Low-intensity exercise and reduction of the risk for falls among at-risk elders

BACKGROUND: Among elderly persons, falls account for 87% of all fractures and are contributing factors in many nursing home admissions. This study evaluated the effect of an easily implemented, low-intensity exercise program on the incidence of falls and the time to first fall among a clinically defined population of elderly men and women. METHODS: This community-based, randomized trial compared the exercise intervention with a no-intervention control. The participants were 294 men and women, aged 60 years or older, who had either a hospital admission or bed rest for 2 days or more within the previous month. Exercise participants were scheduled to attend exercise sessions lasting 45 minutes, including warm-up and cool-down, 3 times a week for 8 weeks (24 sessions). Assessments included gait and balance measures, self-reported physical function, the number of medications being taking at baseline, participant age, sex, and history of falling. Falls were tracked for 1 year after each participant's baseline assessment. RESULTS: 29% of the study participants reported a fall during the study period. The effect of exercise in preventing falls varied significantly by baseline physical function level (p < or =.002). The risk for falls decreased for exercise participants with low baseline physical functioning (hazard ratio,.51) but increased for exercise participants with high baseline physical functioning (hazard ratio, 3.51). CONCLUSIONS: This easily implemented, low-intensity exercise program appears to reduce the risk for falls among elderly men and women recovering from recent hospitalizations, bed rest, or both who have low levels of physical functioning.     

Physical fitness and work capacity in women with rheumatoid arthritis

Objective. To investigate physical fitness and work capacity in women with rheumatoid arthritis (RA). Methods. The 42 subjects were a subset of a prospective trial of conditioning exercise in rheumatic disease. Assignment to an exercise or nonexercise group was determined by proximity to the intervention, a 3-month supervised group exercise program. Physical fitness and work capacity were assessed at baseline, 3 months, and 12 months. Results. At baseline, subjects were deconditioned and limited in hand function, lifting ability, and lower extremity mobility. Only the exercise group improved their aerobic capacity and exercise tolerance. There were no significant changes in measured work capacity in either group. Moderate to strong correlations were found between aerobic capacity. mobility, hand function, and work capacity. Grip strength was a strong and consistent correlate of work capacity. Conclusion. Our findings suggest that physical capacity, particularly hand function, may be important in the complex phenomenon of work disability in RA.     

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.     

The long-term benefits of a multi-component exercise intervention to balance and mobility in healthy older adults

We examined the long-term effects of a multi-component exercise program on balance, mobility and exercise behavior. The benefits of a community-based resistance and flexibility exercise intervention in a group of healthy older (60-75 years) individuals were recorded 12 months after completion of the randomized control intervention. Differences between those participants who continued to exercise and those who discontinued were investigated. Significant improvements from baseline in sit to stand (p < 0.001), timed up and go (p = 0.001), and sway (p < 0.001) remained at follow up in the exercise intervention group, with a control group unchanged. Participants who continued exercising had significantly greater improvements in strength immediately after the intervention, compared to those who discontinued (p = 0.004). Those who continued regular resistance training performed better in the step test at 12-month follow up (p = 0.009) and believed that the program was of more benefit to their physical activity (p < 0.001) than those who discontinued exercising. Benefits to balance and mobility persist 1 year after participation in a multi-component exercise program, due in part to some continuing participation in resistance training. Motivation to continue resistance training may be related real and perceived benefits attained from the intervention as well as the environmental context of the intervention.     

A community-based fitness and mobility exercise program for older adults with chronic stroke: a randomized, controlled trial

OBJECTIVES: To examine the effects of a community-based group exercise program for older individuals with chronic stroke. DESIGN: Prospective, single-blind, randomized, controlled intervention trial. SETTING: Intervention was community-based. Data collection was performed in a research laboratory located in a rehabilitation hospital. PARTICIPANTS: Sixty-three older individuals (aged > or = 50) with chronic stroke (poststroke duration > or = 1 year) who were living in the community. INTERVENTION: Participants were randomized into intervention group (n=32) or control group (n=31). The intervention group underwent a fitness and mobility exercise (FAME) program designed to improve cardiorespiratory fitness, mobility, leg muscle strength, balance, and hip bone mineral density (BMD) (1-hour sessions, three sessions/week, for 19 weeks). The control group underwent a seated upper extremity program. MEASUREMENTS: Cardiorespiratory fitness (maximal oxygen consumption), mobility (6-minute walk test), leg muscle strength (isometric knee extension), balance (Berg Balance Scale), activity and participation (Physical Activity Scale for Individuals with Physical Disabilities), and femoral neck BMD (using dual-energy x-ray absorptiometry). RESULTS: The intervention group had significantly more gains in cardiorespiratory fitness, mobility, and paretic leg muscle strength than controls. Femoral neck BMD of the paretic leg was maintained in the intervention group, whereas a significant decline of the same occurred in controls. There was no significant time-by-group interaction for balance, activity and participation, nonparetic leg muscle strength, or nonparetic femoral neck BMD. CONCLUSION: The FAME program is feasible and beneficial for improving some of the secondary complications resulting from physical inactivity in older adults living with stroke. It may serve as a good model of a community-based fitness program for preventing secondary diseases in older adults living with chronic conditions.     

Attrition in an exercise intervention: a comparison of early and later dropouts

OBJECTIVE: To identify reasons for dropout and factors that may predict dropout from an exercise intervention aimed at improving physical function in frail older persons. DESIGN/SETTING: An 18-month randomized controlled intervention in a community setting. The intervention comprised 2 groups: class-based and self-paced exercise. PARTICIPANTS: 155 community-dwelling older persons, mean age 77.4, with mildly to moderately compromised mobility. MEASUREMENTS: The primary outcome measure was dropout. Dropouts were grouped as: D0, dropout between baseline and 3-month assessment, and D3, dropout after 3-month assessment. MEASUREMENTS: Measurements of demographics, health, and physical performance included self-rated health, SF-36, disease burden, adverse events, PPT-8, MacArthur battery, 6-minute walk, and gait velocity. RESULTS: There were 56 dropouts (36%), 31 in first 3 months. Compared with retained subjects (R), the D0 group had greater disease burden (P = .011), worse self-perceived physical health (P = .014), slower usual gait speed (P = .001), and walked a shorter distance over 6 minutes (P<.001). No differences were found between R and D3. Multinomial logistic regression showed 6-minute walk (P<.001) and usual gait velocity (P<.001) were the strongest independent predictors of dropout. Controlling for all other variables, adverse events after randomization and 6-minute walk distance were the strongest independent predictors of dropout, and self-paced exercise assignment increased the risk of dropout. CONCLUSIONS: We observed baseline differences between early dropouts and retained subjects in disease burden, physical function, and endurance, suggesting that these factors at baseline may predict dropout. Improved understanding of factors that lead to and predict dropout could allow researchers to identify subjects at risk of dropout before randomization. Assigning targeted retention techniques in accordance with these factors could result in decreased attrition in future studies. Therefore, the results of selective attrition of frailer subjects, such as decreased heterogeneity, restricted generalizability of study findings, and limited understanding of exercise effects in this population, would be avoided.     

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.     

Effects of a low intensity exercise program on selected physical performance characteristics of 60- to 71-year olds

The effects of a low intensity exercise program on strength, flexibility, balance, gait and muscular endurance were determined in sixty-two 60- to 71-year-old men and women. Subjects exercised for 1 hour daily 5 days a week for 3 months. Before and after the exercise program, each participant underwent lower extremity range of motion (ROM) determinations, isometric and dynamic strength testing (Cybex) of the knee and ankle musculature, standing balance tests, a gait examination and a fatigue test for the quadriceps. Thirteen control subjects who did not exercise also were tested at two time periods, 3 months apart. Significant improvements in strength occurred for exercise subjects, particularly at the fastest speed settings on the Cybex. ROM measures of the hip and trunk, and standing balance times improved, but no change in endurance or gait parameters was found. With the exception of muscular endurance, no changes were observed among the controls. Exercise subjects frequently reported improvements in functional capacity and activities of daily living. These results suggest that a low intensity exercise program can improve strength, balance and flexibility in sedentary healthy older people.     

Increased Velocity Exercise Specific to Task (InVEST) training: a pilot study exploring effects on leg power, balance, and mobility in community-dwelling older women

OBJECTIVES: To evaluate a dynamic form of weighted vest exercise suitable for home use and designed to enhance muscle power, balance, and mobility. DESIGN: A single-blind, randomized, controlled trial. SETTING: Outpatient exercise research facility situated within an academic long-term care center. PARTICIPANTS: Twenty-one community-dwelling women aged 70 and older with a Short Physical Performance Battery (SPPB) score between 4 and 10 (out of 12). INTERVENTIONS: Subjects were randomized into a progressive resistance-training program using weighted vests for resistance with exercises designed to be specific to mobility tasks and have a component performed at the fastest possible velocity (Increased Velocity Exercise Specific to Task (InVEST), n=11) or a control exercise group (control, n=10), which performed slow-velocity, low-resistance exercise. Both groups exercised three times a week for 12 weeks. MEASUREMENTS: Changes in muscle power, balance, and physical performance were compared. RESULTS: In comparison to control group, InVEST group manifested significant improvements (P<.05) in leg power across measurements obtained at 75% to 90% of the one-repetition maximum. Both groups demonstrated significant improvements in chair stand and SPPB score from baseline, and the InVEST group showed significant improvements in gait speed and chair stand from baseline (P<.05). InVEST produced significantly greater changes in chair stand time than control (P<.05). CONCLUSION: InVEST training appears be an effective means of enhancing leg power and chair rise in this population and is worthy of further investigation as a means of enhancing balance and mobility.     

Does dance-based training improve balance in adult and young old subjects? A pilot randomized controlled trial

BACKGROUND AND AIMS: Loss of balance is a major risk factor for falls in the elderly, and physical exercise may improve balance in both elderly and middle-aged people. We propose a clinical trial to test the efficacy of an exercise program based on dance in improving balance in adult and young old subjects. METHODS: We carried out a mono-institutional, randomized, controlled clinical trial. 40 subjects (aged 58 to 68 yr) were randomly allocated in two separate groups: the exercise group (n = 20) followed a 3-month exercise program; the control group (n = 20) did not engage in physical activities. Differences in balance between the end of the training period and the baseline were assessed using four different balance tests: Tinetti, Romberg, improved Romberg, Sit up and go. RESULTS: Results showed a significant improvement in balance in the exercise group at the end of the exercise program, whereas the control group did not show any significant changes. The comparison between exercise and control group variations in balance test scores showed a highly significant difference. 17 out of 20 subjects in the exercise group reported great or moderate satisfaction with the dance activity. CONCLUSIONS: Results suggest that physical activity based on dance may improve balance and hence be a useful tool in reducing the risk of falling in the elderly. The exercise program also revealed interesting psychosocial benefits.     

Exercise and weight loss in obese older adults with knee osteoarthritis: a preliminary study

OBJECTIVE: The purposes of this pilot study were to determine if a combined dietary and exercise intervention would result in significant weight loss in older obese adults with knee osteoarthritis, and to compare the effects of exercise plus dietary therapy with exercise alone on gait, strength, knee pain, biomarkers of cartilage degradation, and physical function. DESIGN: Single-blind, two-arm, randomized clinical trial conducted for 24 weeks. SETTING: A university health and exercise science center. PARTICIPANTS: Twenty-four community-dwelling obese older adults aged > or = 60 years, body mass index > or = 28, knee pain, radiographic evidence of knee osteoarthritis, and self-reported physical disability. INTERVENTION: Randomization into two groups: exercise and diet (E&D) and exercise alone (E). Exercise consisted of a combined weight training and walking program for 1 hour three times per week. The dietary intervention included weekly sessions with a nutritionist utilizing cognitive-behavior modification to change dietary habits to reach a group goal of an average weight loss of 15 lb (6.8 kg) over 6 months. MEASUREMENTS: All measurements were conducted at baseline and 3 and 6 months, except for synovial fluid analysis, which was obtained only at baseline and 6 months. In addition, weight was measured weekly in the E&D group. Physical disability and knee pain were measured by self-report and physical performance was measured using the 6-minute walk and stair climb tasks. Biomechanical testing included kinetic and kinematic analysis of gait and isokinetic strength testing. Synovial fluid was analyzed for levels of total proteoglycan, keratan sulfate, and interleukin-1 beta. RESULTS: Twenty-one of the 24 participants completed the study, with one dropout in the E&D group and two in the E group. The E&D group lost a mean of 18.8 lb (8.5 kg) at 6 months compared with 4.0 lb (1.8 kg) in the E group (P = .01). Significant improvements were noted in both groups in self-reported disability and knee pain intensity and frequency as well as in physical performance measures. However, no statistical differences were found between the two groups at 6 months in knee pain scores or self-reported performance measures of physical function. There was no difference in knee strength between the groups, with both groups showing modest improvements from baseline to 6 months. At 6 months, the E&D group had a significantly greater loading rate (P = .03) and maximum braking force (P = .01) during gait. There were no significant between-group differences in the other biomechanical measures. Synovial fluid samples were obtainable at both baseline and 6 months in eight participants (four per group). The level of keratan sulfate decreased similarly in both groups from an average baseline of 96.8 +/- 37.1 to 71.5 +/- 23 ng/microg total proteoglycan. The level of IL-1 decreased from 25.3 +/- 9.8 at baseline to 8.3 +/- 6.1 pg/mL. The decrease in IL-1 correlated with the change in pain frequency (r = -0.77, P = .043). CONCLUSIONS: Weight loss can be achieved and sustained over a 6-month period in a cohort of older obese persons with osteoarthritis of the knee through a dietary and exercise intervention. Both exercise and combined weight loss and exercise regimens lead to improvements in pain, disability, and performance. Moreover, the trends in the biomechanical data suggest that exercise combined with diet may have an additional benefit in improved gait compared with exercise alone. A larger study is indicated to determine if weight loss provides additional benefits to exercise alone in this patient population.     

Effects of combined exercise on gait variability in community-dwelling older adults

Training that focuses on strength, balance, and endurance, the so-called combined exercise, can enhance physical function, including gait, according to a literature review. However, the effects of combined exercise on improving gait variability are limited. The objective of this study is to investigate the effects of 12 weeks of combined exercise comprised of resistance, endurance, and balance training on gait performance in older adults. Twenty-nine community-dwelling older adults were recruited and assigned to either the experimental group (n = 17) or the control group (n = 12). The 12-week intervention was a combined exercise program at 1 h per day and 3 days per week. The participants received an assessment for both a 6-min walk and gait during both habitual walking and fast walking conditions at pre-intervention and after 8 and 12 weeks of exercise. The 6-min walk was used to assess gait endurance. GAITRite was used to evaluate gait. An analysis of covariance with the pretest score as the covariate was used to determine the difference in each dependent variable between groups. The level of significance was set as p less than 0.05. Our results showed significant between-group effects in the 6-min walk and velocity, stride time, and stride length in both conditions after 8 weeks of exercise and significant between-group effects in the 6-min walk test and all selected gait parameters in both conditions after 12 weeks of exercise. Our findings demonstrate that a 12-week combined exercise program may positively affect gait endurance and gait performance including gait variability in habitual walking and fast walking conditions among older adults. The current study provides important evidence of short-term combined exercise effects on improvements in gait performance.     

Long-term effects of a stage-based intervention for changing exercise intentions and behavior in older adults

PURPOSE: We examined the efficacy of an intervention tailored to the individual's stage of change for exercise adoption on exercise stage of change, physical activity, and physical function in community-dwelling older adults. DESIGN AND METHODS: We randomized participants to a print and telephone intervention or a contact comparison group. Through the use of longitudinal analyses we examined the intervention's effectiveness in promoting stage progression, altering decisional balance and the processes of change, increasing self-efficacy and physical activity, and improving physical function among older adults who completed the 24-month study (N = 966). We conducted similar analyses that excluded individuals who were in maintenance at baseline and 24 months. RESULTS: At the end of the study, there were no differences in stage progression, self-efficacy, decisional balance, the processes of change, physical activity, or physical function by intervention assignment. When the analyses excluded those participants (n = 358) who were in the maintenance stage for exercise throughout the intervention, we found that, compared with the comparison group, a greater proportion of individuals who received the exercise intervention progressed in stage by 24 months. Conversely, more individuals in the comparison group remained stable or regressed in stage compared with the intervention group. IMPLICATIONS: Results indicate that a tailored intervention is effective in increasing motivational readiness for exercise in individuals who were in stages of change other than maintenance.     

The effects of multidimensional home-based exercise on functional performance in elderly people

BACKGROUND: This study tested the hypothesis that a home-based exercise program would improve functional performance in elderly people. METHODS: We conducted a 6-month, single-blinded, randomized controlled trial. 72 community dwelling men and women (aged >/=70 years) with self-reported and laboratory-based functional impairment were recruited for the study. Participants were randomly assigned to either a home-based progressive strength, balance, and general physical activity intervention or an attention-control group that received home-based nutrition education. Functional performance was measured in the laboratory using the Physical Performance Test (PPT) and the Established Populations for Epidemiologic Studies of the Elderly (EPESE) short physical performance battery. Physiologic capacity was measured by strength (one repetition maximum), dynamic balance (tandem walk), gait speed (2-meter walk), and cardiovascular endurance (6-minute walk). RESULTS: 70 participants (97%) completed the 6-month trial. Compliance with study interventions within each group ranged from 75% in controls to 82% in exercisers. PPT increased by 6.1 +/- 13.4% in exercisers and decreased by 2.8 +/- 13.6% in controls (p =.02). EPESE improved by 26.2 +/- 37.5% in exercisers and decreased by 1.2 +/- 22.1% in controls (p =.001). Dynamic balance improved by 33.8 +/- 14.4% in exercisers versus 11.5 +/- 23.7% in controls (p =.0002). There were no differences between groups in the change in strength, gait speed, or cardiovascular endurance. CONCLUSIONS: Minimally supervised exercise is safe and can improve functional performance in elderly individuals. The improvements in functional performance occurred along with improvements in balance but without a significant change in muscle strength or endurance.     

Reduction of global cardiovascular risk with nutritional versus nutritional plus physical activity intervention in Colombian adults.

BACKGROUND: Cardiovascular disease is a major cause of morbidity/mortality in non-developed countries. Reports of the effects of non-pharmacological interventions on global cardiovascular risk in Latin American adults, however, are scarce. OBJECTIVE: To compare the change in global cardiovascular risk induced by a tailored, Adult Treatment Panel-III compliant nutrition program versus the same program with addition of supervised, regular physical activity in Colombian adults. DESIGN: The study was a randomized, controlled trial. METHODS: Seventy-five Colombian patients aged 40-70 years and with Framingham-estimated global cardiovascular risk of 1% or higher were randomly assigned to a nutritional intervention program or a combined nutritional intervention-physical exercise program for 16 weeks. Patients underwent medical and anthropometric evaluation, bioelectrical impedance, lipid profile and Framingham global cardiovascular risk determination at baseline and at the end of follow-up. RESULTS: The groups were comparable at baseline; 21 persons in the nutritional intervention program group and 27 in the nutritional intervention-physical exercise program group completed the follow-up. Global cardiovascular risk modification (mean+/-SE) was -2.04+/-1.1 absolute percentage points (relative reduction 19.6%) in the nutritional intervention-physical exercise program group, compared with 0.23+/-0.9 (relative increase 2.8%) in the nutritional intervention program group. Mean difference in global cardiovascular risk modification between groups reached borderline statistical significance in ANCOVA (P=0.054). Reductions in systolic and diastolic blood pressure, waist circumference and low-density lipoprotein cholesterol were similar, but the nutritional intervention-physical exercise program group achieved significantly greater improvements in body weight, body mass index, percentage body fat and high-density lipoprotein cholesterol. CONCLUSIONS: Our data suggest that a structured nutritional intervention-physical exercise program is more efficacious than a nutritional intervention program in the reduction of global cardiovascular risk and cardiovascular risk factors, in only 16 weeks.     

Community-based group exercise improves balance and reduces falls in at-risk older people: a randomised controlled trial

BACKGROUND: recent studies have found that moderate intensity exercise is an effective intervention strategy for preventing falls in older people. However, research is required to determine whether supervised group exercise programmes, conducted in community settings with at-risk older people referred by their health care practitioner are also effective in improving physical functioning and preventing falls in this group. OBJECTIVES: to determine whether participation in a weekly group exercise programme with ancillary home exercises over one year improves balance, muscle strength, reaction time, physical functioning, health status and prevents falls in at-risk community-dwelling older people. METHODS: the sample comprised 163 people aged over 65 years identified as at risk of falling using a standardised assessment screen by their general practitioner or hospital-based physiotherapist, residing in South Western Sydney, Australia. Subjects were randomised into either an exercise intervention group or a control group. Physical performance and general health measures were assessed at baseline and repeated 6-months into the trial. Falls were measured over a 12-month follow-up period using monthly postal surveys. RESULTS: at baseline both groups were well matched in their physical performance, health and activity levels. The intervention subjects attended a median of 23 exercise classes over the year, and most undertook the home exercise sessions at least weekly. At retest, the exercise group performed significantly better than the controls in three of six balance measures; postural sway on the floor with eyes open and eyes closed and coordinated stability. The groups did not differ at retest in measures of strength, reaction time and walking speed or on Short-Form 36, Physical Activity Scale for the Elderly or fear of falling scales. Within the 12-month trial period, the rate of falls in the intervention group was 40% lower than that of the control group (IRR=0.60, 95% CI 0.36-0.99). CONCLUSIONS: these findings indicate that participation in a weekly group exercise programme with ancillary home exercises can improve balance and reduce the rate of falling in at-risk community dwelling older people.     

The effect of an individualized fall prevention program on fall risk and falls in older people: a randomized, controlled trial

OBJECTIVES: To determine whether an individualized falls prevention program comprising exercise, visual, and counseling interventions can reduce physiological falls risk and falls in older people. DESIGN: Randomized, controlled trial of 12 months' duration. SETTING: Falls Clinic, Royal North Shore Hospital, Sydney, Australia. PARTICIPANTS: Six hundred twenty people aged 75 and older recruited from a health insurance company membership database. Interventions: Participants in the extensive intervention group (EIG) received individualized interventions comprising exercise and strategies for maximizing vision and sensation; the minimal intervention group (MIG) received brief advice; and the control group (CG) received no intervention. MEASUREMENTS: Accidental falls, vision, postural sway, coordinated stability, reaction time, lower limb muscle strength, sit-to-stand performance, and physiological profile assessment (PPA) falls risk scores. RESULTS: At the 6-month follow-up, PPA falls risk scores were significantly lower in the EIG than in the CG. EIG subjects assigned to the extensive exercise intervention group showed significant improvements in tests of knee flexion strength and sit-to-stand times but no improvements in balance. EIG subjects assigned to the extensive visual intervention group showed significant improvements in tests of visual acuity and contrast sensitivity. The rate of falls and injurious falls within the trial period were similar in the three groups. CONCLUSION: The individualized intervention program reduced some falls risk factors but did not prevent falls. The lack of an effect on falls may reflect insufficient targeting of the intervention to an at-risk 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.     

Implementation and effectiveness of a community-based health promotion program for older adults

BACKGROUND: Because preventing functional decline in older adults is a national priority and senior centers have been identified as potentially important venues for health-promotion activities, a trial of a multicomponent disability prevention program was conducted at a senior center. METHODS: One hundred older adults were recruited for a 6-month randomized clinical trial. All members of the experimental group received an exercise intervention, nutrition counseling, and a home safety assessment. Smoking and alcohol interventions were delivered to at-risk subjects. Outcome variables included the Medical Outcomes Study Short Form (SF-36) health survey, the CES-Depression scale, bed days, and restricted-activity days. RESULTS: A single study announcement resulted in a response sufficient to recruit 100 subjects. The exercise program was well received: 85% of intervention subjects completed the 6-month program and adherence was excellent, with over 90% attendance at exercise classes. After 6 months the intervention group had significantly better scores on 7 of 8 SF-36 subscales and fewer depressive symptoms than controls. CONCLUSIONS: Senior centers may be excellent sites for community-based health promotion interventions: participation and adherence rates may be acceptable, interventions can be designed that are feasible in this setting, and these interventions appear to affect health status positively. The study program improved physical and psychosocial functioning and is a promising model for preventing functional decline through activities based at senior centers.     

Old women with a recent fall history show improved muscle strength and function sustained for six months after finishing training

BACKGROUND AND AIMS: Restricted physical activity as a consequence of chronic disease or injury is a predictor of functional decline. The aim of this study was to test the hypothesis that a 6- month multidimensional training program would have sustained beneficial effects upon the physiological, functional and psychological condition of old women with a recent history of falls. METHODS: Participants were 65 home-dwelling women (70-90 years) identified from hospital records as having had an accidental fall. After assessment of muscle strength, balance performance, walking speed, balance confidence, and physical activity level, the participants were randomly assigned to a control group (n=33) or a training group (n=32), who performed a multidimensional training program including moderate resistance exercise and balance exercise twice weekly for 6 months. Measurements were repeated after 6 and 12 months. RESULTS: Six months of multidimensional training resulted in significant improvements and between-group differences in isometric knee extension strength (p<0.05), trunk extension/ flexion strength (p<0.001), habitual/maximal walking speed (p<0.001) and balance performance (p<0.001). At follow-up, 6 months after intervention, these improvements were preserved in the training group and there was also a significant between- group difference with regard to balance confidence. No between-group differences were found concerning number of falls or physical activity level during the one-year study period. CONCLUSIONS: A multi-dimensional training program produced significant improvements in physiological and functional risk factors for falls and disability in women aged 70-90 years with a recent history of falls.