Brisk walking speed in older adults who walk for exercise

OBJECTIVES: To determine the self-selected exercise intensity of older adults who report that they walk briskly for exercise. An additional aim of the study was to assess the contribution of self-reported physical activity to self-selected exercise intensity. DESIGN: Observational. SETTING: walking path. PARTICIPANTS: Subjects consisted of 212 participants in the Study of Physical Performance and Age-Related Changes in Sonomans who stated in a detailed home interview that they walked briskly for exercise. MEASUREMENTS: Observed brisk walking speed was measured as the time it took participants to walk half a mile at "normal brisk walking speed." Self-reported physical activity was categorized as metabolic equivalent of the task (MET) in minutes of exercise reported in the previous 7 days. Physiological measures and body composition were obtained through laboratory evaluation. RESULTS: Men walked at an average speed+/-standard deviation of 5.72+/-0.69 km/h and women walked at an average speed of 5.54+/-0.64 km/h. Self-reported physical activity was not associated with brisk walking speed when adjusted for age and ratio of lean to fat mass. CONCLUSION: This study found that older adults who report that they walk briskly for exercise do so at a pace considered moderate or greater in absolute intensity as indicated by their walking speed (4.83 km/h). Ninety-eight percent of men (93/95) and 97% of women (113/117) had an observed walking speed equivalent to 3 or more METs based on their calculated walking speed.     

A 2-year follow-up of a lifestyle physical activity versus a structured exercise intervention in older adults

OBJECTIVES: To evaluate the long‐term effects of a lifestyle intervention and a structured exercise intervention on physical fitness and cardiovascular risk factors in older adults. DESIGN: Controlled trial with randomization between the intervention groups. SETTING: Belgium, Vlaams‐Brabant. PARTICIPANTS: One hundred eighty‐six sedentary but healthy men and women aged 60 to 83. INTERVENTIONS: Participants in the lifestyle intervention were stimulated to integrate physical activity into their daily routines and received an individualized home‐based program supported by telephone calls. The structured intervention consisted of three weekly supervised sessions in a fitness center. Both interventions lasted 11 months and focused on endurance, strength, flexibility, and postural and balance exercises. MEASUREMENTS: Cardiorespiratory fitness, muscular strength, functional performance, blood pressure, and body composition were measured before (pretest), at the end (11 months, posttest), and 1 year after the end (23 months, follow‐up) of the interventions. RESULTS: The results from pretest to posttest have already been published. The current study analyzed the results from posttest to follow‐up. There was a decrease in cardiorespiratory fitness, muscular fitness, and functional performance from posttest to follow‐up in the structured intervention group but not in the control group or the lifestyle intervention group. At 23 months, participants in both groups still showed improvements in cardiorespiratory fitness. In addition, the structured group showed long‐term improvements in muscular fitness, whereas the lifestyle group showed long‐term improvements in functional performance. No long‐term effects were found for blood pressure or body composition. CONCLUSION: These results highlight the potential of a structured fitness center–based intervention and a home‐based lifestyle intervention in the battle against inactivity in older adults. Lifestyle programs are especially valuable because they require fewer resources and less time from health institutions and health practitioners.     

Effect of dehydroepiandrosterone on muscle strength and physical function in older adults: a systematic review

OBJECTIVES: To evaluate studies that have assessed the effect of dehydroepiandrosterone (DHEA) supplementation on body composition and physical performance in older adults. DESIGN: A systematic review of the medical literature identified from searches of databases, reference lists, and recent conference proceedings with qualitative assessment of the desired end points. SETTING: Not applicable. PARTICIPANTS: Adults aged 50 and older. INTERVENTIONS: Oral DHEA supplement with or without concomitant exercise. MEASUREMENTS: Muscle strength, physical function, and physical performance. RESULTS: Of the 155 eligible studies, eight (n=661 participants) met inclusion criteria. The studies differed in their included populations, duration of follow‐up, and interventions (e.g., exercise). Seven studies examined measures of muscle strength. One study showed improvement in handgrip strength, one showed improvement in chest press, two showed improvement in leg press, and one showed improvement in knee extension and flexion. Nevertheless, similar numbers of studies had negative results for each of these endpoints. Five studies examined measures of physical function and performance. Only one study showed improvement in a composite score measuring physical performance; the rest reported no differences between DHEA and control for any end point. CONCLUSION: Overall, the benefit of DHEA on muscle strength and physical function in older adults remains inconclusive. Some measures of muscle strength may improve, although consensus was not reached. DHEA does not appear to routinely benefit measures of physical function or performance. Further large clinical trials are necessary to better identify the clinical role of DHEA supplementation in this population.     

Depressive symptoms and self-rated health in community-dwelling older adults: a longitudinal study

OBJECTIVES: To test whether baseline depressive symptoms in older adults increase the risk of subsequent decline in self-rated health and decrease the likelihood of subsequent improvement in self-rated health. DESIGN: A 2-year prospective cohort study. SETTING: Six thousand seven hundred fourteen community-dwelling older persons who completed the first and second wave of the Asset and Health Dynamics among the Oldest-Old Survey in the United States. PARTICIPANTS: Community-dwelling older people in the United States. MEASUREMENTS: Baseline depressive symptoms were measured using a short-form of the Center for Epidemiological Studies Depression Scale. Self-rated health was measured using a single item of global health rating. RESULTS: After adjustment for covariates, a high burden of depressive symptoms at baseline was predictive of greater decline in self-rated health (odds ratio (OR) for decline in those with high burden of depressive symptoms vs those without = 1.47, 95% confidence interval (CI) = 1.26-1.70). Likewise, high burden of depressive symptoms at baseline predicted less improvement in self-rated health (OR for improvement in those with high burden of depressive symptoms vs those without = 0.57, 95% CI = 0.50-0.65). CONCLUSIONS: Depressive symptomatology is an independent risk factor for subsequent changes in self-rated health in older adults. Thus, early prevention and intervention of depressive symptoms in community-dwelling older adults might be critical to promote and maintain their self-rated health.     

Association between self-reported physical activity and indicators of cardiovascular risk in community-dwelling older adults with hypertension in Korea: A cohort study

The prevalence of hypertension has increased with the rise in the elderly population, and high blood pressure is a major cause of cardiovascular disease. Physical activity is an important strategy for preventing cardiovascular disease. The study aimed to explore the association between physical activity and cardiovascular risk indicators in community-dwelling older adults with hypertension.This study is a secondary data analysis of a prospective longitudinal study using data from the Elderly Cohort Database of the National Health Insurance Service in South Korea between 2002 and 2013. Participants included 10,588 older adults (≥60 years) with hypertension. Data assessing self-reported physical activity and directly measured blood pressure, fasting blood glucose, body mass index, and total cholesterol levels throughout the 12-year study were extracted from the original database and analyzed. Participants were categorized into 4 groups based on the reported changes in physical activity over time: Group I (Maintaining No Physical Activity Group), II (Changing from No Physical Activity to Physical Activity Group), III (Changing from Physical Activity to No Physical Activity Group), and IV (Maintaining Physical Activity Group). Cox proportional hazard model was used to confirm the risk of cardiovascular indicators over time in each group.Participants’ mean age was 64.2 years in the initial year of 2002. The number of participants in Groups I, II, III, and IV was 4032, 2697, 1919, and 1940, respectively. Group IV showed a significant decline in risk for uncontrolled hypertension compared to Group I (hazard ratio = 0.87, 95% confidence interval [0.800–0.948]). Group II showed a significant decrease in risk for uncontrolled diabetes compared to Group I (hazard ratio = 0.94, 95% confidence interval [0.888–0.999]).The findings indicated that physical activity is a significant factor associated with indicators of cardiovascular risk in older people with high blood pressure. Healthcare providers should be aware of the importance of older adults’ physical activity and encourage them to perform and maintain it steadily for better long-term cardio-metabolic outcomes.     

Participation of metropolitan, urban and rural community-dwelling older adults

Environmental factors are important in maintaining a high level of participation. This cross-sectional study aimed at comparing the level of participation of older adults living in rural, urban and metropolitan environments and exploring sociodemographic factors associated with participation according to each type of environment. A total of 350 community-dwelling participants showing a normal aging process were randomly recruited. Participation in daily activities and social roles was measured with the Assessment of Life Habits. Sociodemographic and environmental data were gathered using a questionnaire. Participants from the rural region reported less schooling, a lower income, no access to public transportation and less access to stores than others. Participants from the metropolitan region differed in terms of less use of a car, less satisfaction with their social support and feeling less secure in their neighborhood. However, no significant difference was found between the metropolitan, urban and rural groups for participation in daily activities and social roles. Furthermore, the variables most associated with participation were similar for all three regions. This suggests that although the environment of older adults living in metropolitan, urban and rural region differs, their level of engagement in daily activities and social roles is similar.     

Iron deficiency anemia in older adults: A review

Anemia in older adults is a risk factor for numerous negative outcomes. There is no standard definition, but in most studies, anemia is defined as a hemoglobin value <12 g/dL for women and <13 g/dL for men. Absolute iron deficiency anemia is defined as the combination of anemia and the absence of total body iron. Serum ferritin is the most frequently used diagnostic parameter, but its concentration increases with age and in the presence of inflammatory diseases. Other laboratory tests, such as transferrin saturation, soluble transferrin receptor and the soluble transferrin receptor/ferritin index might provide useful information, but there is a wide variety in the cut‐off values and interpretation of the results. Recent research regarding hepcidin as a central regulator of iron homeostasis is promising, but it has not been used yet for the routine diagnosis of iron deficiency anemia. In older iron deficiency anemia patients, an esophagogastroduodenoscopy and colonoscopy should be initiated in order to identify the underlying bleeding cause. CT colonography can replace a colonoscopy, and in specific cases, a video capsule is recommended. It remains crucial to keep in mind which potential benefits might be expected from these investigations in this vulnerable population, taking into account the comorbidity and life expectancy, and one should discuss in advance the possible therapeutic options and complications with the patient, a family member or a proxy. Oral iron administration is the standard treatment, but parenteral iron is a convenient and safe way to provide the total iron dose in one or a few sessions. Geriatr Gerontol Int 2018; 18: 373–379 .     

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.     

Nonpharmacological approaches to the management of chronic pain in community-dwelling older adults: a review of empirical evidence

The objective of this literature review is to gain insight into the efficacy of nonpharmacological interventions in chronic pain management in community-dwelling older adults. An extensive search of pertinent databases was performed to identify reports of studies of nonpharmacological (physical and psychosocial) pain interventions. The review identifies intervention studies that used randomized controlled trials (RCTs) and summarizes existing evidence of effectiveness of nonpharmacological interventions. A literature search yielded 28 RCT intervention studies (18 for physical interventions and 10 for psychosocial interventions) that met inclusion criteria and are included in this review. Twenty-one studies (75%) identified in this review demonstrated statistically significant differences (P < .05) in pain scores between nonpharmacological interventions and no intervention or sham interventions; the intervention groups showed lower pain intensity. More research is needed to determine the best format, intensity, duration, and content of such treatments, as well as their efficacy in the older adult population. Methodological limitations are identified in many of the studies, such as low statistical power due to sample size and imprecise measurement, lack of reliable sham controls, and inadequate blinding. Future intervention studies of nonpharmacological pain therapies may require larger sample sizes, control for comorbidities, and long-term follow-up.