESULTS: Power training significantly improved balance performance (p =.006) in participants who underwent power training compared to controls. Low intensity power training produced the greatest improvement in balance performance (p =.048). Average contraction velocity at low load (40% one repetition maximum [1RM]) at baseline independently predicted improvement in balance following training (r = -.29, p =.004). CONCLUSIONS: Power training improves balance, particularly using a low load, high velocity regimen, in older adults with initial lower muscle power and slower contraction. Further studies are warranted to define the mechanisms underlying this adaptation, as well as the optimum power training intensity for a range of physiological and clinical outcomes in older adults with varying levels of health status and functional independence.     

Long-term exercise and its effect on balance in older, osteoarthritic adults: results from the Fitness, Arthritis, and Seniors Trial (FAST)

OBJECTIVES: To examine the effects of 18-month aerobic walking and strength training programs on static postural stability among older adults with knee osteoarthritis. DESIGN: Randomized, single-blind, clinical trial of therapeutic exercise. SETTING: Both center-based (university) and home-based. PARTICIPANTS: A cohort of 103 older adults (age = 60 years) with knee osteoarthritis who were participants in a large (n = 439) clinical trial and who were randomly assigned to undergo biomechanical testing. INTERVENTION: An 18-month center- (3 months) and home-based (15 months) therapeutic exercise program. The subjects were randomized to one of three treatment arms: (1) aerobic walking; (2) health education control; or (3) weight training. MEASUREMENTS: Force platform static balance measures of average length (Rm) of the center of pressure (COP), average velocity (Vel) of the COP, elliptical area (Ae) of the COP, and balance time (T). Measures were made under four conditions: eyes open, double- and single-leg stances and eyes closed, double- and single-leg stances. RESULTS: In the eyes closed, double-leg stance condition, both the aerobic and weight training groups demonstrated significantly better sway measures relative to the health education group. The aerobic group also demonstrated better balance in the eyes open, single-leg stance condition. CONCLUSIONS: Our results suggest that long-term weight training and aerobic walking programs significantly improve postural sway in older, osteoarthritic adults, thereby decreasing the likelihood of larger postural sway disturbances relative to a control group.     

Sit-to-stand as home exercise for mobility-limited adults over 80 years of age--GrandStand System may keep you standing?

PURPOSE: To compare the effects of functional home exercise of repeated sit-to-stands with low-intensity progressive resistance training, on performance measures in mobility-limited adults over 80 years of age. SETTING: Participants' homes. DESIGN: Community-dwelling older adults > or =80 years of age were invited to participate in a randomised controlled clinical trial. Baseline and outcome measures were: comfortable gait velocity, 30-s chair-stand test, 15-s step test, Berg Balance Scale, Modified Falls Efficacy Scale and the Late-Life Function and Disability Instrument-function component. Participants randomised to the intervention group performed repeated sit-to-stands using a GrandStand System; a biofeedback device that recorded and displayed the number of repetitions performed. Participants randomised to the control group performed knee extensions using ankle cuff weights. Both groups performed the exercises daily for 6 weeks. RESULTS: Sixty-six older adults took part. The intervention group had a statistically significant improvement in Berg Balance Scale mean score, 1.67 +/- 2.64 points, P = 0.001 (control group 0.73 +/- 3.63 points, P = 0.258), indicating an improvement in balance over the 6-week exercise period. There was no statistically significant effect of either intervention on the other outcome measures. CONCLUSIONS: In a highly variable population of older adults with mobility limitations, low-intensity functional home exercise of repeated sit-to-stands using the GrandStand System improved Berg Balance Scale score while low-intensity progressive resistance training did not. While statistically significant, the improvement in Berg Balance Scale score was modest raising the issue of what extent of change in score is clinically significant in this population.