Association between mind-body and cardiovascular exercises and memory in older adults

OBJECTIVES: To compare the memory function of older adults who regularly practiced mind-body (MB) or cardiovascular (CV) exercises with that of those who did not engage in regular exercise. Older adults who engaged in both types of exercise were also included to examine the combined effects. DESIGN: Cross-sectional study between 2002 and 2003. SETTING: Older adults from a local community in Hong Kong. PARTICIPANTS: One hundred forty adults aged 56 and older. MEASUREMENTS: The Hong Kong List Learning Test was used to assess the memory of all participants. It is a clinically validated Chinese verbal-memory test that measures various aspects of memory processing, including learning, retention, and retrieval abilities. MB and CV exercises were defined using three dimensions: motion speed, emphasis on relaxing the mind, and conscious control of movement. RESULTS: Older adults who practiced MB or CV exercises demonstrated a similar level of memory function, and their learning and memory was better than that of individuals who did not exercise regularly. Those who practiced both types of exercises outperformed all other groups, even after corrected for the total hours of exercise. Although memory change across age was found in older adults who did not exercise, this trend was not observed in individuals who practiced MB exercises. CONCLUSION: Practicing both MB and CV exercises appears to have a combined effect that might help to preserve memory in older adults. In addition, MB exercises may be considered as an alternative training for older adults who cannot practice strenuous physical exercise.     

Balance confidence improves with resistance or agility training. Increase is not correlated with objective changes in fall risk and physical abilities

BACKGROUND: While the fear of falling is a common psychological consequence of falling, older adults who have not fallen also frequently report this fear. Fear of falling can lead to activity restriction that is self-imposed rather than due to actual physical impairments. Evidence suggests that exercise can significantly improve balance confidence, as measured by falls-related self-efficacy scales. However, there are no prospective reports that correlate change in balance confidence with changes in fall risk and physical abilities as induced by participating in a group-based exercise program. OBJECTIVE: The primary purpose of this prospective study was to examine the relationship between the change in balance confidence and the changes in fall risk and physical abilities in older women with confirmed low bone mass after 13 weeks of exercise participation. The secondary purpose of this study was to examine the relationship between the change in balance confidence and the change in physical activity level. METHODS: The sample comprised 98 women aged 75-85 years with low bone mass. Participants were randomly assigned to one of three groups: resistance training (n = 32), agility training (n = 34), and stretching (sham) exercises (n = 32). The 50-min exercise classes for each study arm were held twice weekly at a local YMCA community centre. RESULTS: Both resistance training and agility training significantly improved balance confidence by 6% from baseline after 13 weeks. However, the change in balance confidence was only weakly correlated with improved general physical function and not significantly correlated with the changes in fall risk score, postural stability, gait speed, or physical activity level. As well, we observed balance confidence enhancement in the presence of increased fall risk or deterioration in physical abilities. CONCLUSIONS: Two different types of exercise training improved balance confidence in older women with low bone mass. This change in balance confidence was significantly correlated with change in general physical function. Because of the observation of discordance between balance confidence change and changes in fall risk and physical abilities, those who design group-based exercise programs for community-dwelling older adults may wish to consider including an education component on factors that influence fear of falling. Objective changes in fall risk factors cannot be assumed to mirror change in fear of falling and physical abilities in older adults in the short-term.     

The health benefits following regular ongoing exercise lifestyle in independent community‐dwelling older Taiwanese adults

Aim: To examine the effect of regular ongoing exercise lifestyle on mental and physical health in a group of independent community‐dwelling Taiwanese older adults over a 2‐year period. Methods: 197 older adults (mean age 72.5 years; 106 men and 91 women) who were independent in walking, instrumental and basic activities of daily living completed the baseline and a 2‐year follow‐up assessment. Older adults regularly performing exercises during the 2‐year study period were grouped into regular exercise group; otherwise in the irregular exercise group. Baseline and follow‐up assessments included a face‐to‐face interview and a battery of performance tests. Results: The regular exercise group showed significantly less depression (P= 0.03) and tended to regress less on the performance tests (P= 0.025–0.410) across 2 years compared to the irregular exercise group. Conclusion: Regular exercise is important for maintaining or even improving mental and functional health, even for independent community‐dwelling older adults.     

Effects of exercise training on frailty in community-dwelling older adults: results of a randomized,controlled trial

OBJECTIVES: Although deficits in skeletal muscle strength, gait, balance, and oxygen uptake are potentially reversible causes of frailty, the efficacy of exercise in reversing frailty in community-dwelling older adults has not been proven. The aim of this study was to determine the effects of intensive exercise training (ET) on measures of physical frailty in older community-dwelling men and women. DESIGN: Randomized controlled trial. SETTING: Medical school research center. PARTICIPANTS: One hundred fifteen sedentary men and women (mean age +/- standard deviation = 83 +/- 4) with mild to moderate physical frailty, as defined by two of the following three criteria: Modified Physical Performance Test (modified PPT) score between 18 and 32, peak oxygen uptake (VO2 peak) between 10 and 18 mL/kg/min, and self-report of difficulty or assistance with one basic activity of daily living (ADL), or two instrumental ADLs. INTERVENTION: Participants were randomly assigned to a control group that performed a 9-month low-intensity home exercise program (control) or an exercise-training program (ET). The control intervention primarily consisted of flexibility exercises. ET began with 3 months of flexibility, light-resistance, and balance training. During the next 3 months, resistance training was added, and, during the next 3 months, endurance training was added. MEASUREMENTS: Modified PPT score, VO2 peak, performance of ADLs as measured by the Older Americans Resources and Services instrument, and the Functional Status Questionnaire (FSQ). RESULTS: ET resulted in significantly greater improvements than home exercise in three of the four primary outcome measures. Adjusted 95% confidence bounds on the magnitude of improvement in the ET group compared with the control group were 1.0 to 5.2 points for the modified PPT score, 0.9 to 3.6 mL/kg/min for VO2 peak, and 1.6 to 4.9 points for the FSQ score. CONCLUSIONS: Our results show that intensive ET can improve measures of physical function and preclinical disability in older adults who have impairments in physical performance and oxygen uptake and are not taking hormone replacement therapy better than a low-intensity home exercise program.     

Effects of exercise on dual-task ability and balance in older adults: A systematic review

The interest in research on exercise and physical activity effects on dual-task performance has grown rapidly in the last decade due to the aging global population. Most of the available literature is focused on exercise benefits for the risk of falls, attention, and gait-speed; however, there is a lack of evidence reporting the exercise effects on balance in healthy older adults during dual-task performance. The objective of this study was to critically review the existing evidence of a potential relationship between exercise and improvement of static and dynamic balance during dual-task in healthy older adults and secondary outcomes in other physical and cognitive indices. A systematic search using online databases was used to source articles. Inclusion criteria included articles classified as randomized controlled trials (RCT), controlled trials (CT) and uncontrolled trials (UT). Moreover, the studies had to include an exercise or physical activity protocol in the intervention. Eight studies met the eligibility criteria and included 6 RCTs, 1 CT, and 1 UT. Several limitations were identified, mainly focused on the lack of a common and standardized method to evaluate the balance during the dual-task performance. Additionally, exercise protocols were extensively different, and generally lacked reporting measures. Preliminary findings show that the current body of evidence does not support that exercises used in these interventions entail clear and noteworthy benefits on static or dynamic balance improvements during dual-task performance. Innovative measures and exercise programs may need to be developed before efficacious screening and treatment strategies can be used in clinical settings.     

Intensity-effects of strengthening exercise on thigh muscle volume,pro- or anti-inflammatory cytokines,and immunocytes in the older adults: A randomized controlled trial

BackgroundThis study investigated the intensity-effects of strength training on thigh muscle mass, cytokines, and immunocytes in the older adults.Materials and MethodsA total of 81 participated in this study. Participants were assigned randomly to four groups: control group (CON), low- (LSE), moderate- (MSE), and high-intensity strength exercise (HSE) groups. Three exercise groups worked out for 50 min/day, 3 days/week for 12 weeks.ResultsIn the thigh volume analyzed by computed tomography, the exercise groups showed a significant increase in the muscle mass, with a clear pattern of change observed in the groups who exercised with moderate to high intensity. The lowest levels of interleukin (IL)-6 in the MSE group (-20.94%) and tumor necrosis factor-α in the HSE group (-28.75%) were observed. Notably, IL-10 showed a significant increase (35.72%) only in the MSE group. In the CON group, natural killer (NK) cells showed a decrease, while in the exercise groups, their levels increased. The highest levels of NK cells were observed in the HSE group. Similar patterns of change were observed in CD4 T cells and CD19 B cells. CD3 and CD8 T cells exhibited significant increases in the MSE and HSE groups.Conclusions: This study presents evidence that engaging in moderate to high-intensity exercise may have a positive impact on cytokines and immunocytes by increasing muscle mass in older adults who may have sarcopenia.Simple SummaryEngaging in strength training exercises is considered crucial for maintaining the health of older individuals who are susceptible to sarcopenia. When resistance exercises are performed at a moderate to strenuous intensity, it is anticipated that positive changes can occur in cytokines and immunocytes. These changes can be observed through improvements in thigh muscle volumes as measured by computed tomography.     

The renin–angiotensin system and prevention of age-related functional decline: where are we now?

Declining physical function is a major health problem for older adults as it is associated with multiple comorbidities and mortality. Exercise has been shown to improve physical function, though response to exercise is variable. Conversely, drugs targeting the renin–angiotensin system (RAS) pathway, including angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs), are also reported to improve physical function. In the past decade, significant strides have been made to understand the complexity and specificity of the RAS system as it pertains to physical function in older adults. Prior findings have also determined that interactions between antihypertensive medications and exercise may influence physical function above and beyond either factor alone. We review the latest research on RAS, exercise, and physical function for older adults. We also outline future research aims in this area, including genetic influences and clinical phenotyping, for the purpose of maintaining or improving physical function through tailored treatments.     

Training older adults with virtual reality use to improve collision-avoidance behavior when walking through an aperture

Many older adults perform collision-avoidance behavior either insufficiently (i.e., frequent collision) or inefficiently (i.e., exaggerated behavior to ensure collision-avoidance). The present study examined whether a training system using virtual reality (VR) simulation enhanced older adults’ collision-avoidance behavior in response to a VR image of an aperture during real walking. Twenty-five (n = 13 intervention group and n = 12 control group) older individuals participated. During training, a VR image of walking through an aperture was projected onto a large screen. Participants in the intervention group tried to avoid virtual collision with the minimum body rotation required to walk on the spot through a variety of narrow apertures. Participants in the control group remained without body rotation while walking on the spot through a wide aperture. A comparison between pre-test and post-test performances in the real environment indicated that after the training, significantly smaller body rotation angles were observed in the intervention group. This suggests that the training led participants to modify their behavior to try to move efficiently during real walking. However, although not significant, collision rates also tended to be greater, suggesting that, at least for some participants, the modification required to avoid collision was too difficult. Transfer of the learned behavior using the VR environment to real walking is discussed.     

Obesity,intentional weight loss and physical disability in older adults

We examine obesity, intentional weight loss and physical disability in older adults. Based on prospective epidemiological studies, body mass index exhibits a curvilinear relationship with physical disability; there appears to be some protective effect associated with older adults being overweight. Whereas the greatest risk for physical disability occurs in older adults who are ≥class II obesity, the effects of obesity on physical disability appears to be moderated by both sex and race. Obesity at age 30 years constitutes a greater risk for disability later in life than when obesity develops at age 50 years or later; however, physical activity may buffer the adverse effects obesity has on late life physical disability. Data from a limited number of randomized clinical trials reinforce the important role that physical activity plays in weight loss programmes for older adults. Furthermore, short‐term studies have found that resistance training may be particularly beneficial in these programmes as this mode of exercise attenuates the loss of fat‐free mass during caloric restriction. Multi‐year randomized clinical trials are needed to examine whether weight loss can alter the course of physical disablement in aging and to determine the long‐term feasibility and effects of combining resistance exercise with weight loss in older adults.     

Effect of exercise on cognitive performance in community-dwelling older adults: review of intervention trials and recommendations for public health practice and research

There is evidence from observational studies that increasing physical activity may reduce the risk of cognitive decline in older adults. Exercise intervention trials have found conflicting results. A systematic review of physical activity and exercise intervention trials on cognition in older adults was conducted. Six scientific databases and reference lists of previous reviews were searched. Thirty studies were eligible for inclusion. Articles were grouped into intervention-outcome pairings. Interventions were grouped as cardiorespiratory, strength, and multicomponent exercises. Cognitive outcomes were general cognition, executive function, memory, reaction time, attention, cognitive processing, visuospatial, and language. An eight-member multidisciplinary panel rated the quality and effectiveness of each pairing. Although there were some positive studies, the panel did not find sufficient evidence that physical activity or exercise improved cognition in older adults. Future research should report exercise adherence, use longer study durations, and determine the clinical relevance of measures used.     

Improved physical performance in older adults undertaking a short-term programme of high-velocity resistance training

BACKGROUND: The age-related loss of muscle power in older adults is greater than that of muscle strength and is associated with a decline in physical performance. OBJECTIVE: To investigate the effects of a short-term high-velocity varied resistance training programme on physical performance in healthy community-dwelling adults aged 60-80 years. METHODS: Subjects undertook exercise (EX; n=15) or maintained customary activity (controls, CON; n=10) for 8 weeks. The EX group trained 2 days/week using machine weights for three sets of eight repetitions at 35, 55, and 75% of their one-repetition maximum (the maximal weight that an individual can lift once with acceptable form) for seven upper- and lower-body exercises using explosive concentric movements. RESULTS: Fourteen EX and 10 CON subjects completed the study. Dynamic muscle strength significantly increased (p=0.001) in the EX group for all exercises (from 21.4 +/- 9.6 to 82.0 +/- 59.2%, mean +/- SD) following training, as did knee extension power (p <0.01). Significant improvement occurred for the EX group in the floor rise to standing (10.4 +/- 11.5%, p=0.004), usual 6-metre walk (6.6 +/- 8.2%, p=0.010), repeated chair rise (10.4 +/- 15.6%, p=0.013), and lift and reach (25.6 +/- 12.1%, p=0.002) performance tasks but not in the CON group. CONCLUSIONS: Progressive resistance training that incorporates rapid rate-of-force development movements may be safely undertaken in healthy older adults and results in significant gains in muscle strength, muscle power, and physical performance. Such improvements could prolong functional independence and improve the quality of life.     

The influence of physical exercise and leisure activity on neuropsychological functioning in older adults

It has been suggested that leisure activity and physical exercise can be a protective factor for neuropsychological functions and are associated with a reduced risk of dementia. Thus, the purpose of this study was to investigate the influence of physical exercise and leisure on the neuropsychological functions of healthy older adults. The sample was composed of 51 sedentary female volunteers who were 60–70 years old and were distributed into three groups: A—control, B—leisure, and C—training. Volunteers were submitted to a physical and neuropsychological assessment at baseline and after 6 months. Groups A and B were monitored longitudinally three times a week. Group C improved their neuropsychological functioning and oxygen consumption compared to groups A and B (p = <0.05). The neuropsychological functions of groups A and B were significantly worse after 6 months of monitoring (p = <0.05). The data suggest that physical exercise improves neuropsychological functioning, although leisure activities may also improve this functioning. Thus, an aerobic physical fitness program can partially serve as a non-medication alternative for maintaining and improving these functions in older adults; however, leisure activities should also be considered.     

Resistance exercise dosage in older adults: single- versus multiset effects on physical performance and body composition

OBJECTIVES: To determine whether variation in resistance exercise volume affects muscle function and physical performance response in older adults. DESIGN: A randomized trial with subjects assigned to a single-set (1-SET) or three-set (3-SET) exercise group. SETTING: An exercise facility at the University of Queensland. PARTICIPANTS: Twenty-eight community-dwelling men and women aged 65 to 78. INTERVENTION: Progressive resistance training consisting of seven exercises targeting the major muscle groups of the upper and lower body performed on exercise machines twice weekly for 20 weeks at eight-repetition maximum (RM) intensity. MEASUREMENTS: Muscle function included isotonic muscle strength (1-RM) of the seven exercises, isokinetic and isometric knee extensor strength, and muscle endurance for the chest press and leg press exercises. Physical performance included timed chair rise, usual and fast 6-m walk, 6-m backwards walk, 400-m walk, floor rise to standing, and stair climbing ability. In addition, body composition was determined using dual energy x-ray absorptiometry. RESULTS: Isotonic muscle strength increased in both exercise groups for all seven exercises (P<.01), with the gain in the 3-SET group greater (P<.05) for the seated row, triceps extension, and knee extension (analysis of covariance). Similarly, muscle endurance gains were greater for the 3-SET than the 1-SET group (P<.01), with no significant difference between groups for isokinetic and isometric knee extensor strength. Both groups improved (P<.05) in the chair rise (1-SET, 10.1%; 3-SET, 13.6%), 6-m backwards walk (1-SET, 14.3%; 3-SET, 14.8%), 400-m walk (1-SET, 3.8%; 3-SET, 7.4%), and stair climbing test (1-SET, 7.7%; 3-SET, 6.4%), with the only difference between groups for the 400-m walk (P<.05). There was no difference between groups for change in body composition. CONCLUSION: Resistance training consisting of only single-set exercises is sufficient to significantly enhance muscle function and physical performance, although muscle strength and endurance gains are greater with higher-volume work. These findings have application in designing time-efficient exercise regimens to enhance neuromuscular function in older adults.     

Exercise in patients with hypertension

A progressive increase in arterial stiffness with aging contributes to systolic hypertension that results in left ventricular hypertrophy and concentric remodeling in the elderly. Lowering of blood pressure in older adults reduces cardiovascular risks. Endurance exercise training can lower blood pressure in older adults with mild (grade I) hypertension. However, the blood pressure-lowering effect of exercise training, compared with antihypertensive medications, is generally modest for both systolic and diastolic blood pressure. Exercise training alone is likely to be ineffective in lowering blood pressure sufficiently in older adults with moderate to severe (grade II and higher) hypertension. However, exercise and weight loss may potentiate the effects of antihypertensive medications in these subjects. Low-intensity endurance exercise training appears to be most effective in reducing blood pressure in older hypertensive adults. Metabolic adaptations to exercise training can significantly reduce other risk factors for coronary artery disease and atherosclerosis, in addition to reducing blood pressure. Endurance exercise training improves exercise capacity and quality of life, and can induce a modest but significant regression of left ventricular hypertrophy and remodeling in older adults with hypertension.     

Exercise rehabilitation of older patients with cardiovascular disease

As the population of elderly patients with cardiovascular disease continues to increase, much research needs to be done with the goal of maintaining physical functioning and personal independence in this population. It is of particular importance to determine whether training programs can improve physical functioning in the most severely disabled older coronary patients. Effects of cardiac rehabilitation programs on other outcome measures, including psychosocial outcomes, lipid levels, insulin levels, and body composition require better study. Finally, the economic benefits of cardiac rehabilitation in the older coronary patients has received little attention, although early reports are promising. In summary, the older population with coronary disease is characterized by high rates of disability. Exercise training has been demonstrated to be safe and to improve strength, aerobic fitness capacity, endurance and physical function. It remains to be seen whether exercise training can reverse or prevent disability in a broad population of older patients with cardiovascular disease. If successful, cardiac rehabilitation programs will pay great medical, social, and economic dividends in this population.     

The impact of exercise training on blood lipids in older adults

Increasing physical activity is often prescribed to improve blood lipids; however, the efficacy of exercise in improving blood lipids in older adults is not clear. The objective of this study was to examine the effects of different exercise modes on blood lipid levels in previously sedentary older adults engaging in a 16-week exercise intervention. One hundred thirty-one subjects (mean age 74.6+/-6 years) were randomly assigned to a resistance training group, aerobic walking group, combined exercise group, or nonexercising control group. Blood lipids were measured at baseline, 8 weeks, and postintervention. Exercise mode did not impact blood lipids. All groups had lower lipid levels over time. Total cholesterol, low- and high-density lipoprotein, and triglycerides were significantly lower. The decrease in all groups, including the controls, may be due to a seasonal effect in older adults that has been documented in younger individuals.     

Efficacy of resistance and task-specific exercise in older adults who modify tasks of everyday life

BACKGROUND: The purpose of this study was to determine the efficacy of 10 weeks of resistance (RT), functional (FT), or functional plus resistance (FRT) training in older adults who modify tasks of everyday life and are at risk for subsequent disability. METHODS: Thirty-two older adults (75.8 +/- 6.7 years) were tested following a control period and training. The primary outcome of the study was the number of task modifications and timed performance on eight tasks of daily life. Secondary outcomes included knee and elbow strength (extension and flexion), body composition, self-reported physical function, single-leg balance time, walking speed, and time to vacuum a carpet. The RT group performed progressive intensity training, and the FT group performed task-specific exercises 2 days per week. The FRT group performed 1 day of each training type. RESULTS: No changes occurred in the control period. All three training groups reduced the need to modify tasks of everyday life (RT: 21%, FRT: 26%, and FT: 28%) and improved self-rated function and time to vacuum a carpet. Individuals who performed FT either 1 or 2 days per week also reduced their timed performance (RT: 2.5% [p = 0.48], FRT: 18.5%, and FT: 23%). Strength gains were primarily found in groups that performed RT either 1 or 2 days per week (RT and FRT). No significant changes occurred in walking speed, single-leg balance, or body composition. CONCLUSION: The benefits of exercise are dependent on tasks performed during training. Exercise recommendations for low-functioning older adults should reflect task-specific exercise to prevent the onset of disability.