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Exercises for Seniors

Exercises for Seniors – Directory of Scientific Studies

By Maurice

This page contains the largest directory of scientific studies on seniors’ exercises on the Web. (Know of a study that we’ve missed? Please contact us.)

You can filter the studies by clicking one of the buttons below, to choose the topic(s) you’re interested in:

Types of Exercises


Study Name

Strength and Endurance Training Prescription in Healthy and Frail Elderly

PublicationAging and Disease
PurposeThe first purpose of this review was discuss the neuromuscular adaptations to strength training, as well as the cardiovascular adaptations to endurance training in healthy and frail elderly subjects.
In addition, the second purpose of this study was investigate the concurrent training adaptations in the elderly.
Methods

The article provides a review on existing literature on strength and enduarnce training. Subjects covered:

  1. Effects on muscle strength and power output: the influence of intensity, volume and velocity of movement.
  2. The functional benefits of the inclusion of power training in elderly.
  3. Effects on muscle hypertrophy.
  4. Special issue: positive effects of strength and muscle power training on frail elderly.
  5. Effects on cardiorespiratory fitness.
  6. Special issue II: Endurance training on frail elderly.
  7. Concurrent strength and endurance training in healthy elderly: Effects on muscle strength and power, Effects on muscle hypertrophy, Effects on cardiorespiratory fitness.
Results

Strength training is an effective intervention to improve muscle strength, power output, and muscle mass in healthy and frail elderly populations. Endurance training induces improvements on VO2max and submaximal endurance capacity in these populations.

Therefore, a combination of strength and endurance training (i.e., concurrent training) in elderly populations is the most effective way to improve both neuromuscular and cardiorespiratory functions. Based on recent evidence, concurrent training performed at moderate weekly frequency (i.e., 2 times per week) may promote marked gains on muscle hypertrophy, strength and power gains in elderly subjects. The strength training should be performed at moderate- to high-intensity (i.e., 60–80% of 1RM), and moderate volume (i.e., 2 to 3 sets per exercise). Also, endurance training should be performed at moderate- to high-intensity (i.e., 60–85% of VO2max), and moderatevolume (i.e., 25 to 40 minutes).

For concurrent training protocols in which both strength and endurance training are performed on the same day, the strength and endurance gains may be optimized with strength training prior to endurance intra-session exercise sequence.

Moreover, twice per week may be an optimal weekly frequency to promote additional muscle mass and strength gains, as well as cardiorespiratory fitness in previously concurrent trained elderly.

Regarding improving the functional capacity of the elderly, the concurrent strength and endurance training prescription should include high-velocity strength training, designed to improve muscle power output, as muscle power has been associated with the functional capacity in elderly.

Conclusion

Based on the results found, the combination of strength and endurance training (i.e., concurrent training) performed at moderate volume and moderate to high intensity in elderly populations is the most effective way to improve both neuromuscular and cardiorespiratory functions. Moreover, exercise interventions that include muscle power training should be prescribed to frail elderly in order to improve the overall physical status of this population and prevent disability.


In addition to the positive effects of concurrent training on the functional capacity of healthy elderly individuals, another issue that must be further investigated is the potential benefits of combined strength and endurance training on the functional capacity of physically frail individuals, because such intervention improve the overall physical status of this population, maintain the independency and prevent disability and other adverse outcomes.

Based on the current knowledge, it seems that exercise interventions that include endurance, strength, and muscle power training should be prescribed to frail elderly in order to improve the functional capacity.

Study Name

Resistance Exercise for Knee Osteoarthritis

PublicationPM&R
PurposeThis article presents the effects of Resistance exercise (RX) on knee osteoarthritis (OA) and provides clinical guidelines for the prescription and expected adaptations to RX in the population with knee OA.
MethodsThis article will summarize the highest quality evidence (from randomized controlled trials) of the effects of Resistance exercise (RX) on knee osteoarthritis (OA).
Results 
Conclusion

Resistance exercise (RX) has been shown to be an effective intervention both for decreasing pain and improving physical function and self-efficacy.

RX may restore muscle strength and joint mechanics while improving physical function. RX also may normalize muscle firing patterns and joint biomechanics, leading to reductions in joint pain and cartilage degradation. These physical adaptations could lead to improved self-efficacy and decreased anxiety and depression.

RX can be prescribed and performed by patients across the spectrum of OA severity. When designing and implementing an RX program for a patient with knee OA, one should consider both the degree of OA severity and the level of pain. RX, either in the home or at a fitness facility, is an important component of a comprehensive regimen designed to offset the physical and psychological limitations associated with knee OA.

Unique considerations for this population include (1) monitoring pain during and after exercise, (2) providing days of rest when disease flares occur, and (3) infusing variety into the exercise regimen to encourage adherence.

Study Name

Exercise and depressive symptoms: A comparison of aerobic and resistance exercise effects on emotional and physical function in older persons with high and low depressive symptomatology

PublicationThe Journals of Gerontology Series B: Psychological Sciences and Social Sciences
PurposeThis study examines and compares the effect of aerobic and resistance exercise on emotional and physical function among older persons with initially high or low depressive symptomatology.
MethodsData are from the Fitness, Arthritis and Seniors Trial, a trial among 439 persons 60 years or older with knee osteoarthritis randomized to health education (control), resistance exercise, or aerobic exercise groups. Depressive symptoms (assessed by the Center for Epidemiologic Studies–Depression scale) and physical function (disability, walking speed, and pain) were assessed at baseline and after 3, 9, and 18 months.
Results

Compared with results for the control group, aerobic exercise significantly lowered depressive symptoms over time. No such effect was observed for resistance exercise.

The reduction in depressive symptoms with aerobic exercise was found both among the 98 participants with initially high depressive symptomatology and among the 340 participants with initially low depressive symptomatology and was the strongest for the most compliant persons.

Aerobic and resistance exercise significantly reduced disability and pain and increased walking speed both, and to an equal extent, in persons with high depressive symptomatology and persons with low depressive symptomatology.

ConclusionConsequently, exercise may be a more complete treatment option for depression, as this not only improves emotional function but also has a positive influence on physical function. There exist strong reciprocal associations between depression and health decline in older persons (Penninx et al., 1998, 1999). An exercise intervention could play an important role in preventing the process whereby physical and emotional dysfunction interact to cause a progressive downward spiral in the health of older persons.
Study Name

A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis. The Fitness Arthritis and Seniors Trial (FAST)

PublicationJAMA.
PurposeObjective: To determine the effects of structured exercise programs on self-reported disability in older adults with knee osteoarthritis.
Methods

Setting and design: A randomized, single-blind clinical trial lasting 18 months conducted at 2 academic medical centers.

Participants: A total of 439 community-dwelling adults, aged 60 years or older, with radiographically evident knee osteoarthritis, pain, and self-reported physical disability.

Interventions: An aerobic exercise program, a resistance exercise program, and a health education program.

Main outcome measures: The primary outcome was self-reported disability score (range, 1-5). The secondary outcomes were knee pain score (range, 1-6), performance measures of physical function, x-ray score, aerobic capacity, and knee muscle strength.

ResultsA total of 365 (83%) participants completed the trial. Overall compliance with the exercise prescription was 68% in the aerobic training group and 70% in the resistance training group. Postrandomization, participants in the aerobic exercise group had a 10% lower adjusted mean (+/- SE) score on the physical disability questionnaire (1.71 +/- 0.03 vs 1.90 +/- 0.04 units; P<.001), a 12% lower score on the knee pain questionnaire (2.1 +/- 0.05 vs 2.4 +/- 0.05 units; P=.001), and performed better (mean [+/- SE]) on the 6-minute walk test (1507 +/- 16 vs 1349 +/- 16 ft; P<.001), mean (+/-SE) time to climb and descend stairs (12.7 +/- 0.4 vs 13.9 +/- 0.4 seconds; P=.05), time to lift and carry 10 pounds (9.1 +/- 0.2 vs 10.0 +/- 0.1 seconds; P<.001), and mean (+/-SE) time to get in and out of a car (8.7 +/- 0.3 vs 10.6 +/- 0.3 seconds; P<.001) than the health education group. The resistance exercise group had an 8% lower score on the physical disability questionnaire (1.74 +/- 0.04 vs 1.90 +/- 0.03 units; P=.003), 8% lower pain score (2.2 +/- 0.06 vs 2.4 +/- 0.05 units; P=.02), greater distance on the 6-minute walk (1406 +/- 17 vs 1349 +/- 16 ft; P=.02), faster times on the lifting and carrying task (9.3 +/- 0.1 vs 10.0 +/- 0.16 seconds; P=.001), and the car task (9.0 +/- 0.3 vs 10.6 +/- 0.3 seconds; P=.003) than the health education group. There were no differences in x-ray scores between either exercise group and the health education group.
ConclusionOlder disabled persons with osteoarthritis of the knee had modest improvements in measures of disability, physical performance, and pain from participating in either an aerobic or a resistance exercise program. These data suggest that exercise should be prescribed as part of the treatment for knee osteoarthritis.
Study Name

Training for older adults

PublicationAnnales de Réadaptation et de Médecine Physique
PurposeThis article presents training methods used in the literature and their associated effects in order to adapt training protocols to older populations.
Methods

The article provides a review on existing literature and includes:

  1. Table 1 Health benefits of regular physical activity; 
  2. Improvement of muscle function using weights or elastic bands to place adjustable resistance on movements; the most common types of training sessions and their duration.
  3. Improvement in aerobic capacity: typical endurance training activities include cycling, walking, and swimming. Everyday activities that recruit a large muscle mass—such as window washing, vacuuming and gardening—are further examples.
  4. Risk management: It is important to get a thorough physical examination and undergo stress testing before resuming a relatively intense physical activity (e.g. cycling, hiking, jogging) [16].

Major contraindications to exercise and stress testing typically include recent myocardial necrosis, aortic stenosis, decompensated congestive heart failure, unstable angina, complex aneurysm, pulmonary embolism, and ventricular dysrhythmia. Relative contraindications include moderate aortic stenosis, uncontrolled supraventricular tachycardia and uncontrolled hypertension.

Results

exercises are safe for elderly subjects [8,9] and accidents are extremely rare provided the instructions given on the following pages are followed [3].\n\nOsteoarthritis sufferers should be prescribed movement exercises to improve their mobility. These exercises should focus on rising from a chair, walking and everyday activities.\nIndividuals with established osteoporosis should be prescribed exercises that improve their balance and mobility and strengthen their muscles. All steps should be taken to reduce the risk of falls. Quick movements, such as jumping and running, should be avoided. Exercises that place too much stress on the spinal column, such as repeated bending, are contraindicated. Muscle strengthening exercises may be performed almost two to three times a week provided sessions are short (30 min) and weights and movements are moderate.\nIn the case of people with diabetes, the initial physical examination should be conducted to assess the cardiovascular, nervous, renal and visual functions and gauge the risk of complications. Patients should then be prescribed endurance exercises lasting for 20 min at the start of a protocol to several hours after a few weeks of training. In all cases, the weekly amount of exercise should make patients burn an extra 1000–2000 kcal/week, which corresponds to 3–6 hours of moderate to high-intensity exercise [6]. Extra attention should be paid to patients’ feet and gear (socks and shoes).\nPatients who are severely overweight to obese should be prescribed a retraining protocol that includes endurance exercises, such as walking or cycling, and strength exercises. As endurance exercises are designed to raise calorie consumption, they should last for over 45 min and be of moderate intensity (40–60% of VO2 max or the heart rate reserve). Muscle strengthening exercises improve mobility by developing a certain level of functional reserve in everyday activities. Moreover, endurance exercises offer the advantage of raising the metabolism during recovery and via the increase in muscle mass. It should be noted that equipment, such as bicycle seats and weight machines, may not always be suited to the geriatric population and may have to be changed.\nPatients with hypertension should be prescribed a daily endurance activity lasting 40–60 min and at moderate intensity (40–70% of VO2 max). This activity may be supplemented with muscle strengthening activities after a long learning period\non technique, such as proper breathing during strengthening exercises. To avoid increasing their blood pressure, subjects should never hold their breath while exercising. \nExercise is not ruled out for patients with respiratory failure. They should be prescribed endurance exercises that are intermittent at first (four sets lasting 3 min each) then continuous after a few weeks (20–30 min of exercise). The exercise intensity should be limited and ventilation and blood saturation should be monitored to control the risks of exceeding comfort and safety thresholds. Walking and cycling are recommended for such patients.\nIn the light of the risks involved and the fact that they are very deconditioned, cardiac failure patients should always perform a retraining protocol in the presence of a cardiologist and in a specialised facility. Their heart rate should be monitored at least during the first few months of readjustment. “}”>Strength and force exercises are safe for elderly subjects [8,9] and accidents are extremely rare provided the instructions given on the following pages are followed [3].

Osteoarthritis sufferers should be prescribed movement exercises to improve their mobility. These exercises should focus on rising from a chair, walking and everyday activities.

Individuals with established osteoporosis should be prescribed exercises that improve their balance and mobility and strengthen their muscles. All steps should be taken to reduce the risk of falls. Quick movements, such as jumping and running, should be avoided. Exercises that place too much stress on the spinal column, such as repeated bending, are contraindicated. Muscle strengthening exercises may be performed almost two to three times a week provided sessions are short (30 min) and weights and movements are moderate.

In the case of people with diabetes, the initial physical examination should be conducted to assess the cardiovascular, nervous, renal and visual functions and gauge the risk of complications. Patients should then be prescribed endurance exercises lasting for 20 min at the start of a protocol to several hours after a few weeks of training. In all cases, the weekly amount of exercise should make patients burn an extra 1000–2000 kcal/week, which corresponds to 3–6 hours of moderate to high-intensity exercise [6]. Extra attention should be paid to patients’ feet and gear (socks and shoes).

Patients who are severely overweight to obese should be prescribed a retraining protocol that includes endurance exercises, such as walking or cycling, and strength exercises. As endurance exercises are designed to raise calorie consumption, they should last for over 45 min and be of moderate intensity (40–60% of VO2 max or the heart rate reserve). Muscle strengthening exercises improve mobility by developing a certain level of functional reserve in everyday activities.

Moreover, endurance exercises offer the advantage of raising the metabolism during recovery and via the increase in muscle mass. It should be noted that equipment, such as bicycle seats and weight machines, may not always be suited to the geriatric population and may have to be changed.

Patients with hypertension should be prescribed a daily endurance activity lasting 40–60 min and at moderate intensity (40–70% of VO2 max). This activity may be supplemented with muscle strengthening activities after a long learning period on technique, such as proper breathing during strengthening exercises. To avoid increasing their blood pressure, subjects should never hold their breath while exercising.

Exercise is not ruled out for patients with respiratory failure. They should be prescribed endurance exercises that are intermittent at first (four sets lasting 3 min each) then continuous after a few weeks (20–30 min of exercise). The exercise intensity should be limited and ventilation and blood saturation should be monitored to control the risks of exceeding comfort and safety thresholds. Walking and cycling are recommended for such patients.

In the light of the risks involved and the fact that they are very deconditioned, cardiac failure patients should always perform a retraining protocol in the presence of a cardiologist and in a specialised facility. Their heart rate should be monitored at least during the first few months of readjustment.

Conclusion

To maximise benefits from adoption of a program to which the patient can adhere for long time, it is important to tailor the exercise prescription to the individual.

Ageing causes changes in a person’s cardiocirculatory fitness and muscle function. Physical exercise can mitigate the effects of age on these functions and preserve the functional reserve in elderly people [38].

In addition, it can maintain a person’s quality of life and help them to continue pursuing everyday activities. Scores of studies have shown that maintaining the quantity and quality (intensity) of physical activity can diminish the risk of cardiovascular mortality, prevent the development of some cancers, lower the risk of osteoporosis and increase longevity. Specific exercise programmes to improve cardiocirculatory fitness and muscle function have been developed over the past 20 years [3,23,29,36].

The possibility of improving both elements, essential even in extremely elderly subjects, has been proven [38]. Given the fact that the elderly population is growing, the adherence of elderly patients to this type of programme and the difficulty they encounter in adopting a more active lifestyle are a major concern [22,39].

Study Name

Strength Training in the Elderly

PublicationSports Medicine
PurposeThe purpose of this article is to analyze the research literature on the effects of ST on risk factors for age-related diseases and disabilities that have been most commonly studied.
MethodsTherefore, this review will discuss and critically evaluate the research literature on the effects of ST on risk factors for age-related diseases and disabilities that have been most commonly studied. For the purpose of this review, the topics will be limited to include the effects of ST on risk factors for sarcopenia, coronary heart disease (CHD), hypertension, diabetesmellitus,metabolic syndrome, obesity, osteoporosis and osteoarthritis. In addition, the prevention of disability will be discussed by focusing on the research literature that pertains to the effects of ST on the loss of flexibility with age and fall prevention.
Results 
Conclusion

Table 1 provides an overview comparing the effects of aging to the effects of ST on indicators of muscle function and health status. The following conclusions can be made about the effects of ST on risk factors for age-related diseases or disabilities:

(i) Approximately 2 decades worth of ageassociated losses in strength and muscle mass can be regained within the first couple of months of heavy resistance ST.

(ii) ST fails to produce substantial changes in VO2max, but can improve endurance performance.

(iii) There is little or no evidence that ST can improve mean values of lipoprotein-lipid profiles. It is possible that people with certain genotypes may be able to improve their profiles with ST, but no evidence for this exists at the present time.

(iv) There is no evidence that ST can reduce BP in elderly hypertensives, but there is now evidence for normalising BP in the high normal category.

 (v) Some studies show no changes in glucose tolerance with ST and others show reductions in plasma glucose in response to oral glucose tolerance tests. However, most studies show that ST can improve insulin action either through reductions ininsulin responses from oral glucose tolerance tests or increased glucose uptake from glycaemic clamp studies.

(vi) There is evidence for reductions in total body fat and intra-abdominal fat with ST. However, no studies that have reported this have been able to completely rule out the effects of diet.

(vii) There is some evidence that ST can increase RMR in older men, but there is little evidence for this effect in women. An explanation for this gender difference has not been determined, but differences in sympathetic neural activity in response to ST has been suggested.

(viii) The evidence for increases in BMD with ST is mixed, but there is good evidence for the effectiveness of ST in preventing age-associated losses in BMD.

(ix) Although there is little or no evidence for ST preventing falls, there is strong evidence for reduction in several risk factors for falls.

(x) There is no evidence from properly controlled studies that ST improves flexibility, even when both the agonist and antagonist muscle groups are trained through the full ROM. There is suggestive evidence that ST in itself may even worsen flexibility. Therefore, prolonged stretching should be a part of any well designed ST programme.

(xi) There is some evidence that ST may reduce symptoms of osteoarthritis in the knee, but better controlled studies are needed.

Study Name

Benefits of exercise training and the correlation between aerobic capacity and functional outcomes and quality of life in elderly patients with coronary artery disease

PublicationThe Kaohsiung Journal of Medical Sciences
PurposeThe purpose of the current study is to investigate the beneficial effects of exercise training in elderly people with coronary artery disease (CAD), integrating exercise stress testing, functional mobility, handgrip strength, and health-related quality of life.
MethodsElderly people with CAD were enrolled from the outpatient clinic of a cardiac rehabilitation unit in a medical center. Participants were assigned to the exercise training group (N = 21) or the usual care group (N = 15). A total of 36 sessions of exercise training, completed in 12 weeks, was prescribed. Echocardiography, exercise stress testing, the 6-minute walking test, Timed Up and Go test, and handgrip strength testing were performed, and the Short-Form 36 questionnaire (SF-36) was administered at baseline and at 12-week follow-up.
Results

Peak oxygen consumption improved significantly after training. The heart rate recovery improved from 13.90/minute to 16.62/minute after exercise training.

Functional mobility and handgrip strength also improved after training. Significant improvements were found in SF-36 physical function, social function, role limitation due to emotional problems, and mental health domains. A significant correlation between dynamic cardiopulmonary exercise testing parameters, the 6-minute walking test, Timed Up and Go test, handgrip strength, and SF-36 physical function and general health domains was also detected. 

ConclusionTwelve-week, 36-session exercise training, including moderate-intensity cardiopulmonary exercise training, strengthening exercise, and balance training, is beneficial to elderly patients with CAD, and cardiopulmonary exercise testing parameters correlate well with balance and quality of life.
Study Name

Improved Cardiorespiratory Endurance Following 6 Months of Resistance Exercise in Elderly Men and Women

PublicationJAMA Internal Medicine
PurposeObjective: To examine the effect of 6 months of high- or low-intensity resistance exercise on aerobic capacity and treadmill time to exhaustion in adults aged 60 to 83 years.
Methods

Sixty-two men and women completed the study protocol. Subjects were matched for strength and randomly assigned to a control (n = 16), low-intensity exercise (LEX, n = 24), or high-intensity exercise (HEX, n = 22) group.

Subjects trained at either 50% of their one repetition maximum (1-RM) for 13 repetitions (LEX) or 80% of 1-RM for 8 repetitions (HEX) 3 times per week for 24 weeks. One set each of 12 exercises was performed. Strength was measured for the leg press, chest press, leg curl, leg extension, overhead press, biceps curl, seated row, and triceps dip. Muscular endurance was measured for the leg press and chest press.

Aerobic capacity (peak oxygen consumption [V̇O2 peak]) was measured during an incremental treadmill test (Naughton). Treadmill time to exhaustion was measured as the time to exhaustion during the incremental exercise test.

ResultsThe 1-RM significantly increased (P≤.05) for all exercises tested for both the HEX and LEX groups. Aerobic capacity increased (P≤.05) by 23.5% (20.2 to 24.7 mL · kg−1· min−1) and by 20.1% (20.9 to 24.4 mL · kg−1· min−1) for the LEX and HEX groups, respectively. Treadmill time increased (P≤.05) by 26.4% and 23.3% for the LEX and HEX groups, respectively.
ConclusionSignificant improvements in aerobic capacity and treadmill time to exhaustion can be obtained in older adults as a consequence of either high- or low-intensity resistance exercise. These findings suggest that increased strength, as a consequence of resistance exercise training, may allow older adults to reach and/or improve their aerobic capacity.
Study Name

Effects of stair‐climbing on balance, gait, strength, resting heart rate, and submaximal endurance in healthy seniors

PublicationScandinavian Journal of Medicine & Science in Sports
PurposeThe purpose of this study is to provide data on neuromuscular and cardiorespiratory performance after regular stair‐climbing in seniors. Stair‐climbing serves as a feasible opportunity to remain physically active within everyday‐life.
MethodsForty‐eight seniors were stratified to a one‐ (taking every step, INT1) or two‐step strategy (every second step, INT2) or a control group (CON). Thirty‐nine seniors [females: n = 22, males: n = 17; age: 70.5 (SD 5.1) years; BMI: 25.8 (3.1) kg/m2] completed the 8‐week intervention (three weekly sessions). Before and after the intervention, balance, gait, strength, and submaximal endurance (at different intensities) were assessed.
ResultsMaximal strength and explosive power did not improve significantly (0.10 < P < 0.78). Resting heart rate was significantly reduced in INT2 (−8/min) compared with INT1 (0/min, P = 0.02) and CON (0/min, P = 0.03). Compared with CON, perceived exertion for all intensities (0.007 < P < 0.03) and submaximal exercise heart rate during moderate uphill walking significantly decreased (−11/min; P < 0.05) in INT2. Step counts for forward beam balancing (4.5 cm width) increased in INT2 (P = 0.007) compared with CON. With more pronounced effects in INT2, stair‐climbing significantly improved resting and exercise heart rates, perceived exertion, and dynamic balance performance in healthy seniors and may contribute to better overall fitness, reduced fall risk, and less perceived strain during daily life activities.
Conclusion

In this respect, the results of the present study provide evidence that small amounts of regular stairclimbing can result in relevant adaptations in submaximal endurance, resting heart rate, and dynamic balance in active and healthy community-dwelling elderly. No significant effects were present in static balance, strength, and gait.

The observed adaptations may contribute to better overall fitness, reduced fall risk, and less exertion during daily life activities. Regular stair-climbing, thus, can contribute to a healthy lifestyle and limit the aging induced physical decline in seniors. The observed benefits seem to be more pronounced when taking only every second step. This strategy might be suitable and effective for healthy and active seniors. More frail seniors might also benefit from using the one-step strategy.

However, this remains an interesting perspective for future research. The widespread implementation of stair-climbing activities into everyday life, for instance by multicomponent campaigns (Lewis & Eves, 2012) including motivational and volitional measures such as point-of-decision prompts (Soler et al., 2010) with particular regard to relevant target groups and more frail elderly seems promising from a public health perspective.

Study Name

Resource Manual for Active Seniors

PublicationInternational Institute for Sport and Human Performance, University of Oregon
PurposeThis paper provides organized information on topics of interest for active seniors, including exercises.
Methods

This manual includes articles on various topics related to exercises for seniors, such as:

  1.  The Benefit of Exercise
  2.  The Proper Way to Stretch
  3.  Working Out in the Water
  4.  Walking is a Workout
  5.  Ideas for Resistance Training
  6. Working Out at Home with Exercise Bands
  7. Dance
  8. Fitness and Exercise
  9. Lap Swimming
  10. Stretching
  11. Tai Chi and Qigong
  12. Walking
  13. Yoga
Results 
ConclusionThis paper is a resource manual for active seniors and includes refferences to studies/articles, assesses benefits of various exercises and offers some tips for acvtive seniors.
Study Name

Programs on People Older Than 80 Years

PublicationRejuvenation Research
PurposeThis study aimed at comparing the effects of three chair-based exercise programs on people older than 80 years.
MethodsThirty-six participants (87.91 ± 4.70 years) were randomly allocated to an aerobic, muscular resistance, or joint mobility exercise program. The participants exercised 3 days per week during 3 months. A hand-held dynamometer, the Tinetti Gait Balance, the Barthel Index, and the Timed Up and Go Test (TUG) (assessed by means of the Wiva® science sensor) were used to evaluate the effects of the programs on the participants’ strength, balance, functional independence, and functional mobility, respectively.
ResultsAfter the intervention, it was observed that only the elastic-band program resulted in significant improvements in strength and balance.
ConclusionThese results imply that when choosing a low-cost exercise program for very old people, the use of elastic bands stands as a far better option than pedaling on a pedal exerciser or performing mobility exercises.
Study Name
PublicationAmerican Journal of Health Promotion
PurposePurpose: Determine the effects of 16 weeks of strength training using Thera-Band resistive bands on measures of functional ability in elderly who are functionally limited.
Methods

Design: Quasi-experimental trial in which elderly volunteers were assigned to either an exercise group or a control group.

Participants: Eighty-seven participants (65–93 years) living independently but with some functional limitations.

Intervention: Thirteen different strength training exercises using Thera-Band resistive bands (Hygenic Corporation, Akron, Ohio). The program was 16 weeks in duration, and the frequency was three times per week. Participants exercised in a group setting one time per week and were given a home exercise book to follow for two additional sessions per week.

Measures: Functional ability was operationalized to include a variety of measures related to functional ability that impact activities of daily living, morbidity, and mortality in the elderly, including upper- and lower-body strength and gait.

Analysis: Intervention effects were analyzed using a 2 (groups: exercise group vs. control group) X 3 (time: baseline vs. mid vs. post) analysis of variance.

ResultsThe exercise group demonstrated significant improvements in upper-body strength as measured by biceps curl (F[2,140] = 39.870; p < .05) and lower-body strength as measured by chair sit-to-stand (F[2,124] = 25.887; p < .05). Gait velocity (F[2,140] = 37.317; p < .05) and step length (F[2,140] = 4.182; p < .05) both increased for the exercise group at week 9, but this increase disappeared by week 17. Compared with minimal changes in the control group, the exercise group demonstrated significant improvements in upper-body strength as measured by biceps curl and lower-body strength as measured by chair sit-to-stand.
ConclusionSome measures of function ability were improved after a 16-week structured exercise program for functionally limited elderly. Because functional ability has been inversely correlated with short-term morbidity and the need for assisted living among older adults, providing opportunities to exercise is crucial to future functioning and independence of the elderly population. (Am J Health Promot 2011;25[4]:237–243.)
Study Name

Resistance Exercise for Muscular Strength in Older Adults: A Meta-Analysis

PublicationAgeing Research Reviews
PurposeThe effectiveness of resistance exercise for strength improvement among aging persons is inconsistent across investigations, and there is a lack of research synthesis for multiple strength outcomes.
Methods

The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. A meta-analysis was conducted to determine the effect of resistance exercise (RE) for multiple strength outcomes in aging adults. Randomized controlled trials and randomized or non-randomized studies among adults ≥ 50 years, were included. Data were pooled using random effect models.

Outcomes for 4 common strength tests were analyzed for main effects. Heterogeneity between studies was assessed using the Cochran Q and I2 statistics, and publication bias was evaluated through physical inspection of funnel plots as well as formal rank-correlation statistics. A linear mixed model regression was incorporated to examine differences between outcomes, as well as potential study-level predictor variables

ResultsForty-seven studies were included, representing 1079 participants. A positive effect for each of the strength outcomes was determined however there was heterogeneity between studies. Regression revealed that higher intensity training was associated with greater improvement. Strength increases ranged from 9.8 – 31.6 kg, and percent changes were 29 ± 2, 24 ± 2, 33 ± 3, and 25 ± 2, respectively for leg press, chest press, knee extension, and lat pull.
ConclusionRE is effective for improving strength among older adults, particularly with higher intensity training. Findings therefore suggest that RE may be considered a viable strategy to prevent generalized muscular weakness associated with ageing.
Study Name

Effects of combined strength and endurance training on treadmill load carrying walking performance in aging men

PublicationJournal of Strength and Conditioning Research
PurposeThe present study examined the effects of twice weekly total body strength training (ST), endurance cycling (ET), and combined ST and ET (2+2 times a week) (SET) training on the load carrying walking test performance on the treadmill (TM) and changes in neuromuscular and endurance performance during a 21-week training period in aging men.
Methods

Forty healthy men (54.8+/-8.0 years) were divided into 3 training groups (ET n=9, ST n=11, SET n=11) and a control group (C, n=9). Peak oxygen uptake (VO2peak), heart rate, and blood lactate concentration were measured before and after a 21-week training program using a graded TM and maximal incremental bicycle ergometer (BE) tests. Isometric forces, vertical jump, and electromyographic activity of leg extensor and/or forearm flexor (F) muscles were measured before and after training and the TM tests.
Strength training: was a total body program for the lower and upper extremities and trunk.

However, each training session included 2 exercises for the leg extensor muscles (bilateral leg press and knee extension), one exercise for the knee flexors (bilateral or unilateral knee flexion), and 4–5 other exercises for the other main muscle groups of the body (bench press, triceps pushdown, or lateral pull-down exercise for the upper body; sit-up exercise for the trunk flexors or another exercise for the trunk extensors; bilateral or unilateral elbow extension exercise and leg adduction or abduction exercise). Muscle strength exercises used during the first cycle of the training were carried out with light loads (40–60% of the 1 repetition maximum [1RM]) but with a high number of repetitions with multiple sets.

To optimize muscle mass development during the second cycle, the loads increased progressively up to 60–80% of the 1RM with a relatively short recovery time to produce muscle growth (31). The third cycle included somewhat higher loads (70–85% of the 1RM) to optimize strength gains. Both overall intensity and volume of training increased progressively throughout the training period after a periodized training program. The supervised training sessions averaged from 60 to 90 minutes in length (Table 2).

ResultsIncreases of 20-21% in strength and of 7-12% in cycling BE VO2peak occurred in the training groups, whereas the changes of C remained minor. VO2peak was associated, both before and after training, with TM exercise time in all groups (from r=0.65, p=0.030 to r=0.93, p<0.001). Only SET showed a significant training-induced increase (p=0.011) in exercise time of the TM walking with no significant increase in TM VO2peak.
ConclusionThe present data suggest that in older men ET and SET induced specific increases in BE VO2peak and ST and SET in strength. However, only SET increased walking exercise time indicating improved load carrying walking performance because of large individual differences in the magnitude of the development of either strength or endurance capacities.
Study Name

Effects of Different Exercise Interventions on Risk of Falls, Gait Ability, and Balance in Physically Frail Older Adults: A Systematic Review

PublicationRejuvenation Research
PurposeThe aim of this review was to recommend training strategies that improve the functional capacity in physically frail older adults based on scientific literature, focusing specially in supervised exercise programs that improved muscle strength, fall risk, balance, and gait ability.
MethodsScielo, Science Citation Index, MEDLINE, Scopus, Sport Discus, and ScienceDirect databases were searched from 1990 to 2012. Studies must have mentioned the effects of exercise training on at least one of the following four parameters: Incidence of falls, gait, balance, and lower-body strength.
Results

Twenty studies that investigated the effects of multi-component exercise training (10), resistance training (6), endurance training (1), and balance training (3) were included in the present revision. Ten trials investigated the effects of exercise on the incidence of falls in elderly with physical frailty. Seven of them have found a fewer falls incidence after physical training when compared with the control group. Eleven trials investigated the effects of exercise intervention on the gait ability.

Six of them showed enhancements in the gait ability. Ten trials investigated the effects of exercise intervention on the balance performance and seven of them demonstrated enhanced balance. Thirteen trials investigated the effects of exercise intervention on the muscle strength and nine of them showed increases in the muscle strength.

ConclusionThe multi-component exercise intervention composed by strength, endurance and balance training seems to be the best strategy to improve rate of falls, gait ability, balance, and strength performance in physically frail older adults.
Study Name

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

PublicationJournal of the American Geriatrics Society
PurposeObjectives: 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.
Methods

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).

ResultsET 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.
ConclusionOur 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.
Study Name

Long-term effects of three multicomponent exercise interventions on physical performance and fall-related psychological outcomes in community-dwelling older adults: a randomized controlled trial

PublicationJournal of the American Geriatrics Society
PurposeObjectives: To determine the long-term effects of three strength and balance exercise interventions on physical performance, fall-related psychological outcomes, and falls in older people.
Methods

Design: A single-blinded, four-group, randomized controlled trial.

Setting: Community, Germany.
Participants: Community-dwelling adults aged 70 to 90 who had fallen in the past 6 months or reported fear of falling.

Intervention: After baseline assessment, 280 participants were randomly assigned to the control group (CG; no intervention; n = 80) or one of three strength and balance exercise interventions (the strength and balance group (SBG; strength and balance only; n = 63), the fitness group (FG; strength and balance plus endurance training; n = 64), or the multifaceted group (MG; strength and balance plus fall risk education; n = 73). The interventions consisted of 32 one-hour group sessions in 16 weeks.

Measurements: Data on physical performance, fall-related psychological outcomes, and falls were collected for 24 months.

ResultsMixed-effects regression analyses showed improved short- and long-term (12 and 24 months, respectively) physical performance for the SBG and FG, particularly regarding mobility, balance, and walking speed (P < .05). The improvements in physical performance outcomes were most prominent in the FG. Fall-related psychological outcomes, number of falls, and injurious falls were not significantly different from in the control group.
ConclusionTraining focusing on strength, balance, and endurance can enhance physical performance for up to 24 months in community-dwelling older adults. These findings did not translate to improved fall-related psychological outcomes or reduced incidence of falls. This demonstrates the need for a different approach (e.g., regarding intervention dose and components) to gain intervention benefits in the multiple domains that contribute to independence and well-being in older adults.
Study Name

Intense tai chi exercise training and fall occurrences in older, transitionally frail adults: a randomized, controlled trial

PublicationJournal of the American Geriatrics Society
PurposeObjectives: To determine whether an intense tai chi (TC) exercise program could reduce the risk of falls more than a wellness education (WE) program in older adults meeting criteria for transitioning to frailty.
Methods

Design: Randomized, controlled trial of 48 weeks duration.
Getting: Twenty congregate living facilities in the greater Atlanta area.

Participants: Sample of 291 women and 20 men aged 70 to 97.

Measurements: Demographics, time to first fall and all subsequent falls, functional measures, Sickness Impact Profile, Centers for Epidemiologic Studies-Depression Scale, Activities-specific Balance Confidence Scale, Falls Efficacy Scales, and adherence to interventions.

ResultsThe risk ratio (RR) of falling was not statistically different in the TC group and the WE group (RR=0.75, 95% confidence interval (CI)=0.52-1.08), P=.13). Over the 48 weeks of intervention, 46% (n=132) of the participants did not fall; the percentage of participants that fell at least once was 47.6% for the TC group and 60.3% for the WE group.
ConclusionTC did not reduce the RR of falling in transitionally frail, older adults, but the direction of effect observed in this study, together with positive findings seen previously in more-robust older adults, suggests that TC may be clinically important and should be evaluated further in this high-risk population.
Study Name

Tai Chi and Low Impact Exercise: Effects on the Physical Functioning and Psychological Well-Being of Older People

PublicationJournal of Applied Gerontology
PurposeThe effects of tai chi (TC) and low impact exercise (LIE) interventions on physical functioning and psychological well-being of sedentary older people were contrasted.
MethodsParticipants were randomized to TC, LIE, or non-exercise control groups with interventions running for 12 weeks.
ResultsPost-intervention assessments with 72 participants who completed the study revealed that participants in both exercise groups improved with respect to upper body strength, balance, cardiovascular endurance, lower body strength, sleep disturbances, and anxiety. Participants in the LIE group reported better functional ability while those in the TC group reported better subjective health.
ConclusionFindings suggest that tai chi and low impact exercise are safe, cost-effective ways to improve both physical and psychological functioning of older people.
Study Name
PublicationArchives of Gerontology and Geriatrics
PurposeThe aim of this report is to investigate the effects of 8 weeks of intensive Tai Chi Chuan (TCC) training on physiological function and fear of falling (FOF) in the less-robust elderly.
MethodsForty-nine community-dwelling elderly, aged 60 or older, were classified randomly into a TCC training or control group. Physical performance measures (including one-leg stance, trunk flexion, and walking speed) and interviews were conducted before and after the intervention. The TCC group showed significant improvements in balance and flexibility, and a reduced FOF, when compared with the control group after the intervention. However, walking speed did not change significantly.
ResultsThe results suggest that a high-frequency, short-term TCC training program can improve balance, flexibility, and increase the confidence of less-robust elderly.
ConclusionThese suggest the effectiveness of TCC for intervention as a means to prevent falling among high-risk elderly populations.
Study Name

Balance and strength training in older adults: intervention gains and Tai Chi maintenance

PublicationJournal of the American Geriatrics Society
PurposeObjective: To determine the effect on balance and strength of 3 months of intensive balance and/or weight training followed by 6 months of low intensity Tai Chi training for maintenance of gains.
Methods

Design: Randomized control intervention. Four groups in 2 x 2 design: Control, Balance, Strength, Balance + Strength, using blinded testers.

Setting: Exercise and balance laboratory at University of Connecticut Health Center.

Participants: Subjects were 110 healthy community dwellers (mean age 80) who were free of dementia, neurological disease, and serious cardiovascular or musculoskeletal conditions.

Interventions: Short-term training (3 months) occurred 3 times/week (45 minutes Balance and Strength, 90 minutes Balance + Strength). Balance training included equilibrium control exercises of firm and foam surfaces and center-of-pressure biofeedback. Strengthening consisted of lower extremity weight-lifting. All subjects than received long-term group Tai Chi instruction (6 months, 1 hour, 1 time/week).

Measurements: Losses of balance during Sensory Organization Testing (LOB), single stance time (SST), voluntary limits of stability (FBOS), summed isokinetic torque of eight lower extremity movements (ISOK), and usual gait velocity (GVU).

ResultsBalance training meaningfully improved all balance measures by restoring performance to a level analogous to an individual 3 to 10 years younger: LOB = -2.0 +/- 0.3 (adjusted paired differences, P < .005 ANOVA); SST = 7.0 +/- 1.2 sec; and FBOS = 9.0 +/- 2.0% of foot length (P < .05). Strengthening increased ISOK by 1.1 +/- 0.1 Nm kg-1 (P < .005). There was no interaction between balance and strength training. Significant gains persisted after 6 months of Tai Chi, although there was some decrement.
ConclusionBalance training meaningfully improved all balance measures by restoring performance to a level analogous to an individual 3 to 10 years younger. There was no interaction between balance and strength training. Significant gains persisted after 6 months of Tai Chi, although there was some decrement.
Study Name

Effects of Tai Chi and Western Exercise on Physical and Cognitive Functioning in Healthy Community-Dwelling Older Adults

PublicationJournal of Aging and Physical Activity
PurposeObjective: To compare the effects of Tai Chi (TC, n = 37) and Western exercise (WE, n = 39) with an attention-control group (C, n = 56) on physical and cognitive functioning in healthy adults age 69 ± 5.8 yr, in a 2-phase randomized trial.
Methods

TC and WE involved combined class and home-based protocols. Physical functioning included balance, strength, flexibility, and cardiorespiratory endurance. Cognitive functioning included semantic fluency and digit-span tests. Data were analyzed using intention-to-treat analysis.

The WE program incorporated endurance, resistance/strength, and flexibility exercises.

ResultsAt 6 mo, WE had greater improvements in upper body flexibility (F = 4.67, p = .01) than TC and C. TC had greater improvements in balance (F = 3.36, p = .04) and a cognitive-function measure (F = 7.75, p < .001) than WE and C. The differential cognitive-function improvements observed in TC were maintained through 12 mo.
ConclusionThe TC and WE interventions resulted in differential improvements in physical functioning among generally healthy older adults. TC led to improvement in an indicator of cognitive functioning that was maintained through 12 mo.
Study Name

Group and home-based tai chi in elderly subjects with knee osteoarthritis: a randomized controlled trial

PublicationClinical Rehabilitation
PurposeObjective: To evaluate the effects of tai chi consisting of group and home-based sessions in elderly subjects with knee osteoarthritis.
Methods

Design: A randomized, controlled, single-blinded 12-week trial with stratification by age and sex, and six weeks of follow-up.

Setting: General community.
Participants: Forty-one adults (709 / 9.2 years) with knee osteoarthritis.

Interventions: The tai chi programme featured six weeks of group tai chi sessions, 40 min/session, three times a week, followed by another six weeks (weeks 7 -12) of home-based tai chi training. Subjects were requested to discontinue tai chi training during a six-week follow-up detraining period (weeks 13-18). Subjects in the attention control group attended six weeks of health lectures following the same schedule as the group-based tai chi intervention (weeks 0 -6), followed by 12 weeks of no activity (weeks 7-18).

Main outcome measures: Knee pain measured by visual analogue scale, knee range of motion and physical function measured by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were recorded at baseline and every three weeks throughout the 18-week study period. Data were analysed using a mixed model ANOVA.

ResultsThe six weeks of group tai chi followed by another six weeks of home tai chi training showed significant improvements in mean overall knee pain (P = 0.0078), maximum knee pain (P = 0.0035) and the WOMAC subscales of physical function (P = 0.0075) and stiffness (P = 0.0206) compared to the baseline. No significant change of any outcome measure was noted in the attention control group throughout the study.
ConclusionThe tai chi group reported lower overall pain and better WOMAC physical function than the attention control group at weeks 9 and 12. All improvements disappeared after detraining.
Study Name

Direction-Induced Effects of Visually Guided Weight-Shifting Training on Standing Balance in the Elderly

PublicationGerontology
PurposeThe purpose of this study was to investigate the impact of two direction-specific, visually guided WS training protocols on standing balance of healthy elderly women.
MethodsForty-eight community-dwelling elderly women, all free of any neurological or musculoskeletal impairment, were randomly assigned into: a group that practiced WS in the anterior/posterior direction (A/P group, n = 19), a group that practiced WS in the medio/lateral direction (M/L group, n = 15) and a control group (n = 14). Participants performed 12 training sessions of visually guided WS (3 sessions a week for 25 minutes per session). Static balance was measured before and after training in normal (bipedal) quiet stance (NQS) and sharpened-Romberg stance (SRS) by recording center of pressure (CoP) variations and angular segment kinematics.
ResultsIn NQS, neither of the two training protocols had a significant impact on postural sway measures, although a significant decrease in interlimb asymmetry of CoP displacement was noted for the A/P group. In SRS, A/P training induced a significant reduction of CoP displacement, lower limb pitch and upper trunk roll rotation.
ConclusionThe results of the study stress the importance of using direction-specific WS tasks in balance training, particularly in the A/P direction, in order to improve control of static balance in elderly women.
Study Name

Balance training in 70-year-old women

PublicationPhysiotherapy Theory and Practice
PurposeThe aim of this study was to discover whether or not the balance of a group of older women could be improved using nine simple, clinical balance tests before and after a training period.
MethodsA total of 34 healthy 70-year-old women volunteered for the study and they were randomised into two groups: the first received 1 hour’s training twice a week for 5 weeks; the second the control group did not receive any training. The tests included: standing on one leg (a) with or without visual feedback and (b) with or without rotation of the neck; walking along a beam; walking in a figure-of-eight; and walking as fast as possible.
ResultsThe balance of the training group improved significantly in six out of the nine tests, whereas no such improvement was seen among the controls.
ConclusionWe conclude that healthy women aged 70 years are able to improve their balance both when standing and walking.
Study Name

The Effect of 6 Months Training on Leg Power, Balance, and Functional Mobility of Independently Living Adults Over 70 Years Old

PublicationJournal of Aging and Physical Activity
PurposeWhere strength training has been used in conjunction with functional-task training in older people, not only have there been improvements in leg strength but also improved function has been measured (e.g., Skelton & McLaughlin, 1996). Many studies use participants from care homes rather than community dwellers. We investigated changes in leg power, balance, and functional mobility in community-dwelling sedentary men and women over 70 years of age.
Methods

We investigated changes in leg power, balance, and functional mobility in community-dwelling sedentary men and women over 70 years of age (n = 6 for training group [TR]; n = 10 for control group [CN]). Progressive training took place over 24 weeks using seated and nonseated exercise.

During Weeks 0–4, exercises were mainly performed seated on a chair (e.g., knee raises, ankle rotation, swinging the legs forward and backward, and half-squats—the latter two exercises using the chair as support), and simple step sequences (forward and, later, backward movements) were used to challenge balance and coordination. This was followed by exercises that involved getting down on to and up from the floor with the use of (body) weight-bearing exercises to improve lower limb strength, flexibility (e.g., Achilles and hamstring stretches), and mobility.

After 12 weeks, use of dynabands provided additional resistance for the arms (e.g., extending the triceps and pectoral muscles) and legs (e.g., abduction of the thighs, single-leg extensions), floor work was introduced to challenge the back and stomach muscles (e.g., tummy-strengthening exercises, hamstring stretch), and simple ball games (throwing and catching) and movement exercises provided an opportunity for increased movement, balance, and coordination.

A 5-min cool-down period followed each class, which provided further opportunities for stretching. Progression during the classes was achieved by gradually building up the number of repetitions of an exercise (0–12 weeks) and then increasing the resistance and speed of movement (12–24 weeks), the latter by changing the rhythm and content of the background music. Exercises to improve lower limb power, balance, and coordination were taken from the booklet Exercise for Healthy Ageing (1998). Mobility exercises were taken from the leaflet Take a Seat and Stretch (Keep Fit Association, 2001).

ResultsFor TR, leg power increased 40%, from 108 ± 40 to 141 ± 53 W (p < .01); dynamic balance increased 48%, from 22.3 ± 7.9 to 33.1 ± 6.1 cm (p < .01; functional reach); and functional mobility increased 12%, from 7.46 ± 1.32 to 6.54 ± 1.41 s (p < .05; timed walk). CN showed no significant change.
ConclusionIn conclusion, a community-based exercise program led to large improvements in leg-extensor power, dynamic balance, and functional mobility.
Study Name

Fall Incidence in Frail Older Women after Individualized Visual Feedback-Based Balance Training

PublicationGerontology
PurposeThe aim of this study was to examine the effects of a 4-week individualized visual feedback-based balance training on the fall incidence during 1-year follow-up among frail older women living in residential care.
MethodsTwenty-seven older women from 2 residential care homes were randomized into exercise (n = 20) and control (n = 7) groups. Balance measurements were carried out before and after a 4-week training period and falls were monitored by monthly diaries for 1 year. An interview about fear of falling and physical activity was completed before and after the intervention and after the 1-year follow-up.
ResultsA positive effect of balance training on fall incidence was found. A dynamic Poisson regression model showed that during the follow-up the monthly risk of falling was decreased in the exercise group compared to controls (risk ratio 0.398, 95% CI 0.174–0.911, p = 0.029). In addition, the exercise group reported a reduced fear of falling and increased physical activity after a training period but these changes declined during the follow-up period.
ConclusionIndividualized visual feedback-based balance training was shown to be a promising method for fall prevention among frail older women. High compliance (97.5%) with the training program showed that carefully targeted training programs can be carried out among older people with health limitations.
Study Name

A Controlled Trial of Exercise by Residents of Old People’s Homes

PublicationAge and Ageing
PurposeThis study reports the findings of a controlled trial of seated exercise in residents of local authority homes for the elderly.
MethodsForty-nine residents aged 64–91 years volunteered for the 7-month project, and participated in either twice-weekly exercise or reminiscence sessions. Primary outcome measures were postural sway, flexibility of the spine and knees, hand-grip strength and functional capacity. The average (range of) attendance at the exercise sessions was 91% (64–100%), and at the reminiscence sessions was 86% (46–100%).
ResultsBy the end of the project, the change observed in the exercise group was significantly different from that of the reminiscence group in terms of grip strength (p<0.02), spinal flexion (p<0.001), chair-to-stand time (p<0.001), activities of daily living (p<0.05), and self-rating of depression (p<0.01).
ConclusionEven very elderly residents of old peoples homes can benefit from participation in regular seated exercise and improve their functional capacity.
Study Name

The Effect of Functional Circuit Training on Physical Frailty in Frail Older Adults: A Randomized Controlled Trial

PublicationJournal of Aging and Physical Activity
PurposeThe purpose of this study was to evaluate whether a 12-wk functional circuit-training program (FCT) could alter markers of physical frailty in a group of frail community-dwelling adults.
MethodsFifty-one individuals (31 women, 20 men), mean age (± SD) 84 (± 2.9) yr, met frailty criteria and were randomly assigned into groups (FCT = 26, control group [CG] = 25). FCT underwent a 12-wk exercise program. CG met once a week for health education meetings. Measures of physical frailty, function, strength, balance, and gait speed were assessed at Weeks 0, 12, and 36.
ResultsPhysical-frailty measures in FCT showed significant (p < .05) improvements relative to those in CG (Barthel Index at Weeks 0 and 36: 73.41 (± 2.35) and 77.0 (± 2.38) for the FCT and 70.79 (± 2.53) and 66.73 (± 2.73) for the CG.
ConclusionThese data indicate that an FCT program is effective in improving measures of function and reducing physical frailty among frail older adults.
Study Name

Effect of additional functional exercises on balance in elderly people

PublicationClinical Rehabilitation
PurposeObjective: To evaluate the additional effect of functional exercises on balance and lower extremity function among hostel-dwelling elderly people partaking in strength,training.
Methods

Design: A randomized two-group parallel controlled trial.
Setting: A senior resident’s hostel in Switzerland.

Participants: Thirty-two individuals randomized to either strength or strength and functional exercise groups.

Interventions: Both groups received machine-driven strength training for 45 min, twice weekly, for 12 weeks. The strength and functional exercises group received an additional 30 min of functional exercise training, once weekly.

Main outcome measures: Tinetti test, balance tests and a physical performance test. Assessments were performed before and after the intervention.

ResultsImprovements for the balance test depended on the type of training (significant interaction effects [F(1,20)= 6.7; P = 0.018]). This test improved from 11.3 ∓ 11.7 to 17 ∓ 11.2 (P = 0.009) in the combined training group (n = 12) and remained from 7.3 ∓ 9.5 to 6.9 ∓ 9.2 unchanged (P = 0.821) in the strength training group (n = 13). A significant difference between groups following training was observed (P = 0.031). The Tinetti balance score and the chair stand test of the physical performance assessment improved from 14.3 ∓ 1.9 to 15.3 ∓ 1.1 (P = 0.026) and 1.8 ∓ 1.2 to 2.8 ∓ 1.1 (P = 0.012) respectively in the combined training group only.
ConclusionOur findings suggest that twice-weekly lower extremity strength training of 12 weeks’ duration in hostel-dwelling elderly people only improves task-specific balance performance and lower extremity physical function when additional functional exercises are added.
Study Name

Integration of balance and strength training into daily life activity to reduce rate of falls in older people (the LiFE study): randomised parallel trial

PublicationBMJ
PurposeObjectives: To determine whether a lifestyle integrated approach to balance and strength training is effective in reducing the rate of falls in older, high risk people living at home.
Methods

Design: Three arm, randomised parallel trial; assessments at baseline and after six and 12 months. Randomisation done by computer generated random blocks, stratified by sex and fall history and concealed by an independent secure website.

Setting: Residents in metropolitan Sydney, Australia.
Participants: Participants aged 70 years or older who had two or more falls or one injurious fall in past 12 months, recruited from Veteran’s Affairs databases and general practice databases. Exclusion criteria were moderate to severe cognitive problems, inability to ambulate independently, neurological conditions that severely influenced gait and mobility, resident in a nursing home or hostel, or any unstable or terminal illness that would affect ability to do exercises.

Interventions: Three home based interventions: Lifestyle integrated Functional Exercise (LiFE) approach (n=107; taught principles of balance and strength training and integrated selected activities into everyday routines), structured programme (n=105; exercises for balance and lower limb strength, done three times a week), sham control programme (n=105; gentle exercise). LiFE and structured groups received five sessions with two booster visits and two phone calls; controls received three home visits and six phone calls. Assessments made at baseline and after six and 12 months.

Main outcome measures: Primary measure: rate of falls over 12 months, collected by self report. Secondary measures: static and dynamic balance; ankle, knee and hip strength; balance self efficacy; daily livingactivities; participation; habitual physical activity; quality of life; energy expenditure; body mass index; and fat free mass.

ResultsAfter 12 months’ follow-up, we recorded 172, 193, and 224 falls in the LiFE, structured exercise, and control groups, respectively. The overall incidence of falls in the LiFE programme was 1.66 per person years, compared with 1.90 in the structured programme and 2.28 in the control group. We saw a significant reduction of 31% in the rate of falls for the LiFE programme compared with controls (incidence rate ratio 0.69 (95% confidence interval 0.48 to 0.99)); the corresponding difference between the structured group and controls was non-significant (0.81 (0.56 to 1.17)). Static balance on an eight level hierarchy scale, ankle strength, function, and participation were significantly better in the LiFE group than in controls. LiFE and structured groups had a significant and moderate improvement in dynamic balance, compared with controls.
ConclusionThe LiFE programme provides an alternative to traditional exercise to consider for fall prevention. Functional based exercise should be a focus for interventions to protect older, high risk people from falling and to improve and maintain functional capacity.
Study Name

Functional Training Induces Greater Variety and Magnitude of Training Improvements than Traditional Resistance Training in Elderly Women

PublicationJournal of Sports Science and Medicine
PurposeThe objective was to investigate the effects of functional (FT) and traditional (TT) training on trunk muscles maximal isometric strength, rate of force development and endurance with trained elderly women.
MethodsForty-five elderly women were directed into three groups: FT (n =1 6), TT (n = 14) and Control (n = 15). The FT (multi-planar, and multi-articular movements) and TT (primarily machine-based resistance exercises) performed mobility, muscle strength and power exercises. Both training groups also performed intermittent cardiometabolic activities. The maximum strength and endurance of the trunk muscles were verified, both at baseline and after 12 weeks of training (3xweek for 50 min each). Data were analyzed using a 2-way ANCOVA with contrast of adjusted mean values.
ResultsFT significantly increased all variables: maximum trunk flexor strength (p = 0.002, 22%); rate of flexor force development (p = 0.001, 84%); trunk extensors maximal strength (p = 0.003, 17%); trunk extensor rate of force development (p = 0.05, 16%); trunk flexors (p = 0.001, 19%) and extensors (p = 0.017, 13%) endurance compared to baseline. TT showed an increase only in RFD of trunk extensors (p = 0.003, 53%), and flexors (p = 0.033, 42%), and trunk flexors endurance (p = 0.008, 11%).
ConclusionHowever, there was no statistically significant difference between groups. FT promoted improvement in all variables; strength, endurance and rate of force development of the trunk flexors and extensors of the elderly. On the other hand, TT improved only the rate of force development of trunk flexors and extensors and endurance of the trunk flexors. FT is recommended for elderly women as it improves a broader array of physiological parameters.
Study Name

Effects of prolonged and maintenance strength training on force production, walking, and balance in aging women and men

PublicationScandinavian Journal of Medicine & Science in Sports
PurposeObjective: To examine effects of 21-week twice/week strength training (ST) period followed by an additional 21-week twice or once/week ST period on force production, walking and balance in aging people.
MethodsSeventy-two women (58 ± 7 years; W) and 63 (58 ± 6 years) men (M) were randomized for the first 21-week ST period: STW and STM, control (C) CW and CM. Training participants were randomized for the second 21-week ST period: once/week STWx1 and STMx1, twice/week STWx2 and STMx2. LegPress, isometric leg extension rate of force development (RFD), walking time, and balance.
ResultsFirst 21-week ST period: leg press, RFD, balance, and walking improved significantly in STW and STM. Second 21-week ST period: leg press first increased in STMx1 and STMx2, and then decreased to the level of 21 weeks in STMx2 and remained unchanged in STWx2 and decreased in STWx1 and STMx1. Walking and balance improved significantly in STWx1 and STWx2.
ConclusionA progressive 21-week ST period twice/week in aging people can lead to large improvements in maximal strength, walking time, and balance in both genders. A further strength training period with the same amount of training may maintain the strength gains, whereas balance and walking may be maintained with less training.
Study Name

3 Different types of strength training in older women

PublicationInternational Journal of Sports Medicine
PurposeThe objective of the present study was to evaluate and compare the neuromuscular, morphological and functional adaptations of older women subjected to 3 different types of strength training.
Methods

58, healthy women (67 ± 5 year) were randomized to experimental (EG, n=41) and control groups (CG, n=17) during the first 6 weeks when the EG group performed traditional resistance exercise for the lower extremity.

Afterwards, EG was divided into three specific strength training groups; a traditional group (TG, n=14), a power group (PG, n=13) that performed the concentric phase of contraction at high speed and a rapid strength group (RG, n=14) that performed a lateral box jump exercise emphasizing the stretch-shortening-cycle (SSC). Subjects trained 2 days per week through the entire 12 weeks.

ResultsFollowing 6 weeks of generalized strength training, significant improvements occurred in EG for knee extension one-repetition (1RM) maximum strength (+19%), knee extensor muscle thickness (MT, +15%), maximal muscle activation (+44% average) and onset latency ( -31% average) for vastus lateralis (VL), vastus medialis (VM) and rectus femoris (RF) compared to CG (p<0.05). Following 6 more weeks of specific strength training, the 1RM increased significantly and similarly between groups (average of +21%), as did muscle thickness of the VL (+25%), and activation of VL (+44%) and VM (+26%). The onset latency of RF (TG=285 ± 109 ms, PG=252 ± 76 ms, RG=203 ± 43 ms), reaction time (TG=366 ± 99 ms, PG=274 ± 76 ms, RG=201 ± 41 ms), 30-s chair stand (TG=18 ± 3, PG=18 ± 1, RG=21 ± 2) and counter movement jump (TG=8 ± 2 cm, PG=10 ± 3 cm, RG=13 ± 2 cm) was significantly improved only in RG (p<0.05). At the end of training, the rate of force development (RFD) over 150 ms (TG=2.3 ± 9.8 N·s(-1), PG=3.3 ± 3.2 N·s(-1), RG=3.8 ± 6.8 N·s(-1), CG=2.3 ± 7.0 N·s(-1)) was significantly greater in RG and PG than in TG and CG (p<0.05).
ConclusionIn conclusion, rapid strength training is more effective for the development of rapid force production of muscle than other specific types of strength training and by consequence, better develops the functional capabilities of older women.
Study Name

Exercise for improving balance in older people

PublicationCochrane Database of Systematic Reviews
PurposeTo examine the effects of exercise interventions on balance in older people, aged 60 and over, living in the community or in institutional care.
Methods

Search methods: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, CENTRAL (The Cochrane Library 2011, Issue 1), MEDLINE and EMBASE (to February 2011).

Selection criteria: Randomised controlled studies testing the effects of exercise interventions on balance in older people. The primary outcomes of the review were clinical measures of balance.

Data collection and analysis: Pairs of review authors independently assessed risk of bias and extracted data from studies. Data were pooled where appropriate.

Results

This update included 94 studies (62 new) with 9,821 participants. Most participants were women living in their own home.

Most trials were judged at unclear risk of selection bias, generally reflecting inadequate reporting of the randomisation methods, but at high risk of performance bias relating to lack of participant blinding, which is largely unavoidable for these trials. Most studies only reported outcome up to the end of the exercise programme.

There were eight categories of exercise programmes. These are listed below together with primary measures of balance for which there was some evidence of a statistically significant effect at the end of the exercise programme. Some trials tested more than one type of exercise. Crucially, the evidence for each outcome was generally from only a few of the trials for each exercise category.

1. Gait, balance, co‐ordination and functional tasks (19 studies of which 10 provided primary outcome data): Timed Up & Go test (mean difference (MD) ‐0.82 s; 95% CI ‐1.56 to ‐0.08 s, 114 participants, 4 studies); walking speed (standardised mean difference (SMD) 0.43; 95% CI 0.11 to 0.75, 156 participants, 4 studies), and the Berg Balance Scale (MD 3.48 points; 95% CI 2.01 to 4.95 points, 145 participants, 4 studies).

2. Strengthening exercise (including resistance or power training) (21 studies of which 11 provided primary outcome data): Timed Up & Go Test (MD ‐4.30 s; 95% CI ‐7.60 to ‐1.00 s, 71 participants, 3 studies); standing on one leg for as long as possible with eyes closed (MD 1.64 s; 95% CI 0.97 to 2.31 s, 120 participants, 3 studies); and walking speed (SMD 0.25; 95% CI 0.05 to 0.46, 375 participants, 8 studies).

3. 3D (3 dimensional) exercise (including Tai Chi, qi gong, dance, yoga) (15 studies of which seven provided primary outcome data): Timed Up & Go Test (MD ‐1.30 s; 95% CI ‐2.40 to ‐0.20 s, 44 participants, 1 study); standing on one leg for as long as possible with eyes open (MD 9.60 s; 95% CI 6.64 to 12.56 s, 47 participants, 1 study), and with eyes closed (MD 2.21 s; 95% CI 0.69 to 3.73 s, 48 participants, 1 study); and the Berg Balance Scale (MD 1.06 points; 95% CI 0.37 to 1.76 points, 150 participants, 2 studies).

4. General physical activity (walking) (seven studies of which five provided primary outcome data).

5. General physical activity (cycling) (one study which provided data for walking speed).

6. Computerised balance training using visual feedback (two studies, neither of which provided primary outcome data).

7. Vibration platform used as intervention (three studies of which one provided primary outcome data).

8. Multiple exercise types (combinations of the above) (43 studies of which 29 provided data for one or more primary outcomes): Timed Up & Go Test (MD ‐1.63 s; 95% CI ‐2.28 to ‐0.98 s, 635 participants, 12 studies); standing on one leg for as long as possible with eyes open (MD 5.03 s; 95% CI 1.19 to 8.87 s, 545 participants, 9 studies), and with eyes closed ((MD 1.60 s; 95% CI ‐0.01 to 3.20 s, 176 participants, 2 studies); and the Berg Balance Scale ((MD 1.84 points; 95% CI 0.71 to 2.97 points, 80 participants, 2 studies).

Few adverse events were reported but most studies did not monitor or report adverse events.

In general, the more effective programmes ran three times a week for three months and involved dynamic exercise in standing.

ConclusionThere is weak evidence that some types of exercise (gait, balance, co‐ordination and functional tasks; strengthening exercise; 3D exercise and multiple exercise types) are moderately effective, immediately post intervention, in improving clinical balance outcomes in older people. Such interventions are probably safe. There is either no or insufficient evidence to draw any conclusions for general physical activity (walking or cycling) and exercise involving computerised balance programmes or vibration plates. Further high methodological quality research using core outcome measures and adequate surveillance is required.
Study Name

Healthy Elderly Women Using the T-Bow® Device

PublicationThe Physician and Sportsmedicine
PurposeThis study aims to determine the effects of a training program to develop balance using a new device called the T-Bow®.
MethodsA total of 28 women > 65 years were randomly assigned to an experimental group (EG) (n = 18; 69.50 [0.99] years), or a control group (CG) (n = 10; 70.70 [2.18] years). A program for lower limbs was applied for 8 weeks using 5 exercises on the T-Bow®: squat, lateral and frontal swings, lunges, and plantarflexions. The intensity of the exercises was controlled by time of exposure, support base, and ratings of perceived exertion. Clinical tests were used to evaluate variables of balance. Static balance was measured by a 1-leg balance test (unipedal stance test), dynamic balance was measured by the 8-foot-up-and-go test, and overall balance was measured using the Tinetti test.
ResultsResults for the EG showed an increase of 35.2% in static balance (P < 0.005), 12.7% in dynamic balance (P < 0.005), and 5.9% in overall balance (P > 0.05). Results for the CG showed a decline of 5.79% in static balance (P > 0.05) but no change in the other balance variables.
ConclusionThus the data suggest that implementing a training program using the T-Bow® could improve balance in healthy older women.
Study Name

A comparison of the effects of three types of endurance training on balance and other fall risk factors in older adults

PublicationAging Clinical and Experimental Research
PurposeWe hypothesized that short-term endurance training improves balance in older adults, if training involves movements that “stress” balance. We tested the hypothesis by looking for a dose-response relationship between movement during exercise and balance improvement.
Methods

The study was a single-blinded, randomized controlled trial. Subjects were sedentary adults (N=106) aged 68–85 with at least mild deficits in balance. Exercise groups were: stationary cycle (low movement), walking (medium movement), and aerobic movement (high movement).

Subjects attended supervised exercise classes three times a week for three months, followed by self-directed exercise of any type for three months. The primary test of the hypothesis compared changes in balance after three months of supervised exercise. 

ResultsThe study hypothesis was supported only for one balance measure. Only walking improved at least one measure of all major outcomes (endurance, strength, gait, balance, health status), suggesting that walking is most useful for fall prevention. Cycle exercise appeared least useful.
ConclusionThe study hypothesis was supported only for one balance measure. Only walking improved at least one measure of all major outcomes (endurance, strength, gait, balance, health status), suggesting that walking is most useful for fall prevention. Cycle exercise appeared least useful.
Study Name
PublicationJournal of the American Geriatrics Society
PurposeOBJECTIVES: To examine the effects of 18‐month aerobic walking and strength training programs on static postural stability among older adults with knee osteoarthritis.
Methods

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.

ResultsIn 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.
ConclusionOur 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.
Study Name

Effects of Resistance- and Flexibility-Exercise Interventions on Balance and Related Measures in Older Adults

PublicationJournal of Aging and Physical Activity
PurposeThis research explored the balance benefits to untrained older adults of participating in community-based resistance and flexibility programs.
MethodsIn a blinded randomized crossover trial, 32 older adults (M = 66.9 yr) participated in a resistance-exercise program and a flexibility-exercise program for 16 weeks each. Sway velocity and mediolateral sway range were recorded. Timed up-and-go, 10 times sit-to-stand, and step test were also assessed, and lower limb strength was measured.
ResultsSignificant improvements in sway velocity, as well as timed up-and-go, 10 times sit-to-stand, and step test, were seen with both interventions, with no significant differences between the 2 groups. Resistance training resulted in significant increases in strength that were not evident in the flexibility intervention.
ConclusionBalance performance was significantly improved after both resistance training and standing flexibility training; however, further investigation is required to determine the mechanisms responsible for the improvement.
Study Name

Changes in spinal range of motion after a flexibility training program in elderly women

PublicationClinical Interventions in Aging
PurposeThe purpose of this study was to investigate the effects of an 8-week specific and standardized flexibility training program on the range of spinal motion in elderly women.
Methods

Participants were recruited in a senior center of Palermo and randomly assigned in two groups: trained group (TG) and control group (CG), which included 19 and 18 women, respectively. TG was trained for 8 weeks at two sessions/week. In particular, every session included three phases: warm up (~10 minutes), central period (~50 minutes), and cool down (~10 minutes).

CG did not perform any physical activity during the experimental period. Spinal ranges of motion (ROM) were measured from neutral standing position to maximum bending position and from neutral standing position to maximum extension position before and after the experimental period, using a SpinalMouse® device (Idiag, Volkerswill, Switzerland).

ResultsAfter the training period, TG showed an increase in spinal inclination by 16.4% (P<0.05), in sacral/hip ROM by 29.2% (P<0.05), and in thoracic ROM by 22.5% (P>0.05) compared with CG from maximum extension position to maximum bending position. We did not observe any significant difference in TG’s lumbar ROM compared with CG after the training period (P>0.05).
ConclusionWe found that an 8-week flexibility training program improved ROMs of the spine in elderly women. The training protocol appeared to be practicable for active elderly people with autonomy and the capability for self-care.
Study Name

Flexibility of the Elderly after One-Year Practice of Yoga and Calisthenics

PublicationInternational Journal of Yoga Therapy
PurposeThis study compared the flexibility of elderly individuals before and after having practiced hatha yoga and calisthenics for 1 year (52 weeks), at least 3 times/week.
MethodsSixty-six subjects (12 men) measured and assigned to 3 groups: control (n = 24, age = 67.7±6.9 years), hatha yoga (n = 22, age = 61.2±4.8 years), and calisthenics (n = 20, age = 69.0±5.8 years). The maximal range of passive motion of 13 movements in 7 joints was assessed by the Flexitest, comparing the range obtained with standard charts representing each arc of movement on a discontinuous and non-dimensional scale from 0 to 4. Results of individual movements were summed to define 4 indexes (ankle+knee, hip+trunk, wrist+elbow, and shoulder) and total flexibility (Flexindex).
ResultsResults showed significant increases of total flexibility in the hatha yoga group (by 22.5 points) and the calisthenics group (by 5.8 points) (p < 0.01 for each) and a decrease in the control group (by 2.1 points) (p < 0.01) after one year of intervention. Between-group comparison showed that increases in the hatha yoga group were greater than in the calisthenics group for most flexibility indexes, particularly the overall flexibility (p <0.05).
ConclusionIn conclusion, the practice of hatha yoga (i.e., slow/passive movements) was more effective in improving flexibility compared to calisthenics (i.e., fast/dynamic movements), but calisthenics was able to prevent flexibility losses observed in sedentary elderly subjects.
Study Name

Effect of a Gentle Iyengar Yoga Program on Gait in the Elderly: An Exploratory Study

PublicationArchives of Physical Medicine and Rehabilitation
PurposeObjective: To determine if a tailored yoga program could improve age-related changes in hip extension, stride length, and associated indices of gait function in healthy elders, changes that have been linked to increased risk for falls, dependency, and mortality in geriatric populations.
Methods

Design: Single group pre-post test exploratory study. A 3-dimensional quantitative gait evaluation, including kinematic and kinetic measurements, was performed pre- and postintervention. Changes over time (baseline to postintervention) in primary and secondary outcome variables were assessed using repeated-measures analysis of variance.

Setting: Yoga exercises were performed in an academic medical center (group classes) and in the subjects’ homes (yoga home-practice assignments). Pre- and postassessments were performed in a gait laboratory.
Participants: Twenty-three healthy adults (age range, 62–83y) who were naive to yoga were recruited; 19 participants completed the program.

Intervention: An 8-week Iyengar Hatha yoga program specifically tailored to elderly persons and designed to improve lower-body strength and flexibility. Participants attended two 90-minute yoga classes per week, and were asked to complete at least 20 minutes of directed home practice on alternate days.

Main Outcome Measures: Peak hip extension, average anterior pelvic tilt, and stride length at comfortable walking speed.

ResultsPeak hip extension and stride length significantly increased (F1,18=15.44, P<.001; F1,18=5.57, P=.03, respectively). We also observed a trend toward reduced average pelvic tilt (F1,18=4.10, P=.06); adjusting for the modifying influence of frequency of home yoga practice strengthened the significance of this association (adjusted F1,17=14.30, P=.001). Both the frequency and duration of yoga home practice showed a strong, linear, dose-response relationship to changes in hip extension and average pelvic tilt.
ConclusionFindings of this exploratory study suggest that yoga practice may improve hip extension, increase stride length, and decrease anterior pelvic tilt in healthy elders, and that yoga programs tailored to elderly adults may offer a cost-effective means of preventing or reducing age-related changes in these indices of gait function.
Study Name

Improving Flexibility And Endurance Of Elderly Women Through A Six-Month Training Programme

PublicationHuman Movement
PurposeThe purpose of this study was to assess whether two slightly different half-year-long regular training programmes had a positive effect on flexibility, range of motion and endurance in a sample population of elderly persons. Also analysed was which programme was found to be more effective.
MethodsA group of women (N = 42, M = 67.1 ± 4.5 years) was chosen from retired persons clubs from Eger, Hungary. They were randomly divided into three groups. The first group (N = 15, M = 66.2 ± 3.8 years) took part in a one-hour-long Pilates training session three times a week, the second group (N = 15, M = 67.1 ± 5.9 years) took part in an aqua-fitness class twice a week with one Pilates class once a week and the third group (N = 12, M = 68.2 ± 3.2 years) was the control group. Pre-and postmeasurements were conducted on: flexion of the right shoulder and hip, lumbar spine flexion, thoracolumbar spine flexion, trunk lateral flexion on the right side, a 6-minute walk test, and a 30-second sit-to-stand test. Significant inter-group differences could be found in all of the measurements. Data were analysed using statistical software with the Paired-Samples T-test and Multivariate Analysis of Variance (p < 0.05).
ResultsAfter the six-month regular training programmes no differences were found in the control group. For the two groups subjected to the training programmes all the other variables showed significant differences. The most remarkable results for the Pilates group were with the 6-minute walk and sit-to-stand test, while for the aqua-fitness and Pilates group shoulder and hip flexion.
ConclusionA half-year-long training program can considerably improve the physical performance elderly adults need in everyday life.
Study Name

Effect of a physical training program using the Pilates method on flexibility in elderly subjects

PublicationAGE
PurposeWe aimed to evaluate the effects of physical training using the Pilates method on body flexibility of elderly individuals.
Methods

Eighteen elderly women and two elderly men (aged 70 ± 4 years) followed a 10-week Pilates training program. Individuals were recruited from the local community via open invitations. At study entry, none of them had limited mobility (walking requiring the use of walkers or canes).

Furthermore, those with neurologic, muscular, or psychiatric disorders as well as those using an assistive device for ambulation were excluded secondary to limited participation. Flexibility assessment tests (flexion, extension, right and left tilt, and right and left rotation of the cervical and thoracolumbar spine; flexion, extension, abduction, and lateral and medial right and left rotation of the glenohumeral joint; flexion, extension, abduction, adduction, and lateral and medial rotation of the right and left hip; and flexion of the right and left knee) were performed by a blinded evaluator using a flexometer before and after the training period. All assessments were carried out at the same time of day. 

ResultsThere was an observed increase in flexion (22.86 %; p < 0.001), extension (10.49 %; p < 0.036), and rotation to the left side (20.45 %; p < 0.019) of the cervical spine; flexion (16.45 %; p < 0.001), extension (23.74 %; p = 0.006), lateral bending right (39.52 %; p < 0.001) and left (38.02 %; p < 0.001), and right rotation (24.85 %; p < 0.001) and left (24.24 %; p < 0.001) of the thoracolumbar spine; flexion (right—8.80 %, p = 0.034; left—7.03 %, p = 0.050), abduction (right—20.69 %, p < 0.001; left—16.26 %, p = 0.005), and external rotation (right—116.07 % and left—143 %; p < 0.001 for both directions) of the glenohumeral joint; flexion (right—15.83 %, p = 0.050; left—9.55 %, p = 0.047) of the hips; and bending (right—14.20 %, p = 0.006; left—15.20 %, p = 0.017) the knees. The joint with the greatest magnitude of improvement was the thoracolumbar spine.
ConclusionThus, this type of training may minimize the deleterious effects of aging and may improve the functionality of elderly individuals, which would reduce the likelihood of accidents (especially falls).
Study Name

Effects of flexibility training on enhancing spinal mobility in older women

PublicationThe Journal of Sports Medicine and Physical Fitness
PurposeThe purpose of this study was to examine the extent to which spinal flexion and extension, or spinal mobility, could be improved in a population of older adults participating in a 10 week flexibility training program.
Methods

Twenty female volunteers, mean age 71.8, were randomly assigned to either the experimental group (flexibility training) or the control group (no training). Prior to the initiation of training, all subjects were tested for total spinal mobility, the combined sum of spinal flexion and extension.

Subjects in the experimental group were exposed to a series of flexibility exercises, three times per week, for 20-30 minutes in duration, for a total of 10 weeks. The control group participated in an alternative exercise program with the experimental group, including walking, swimming, dance, and other locomotor activities, however, they did not receive the additional flexibility training. At the conclusion of the 10 week period, all subjects were retested for spinal mobility, using back flexion and extension measures. 

ResultsResults indicated a significant improvement in spinal mobility in the experimental group, and virtually no measurable change in the control group.
ConclusionThis study suggests that specialized training in back flexibility for older adults is warranted, and that significant gains in spinal mobility can be obtained, regardless of age.
Study Name

Effects of strength and flexibility training on functional performance of healthy older people

PublicationBrazilian Journal of Physical Therapy
PurposeOBJECTIVE: To evaluate the effects of stretching and/or resistive exercise, followed by detraining, on the functional status of older people.
Methods

Forty-five subjects were divided into four groups: control (CG; n=13; 66±6 years), stretching (SG; n=10; 69±6 years), resistive exercise (RG; n=13; 69±5 years), and resistive exercise and stretching (RSG; n=9; 66±5 years). The CG did not perform any exercise. The SG, RG, and RSG had warm-up sessions prior to performing lower-body exercises twice a week. The SG performed 4 repetitions of stretching. Resistive exercise was performed at a load of 65% of 10 repetitions maximum (RM) for five weeks, 70% for the next four weeks, and 75% for the last three weeks of the program.

The RSG performed both exercises. Cardiorespiratory capacity was evaluated using the 6-minute walk test (6MWT) at baseline, at the six- and 12-week follow-ups, and after a six-week period of detraining. Lower limb muscle strength was assessed using the stand up from a chair and sit down test (SUCSD), and blood pressure was measured using a sphygmomanometer and a stethoscope. The results were analyzed using ANOVA (p<0.05).

ResultsSix weeks of training increased walking distance (6MWT) in the RG and decreased SUCSD time in the SG. However, detraining increased systolic blood pressure (SBP) in the RG compared to the SG. Diastolic blood pressure (DBP) decreased after six weeks in the RSG and 12 weeks in the SG.
ConclusionSix weeks of stretching or resistive training can improve the functional status of older people. Nevertheless, DBP decreased after six weeks with the combination of resistive exercise and stretching. Detraining increased SBP when resistive exercise alone was used.
Study Name

Exercise in the Elderly: Research and Clinical Practice

PublicationClinics in Geriatric Medicine
PurposeThis article incorporates some of the latest available data on the benefits of exercise in the elderly.
MethodsExercise programs generally consist of four major components: strength, endurance, balance, and flexibility. This article outlines the normal physiology of each component, the natural effects of aging and the effects of medical comorbidities
on each, research into the primary effects of exercise in elderly patients, and specific prescription recommendations.
Results 
ConclusionAlthough this article focuses on individual types of exercise and their contributions to patient health, any exercise program for a senior will incorporate aspects of them all. The program must be tailored to the individual needs of the patient, based on physical examination and laboratory and diagnostic data.
Study Name

Efficacy of physical conditioning exercise in patients with rheumatoid arthritis and osteoarthritis

PublicationArthritis & Rheumatology
PurposeThe purpose of this study is to assess the efficacy of aerobic and nonaerobic exercise in patients with rheumatoid arthritis and osteoarthritis.
MethodsA group of 120 patients with rheumatoid arthritis or osteoarthritis volunteered to be subjects for this study of aerobic versus nonaerobic exercise. Patients were stratified by diagnosis and randomized into an exercise program of aerobic walking, aerobic aquatics, or nonaerobic range of motion (controls). The retention rate for the 12-week program was 83%. Exercise tolerance, disease-related measures, and self-reported health status were assessed.
ResultsThe aquatics and walking exercise groups showed significant improvement over the control group in aerobic capacity, 50-foot walking time, depression, anxiety, and physical activity after the 12-week exercise program. There were no significant between-group group differences in the change scores for flexibility, number of clinically active joints, duration of morning stiffness, or grip strength.
ConclusionOur findings document the feasibility and efficacy of conditioning exercise for people who have rheumatoid arthritis or osteoarthritis.
Study Name

Is water-based exercise training sufficient to improve physical fitness in the elderly?

PublicationEuropean Review of Aging and Physical Activity
PurposeThe purpose of this study was to critically review the existing evidence of a potential relationship between water-based exercise and improvement of physical fitness in healthy elderly subjects.
MethodsA systematic database search for manuscripts and a quality control were performed. A system of rating was defined. Aerobic, muscular strength, flexibility and body composition outcomes were then extracted. Nine studies were analyzed after the screening for eligibility: five randomized controlled trials (RCT), three randomized uncontrolled trials (UT) and one controlled trial (CT). Four RCT and two randomized UT were classified as high quality studies. One RCT, one randomized UT and one CTwere considered low quality studies.
Results 
Conclusion

Strong evidence supports the use of water-based exercise for the improvement of aerobic capacity and strength. Moderate evidence highlights the benefits on flexibility, and inconclusive evidence was found supporting the modification of body composition.

The evidences provided from this review suggest that a minimum frequency of twice per week water-based exercise sessions performed at moderate–high intensities can lead to improvements in aerobic capacity. However, it seems that three sessions per week of combined aerobic and resistance training should be required in order to obtain significant improvements in both aerobic capacity and muscular strength.

Study Name

Water-based exercise improves health-related aspects of fitness in older women

PublicationMedicine & Science in Sports & Exercise
PurposeThe purpose of this study was to determine the physiological responses of elderly women to a well-rounded exercise program performed in water (WEX).
MethodsThe participants (60-75 yr of age) were randomly divided into a training (TR) group (N = 15) and a control group (N = 15). The TR group participated in a 12-wk supervised WEX program, 70 min x day(-1), 3 d x wk(-1). The WEX consisted of 20 min of warm-up and stretching exercise, 10 min of resistance exercise, 30 min of endurance-type exercise (walking and dancing), and 10 min of cool-down exercise.
ResultsThe WEX led to an increase (P < 0.05) in peak VO2 (12%) and VO2 at lactate threshold (20%). Muscular strength evaluated by a hydraulic resistance machine increased significantly at resistance dial setting 8 (slow) for knee extension (8%), knee flexion (13%), chest press (7%) and pull (11%), shoulder press (4%) and pull (6%), and back extension (6%). Vertical jump (9%), side-stepping agility (22%), trunk extension (11%), and FEV1.0 (7%) also increased significantly. There was a significant decrease in skin-fold thickness (-8%), low-density lipoprotein (LDL) cholesterol (-17%), and total cholesterol (-11%). There were no significant changes in these variables in the control group.
ConclusionThese results indicate that WEX elicits significant improvements in cardiorespiratory fitness, muscular strength, body fat, and total cholesterol in older adult women. Water-based exercise appears to be a very safe and beneficial mode of exercise that can be performed as part of a well-rounded exercise program.
Study Name

Water-based aerobic and combined training in elderly women: Effects on functional capacity and quality of life

PublicationExperimental Gerontology
PurposeThis study aimed to investigate the effects of two water-based training programs (aerobic and combined) and a non-periodized physical activity program on functional capacity and quality of life (QoL) of elderly women.
MethodsForty-one elderly female volunteers (65 ± 4 years) were divided into three groups: aerobic training group (WBA, n = 13), combined training (sequence: resistance/aerobic; WBC; n = 11) and a control group of non-periodized physical activity program (CG, n = 9). The participants performed the water-based trainings twice a week for 12 weeks. The resistance training sets were performed at maximal effort and the aerobic training was performed in the percentage of the heart rate corresponding to the anaerobic threshold (85–110%) determined in an aquatic progressive test. Assessments of QoL perception (WHOQOL-BREF) and functional tests 30-Second Chair Stand, 6-Minute Walk and 8-Foot Up-and-go were performed before and after training. The data were analyzed using Generalized Estimating Equations (GEE), and Bonferroni post-hoc test (α = 0.05).
ResultsIn CG, QoL perception in the physical domain decreased (12 ± 10%) and there was no difference in the other domains. On the other hand, QoL perception was significantly increased in the water-based training groups after the training period in the physical (WBC: 13 ± 16%), psychological (WBA: 9 ± 16%; WBC: 10 ± 11%), social relationships (WBA: 19 ± 42%; WBC: 16 ± 21%) and environmental (WBA: 10 ± 17%; WBC: 16 ± 28%) domains and overall QoL (WBA: 17 ± 22%). No significant difference was observed in the physical domain for WBA and in the overall for WBC. Significant improvements were observed for all groups in the functional tests 30-Second Chair Stand (WBA: 32 ± 11%; WBC: 24 ± 14%; CG: 20 ± 9), 6-Minute Walk (WBA: 10 ± 7%; WBC: 7 ± 6%; CG: 7 ± 5%) and 8-Foot Up-and-go (WBA: 11 ± 5%; WBC: 10 ± 9%; CG: 10 ± 6%).
ConclusionBased on the results observed in this study, it can be concluded that both water-based trainings (aerobic and combined) are effective in improving functional capacity and QoL perception of elderly women. Although non-periodized physical activities seem to be sufficient to positively modify the functional capacity of this population, they are not efficient in improving QoL perception.
Study Name

Impact of two hydrogymnastics class methodologies on the functional capacity and flexibility of elderly women

PublicationThe Journal of Sports Medicine and Physical Fitness
PurposeThe aim of this study was to compare the effects of performing two hydrogymnastic class methodologies on the functional capacity and flexibility in elderly women.
MethodsNinety women, aged 55-70 years, were divided into three groups, the control group (CG; N.=30) who did not exercise during the 12 weeks, experimental group 1 (EG1; N.=30), who performed water gymnastics classes with emphasis on lower limb exercises for 12 weeks, and experimental group 2 (EG2; N.=30), who performed conventional hydrogymnastics classes for 12 weeks. The volunteers were evaluated through the 30-second chair stand (30CST), 2-minute step test (2MST), timed up and go (TUG), static balance (SB) and chair sit-and-reach (CSR) tests.
ResultsIn the intragroup comparison, there were significant improvements in the performance of 30CST tests (F=5.5, P=0.022), TUG (F=19.3, P<0.001), SB (F=5.3, P=0.025), and CSR (F=12.0, P=0.001) in EG1 and EG2. For intergroup comparisons, the EG1 presented better results than CG in CST (P<0.05). The EG2, presented better results than CG in CST, TUG, SB and CSR (P<0.05). There were no significant differences for the comparison between EG1 and EG2.
ConclusionIt was concluded that 12 weeks of hydrogymnastics practice improved the functional capacity and flexibility of the elderly women evaluated, and no differences were found between the two types of methodologies used.
Study Name

The effect of Aerobics, water aerobic exercise, and water-based exercise training on working memory of elderly women diagnosed with Alzheimer’s disease

PublicationSport Science Research Institute
PurposeThis study aimed to investigate the effect of Aerobics, ware aerobic exercise, and water-based exercise training on working memory of elderly women diagnosed with Alzheimer’s disease.
Methods

This was a quasi-experimental study with three groups’ pre-test post-test design. The participants, 30 elderly women diagnosed with Alzheimer’s disease, with the mean age of 64 years were randomly assigned into three groups (aerobic, water aerobic exercise, and water-based exercise training). The training protocol consisted of 18 sessions, and each session lasted 45 minutes.

The Wechsler Memory Scale (WMS) was used to measure the memory and the N-Back software was used to assess the working memory of the study participants. Data were analyzed using the SPSS software version22. Two-way repeated measurement ANOVA (3 group × 2 times) and paired sample t-test were used to analyze the data.

ResultsAfter the training, participants in all groups had better working memory status. However, the participants in the water aerobic exercise group showed greater improvement in working memory compares to other groups. There were significant differences between the three groups in the three subscales of visual memory, associated learning, and memory span.
ConclusionThe result of this study indicated that water aerobic exercise can effectively improve the cognitive function of elderly women diagnosed with Alzheimer’s disease. The study findings could be useful guidelines for enhancing the cognitive function of elderly patients.
Study Name

The Effect of Eight Weeks of Exercise in Water on the Levels of Stress, Anxiety and Depression of Elderly Men

PublicationReport of Health Care
PurposeNowadays, the trend of dramatic growth in the aging population and its relation with mental disorders is on the rise. In this vein, the present study aimed to investigate the effect of eight weeks of exercise in water on the levels of stress, anxiety and depression of elderly men in Gachsaran city.
Methods

In this semi-experimental study, 30 male volunteers with a mean age of 66 ± 0.5 years, who met the inclusion criteria of the study, were randomly selected and assigned into two control and experimental groups of 15 subjects. The experimental group performed the selected exercises in water in accordance with the planned protocol, and the control group just performed their daily routine activities during this period.

Running pretest and post-test, stress (GHQ questionnaire), anxiety (Cattle’s questionnaire) and depression (Beck’s questionnaire) were measured in both groups. To analyze the findings, analysis of covariance was employed using SPSS software (version 21) (p≤0.05).

ResultsExercise in water had a significant effect on stress components such as reduction of physical symptoms, anxiety symptoms and symptoms of depression and an increase in symptoms of social action compared to control group (p≤0.05), exercise in water had a significant effect on anxiety reduction compared to control group (p≤0.05) Also, exercise in water had a significant effect on depression reduction compared to control group (p≤0.05).
ConclusionRegarding the results of this study, it seems that exercise in water reduces anxiety and depression and some stress factors in elderly people.
Study Name

The Effects of a Brief, Water-Based Exercise Intervention on Cognitive Function in Older Adults

PublicationArchives of Clinical Neuropsychology
PurposeThe current study evaluated the effects of a brief, water-based exercise intervention on cognitive functioning and cardiovascular fitness in a group of community dwelling older adults.
MethodsThe exercise group (n = 27, Mage = 63.26 ± 7.64, 78% female) attended one moderate intensity water aerobics class per day for six consecutive days whereas the control group (n = 33, Mage = 65.67 ± 6.69, 75% female) continued their typical routine. Neuropsychological and cardiovascular fitness tests were given the week before and the week after the intervention to both groups.
ResultsThe exercise group demonstrated significant improvements in cardiovascular fitness, as well as executive function, attention, and memory over controls. This suggests a brief exercise program can provide benefits for older adults.
ConclusionIn summary, the current study shows that older adults exhibit improved cardiovascular fitness and cognitive function after a brief, water-based exercise program. While future research is needed to confirm these effects, the current study raises the possibility that even brief exercise interventions can provide meaningful benefits in a high-risk population.
Study Name

Effects of a Water Aerobics Program on the Blood Pressure, Percentage of Body Fat, Weight, and Resting Pulse Rate of Senior Citizens

PublicationJournal of Applied Gerontology
PurposeThe aim of this study was to assess the effects of a 16-week water aerobics class on the blood pressure, percentage of body fat, weight, and resting pulse rate of senior citizens.
MethodsTen men and 18 women aged 57 to 76 participated in a 16-week water exercise class at Rose State College, Oklahoma City. The class met for one hour twice a week for the 16 weeks and was composed of flexibility exercises, aerobic exercises, and cool-down exercises. Pre- and postclass measurements were taken for blood pressure, weight, percentage of body fat, and resting pulse rate and were compared using a paired t-test.
ResultsReductions significant at the .05 level were recorded for diastolic blood pressure, weight, and percentage of body fat. There were no significant reductions in systolic blood pressure and resting pulse rate.
ConclusionI concluded that water aerobics is an ideal modality for senior citizens’aerobic exercise because of the favorable changes it produces in the health parameters investigated and because it places little stress on the weight-bearing joints during exercise.
Study Name

Effect of Nordic Walking and Water Aerobics Training on Body Composition and the Blood Flow in Lower Extremities in Elderly Women

PublicationJournal of Human Kinetics
PurposeThe aim of the study was to evaluate the influence of regular health training on the venous blood flow in lower extremities and body composition in women over 50 years old.
MethodsTwenty-four women of mean age 57.9 (± 3.43) years, randomly divided into three groups (Nordic walking, water aerobics, and non-training), participated in the study. The training lasted 8 weeks, with one-hour sessions twice a week. Dietary habits were not changed. Before and after training vein refilling time and the function of the venous pump of the lower extremities were measured by photoplethysmography. Body composition was determined by bioelectrical impedance.
ResultsEight weeks of Nordic walking training improved the venous blood flow in lower extremities and normalized body composition in the direction of reducing chronic venous disorder risk factors. The average values of the refilling time variable (p = 0.04, p = 0.02, respectively) decreased in both the right and the left leg. After training a statistically significant increase in the venous pump function index was found only in the right leg (p = 0.04). A significant increase in fat-free mass, body cell mass and total body water was observed (p = 0.01), whereas body mass, the body mass index, and body fat decreased (p < 0.03). With regard to water aerobic training, no similar changes in the functions of the venous system or body composition were observed.
Conclusion

Eight weeks of NW training in women aged over 50 years improve the venous blood flow in lower extremities and normalize body composition towards the reduction of CVD risk factors.

Eight weeks of WA training in women aged over 50 years are not sufficient to significantly change body composition towards a reduction of body fat content and development of muscle mass and do not lead to an improvement of the function of the musculo-vascular pump of lower extremities.

Study Name

Balance as an Additional Effect of Strength and Flexibility Aquatic Training in Sedentary Lifestyle Elderly Women

PublicationHindawi Current Gerontology and Geriatrics Research Volume 2020
PurposeObjective: To evaluate the additional effects of on balance an aquatic muscle strengthening and flexibility training program in healthy sedentary lifestyle elderly women.
MethodsThis controlled clinical trial included 56 healthy sedentary women, aged from 65 to 70 years, divided into two groups. The aquatic group (AG) underwent aquatic training (45 minutes/session, 32 sessions), and the control group (CG) received no intervention. Data were collected pre- and post-intervention, during a one-week period. Lower limb muscle strength was measured by a force sensor (myometer). Flexibility was measured by biophotogrammetry. Functional balance was evaluated by the Performance Oriented Mobility Assessment (POMA) and the Berg Balance Scale (BBS).
ResultsMuscle strength, flexibility, and balance improved in AG (p<0.001), but not in CG.
ConclusionThe aquatic exercises program, which was originally developed to promote muscle strength and flexibility, also improved functional balance. Aquatic training is an option for physical health promotion for sedentary lifestyle elderly women.
Study Name

The Effect of Thera Band Exercise on Muscle Flexibility, Balance Ability, Muscle Strength in Elderly Women

PublicationJournal of Korean Academy of Community Health Nursing
PurposeThe purpose of this study was to examine the effects of thera band exercise on muscle flexibility, balance ability, muscle strength and self-rated health in elderly women.
MethodsThe quasi-experimental research design (one-group pretest-post test) was employed. Participants were recruited in S-city and a total of 14 elderly women completed 15-week thera band exercise. Descriptive statistics, paired t-test and McNemar-test were used in data analysis by SPSS/WIN 12.0.
ResultsCompared with those before participation, the participants showed higher muscle flexibility, balance ability, and muscle strength after participation in thera band exercise.
ConclusionFindings of this study indicated that the 15-week thera band exercise program had a favorable effect on muscle flexibility, balance ability and muscle strength of elderly women. Future research needs to develop combined exercise programs with other types of exercise for the health of elderly women.
Study Name

Effects of elastic band exercises on physical ability and muscular topography of elderly females

PublicationJournal of Physical Therapy Science
PurposeThis study examined the effects of band exercise types on the physical ability and muscular topography for elderly females.
MethodsTwenty-six females older than 65 years were divided into the dynamic band exercise (DBE; n=13) group and the Static band exercise (SBE; n=13) group. Each participant performed 12 weeks of elastic band exercises. Physical abilities were measured by leg extension power, sitting trunk flexion, closed eyes foot balance, and time to get up. Changes in muscle topography were evaluated with Moire measurement equipment for the chest, abdomen, and lumbar region. All results were compared before and after 12 weeks of exercise.
ResultsChanges in physical ability were significantly increased in both groups. The scores for the muscular topography of the chest, abdomen, lumbar region, and all body parts was significantly improved in both groups for closed eyes foot balance. There were more improvements in the DBE group.
ConclusionTwo types of static and dynamic elastic band exercises effectively changed the physical fitness and muscle topography of elderly females. Therefore, to increase the effects of exercise, dynamic band exercises are considered useful. Because band exercises are simple, they can be used to maintain the health of elderly people.
Study Name

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

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

Training to Reduce Postural Sway and Increase Functional Reach in the Elderly

PublicationJournal of Occupational Rehabilitation
PurposePoor balance is one of the most common risk factors for falling, a common cause of work-related injury and death. The aim of this study is to evaluate the effects of a 10-week intervention program on balance in older adults.
MethodsTo evaluate the effects of a 10-week intervention program on balance in older adults, 12 participants aged 61–77 years (age = 70.4 ± 5.4 years; mean ± SD) completed an exercise program (60 min, 2 days · week−1 for 10 weeks) performed while laying/sitting on large air-filled exercise balls (Thera-Band®). Several postural sway composite scores (determined while standing with feet apart and semitandem, eyes open and closed) improved (p ≤ 0.05) including medial–lateral amplitude and speed of sway (reduced by ∼9%), and instantaneous speed (reduced by ∼13%).
ResultsReductions in XY area approached (p = 0.06) statistical significance and anterior–posterior amplitude and speed of sway did not change. Functional reach also improved (20.3%).
ConclusionThese results suggest that challenging the physiological systems involved in balance control while on the nonstable support surface of the exercise balls improves both static and dynamic balance in older adults and may reduce the risk for falling.
Study Name

Exercises Including Weight Vests and a Patient Education Program for Women With Osteopenia: A Feasibility Study of the OsteoACTIVE Rehabilitation Program

PublicationJournal of Orthopaedic & Sports Physical Therapy
PurposeThe primary aim was to describe the OsteoACTIVE rehabilitation program and evaluate its feasibility in terms of progression, adherence, and adverse events in patients with low bone mineral density (BMD) and a healed forearm fracture. The secondary aim was to assess changes in measures of function and quality of life.
MethodsForty-two postmenopausal women with osteopenia and a healed forearm fracture attended the OsteoACTIVE program for 6 months (3 sessions of 60 minutes per week). Feasibility was assessed by documenting training progression (load and exercises), program adherence (aiming for greater than 80%), and adverse events (joint pain, muscle soreness, and falls). Secondary measures included quadriceps strength, BMD, dynamic balance, walking ability, and self-report functional outcome measures. All outcome measures were recorded preintervention (baseline), postintervention, and at 1-year follow-up
ResultsThirty-five women (83%) completed the 6-month program and 31 women (74%) attended all the follow-up measurement sessions. All participants progressed during the rehabilitation program for both load and type of exercises. Furthermore, 87% of the participants met the a priori goal of 80% adherence, and no participants reported adverse events. Improvements in quadriceps strength and BMD of the femoral trochanter were noted at the end of the 6-month training period (P<.05). At 1-year follow-up, there were significant improvements in quadriceps strength and dynamic balance compared to baseline (P<.05).
Conclusion

The OsteoACTIVE rehabilitation program was feasible and achieved progression of training level, had high adherence, and had no adverse events. Positive improvements were established in lower extremity function and femoral trochanter BMD.

The article has an Appendix with Active Rehabilitation Program with Examples of Some Exercises, including flexibility exercises, Exercises for strength, balance, core stability, and use of weight vest (40 minutes), Cool-down and flexibility (7 minutes).

Study Name

Reducing Risk of Falling in Older People Discharged From Hospital: A Randomized Controlled Trial Comparing Seated Exercises, Weight-Bearing Exercises, and Social Visits

PublicationArchives of Physical Medicine and Rehabilitation
PurposeObjective: To compare the efficacy of seated exercises and weight-bearing (WB) exercises with social visits on fall risk factors in older people recently discharged from hospital.
MethodsDesign: Twelve-week randomized, controlled trial.
Setting: Home-based exercises.
Participants: Subjects (N=180) aged 65 and older, recently discharged from hospital.
Interventions: Seated exercises (n=60), WB exercises (n=60), and social visits (n=60).
Main Outcome Measures: Primary outcome factors were Physiological Profile Assessment (PPA) fall risk score, and balance while standing (Coordinated Stability and Maximal Balance Range tests). Secondary outcomes included the component parts of the PPA and other physical and psychosocial measures.
ResultsSubjects were tested at baseline and at completion of the intervention period. After 12 weeks of interventions, subjects in the WB exercise group had significantly better performance than the social visit group on the following: PPA score (P=.048), Coordinated Stability (P<.001), Maximal Balance Range (P=.019); body sway on floor with eyes closed (P=.017); and finger-press reaction time (P=.007) tests. The seated exercise group performed better than the social visit group in PPA score (P=.019) but for no other outcome factor. The seated exercise group had the highest rate of musculoskeletal soreness.
ConclusionIn older people recently discharged from the hospital, both exercise programs reduced fall risk score in older people. The WB exercises led to additional beneficial impacts for controlled leaning, reaction time, and caused less musculoskeletal soreness than the seated exercises.
Study Name

The Effects of Trunk Stabilization Exercises with a Swiss Ball on Core Muscle Activation in the Elderly

PublicationJournal of Physical Therapy Science
PurposeThe purpose of this study was to investigate the effects of trunk stabilization exercise on the muscle EMG activations related to core stability.
MethodsFifteen elderly people in a geriatric hospital performed trunk stabilization exercises with a Swiss ball for 20 minutes five times per week for 8 weeks. Trunk muscle activations were measured using electromyography before and after the intervention.
ResultsAfter the intervention, the muscle activations of the rectus abdominis, erector spinae, lateral low-back (quadratus lumborum and external oblique), and gluteus medius muscles increased significantly.
ConclusionThe trunk stabilization exercise with a Swiss ball significantly increased the muscle activities of the elderly.
Study Name

Effect of Squat Exercises on Lung Function in Elderly Women with Sarcopenia

PublicationJournal of Clinical Medicine
PurposeWe explored whether a mechanically-assisted squat exercise improved muscle mass, muscle function, and pulmonary function in elderly women with or without sarcopenia.
MethodsIn total, 76 community-dwelling elderly subjects (>60 years of age) were screened. We ultimately included 30 subjects who completed more than 80% of the six-week course of mechanically-assisted squat exercises (three days per week, 30 min per day). We measured body composition, lung function, knee extensor strength, hand grip strength, and the 3-min walk distance (3MWD) before and after the exercise program. Subjects with sarcopenia had poor hand grip strength and knee extensor strength, and a slow walking speed. Their lung function parameters, including forced vital capacity (FVC), was lower than those of the controls.
ResultsAfter six weeks of squat exercises, the hand grip strength, knee extensor strength, and 3MWD increased significantly in both groups. Appendicular skeletal muscle mass and leg lean mass were increased in subjects without sarcopenia. The FVC (L) increased significantly only in the sarcopenia group (p = 0.019).
ConclusionThe mechanically-assisted squat exercise program increased muscle function and lung function, including FVC, in patients with sarcopenia. Muscle mass increased in subjects without sarcopenia.
Study Name

Balance improvement and reduction of likelihood of falls in older women after Cawthorne and Cooksey exercises

PublicationBrazilian Journal of Otorhinolaryngology
PurposeAim: To verify whether specific therapeutic approach of the system can promote motor learning and can contribute to the improvement of balance and to decrease of likelihood of falls.
MethodsStudy design: Clinical prospective.
Material and Method: Fifteen women, aged 60 to 69, mean = 64.8 years old (±2.95), resident in Barra Mansa-RJ, were submitted to Cawthorne and Cooksey exercises during three months, three times a week, during sixty minutes. They were evaluated with Berg Balance Scale (BBS), whose scores determine the possibility of fall (PQ).
ResultsComparing the data obtained before and after intervention, we observed significant difference (p < 0.05), showing improvement in BBS scores and decrease in PF.
ConclusionCawthorne and Cooksey exercises were able to promote significant improvement in the balance of this sample and they can be applied as prevention and treatment in balance disturbances in elderly people.
Study Name

Comparison of the effects of two selected exercises of Theraband and Pilates on the balance and strength of lower limb in elderly women

PublicationThe Iranian Journal of Obstetrics, Gynecology and Infertility
PurposeThe present study was performed with aim to compare the effects of two selected exercises of Theraband and Pilates on the balance and strength of lower limb in elderly women.
Methods

Methods: This semi-experimental (interventional) study was performed with pre-test and post-test on 45 women aged 60-75 years old in Mashhad in 2014. They were randomly divided into three groups: the Theraband training, Pilates training, and control groups. The experimental groups participated for six weeks in Theraband and Pilates trainings.

The control group did their daily activities during the project. Before and after the six weeks of training, Berg test (dynamic balance) and thirty Second Chair Stand test (strength of lower limb) were given. Data were analyzed by covariance analysis (ANCOVA), Analysis of variance (ANOVA), Bonferroni post hoc test and Mean Difference. P˂0.05 was considered significant.

ResultsResults: Pilates and Theraband trainings led to a significant improvement in the dynamic balance and strength of lower limb in elderly women. Furthermore, Theraband trainings was more affective on the dynamic balance and Pilates trainings on the strength of lower limb.
ConclusionConclusions: both Pilates and Theraband trainings lead to the increase of the dynamic balance and strength of lower limb in elderly women, but, Pilates training was more effective on strength of lower limb and Theraband training was more effective on dynamic balance.
Study Name

Effects of Resistive and Balance Exercises on Isokinetic Strength in Older Persons

PublicationJournal of the American Geriatrics Society
PurposeOBJECTIVE: To determine the safety and efficacy of 3 months of resistive training of multiple lower extremity muscle groups compared with balance training in persons over 75 years.
MethodsDESIGN: Randomized 3‐month clinical trial. Subjects (n = 110, mean age 80) were randomized to 4 groups in a 2 × 2 design (control, resistive, balance, combined resistive/balance).
INTERVENTIONS: Resistive training involved knee extension and flexion, hip abduction and extension, and plantar and dorsiflexion using simple resistive machines and sandbags. Balance training consisted of exercises to improve postural control. The control group attended 5 health‐related discussion sessions.
MEASUREMENTS: Summed isokinetic moments (N m) of 8 leg movements: hip, knee and ankle flexion/extension, and hip abduction/adduction. Secondary outcomes were gait velocity and chair rise time.
ResultsSummed peak moment increased in both resistive exercise‐trained groups (13% increase in the resistive group and 21% in the combined training group, P < 0.001). The effect of resistance training was significant (MANOVA F = 21.1, P < 0.001), but balance training did not improve strength, and there was no interaction (positive or negative) between balance and resistive training. Maximal gait velocity and chair rise time did not improve. Eleven subjects (20%) had musculoskeletal complaints related to resistive training, but all were able to complete the program with modifications.
ConclusionResistive training using simple equipment is an effective and acceptable method to increase overall leg strength in older persons. Resistive or balance training did not improve maximal gait velocity or chair rise time in this sample of relatively healthy older persons.
Study Name

Comparative Study of Balance Exercises (Frenkel) and Aerobic Exercises (Walking) on Improving Balance in the Elderly

PublicationElderly Health Journal
PurposeThe aim of this study was to investigate the effect of Frenkel balance exercise and aerobic exercise (walking) on improving the balance of elderly patients in Kerman province in 2016-2017.
MethodsWe used a randomized block design, with 4 participants in each block; 48 elderly men and women living in the nursing homes of Kerman province were randomly assigned to two groups, balance (Frenkel) exercises and aerobic exercises (walking). The two groups performed Frenkel exercises and aerobic exercises (walking) for three 10- to 15-min sessions a week for five weeks. The balance time using the Sharpened Romberg test was recorded to measure static balance and the Get Up and Go test used to measure dynamic balance before and after the exercise program. To describe the variables studied, central tendency indicators and dispersion were used. Paired t-test was used to compare the time of balance before and after intervention and independent t-test to compare changes in balance time between two groups.
ResultsThe mean static balance (with Sharpend Römberg test) was increased from 3.16 s to 6.01 s in Frenkel exercise, and from 3.33 s to 4.95 s in aerobic training group, indicating an improvement in the static balance after intervention. The mean time of dynamic balance (in the Get Up and Go test) during Frenkel exercise reduced from 17.07 s to 12.03 s, and during aerobic training from 17.08 s to 10.9 seconds, indicating an improvement in dynamic balance (p < 0.01). However, there was no significant difference in the mean changes in the duration of dynamic and static balance before and after intervention in the two groups.
ConclusionBoth Frenkel exercise and walking equally improve static and dynamic balance in the elderly in different settings.
Study Name

Effect of a Home Program of Hip Abductor Exercises on Knee Joint Loading, Strength, Function, and Pain in People With Knee Osteoarthritis: A Clinical Trial

PublicationPhysical Therapy & Rehabilitation Journal
Purpose

This study investigated the effect of an 8-week home strengthening program for the hip abductor muscles on knee joint loading (measured by the external knee adduction moment during gait), strength (force-generating capacity), and function and pain in individuals with medial knee OA.

Hip abductor muscle weakness may result in impaired frontal-plane pelvic control during gait, leading to greater medial compartment loading in people with knee osteoarthritis (OA).

Methods

Design: The study design was a nonequivalent, pretest-posttest, control group design.

Setting: Testing was conducted in a motor performance laboratory.

Patients: An a priori sample size calculation was performed. Forty participants with knee OA were matched for age and sex with a control group of participants without knee OA.
Intervention: Participants with knee OA completed a home hip abductor strengthening program.

Measurements: Three-dimensional gait analysis was performed to obtain peak knee adduction moments in the first 50% of the stance phase. Isokinetic concentric strength of the hip abductor muscles was measured using an isokinetic dynamometer. The Five-Times-Sit-to-Stand Test was used to evaluate functional performance. Knee pain was assessed with the Western Ontario and McMaster Universities Osteoarthritis Index questionnaire.

ResultsFollowing the intervention, the OA group demonstrated significant improvement in hip abductor strength, but not in the knee adduction moment. Functional performance on the sit-to-stand test improved in the OA group compared with the control group. The OA group reported decreased knee pain after the intervention.
Limitations: Gait strategies that may have affected the knee adduction moment, including lateral trunk lean, were not evaluated in this study.
ConclusionHip abductor strengthening did not reduce knee joint loading but did improve function and reduce pain in a group with medial knee OA.
Study Name

Home exercise to improve strength and walking velocity after hip fracture: A randomized controlled trial

PublicationArchives of Physical Medicine and Rehabilitation
PurposeObjective: To determine the effect of a home exercise program on strength, postural control, and mobility following hip fracture.
Methods

Design: Randomized controlled trial of 1 month’s duration.
Setting: Daily exercise carried out within the subjects’ home environments.

Participants: Forty-two people 64 to 94 years of age, 35 of whom were living independently in the community and 7 of whom were residing in institutional care. Subjects were recruited on average 7 months after a fall-related hip fracture and randomly allocated to either the intervention or the control group (n = 21 each). The groups were well matched in terms of medical conditions, medication use, disability, and activity levels.

Intervention: A “home-based” program of weight-bearing exercise established at a visit by a physiotherapist.
Main Outcome Measures: Quadriceps strength, postural sway, functional reach, weight-bearing ability, walking velocity, and self-rated fall risk. The subjects undertook these assessments at the beginning and end of the trial.

ResultsAt pretest, exercisers and controls performed similarly in all tests. At the end of the trial, the intervention group showed significantly greater quadriceps strength in the affected (hip-fractured) leg and increased walking velocity. The intervention subjects also improved their weight-bearing ability and reported reduced subjective falls risk. In contrast, there were no significant improvements in any of the test measures in the controls. Within the intervention group, improvements in quadriceps strength were significantly associated with improved performances in the weight-bearing test measures and with increased walking.
ConclusionThis exercise program improved strength and mobility following hip fracture. Further research is needed to ascertain whether the extent of this improvement in these fall risk factors is sufficient to prevent falls.
Study Name

Multicomponent Training Program with Weight-Bearing Exercises Elicits Favorable Bone Density, Muscle Strength, and Balance Adaptations in Older Women

PublicationCalcified Tissue International
PurposeIn this study we examined the effects of 8-month multicomponent training with weight-bearing exercises on different risk factors of falling, including muscle strength, balance, agility, and bone mineral density (BMD) in older women.
Methods

Participants were randomly assigned to either an exercise-training group (ET, n = 30) or a control group (CON, n = 30). Twenty-seven subjects in the ET group and 22 in the CON group completed the study. Training was performed twice a week and was designed to load bones with intermittent and multidirectional compressive forces and to improve physical function.

Outcome measures included lumbar spine and proximal femoral BMD (by dual X-ray absorptiometry), muscle strength, balance, handgrip strength, walking performance, fat mass, and anthropometric data. Potential confounding variables included dietary intake, accelerometer-based physical activity, and molecularly defined lactase nonpersistence.

ResultsAfter 8 months, the ET group decreased percent fat mass and improved handgrip strength, postural sway, strength on knee flexion at 180°/s, and BMD at the femoral neck (+2.8%). Both groups decreased waist circumference and improved dynamic balance, chair stand performance, strength on knee extension for the right leg at 180°/s, and knee flexion for both legs at 60°/s. No associations were found between lactase nonpersistence and BMD changes.
ConclusionData suggest that 8 months of moderate-impact weight-bearing and multicomponent exercises reduces the potential risk factors for falls and related fractures in older women.
Study Name

Safe Antiaging Full-Body In-Bed Gym and FES for Lazy Persons: Home In-Bed Exercises for Fighting Muscle Weakness in Advanced Age

PublicationIn: Masiero S., Carraro U. (eds) Rehabilitation Medicine for Elderly Patients. Practical Issues in Geriatrics. Springer, Cham.
PurposeInspired by the proven capability to recover skeletal muscle contractility and strength by home-based functional electrical stimulation and guided by common sense, we suggest a short (15–20 min) daily routine of 12 easy-to-perform physical exercises that may be performed in bed (full-body in-bed gym).
Methods

Sedentary people may gradually start, after asking their family physician’s advice, with five repetitions of each suggested exercise. The next week they may add groups of five additional repetitions up to 30. The daily routine exercises may last from 10 (in the beginning) to 30 min (for complete session in accustomed persons).

Suggested Exercises:

  1.  Flexion and extension of the ankles;
  2.  Cycling movements;
  3.  Arms up and arms down;
  4.  Deep breathing;
  5.  Forward bending;
  6.  To raise the pelvis;
  7.  Neck torsions;
  8.  Sit up;
  9. Lift the legs when in sitting position;
  10.  Stand up;
  11. Get up on toes.
Results 
Conclusion

Instructing and supporting patients to perform daily in-bed exercises are an effective and low-cost measure to limit disability and improve physical and mental being of older patients.

If sedentary persons, without major comorbidities but with rest-related muscle weakness, challenge themselves, avoiding stress, in a few days of full-body in-bed gym, they may increase their muscle strength, fatigue resistance, and independence in daily life activities. Cautious in-bed gym may help patient’s recovery after the acute phase of hospitalization, prevent the risk of thromboembolism after surgical interventions, and concur to reduce arterial hypertension.

Full-body in-bed gym could mitigate the bad mood that is usually associated to mobility limitations, strengthening patients’ confidence in recovering partial or total independence, thus reducing the risk of accidental falls.

Study Name

Effects of unsupported upper extremity exercise training in patients with COPD: a randomized clinical trial

PublicationChest
PurposeWe studied the effects of 15 sessions of unsupported upper extremity exercise training (UEET) on functional exercise capacity, the ability to perform activities of daily living (ADL), and symptoms perceived during activities involving arms in patients with COPD.
Methods

We conducted a randomized trial that consisted of 3 weeks of inpatient PR, comparing the short-term effects of unsupported UEET plus PR (intervention group) to those of PR alone (control group). A change in the 6-min ring test (6MRT) was the primary outcome; the ADL field test (four shuttle stations), the dyspnea score as assessed by the Medical Research Council scale, the London Chest Activity of Daily Living scale (LCADL), and the distance walked in 6 min served as secondary outcomes of the study. At the 6-month follow-up, we repeated the 6MRT and the LCADL.

The UEET involved 15 sessions of resistance exercises specificbbto five different muscular groups, which were performed by using dumbbells. This training consisted of five movements that specifically require the activation of muscles that may be involved in respiration and/or in the support of the shoulder girdle during the ADL performed with unsupported arms (see Appendix for details). Patients performed the training in a standing posture with slight hip abduction and knee flexion, without the support of the UEs.
Patients: 50 (33 men and 17 women), age 69.5+/- 8.9.

ResultsFifty patients with COPD were randomly assigned to the two groups and completed the study. At the end of the study period, patients in the intervention group improved in the 6MRT and ADL field test compared with those patients in the control group (p = 0.018 and p = 0.010, respectively) with reduced perception of fatigue (p <or= 0.006). At the 6-month follow-up, 6MRT (p = 0.001) and LCADL (p = 0.039) scores were still significantly better in the intervention group compared with the control group.
ConclusionOur trial corroborates the effectiveness of unsupported UEET in specifically improving functional exercise capacity of patients with COPD. Moreover, it also provides evidence that this training modality may ameliorate and maintain the patients’ autonomy over and above standard PR.
Study Name

Leg press exercise can reduce functional hamstring: quadriceps ratio in the elderly

PublicationJournal of Bodywork and Movement Therapies
PurposeThe aim of this study was to investigate whether 12 weeks of leg press strength training exercise could affect the conventional and functional hamstring:quadriceps ratios in the elderly.
MethodsTwelve elderly participants were submitted to a 12 week progressive training protocol (two sessions/week) using a 45° leg press exercise.
ResultsA significant increase in the one repetition maximum was observed after 4, 8, and 12 weeks (p = 0.001, p < 0.001, and p < 0.001, respectively) compared to week 0 and after 8 (p = 0.011) and 12 weeks (p = 0.001) compared to week 4. The concentric knee extensor peak torque was significantly higher at weeks 8 (p = 0.001) and 12 (p = 0.024) compared to week 0. There was no change in the concentric and eccentric knee flexor peak torques (p = 0.629 and 0.274, respectively) and conventional ratio (p > 0.314) after 12 weeks of training. The functional ratio (eccentric knee flexor peak torque:concentric knee extensor peak torque) reduced significantly after 8 (p = 0.034) and 12 (p = 0.036) weeks of strength training.
ConclusionAlthough the 45° leg press exercise requires knee extensor and flexor, hip extensor, and plantar flexor muscle strength, our findings suggest that the isolated use of the 45° leg press exercise reduces the knee functional ratio after 8 weeks of training. Therefore, 45° leg press exercise alone, without a hamstring exercise, should not be recommended for elderly individuals.
Study Name

The Importance of Trunk Muscle Strength for Balance, Functional Performance, and Fall Prevention in Seniors: A Systematic Review

PublicationSports Medicine
PurposeThe objectives of this systematic literature review are: (a) to report potential associations between TMS/trunk muscle composition and balance, functional performance, and falls in old adults, and (b) to describe and discuss the effects of CST/PET on measures of TMS, balance, functional performance, and falls in seniors.
Methods

Data Sources: A systematic approach was employed to capture all articles related to TMS/trunk muscle composition, balance, functional performance, and falls in seniors that were identified using the electronic databases PubMed and Web of Science (1972 to February 2013).

Study Selection: A systematic approach was used to evaluate the 582 articles identified for initial review. Cross-sectional (i.e., relationship) or longitudinal (i.e., intervention) studies were included if they investigated TMS and an outcome-related measure of balance, functional performance, and/or falls. In total, 20 studies met the inclusionary criteria for review.

Study Appraisal and Synthesis Methods: Longitudinal studies were evaluated using the Physiotherapy Evidence Database (PEDro) scale. Effect sizes (ES) were calculated whenever possible. For ease of discussion, the 20 articles were separated into three groups [i.e., cross-sectional (n = 6), CST (n = 9), PET (n = 5)].

Results

The cross-sectional studies reported small-to-medium correlations between TMS/trunk muscle composition and balance, functional performance, and falls in older adults. Further, CST and/or PET proved to be feasible exercise programs for seniors with high-adherence rates. Age-related deficits in measures of TMS, balance, functional performance, and falls can be mitigated by CST (mean strength gain = 30 %, mean effect size = 0.99; mean balance/functional performance gain = 23 %, mean ES = 0.88) and by PET (mean strength gain = 12 %, mean ES = 0.52; mean balance/functional performance gain = 18 %, mean ES = 0.71).

Limitations: Given that the mean PEDro quality score did not reach the predetermined cut-off of ≥6 for the intervention studies, there is a need for more high-quality studies to explicitly identify the relevance of CST and PET to the elderly population.

ConclusionCore strength training and/or PET can be used as an adjunct or even alternative to traditional balance and/or resistance training programs for old adults. Further, CST and PET are easy to administer in a group setting or in individual fall preventive or rehabilitative intervention programs because little equipment and space is needed to perform such exercises.
Study Name

Effect of Core Strengthening Exercise Programs on Symmetric Double Limb Support and Balance Ability for the Elderly

PublicationJournal of International Academy of Physical Therapy Research
PurposeThe purpose of this study effectiveness of core strengthening exercise programs on symmetric double limb support and balance ability for elderly.
MethodsThe subjects that 30 persons between the ages of 65~80 elderly participated were divided into two groups randomly for 8 weeks. Tetrax interactive balance system and Berg’s balance scale were used to assess support and stability. Paired t-tests were used to evaluate the changes before and after intervention. The difference between the groups was compared using an independent t-test.
ResultsThe subjects that 30 persons between the ages of 65~80 elderly participated were divided into two groups randomly for 8 weeks. Tetrax interactive balance system and Berg’s balance scale were used to assess support and stability. Paired t-tests were used to evaluate the changes before and after intervention. The difference between the groups was compared using an independent t-test.
ConclusionConsequently, core strengthening exercise program should be considered as a therapeutic method for the elderly to improve the balance ability and effectiveness on falls.
Study Name

Effect of 12-week Swiss Ball Exercise Program on Physical Fitness and Balance Ability of Elderly Women

PublicationJournal of Physical Therapy Science
PurposeThis study examined the effect of a Swiss ball exercise program for elderly females on physical fitness and balance ability in order to offer basic data for the development of an exercise program to improve the quality of life and promote the health of elderly females.
MethodsSixty-five elderly women aged over 78 participated in this study. The subjects were divided into two groups: an exercise group and a control group.
The exercise group (n=38) performed a Swiss ball exercise program which consisted of 12 types of exercises required for balance and performance of functions twice a week for 12 weeks. Physical fitness (Sit-to-Stand, Arm Curl, Sit-and-Reach, Back Scratch) and balance ability (One-Legged Standing time, Timed Up & Go) were evaluated.
ResultsThere was a significant increase in the physical fitness and balance ability of the exercise group.
ConclusionThe Swiss ball exercise program had a positive effect on physical fitness and balance ability of elderly women. We consider that the ball which is easy, safe and interesting to use will encourage the elderly’s active participation in exercise.
Study Name

The Effects of Trunk Stabilization Exercise Using Swiss Ball and Core Stabilization Exercise on Balance and Gait in Elderly Women

PublicationJournal of The Korean Society of Physical Medicine
PurposeThe purpose of this study was to investigate the effects of trunk stabilization exercise using swiss ball and core stabilization exercise on balance and gait in elderly women.
MethodsSubjects 19 elderly women were randomly divided by the swiss ball exercise group (n=10) and the core stabilization exercise group (n=9). In a period of 4 weeks, they took trunk stabilization exercise using swiss ball and core stabilization exercise for 60 minutes 3 times a week. Balance and gait were measured by Functional Reach Test (FRT), One Leg Stand Test with Open Eye (OLSTOE), One Leg Stand Test with Closed Eye (OLSTCE), Timed Up and Go Test (TUG) and 6 m Walking Test (6MWT). These tests were measured at before exercise, 4 weeks after exercise and after the follow-up period of 2 weeks.
ResultsAs a result, in all measurement values there was no significant difference in two groups (p>.05). In FRT, TUG, OLSTOE and 6MWT before exercise and 4 weeks after exercise, there was significant difference in both of two groups (p<.05). Moreover, according to results from 4 weeks after exercise and after the follow-up period of 2 weeks, without any particular exercise, in FRT and 6MWT there was no significant difference (p>.05).
ConclusionThese finding indicate that trunk stabilization exercise using swiss ball could improve balance and gait in elderly women. Accordingly, In this study trunk stabilization exercise using swiss ball and core stabilization exercise is judged to be used for elderly people with gait and balance problems to prevent hurts from fall.
Study Name

Improvement of Postural Balance and Trunk Muscle Strength: Effect of Free Exercise, Elastic Band Exercise and Balance Exercise

PublicationJournal of the Korean Society for Precision Engineering
PurposeThis study was to verify the effect of complex training programs on the postural balance and trunk muscle strength of the elderly.
MethodsWe recruited 40 elderly participants aged 60 to 75 years. Subjects were evaluated before, and 12 weeks after. The participants underwent complex training programs, including free exercise, elastic band and unstable plate. Exercise were performed as follows: 10 repeats in 50 minutes (0 to 4 weeks), 13 repeats in 50 minutes (5 to 8 weeks), and 15 repeats in 50 minutes (9 to 12 weeks). The training group underwent complex training, including warm up, thrice a week for twelve weeks. The control group did not perform any complex training.
ResultsResults indicate that the postural balance and trunk muscle strength in the training group significantly increased.
ConclusionPostural balance and trunk muscle strength in the training group significantly increased. Data generated from this study could be applied to develop a complex training program to efficiently build whole body muscle strength.
Study Name

The Effects of Fall Prevention Static and Dynamic Trunk Stabilization Exercises on the Balance of Elderly Females

PublicationIndian Journal of Public Health Research & Development
PurposeThe purpose of this study is to investigate the effects of static/dynamic trunk stabilization exercises on the balance abilities of female patients above the age of 65 years.
MethodsThis study included 30 females above the age of 65 years, who were randomly divided into the static trunk exercise stabilization group (n=15) and the dynamic trunk exercise stabilization group (n=15). The stabilization exercises were performed three times a week for four weeks. Static and dynamic balance abilities were measured before and after the exercise to determine its effects. Frailty and cooperative studies of intervention techniques-4 (FICSIT-4) and one leg standing test (OLST) were measured to evaluate static balance, while time up & go test (TUG) and functional reach test (FRT) were measured to evaluate dynamic balance.
ResultsOur results showed that static trunk stabilization exercises significantly improved static balance ability (OLST) and dynamic balance ability (TUG) (p<0.05). Dynamic trunk stabilization exercises significantly improved static balance abilities (FICSIT-4, OLST) and dynamic balance abilities (FRT, TUG) (p<0.05). OLST, which reflects static balance ability, significantly differed between the two groups (p<0.05).
ConclusionThe static/dynamic trunk stabilization exercise group showed improvements in balance abilities, and in both groups, static and dynamic balances improved. In terms of effectiveness, no significant differences were observed between the outcomes of static and dynamic trunk stabilization exercises.
Study Name

Effects of Neck and Trunk Stabilization Exercise on Balance in Older Adults

PublicationThe Journal of Korean Physical Therapy
PurposeThis study was conducted to evaluate the effects of neck and trunk stabilization exercise on static and dynamic balance in older adults.
MethodsA total of 30 older adults participated in this study. Participants were randomly assigned to the neck and trunk stabilization exercise group (NTSG) (n=15) or the trunk stabilization exercise group (TSG) (n=15). The NTSG performed a trunk stabilization exercise added to a neck stabilization exercise that included biofeedback. Both groups received training for 30 minutes per day three times per week for eight weeks. The anterior, posterior limit of stability and sway length was used to measure static balance ability, while the timed up and go (TUG) test was used to measure dynamic balance ability.
ResultsParticipants showed significant differences in sway length, anterior limit of stability, posterior limit of stability, and the results of the TUG test between their pre- and post mediation evaluations (p<0.05). The NTSG showed a more significant increase than the TSG (p<0.05).
ConclusionAccording to the results of this study, both exercises effectively improved static and dynamic balance ability. However, the neck and trunk stabilization exercise is more efficient for increasing the balance ability of older adults.
Study Name

The Effect Of Core Stabilization Training Program On Elderly Postural Control

PublicationTurkish Journal of Sports Medicine
PurposeIn view of this divergence, and because of the potential and obvious importance of core stability training on the balance and postural control of the elderly, the purpose of this study was to study the effects of a core stability training program on postural control in an elderly population.
Methods

Sixty females recruited from a total of 200 and aged more than 60 years (70.6 ± 6.0 yrs, 55.8 ± 5.8 kg of weight and 157.8 ± 7.8 cm of height) were classified as low falling risk and high falling risk. Then, these subjects were randomly divided into two experimental and control groups. A week prior to starting the training program, their balance status were measured with the Berg balance test (BBT) and compared with independent and dependent t-tests. The experimental group followed a core stabilization program of three days per week, for eight weeks.

The core stability training program was divided into three sections. The first week program consisted of simple exercises as finding neutral position, sitting stabilization, prone gluteal squeezes, supine pelvic bracing, pelvic progression, side bridging, knee stabilization and supine bridging.

“Physioball” exercises for the core were introduced in the following weeks: abdominal crunch, balancing exercise while seated, “Superman” prone exercise, modified push-up, pelvic bridging. Core strengthening exercises were performed in the last weeks: body weight and gravitational loading (push-ups, pull-ups, rope climbs), body blade exercises, medicine ball exercises (throwing and catching), dumbbell exercises in diagonal patterns, core stretching exercises, balance training on a labile surface, squats, and lunges.

ResultsAt the end of this period, they performed better (p<0.05) than the controls. The training program had also better effects on the high risk group. Significant differences were observed for balance following the training program, in both the anteroposterior and mediolateral planes (p<0.05).
ConclusionIn conclusion, significant differences were shown in improving balance and postural control after a related training program in elderly women.
Study Name

Effect of 12-week neck, core, and combined stabilization exercises on the pain and disability of elderly patients with chronic non-specific neck pain: A clinical trial

PublicationSalmand: Iranian Journal of Ageing
PurposeObjectives: To investigate the effect of 12 weeks of neck stabilization, core stabilization, and combined stabilization exercises on pain and disability among elderly people in Tehran City, Iran.
MethodsMethods & Materials: This study was a 12 weeks open-label clinical trial. A total of 18 elderly patients with chronic neck pain were randomly assigned into three groups: neck stabilization training (6 people), core stabilization training (6 people), and combined stabilization training (6 people). The severity of neck pain and disability before the beginning of the training, 8 weeks after training and one week after the completion of the exercises were measured using the Visual Analog Scale (VAS), Neck Disability Index (NDI) and Neck Pain and Disability Scale (NPDI). To investigate the effect of time, repeated measure analysis of variance was used to analyze the data in SPSS version 21.
ResultsThe Mean±SD scores of pain before and after neck stabilization treatment were respectively 6.08±0.58, 4.83±0.52 for VAS and 49.17±2.86 and 39.17±2.79 for NDI; and 56.4±2.11 and 50.0±1.64 for NPDI; those differences between pairs were significant. The Mean±SD scores of pain before and after core stabilization treatment were respectively, 6.00±0.55, 4.92±0.20 for VAS; 49.67±1.86 and 39.17 ±1.94 for NDI; and 56.01±2.44, and 48.92±1.16 for NPDI; those differences between pairs were significant. Also, the Mean±SD scores of pain before and after combined stabilization treatment were respectively, 6.00±0.45, 4.00±0.32 for VAS; 49.83±2.23 and 37.17±2.86 for NDI; and 55.25±0.28 and 47.51±1.44 for NPDI; those differences between pairs were significant (P < 0.05). Among the underlying variables, gender was the only significant factor in pain relief in the elderly (F=6.21, P=0.02), while other variables were not significant (P > 0.05).
ConclusionThe findings of this study showed that 12 sessions of neck, core, and combined stabilization training in the neck region could improve the tolerance and pain of the elderly with nonspecific chronic neck pain
Study Name

Four-week trunk-specific exercise program decreases forward trunk flexion in Parkinson’s disease: A single-blinded, randomized controlled trial

PublicationParkinsonism & Related Disorders
PurposeThe primary aim was to compare the effects of a four-week trunk-specific rehabilitation program on the severity of the forward trunk flexion. The secondary aim was to compare the training effects on the motor impairments, dynamic and static balance, pain, falls, and quality of life.
Methods37 patients with PD (H&Y ≤ 4) and forward trunk flexion were randomized in the experimental (n = 19) or control group (n = 18). The former consisted of active self-correction exercises with visual and proprioceptive feedback, passive and active trunk stabilization exercises and functional tasks. The latter consisted of joint mobilization, muscle strengthening and stretching, gait and balance exercises. Protocols lasted 4 weeks (60 min/day, 5 days/week). Before, after, and at 1-month follow-up, a blinded examiner evaluated patients using primary and secondary outcomes. The primary outcome was the forward trunk flexion severity (degree). Secondary outcomes were the UPDRS III, dynamic and static balance, pain falls, and quality of life assessment.
ResultsThe experimental group reported a significantly greater reduction in forward trunk flexion than the control group from T0 to both T1 (p = 0.003) and T2 (p = 0.004). The improvements in dynamic and static balance were significantly greater for the experimental group than the control group from T0 to T2 (p = 0.017 and 0.004, respectively). Comparable effects were reported on the other outcomes. Pre-treatment forward trunk flexion values were highly correlated to post-treatment trunk deviation changes.
ConclusionThe four-week trunk-specific rehabilitation training decreased the forward trunk flexion severity and increased postural control in patients with PD.
Study Name

Effects of Different Bridge Exercises for the Elderly on Trunk and Gluteal Muscles

PublicationJournal of Physical Therapy Science
PurposeThe purpose of this study was to show the effects of different bridge exercises for the elderly on trunk and gluteal muscles.
MethodsTwenty elderly persons were recruited.
The EMG activities of the right side L5 paraspinal, external abdominal oblique (EO), and gluteus maximus (GM) muscles were measured during three bridge exercises: conditions 1, 2, and 3.
ResultsThe EMG activities of the for the L5 paraspinal, EO, and GM muscles showed significant differences among the 3 bridge exercise conditions. The EMG activity of the EO muscle significantly increased in the order of condition 1<2<3. The EMG activity of the GM muscle also significantly increased in the order of condition 1<2<3.
ConclusionBridge exercises with special boards are effective exercises because they help to strengthen and develop the EO and GM muscles that help to stabilize the spine of the elderly.
Study Name

Effect of spinal stabilization exercises to reduce urinary incontinence in the elderly

PublicationResearch in Sport Medicine and Technology
PurposeThe purpose of this study is to investigate effect of 4 weeks Spinal Stabilization exercises on urinary incontinence of the elderly people.
MethodsIn this study, participants are elderly women from age of 50 to 70 years old (67±11kg and BMI of 27±4kg/m2), who were placed in two experimental and control groups (10 people in each group) for 4 weeks (3 sessions per week). Urinary incontinence of the participants was measured through ICIQ-OAB questionnaire in pretest and posttest steps. According to abnormal distribution of data, nonparametric tests are used such as Wilcoxon and U Mann Whitney tests to test intragroup and intergroup variations at the level of p≤0.05.
ResultsSpinal stabilization exercises caused significant reduction of urinary incontinence in elderly women (p=0.001), so that the exercises can result in insignificant reduction of urinary frequency per day (p=0.083), significant reduction of urinary frequency per night (p=0.001), stress of fast use of WC (p=0.001) and leakage of urine (p=0.002). Moreover, intergroup investigations showed that experimental group has lower urinary incontinence than control group (p=0.01).
ConclusionSpinal stabilization exercises can result in reduction of urinary incontinence and its components through strengthening pelvic floor and abdominal muscles.
Study Name

Exercises to Activate Seniors

PublicationThe Physician and Sportsmedicine
PurposeThe article provides a list of sitting and standing exercises for seniors and a short description of each exercise.
Methods

Exercises cover a wide range of sitting and standing exercises:

  1.  Deep Breathing and Slow Stretching exercises;
  2.  Head and Face exercises;
  3.  Neck exercises;
  4.  Upper Back, Arms, Shoulder, Circulation exercises;
  5.  Hips, Stomach, Legs exercises;
  6.  Torso exercises;
  7.  Arms, Wrists, Hands exercises;
  8.  Feet, Ankles, Legs exercises;
  9.  Back Massage;
  10.  In and Out of Chair exercises;
  11.  Balance and Body exercises.
Results 
ConclusionOlder adults who participate regularly in a specially designed fitness program significantly increase their flexibility, strength, and mobility and develop a new sense of confidence and competence.
Study Name

Effectiveness of Strengthening Exercises for the Elderly with Low Back Pain to Improve Symptoms and Functions: A Systematic Review

PublicationScientifica
PurposeObjective: To determine the effect of strengthening exercises for older people with low back pain (LBP).
MethodsThis study is a systematic review of experimental study which evaluated the evidence regarding exercises for older people with LBP by using EBSCO Academic Search Premier, EBSCO EconLit, Science Direct, PUBMED, and PEDro from 2006 to 2016. Search strategy for each database was conducted by using keywords such as “low back pain”, “older people”, and “strengthening exercise”. Boolean operators were used to combine keywords and manual exclusion was conducted to verify studies which met the inclusion criteria. The articles reviewed were evaluated and critically appraised by using PEDro scale and SPSS version 20 was used to analyze the data.
ResultsThree articles were found regarding strengthening exercise for older people with LBP whereas one study was conducted on multicomponent exercise. The mean, standard deviation, and variance of the PEDro score of all the studies were 5.67, 2.33, and 1.528, respectively. Overall, the qualities of all studies reviewed were fair. Two articles showed significant results when compared to control group ().
ConclusionStrengthening exercise is a beneficial treatment for older people with LBP in reducing pain intensity, disability, and improved functional performances.
Study Name

Intervention study of finger-movement exercises and finger weight-lift training for improvement of handgrip strength among the very elderly

PublicationInternational Journal of Nursing Sciences
PurposeObjectives: To examine the effects of finger-movement exercises and finger weight-lift training on handgrip strength and Activities of Daily Living Scale (ADLS) values.
MethodsA total of 80 very elderly adults (aged ≥80 years) were assigned to either an intervention group (n = 40) or a control group (n = 40). Subjects in the intervention group performed finger-movement exercises and weight-lift training for a period of 3 months, while subjects in the control group received no intervention, and were unaware of the interventions received in the other group.
ResultsAfter completing 3 months of finger-movement exercises and weight-lift training, the average handgrip strength of the 40 participants in the intervention group had increased by 2.1 kg, whereas that in the control group decreased by 0.27 kg (P < 0.05). After receiving intervention, the number of subjects in the intervention group with an ADLS score >22 points decreased by 7.5% (P < 0.05, vs. pre-intervention).
ConclusionThe combined use intervention with finger-movement exercises and proper finger weight-lift training improved the handgrip strength and ADLS values of very elderly individuals. These rehabilitation exercises may be used to help the elderly maintain their self-care abilities.
Study Name

The Effect of William Flexion Exercise on Reducing Pain Intensity For Elderly with Low Back Pain

PublicationInternational Journal of Nursing and Health Services (IJNHS)
PurposeOne of the issues that often arise in the elderly is low back pain (NPB). The purpose of this study is to evaluate the effect of the William Flexion Exercise on reducing the pain intensity for elderly with low back pain at Hisosu Binjai Resident Home, Indonesia.
MethodsThe research design is quasi-experimental with the pre and post-test control group approach in 2017. This study’s sample consisted of 28 people in the intervention group and 28 people in the control group. The sampling technique utilized consecutive sampling. This study used The Pain Numerical Rating Scale to evaluate the level of pain intensity perceived by the patient. The data were analyzed by dependent and independent t-test with significance ? < 0.05.
ResultsThe dependent t-test found a significant difference in the low back pain before and after the intervention group intervention (p-value =0.000). In contrast, there is no significant difference in the control group (p-value = 0.081). The result of the independent t-test found that there are significant differences in the low back pain between the intervention group and the control group.
ConclusionThis study concludes that William’s flexion exercise provided benefits to most of the participants in this study. Thus, it may be an effective technique to reduce pain intensity and increase the range of motions.
Study Name

Aerobic walking or strengthening exercise for osteoarthritis of the knee? A systematic review

PublicationAnnals of the Rheumatic Diseases
PurposeObjective: To compare the efficacy of aerobic walking and home based quadriceps strengthening exercises in patients with knee osteoarthritis.
MethodsThe Medline, Pubmed, EMBASE, CINAHL, and PEDro databases and the Cochrane controlled trials register were searched for randomised controlled trials (RCTs) of subjects with knee osteoarthritis comparing aerobic walking or home based quadriceps strengthening exercise with a non-exercise control group. Methodological quality of retrieved RCTs was assessed. Outcome data were abstracted for pain and self reported disability and the effect size calculated for each outcome. RCTs were grouped according to exercise mode and the data pooled using both fixed and random effects models.
Results35 RCTs were identified, 13 of which met inclusion criteria and provided data suitable for further analysis. Pooled effect sizes for pain were 0.52 for aerobic walking and 0.39 for quadriceps strengthening. For self reported disability, pooled effect sizes were 0.46 for aerobic walking and 0.32 for quadriceps strengthening.
ConclusionBoth aerobic walking and home based quadriceps strengthening exercise reduce pain and disability from knee osteoarthritis but no difference between them was found on indirect comparison.
Study Name

Effectiveness of a home-based exercise therapy and walking program on osteoarthritis of the knee

PublicationRheumatology International
PurposeThe aim of this study was to investigate the effects of home-based exercise and walking programs in the treatment of Osteoarthritis (OA).
Methods

A total of 90 patients with knee osteoarthritis were included. Their ages ranged between 48 and 71 years. The patients were separated into three groups. None of them had practiced a daily simple exercise program during the previous year. Group 1 (n=30) was given a home-based exercise program. Group 2 (n=30) had regular a walking program three times per week, starting with 10-min duration. Group 3 (n=30) was accepted as the control group. Patients were assessed according to pain, functional capacity, and quality of life parameters. Pain was evaluated by the Western Ontario McMaster osteoarthritis index (WOMAC) of pain score and visual analogue scale (VAS).

Functional capacity was measured by WOMAC physical function index. Quality of life was assessed by the Nottingham Health Profile questionnaire (NHP). All groups continued the program for 3 months.

The home exercise program included isometric and isotonic quadriceps exercises:

  1. Isometric straight leg lifts (patient lies supine on a flat surface, slowly contracts the thigh muscles and dorsoflex the foot, slowly lifts the foot 10 cm up from the surface and holds for 5 s, then lowers slowly)
  2. Isometric quadriceps contraction (patient sits on the floor, puts a hand under the knee with legs extended, and contracts the quadriceps by pushing against the hand)
  3. Isotonic quadriceps exercise (begin in a sitting position with the knee bent about 90 , slowly extend the leg, and hold this position for 5 s). Patients also received this program adding weight.

They started with the lowest weight (0.5 kg) and progressed up to a maximum of 5 kg.

Each of the exercises was applied at least ten times, twice a day at home. They were taught by a physiotherapist at the hospital.

ResultsAt the end of the therapy, the patients were called and 81 were accepted to come to the hospital. Although WOMAC pain and physical functional scores and VAS scores were statistically lower in both groups than in the control group (P<0.001), the difference between groups 1 and 2 was not statistically significant (P>0.05). But the result of the NHP showed a statistically significant improvement in the walking group when compared to the home-based exercise and control groups (P<0.001).
ConclusionAs a result, we conclude that a simple home-based exercise therapy and a regular walking program are effective in treating the symptoms of OA.
Study Name

Effect of Home Exercise of Quadriceps on Knee Osteoarthritis Compared with Nonsteroidal Antiinflammatory Drugs

PublicationAmerican Journal of Physical Medicine & Rehabilitation
PurposeObjectives: To examine the effect of home-based exercise on knee osteoarthritis among Japanese in comparison with that of nonsteroidal antiinflammatory drugs (NSAIDs).
Methods

Design: An open-labeled, randomized, controlled, multiclinic trial compared home-based quadriceps exercise with NSAIDs. Treatments were basically evaluated after 8 wks and compared with the baseline scores. Outcomes were evaluated with a set of psychometric measurements including the Western Ontario and McMaster Universities Arthritis Index (WOMAC), 36-Item Short-Form Health Survey (SF-36), Japanese Knee Osteoarthritis Measure (JKOM), and pain with the visual analog scale.

Age of participants:
Exercise group: 66.8+/-12.8
NSAIDs group: 68.9+/-21.1

ResultsA total of 142 patients entered this trial to provide the baseline data. After 21 cases withdrew, the final number analyzed was 121 cases: 63 for the exercise group and 58 for the NSAIDs group. Between these two groups, there was no significant difference in gender, age, body height and weight, body mass index, or each score at baseline. The subjects in both groups showed improvements in all scores at the end of intervention. The difference in improvement rate of each score between the two groups was not statistically significant, though the mean rank score measured with JKOM in the exercise was slightly better than that of the NSAIDs.
ConclusionHome-based exercise using quadriceps strengthening improves knee osteoarthritis no less than NSAIDs.
Study Name

Effects of Different Stretching Techniques on the Outcomes of Isokinetic Exercise in Patients with Knee Osteoarthritis

PublicationThe Kaohsiung Journal of Medical Sciences
PurposeWe recruited 132 subjects with bilateral knee osteoarthritis (Altman Grade II) to compare the effects of different stretching techniques on the outcomes of isokinetic muscle strengthening exercises.
MethodsThe 132 patients ranged in age from 46 to 78 years (mean, 64.0 ± 7.5 years), with a female:male ratio of 106:26. Patients were randomly divided into four groups (I–IV). The patients in Group I received isokinetic muscular strengthening exercises, Group II received bilateral knee static stretching and isokinetic exercises, Group III received proprioceptive neuromuscular facilitation (PNF) stretching and isokinetic exercises, and Group IV acted as controls.
Outcomes were measured by changes in Lequesne’s index, range of knee motion, visual analog pain scale, and peak muscle torques during knee flexion and extension.
ResultsPatients in all the treated groups experienced significant reductions in knee pain and disability, and increased peak muscle torques after treatment and at follow‐up. However, only patients in Groups II and III had significant improvements in range of motion and muscle strength gain during 60°/second angular velocity peak torques. Group III demonstrated the greatest increase in muscle strength gain during 180°/second angular velocity peak torques.
ConclusionIn conclusion, stretching therapy could increase the effectiveness of isokinetic exercise in terms of functional improvement in patients with knee osteoarthritis. PNF techniques were more effective than static stretching.
Study Name

Relative Efficacy of Different Exercises for Pain, Function, Performance and Quality of Life in Knee and Hip Osteoarthritis: Systematic Review and Network Meta-Analysis

PublicationSports Medicine
PurposeThe aim of this systematic review and network meta-analysis was to investigate the relative efficacy of different exercises (aerobic, mind–body, strengthening, flexibility/skill, or mixed) for improving pain, function, performance and quality of life (QoL) for knee and hip OA at, or nearest to, 8 weeks.
MethodsWe searched nine electronic databases up until December 2017 for randomised controlled trials that compared exercise with usual care or with another exercise type. Bayesian network meta-analysis was used to estimate the relative effect size (ES) and corresponding 95% credibility interval (CrI) (PROSPERO registration: CRD42016033865).
We identified and analysed 103 trials (9134 participants).
ResultsAerobic exercise was most beneficial for pain (ES 1.11; 95% CrI 0.69, 1.54) and performance (1.05; 0.63, 1.48). Mind–body exercise, which had pain benefit equivalent to that of aerobic exercise (1.11; 0.63, 1.59), was the best for function (0.81; 0.27, 1.36). Strengthening and flexibility/skill exercises improved multiple outcomes at a moderate level. Mixed exercise was the least effective for all outcomes and had significantly less pain relief than aerobic and mind–body exercises. The trend was significant for pain (p = 0.01), but not for function (p = 0.07), performance (p = 0.06) or QoL (p = 0.65).
ConclusionThe effect of exercise varies according to the type of exercise and target outcome. Aerobic or mind–body exercise may be the best for pain and function improvements. Strengthening and flexibility/skill exercises may be used for multiple outcomes. Mixed exercise is the least effective and the reason for this merits further investigation.
Study Name

Home Stretching Exercise is Effective for Improving Knee Range of Motion and Gait in Patients with Knee Osteoarthritis

PublicationJournal of Physical Therapy Science
PurposeThe purpose of this study was to assess the effects of home-based knee stretching exercises on knee range of motion (ROM) and gait speed in patients with knee osteoarthritis awaiting total knee arthroplasty.
Methods

Thirty-six patients with severe knee osteoarthritis were randomly allocated to stretching (n=17) and control (n=19) groups.

The subjects in the stretching group were instructed to perform home-based knee stretching exercises once a day for about 80 days, whereas the subjects in the control group were told to maintain their current level of physical activity.

Outcomes assessed percentage changes in the total range of knee ROM in the supine position (S-ROM), pain, gait speed and knee ROM during gait (G-ROM).

Patient’s age: 73.3+/-5.8

ResultsThe stretching group showed significantly greater improvement in S-ROM, gait speed and G-ROM than the control group (control vs stretching; S-ROM, 0.4 ± 8.6% vs 9.5 ± 16.2%; gait speed, 1.6 ± 11.4% vs 11.6 ± 10.7%; G-ROM, 0.6 ± 15.2% vs 14.2 ± 14.6%; p<0.05 for all).
ConclusionPain was significantly decreased in the stretching group compared to the control group (median values: -15.6% and 6.5%, p<0.01).
Study Name

Efficacy of Hip Strengthening Exercises Compared With Leg Strengthening Exercises on Knee Pain, Function, and Quality of Life in Patients With Knee Osteoarthritis

PublicationClinical Journal of Sport Medicine
PurposeObjective: The purpose of this study was to compare the efficacy of hip and leg strengthening exercise programs on knee pain, function, and quality of life (QOL) of patients with knee osteoarthritis (KOA).
Methods

Design: Single-Blinded Randomized Clinical Trial.
Setting: Patients with KOA.

Participants: Male and female subjects were recruited from patients referred to the University of Calgary Sport Medicine Center and from newspaper advertisements.

Interventions: Thirty-seven and 35 patients with KOA were randomly assigned to either a 12-week hip or leg strengthening exercise program, respectively. Both exercise programs consisted of strengthening and flexibility exercises, which were completed 3 to 5 days a week. The first 3 weeks of exercise were supervised and the remaining 9 weeks consisted of at-home exercise.

Main outcome measures: Knee Injury and Osteoarthritis Score (KOOS) and Western Ontario McMaster Arthritis Index (WOMAC) questionnaires, 6-minute walk test, hip and knee range of motion (ROM), and hip and leg muscle strength.

ResultsStatistically and clinically significant improvements in the KOOS and WOMAC pain subscale scores were observed in both the hip and leg strengthening programs. There was no statistical difference in the change in scores observed between the 2 groups. Equal improvements in the KOOS and WOMAC function and QOL subscales were observed for both programs. There was no change in hip and knee ROM or hip and leg strength in either group.
Conclusion

Isolated hip and leg strengthening exercise programs seem to similarly improve knee pain, function, and QOL in patients with KOA.

Clinical relevance: The results of this study show that both hip and leg strengthening exercises improve pain and QOL in patients with KOA and should be incorporated into the exercise prescription of patients with KOA.

Study Name

Effects of aquatic exercise and land-based exercise on postural sway in elderly with knee osteoarthritis

PublicationAsian Biomedicine
PurposeObjectives: Compare effects of aquatic exercise and land-based exercise on postural sway and physical performance (pain, quality of life, leg muscle strength and leg muscle flexibility) in the elderly with knee OA.
Methods

Fifty elderly women with knee OA were recruited for this study. They were randomized into aquatic exercise (n=25) and land-based exercise group (n=25). Postural sway views by anterior-posterior amplitude, medio-lateral amplitude, and total area were measured in subjects with eye opened or closed during double and single leg stance after six-week training, using the Force platform.

Functional outcome was tested by the modified WOMAC. Knee injury and Osteoarthritis Outcome Score (KOOS), and pain scale were tested by Visual Analog Scale (VAS). Leg muscle strength was measured by chair stand, and leg muscle flexibility was measured by sit-andreach test. Aquatic group exercised at King Chulalongkorn Memorial Hospital therapeutic pool, while landbased group exercised at home.

The warm-up consisted of stretching of hamstring, adductor and calf muscles, and slow walk. Exercise included double-leg squat, double-leg calf raise, stand stretch and bend knee, standing kick leg-to-side, standing kick leg-to-front, sitting stretch knee, sit spin bike, and fast walking forward and backward. The cool-down consisted of slow walking. During the last three weeks single-leg squat and single calf raise were added.

ResultsIn comparing postural sway before and after exercise, reduction in postural sway and pain, and increase in strength, the aquatic group were significantly better than those for land-based group (p <0.05). WOMAC, KOOS scores, and sit-and-reach test after six-weeks training were improved after exercise, but these were not significantly different between groups (p >0.05).
ConclusionElderly patients with knee OA need exercise to improve balance and reduce sway. Six-week aquatic exercise was better than land-based exercise in sway reduction.
Study Name

Home exercise therapy to improve muscle strength and joint flexibility effectively treats pre-radiographic knee OA in community-dwelling elderly: a randomized controlled trial

PublicationClinical Rheumatology
PurposeObjective: To compare the efficacy and adherence rates of two parallel home exercise therapy programs—multiple exercise (training and stretching the knee and hip muscles) and control (training the quadriceps muscles)—on knee pain, physical function, and knee extension strength in community-dwelling elderly individuals with pre-radiographic knee osteoarthritis (OA).
MethodsOne hundred patients with medial knee pain were randomly allocated to one of two 4-week home exercise programs. Individuals with a Kellgren/Lawrence (K/L) grade 0 or 1OA(pre-radiographic kneeOA) in themedial compartment were enrolled. Primary outcomeswere knee pain (visual analog scale), self-reported physical function (Japanese Knee Osteoarthritis Measure [JKOM]), and isometric maximum muscle strength of the knee extensor measured using a hand-held dynamometer. A total of 52 patients (28 [53.8%] in the multiple exercise group, 24 [46.2%] in the control group) completed the trial.
ResultsThe JKOMactivities of daily living and general health conditions outcomes improved significantly in the multiple exercise group compared to the control group (JKOM activities of daily living, beta = − 0.76;: 95% confidence interval [CI], − 1.39 to − 0.13; p = 0.01; JKOM general health conditions, beta = − 0.25; 95% CI, − 0.48 to − 0.01; p =0.03). The home exercise compliance rates of the multiple exercise and control groups were 96.6 and 100%, respectively.
Conclusion

The multiple exercise group demonstrated significantly improved knee pain, JKOM subscale scores, and knee extension strength. Moreover, the JKOM activities of daily living and general health conditions outcomes showed significant improvement in the multiple exercise group compared to the control group, while the JKOM participation in social activities outcome showed an improvement trend in the multiple exercise group compared to the control group. A high adherence rate to both home exercise therapy programs was maintained.

When targeting pre-radiographic knee OA in community-dwelling elderly, it is important to implement home exercise programs that aim to improve muscle strength and joint flexibility rather than knee extension muscle power only.

Study Name

The effects of an exercise program for older adults with osteoarthritis of the hip.

PublicationThe Journal of Rheumatology
PurposeEvaluation of an 8-week exercise program with strength training and lifestyle advice for older adults with osteoarthritis (OA) of the hip. Outcome measures were pain, hip function, disability, quality of life (QOL), and body mass index (BMI).
Methods

or=55 years, clinical diagnosis of OA according to American College of Rheumatology criteria, and living independently. Interview and physical data were collected at baseline, post-test, and followup (3 mo) by trained interviewers and physical therapists with validated instruments: Harris Hip Score, Sickness Impact Profile, Groningen Activity Restriction Scale, functional tests (walking, timed Up & Go, ascending and descending stairs, and toe reaching), and visual analog scales (pain and QOL). Data were analyzed on an intention-to-treat basis. Effect sizes were calculated. “}”>Inclusion criteria for this randomized controlled trial were: age >or=55 years, clinical diagnosis of OA according to American College of Rheumatology criteria, and living independently. Interview and physical data were collected at baseline, post-test, and followup (3 mo) by trained interviewers and physical therapists with validated

or=55 years, clinical diagnosis of OA according to American College of Rheumatology criteria, and living independently. Interview and physical data were collected at baseline, post-test, and followup (3 mo) by trained interviewers and physical therapists with validated instruments: Harris Hip Score, Sickness Impact Profile, Groningen Activity Restriction Scale, functional tests (walking, timed Up & Go, ascending and descending stairs, and toe reaching), and visual analog scales (pain and QOL). Data were analyzed on an intention-to-treat basis. Effect sizes were calculated. “}”>instruments: Harris Hip Score, Sickness Impact Profile, Groningen Activity Restriction Scale, functional tests (walking, timed Up & Go, ascending and descending stairs, and toe reaching), and visual analog scales (pain and QOL). Data were analyzed on an intention-to-treat basis. Effect sizes were calculated. 

ResultsThere were 109 participants (55 experimental, 54 controls). The 15 participants who dropped out were characterized by less tolerance to pain and younger age. The program had a positive effect on pain (moderate effect at post-test and small effect at followup), hip function (small effect at post-test), self-reported disability (small effect at followup), and the timed Up & Go test (small effect at followup). It did not affect QOL, other measures of observed disability, or BMI.
ConclusionThe exercise program had positive effects on pain and hip function, which are important mediators of disability. This study fulfilled a need for older adults with hip OA and provides evidence of the benefit of exercise in the management of hip OA.
Study Name

The effects of physical training without equipment on pain perception and balance in the elderly: A randomized controlled trial

PublicationWork
PurposeOur aims were to evaluate pain perception and balance skills in a group of elderly subjects and to examine the consequences of a standardized equipment-free exercise program intervention on these variables. The study utilized a randomized controlled trial method.
Methods92 subjects were recruited from a rural Sicilian village (Resuttano, Sicily, Italy). Subjects were randomly split into two groups, an experimental group (EG; n = 49) and a control group (CG; n = 43). Qualified fitness instructors delivered the standardized physical exercise program for the EG whilst the CG did not receive this exercise intervention. The Berg Balance Scale and the Oswestry Disability Index were administered in both groups before (T0) and after the intervention (T1).
ResultsAt T1, the EG group significantly improvement in balance (p < 0.0001) and pain perception (p < 0.0001). No significant differences were found within the CG both in BBS and ODI, respectively.
ConclusionOur findings suggest that a 13-weeks standardized exercise equipment-free program is effective in improving balance and perception of pain in the elderly. This type of intervention can consequently provide a low cost strategy to counteract the rate of disability in elderly.
Study Name

A cycling and education intervention for the treatment of hip osteoarthritis: A quality improvement replication programme

PublicationSAGE Open Medicine
PurposeThe Cycling against Hip Pain programme is a 6-week exercise and education treatment pathway for people with hip osteoarthritis. Preliminary results of the Cycling against Hip Pain programme found significant improvements in clinical and patient-reported outcome measures for patients referred from primary care. This article evaluates the effectiveness of the changes made to the pathway in a quality improvement replication programme.
MethodsThe replicated Cycling against Hip Pain programme was delivered between February 2018 and September 2019 in a region of England with a high percentage of adults aged over 65 years. All participants were referred from the orthopaedic outpatient department of the funding hospital (secondary care). The programme was delivered at a local leisure centre and combined 30 min of education on osteoarthritis with 30 min of progressive static cycling, once a week for 6 weeks.
ResultsThe participants on the replicated Cycling against Hip Pain programme did not differ from the original cohort in terms of age or pre-programme weight, however, presented with worse hip symptoms at baseline. Consistent with the findings from the original cohort, participants demonstrated significant improvements to their Oxford Hip Score, 30-s chair stand performance, Timed Up and Go score, Hip Osteoarthritis Outcome Score function and pain, EQ5D health rating, EQ5D-5L score and pain at rest and on weight bearing. In addition, participants reported an increase in knowledge, confidence and motivation to exercise.
ConclusionA 6-week cycling and education intervention for the treatment of hip osteoarthritis provided benefits to function, pain and quality of life for patients referred from secondary care. These results are consistent with findings from patients who were referred from primary care and further support the potential of the pathway in the conservative management of hip osteoarthritis.
Study Name

Physical activity for osteoarthritis management: a randomized controlled clinical trial evaluating hydrotherapy or Tai Chi classes

PublicationArthritis Care & Research
PurposeObjective: To determine whether Tai Chi or hydrotherapy classes for individuals with chronic symptomatic hip or knee osteoarthritis (OA) result in measurable clinical benefits.
Methods

A randomized controlled trial was conducted among 152 older persons (age 59 -85 years) with chronic symptomatic hip or knee OA. Participants were randomly allocated for 12 weeks to hydrotherapy classes (n = 55), Tai Chi classes (n = 56), or a waiting list control group (n = 41). Outcomes were assessed 12 and 24 weeks after randomization and included pain and physical function (Western Ontario and McMaster Universities Osteoarthritis Index), general health status (Medical Outcomes Study Short Form 12 Health Survey [SF‐12], version 2), psychological well‐being, and physical performance (Up and Go test, 50‐foot walk time, timed stair climb).

HYDROTHERAPY PROTOCOL (Water temperature 34°C).Patients exercise with the water at approximately waist height. Types of exercises: walking, bar work: one hand hold, bar work: both hands on bar, seated, deep water noodle, step, bar work with rings/noodles, free standing, running, stairs.

ResultsAt 12 weeks, compared with controls, participants allocated to hydrotherapy classes demonstrated mean improvements (95% confidence interval) of 6.5 (0.4, 12.7) and 10.5 (3.6, 14.5) for pain and physical function scores (range 0–100), respectively, whereas participants allocated to Tai Chi classes demonstrated improvements of 5.2 (−0.8, 11.1) and 9.7 (2.8, 16.7), respectively. Both class allocations achieved significant improvements in the SF‐12 physical component summary score, but only allocation to hydrotherapy achieved significant improvements in the physical performance measures. All significant improvements were sustained at 24 weeks. In this almost exclusively white sample, class attendance was higher for hydrotherapy, with 81% attending at least half of the available 24 classes, compared with 61% for Tai Chi.
ConclusionAccess to either hydrotherapy or Tai Chi classes can provide large and sustained improvements in physical function for many older, sedentary individuals with chronic hip or knee OA.
Study Name

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

PublicationAge and Ageing
PurposePurpose: 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.
Methods

Setting: participants’ homes.
Design: community-dwelling older adults ≥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 TM ; 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.

ResultsResults: 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.
ConclusionIn a highly variable population of older adults with mobility limitations, low-intensity functional home exercise of repeated sit-to-stands using the GrandStand System TM 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.
Study Name

Functional sit-to-stands evoke greater neuromuscular activation than orthopaedic bed exercises in healthy older adults

PublicationIsokinetics and Exercise Science
PurposeOBJECTIVE: To compare EMG activity of the hip and thigh muscles during traditional static bed exercises and the sit-to-stand exercise in healthy older adults.
MethodsTwenty-four healthy, older adults (8 males; age 65 ± 7 y) performed four static rehabilitation exercises: isometric contractions of the gluteal, abductor, inner quadriceps and quadriceps (ten, ∼ 5 s submaximal contractions, with 60 rests), and the sit-to-stand test. Electromyographic (EMG) activity was recorded from the rectus femoris, vastus medialis, gluteus medius, biceps femoris and gluteus maximus, and root mean square-processed (RMS) in this observational preliminary study. Handgrip strength and 10 m walking speed represented participant characteristics.
ResultsHip and thigh muscles were activated differently between the isometric bed and sit-to-stand exercises. Greatest RMS activity was shown in the chair rising phase of the sit-to-stand exercise. No bed exercise exceeded the muscle RMS activity required to perform a sit-to-stand, and only for sit-to-stands were all muscles activated over 40% of maximal; the level required to stimulate muscle strength adaptation.
ConclusionFunctional daily activities, such as sit-to-standing, produce greater muscle activity than static bed exercises in healthy older adults. Sit-to-stands should be included in exercise and rehabilitation programs for older adults to evoke sufficient levels of neuromuscular activation for muscle strength adaptation.
Study Name

Effects of elastic-band resistance exercise on balance, mobility and gait function, flexibility and fall efficacy in elderly people

PublicationJournal of Physical Therapy Science
PurposeThe purpose of this study was to analyze the effects of elastic-band resistance exercise on balance, gait function, flexibility and fall efficacy in the elderly people of rural community.
MethodsIt is selected by 45 outpatients. They have come into the clinic continually to treat of physical therapy at least 1–2 times for a week. A group treated with both general physical therapy and elastic-band resistance exercise (23 patients), and the other group treated with only general physical therapy (22 patients). Elastic-band resistance exercise is composed of 8 movements of lower extremity joints. It is performed for 30 minutes during 8 weeks by 3 times for a week. It is measured and recorded at the pre and post test that sit and reach test (SRT), functional reach test (FRT), timed up and go test (TUG) for every subjects by measurement equipments. And, subjects performed for the form of performance and question as its rated scale by Berg’s balance scale (BBS), dynamic gait index (DGI), activities-specific balance confidence scale (ABC).
ResultsIn the study, both the elastic-band exercise group and the general physical therapy group showed a significant improvement in balance, gait function, flexibility and fall efficacy. And the group with elastic-band resistance exercise showed more effectiveness than the contrast group in value of variation.
ConclusionFrom this study, it was confirmed that elastic-band resistance exercise has influence on balance, gait function, flexibility and fall efficacy are working for agriculture of elderly people of rural community. Based on this result, elastic-band resistance exercise can be better instrument and easier to elderly people of rural community for the improvement in balance, gait function, flexibility and fall efficacy as it performing along with and reciprocal physical therapy.
Study Name

Influence of Two Different Exercise Programs on Physical Fitness and Cognitive Performance in Active Older Adults: Functional Resistance-Band Exercises vs. Recreational Oriented Exercises

PublicationJournal of Sports Science & Medicine
PurposeThis study examines the impact of a resistance-band functional exercise program, compared with a recreational exercise program, on physical fitness and reaction times in persons older than 60 years.
MethodsFifty-four community-dwelling volunteers (71.76 ± 6.02 years) were assigned to a specific exercise program: Functional activity program (focused on resistance-band multi-joint activities; experimental group, EG), or recreational physical activity program (with gross motor activities of ludic content; control group, CG). Before and after the intervention, we determined cognitive capacity in terms of simple reaction time (S-RT), choice reaction time (C-RT) and fitness.
ResultsIn both groups physical performance improved, though this improvement was more marked in the EG for grip strength, arm strength and gross motor abilities (p < 0.05). Reaction times were better only in EG (S-RT = 10.70%, C-RT = 14.34%; p < 0.05) after the corresponding physical training intervention. The training period showed no effect on the moderate relationship between both RT and gross motor abilities in the CG, whereas the EG displayed an enhanced relationship between S-RT and grip-strength as well as the C-RT with arm strength and aerobic capacity (r ~ 0.457; p < 0.05).
Conclusion

Our findings indicate that a functional exercise program using a resistance band improves fitness and cognitive performance in healthy older adults.

Key points:
Better cognitive processes can be achieved as physical condition improves.
Exercise sessions of a more recreational type do not seem to constitute a stimulus able to improve both physical and cognitive performance in healthy active older adults.

The improvement of cognitive function, as assessed through reaction times, seems more linked to the workload and strength component of the training program.

Study Name

Elastic resistance training to increase muscle strength in elderly: A systematic review with meta-analysis

PublicationArchives of Gerontology and Geriatrics
PurposeObjective: Analyze the efficiency of training programs with progressive elastic resistance on muscle strength in elderly ‘healthy’ and ‘not healthy’.
MethodsIt was performed a systematic review in relevant databases to identify controlled clinical trials with outcomes from parameters of muscle strength. Two independent reviewers decided about the inclusion criteria, data extraction and evaluation of methodological quality of the articles. Standardized mean difference (SMD) and 95% confidence intervals (CI) were calculated for relevant outcomes and pooled using a random effects model. Among the 11 studies whose effect sizes were used in the meta-analysis, there were 834 individuals between the ages of 60 and 79.
ResultsThe resistance training with elastic bands showed strong effects on muscle strength in healthy elderly (SMD = 1.30; 95% CI: 0.90, 1.71) and with some functional incapacity (SMD = 1.01; 95% CI: 0.82, 1.19), and a moderate effect on muscle strength in elderly patients with pathology (SMD = 0.54; 95% CI: 0.12, 0.96). There was little information available about the training intensity.
ConclusionThe training with elastic resistance proved to be effective for improving muscle strength in ‘healthy’ and ‘not healthy’ elderly. Our results suggest that training with elastic resistance is most effective in ‘healthy’ subjects and with functional limitations, and less effective in subjects with some kind of disorders. To establish dose–response relations from different intensities of training on muscle strength in the elderly, new studies are needed to identify reliable and objective methods of evaluation of muscle strength using elastic materials directly.
Study Name

Effect of elastic-band-based resistance training on leg blood flow in elderly women

PublicationApplied Physiology, Nutrition, and Metabolism
PurposeThis study aimed to examine the effects of a 12-week progressive resistance training program using elastic bands on basal leg blood flow, vascular conductance, and functional performance in postmenopausal elderly women. 
MethodsSixteen healthy postmenopausal females (age, 67 ± 5 years) were randomly assigned to a control (n = 8) or resistance training (n = 8) group, where they underwent 2 supervised strength sessions per week for 12 weeks. Prior to and at completion of this 12-week period, functional and strength performance and leg haemodynamic responses were measured.
ResultsThe training intervention produced significant increases in basal leg blood flow (31%), vascular conductance (34%), and a significant reduction in cardiac work (i.e., rate pressure product) at rest, as well as significant improvements in the 3 functional ability tests performed (30-s bicep curl, 30-s sit to stand, and back scratch). Haemodynamic or functional performance responses were not altered after the 12 weeks in the control group. 
ConclusionThis study demonstrates that a resistance training program using elastic bands elicits significant improvements in basal leg blood flow in postmenopausal elderly women.
Study Name

Efficacy of Progressive Resistance Tube Training in Community Dwelling Older Adults: A Pilot Study

PublicationInternational Journal of Gerontology
PurposeThis is a pilot study to assess the effects of a 12-week progressive resistance tube training session on the lower limb muscle strength, dynamic balance, and functional mobility in elderly people.
MethodsSeventeen community dwelling older adults with a mean age of 69.2 ± 4.62 years were recruited among residents of a senior day care center in Malaysia to participate in this pilot study. Eight out of 17 participants completed their lower extremity resistance tube training sessions three times per week for 12 weeks. Lower limb muscle strength and functional mobility were tested by five times sit to stand test (FRSTST), and timed up and go test (TUG), respectively. Functional reach test (FRT) and four square step test (FSST) were applied to measure dynamic balance.
ResultsThe results revealed significant increases in lower limb strength (30.3%), dynamic balance (29.6% in FRT and 15.3% in FSST), and functional mobility (27.1%) (all significant at p < 0.05).
ConclusionIt was concluded that the use of a simple and inexpensive strength training program may improve leg muscle strength and consequently dynamic balance and mobility in elderly people and make them independent in their daily activities.
Study Name
PublicationThe Journal of Korean Society of Physical Therapy
PurposeThis study was conducted in order to determine the physical effect on grip strength and balance ability of progressive resistance training using an elastic band for middle elderly women.
MethodsWe randomly recruited 13 middle elderly female subjects (from 75 years old to 84 years old). They practiced the elastic band exercise for 50 minutes once every week and were instructed to perform the same exercise as a home exercise for 16 weeks. Subjects who participated voluntarily had not participated in any other exercise program. Grip strength, one leg stance, and TIme Up & Go Test (TUG) were measured before and after elastic band exercise using the one group pre-posttest design. Wilcoxon’s signed ranks test and simple regression analysis were performed using SPSS 18.0.
ResultsSignificant differences in TUG and grip strength test scores were observed pre and post exercise (p<0.05), except one leg stance test. Significant correlation was observed only between age and change of right one leg stance.
ConclusionProgressive resistance training using an elastic band for middle elderly women was effective for dynamic balance and grip strength, but was not effective for static balance. Therefore, investigation of factors that affect improvement of static balance using an elastic band and the lasting duration of the effect and its association with age will be necessary in the future.
Study Name

Effect of physical training performed on unstable surfaces with use of elastic bands for resistance exercises on physical performance and quality of life in elderly persons

PublicationMedical Rehabilitation
PurposeThe authors tried to evaluate the effectiveness of physical exercises, particularly exercises on unstable surfaces, in improving functional efficiency and self-evaluation of quality of life in elderly people.
Methods

The experiment was completed by a group of 37 out of 45 participants who had fulfilled selection criteria. Age range was from 65 to 90 years, and the average age was 79.5 + 12 years. The following tests were administered: manipulation test, Get Up And Go Test, Tinetti Balance and Walking Test, Single Leg Stance with Eyes Open and Closed, The Sit-And-Reach Test and measurement of back muscles strength. For subjective quality of life evaluation, psychometric testing was employed: SF-36 Health Questionnaire Survey and Life Satisfaction Index.

The participants performed physical exercises 3 times a week for 3 months, attending 33 sessions of 45 minutes duration each. The exercises defined in the training schedule were performed individually and under supervision of the physiotherapist. Use of special tools (the Swiss ball, the sensory pillow, and the elastic band) enabled performance of sensorimotor and resistance exercises whilst encouraging a sense of play, which facilitates achieving the aims of therapy.

Results

Statistically significant improvement following the physical training was noticed only in the strength of back muscles (p<0.001), in the manipulation ability test (p<0.01), and in the Single Leg Stance with Eyes Open test (p<0.05).

In physical categories of quality of life in the SF-36 test, statistically significant improvement was confined to the categories: “role limitations due to physical problems” (p<0.05) and “general health selfperception” (p<0.001). Among all mental categories of the SF-36 test, statistically significant difference was found only in “role limitations due to emotional problems” (p<0.01) and in “vitality” (p<0.05). 

ConclusionThe applied physical exercise programme positively influences the results of two out of seven tests describing physical performance of elderly people. Higher self-evaluation of quality of life was reported by these people in two physical categories and in two mental categories of the SF-36 test.
Study Name

Effects of Elastic Band Resistance Exercise on Physical Fitness, Activities of Daily Living, Falls Efficacy, and Quality of Life Among Older Women Receiving Home Nursing

PublicationJournal of Muscle and Joint Health
PurposeThis thesis study aimed to examine the effects of elastic-band resistance exercise on physical fitness, activities of daily living (ADLs), falls efficacy, and quality of life among older women receiving home nursing care under long-term care insurance.
MethodsWe used an equivalent control group pre-test/post-test design. We assigned older women at the nursing care center J to the experimental group (n=21), and older adult women at the nursing care center H to the control group (n=21). The experimental group engaged in an elastic band resistance exercise twice per week from February 18 to April 12, 2019.
ResultsThere were significant differences in the Short Physical Performance Battery score (t=4.15 p<.001), left grip strength (t=0.57, p<.569), right grip strength (t=1.38 p<.177), flexibility test scores (t=2.34, p<.024), ADLs (t=6.86, p<.001), falls efficacy (t=5.16, p<.001), and quality of life (t=3.87, p<.001). Grip strength was increased slightly in the experimental group, but the increase was not significant.
ConclusionElastic band resistance exercise is an effective nursing intervention to enhance physical fitness, flexibility, ADLs, falls efficacy, and quality of life among older women receiving home nursing care under long term care insurance.
Study Name
PublicationElderly Health Journal
PurposeThe aim of this study was to investigate the effect of an 8-week resistance exercise program on balance, walking speed, and muscle strength in elderly women.
MethodsThis randomized controlled trial was performed on 50 elderly women aged 60-66 years who were assigned to two groups of experimental and control. The Time Up and Go test, was used to measure dynamic balance, Romberg’s test was used to measure static balance, and the 10 Meter Walk Test was used to measure walking speed, and the 30 Second Chair Stand test was used to measure muscle strength. Paired t-test and independent t-test was used for comparing balance time before and after the exercise program.
ResultsThe mean duration of static balance increased in the experimental group from 21.64 ± 10.98 before exercise to 28.20 ± 13.47 after exercise (p < 0.001). The mean duration of Up and Go Time decreased from 12.88 ± 1.45 seconds before exercise to 10.80 ± 1.80 seconds after exercise (p < 0.001). Ten-meter walking time in the experimental group decreased from 1.15 ± 0.1 seconds before exercise to 1.00 ± 0.11 seconds after exercise (p < 0.001) and muscle strength in the experimental group increased from 7.8 ± 1 before exercise to 9.56 ± 1.71 after exercise (p < 0.001).
ConclusionLower limb resistance exercises with elastic band improve static and dynamic balance and also walking speed, which possibly improve muscle strength. It is recommended that these exercises be considered in developing the elderly women’s health care programs due to their accessibility, affordability, and reliability.
Study Name

Effects of resistance training on strength, power, and selected functional abilities of women aged 75 and older

PublicationJournal of the American Geriatrics Society
PurposeOBJECTIVE: To determine the effects of 12 weeks of progressive resistance strength training on the isometric strength, explosive power, and selected functional abilities of healthy women aged 75 and over.
Methods

DESIGN: Subjects were matched for age and habitual physical activity and then randomly assigned into either a control or an exercise group.

SETTING: The Muscle Function Laboratory, Royal Free Hospital School of Medicine, London.

PARTICIPANTS: Fifty‐two healthy women were recruited through local and national newspapers. Five dropped out before and seven (4 exercisers and 3 controls) during the study. Pre‐ and posttraining measurements were obtained from 20 exercisers (median age 79.5, range 76 to 93 years) and 20 controls (median age 79.5, range 75 to 90 years).

INTERVENTIONS: Training comprised one supervised session (1 hour) at the Medical School and two unsupervised home sessions (supported by an exercise tape and booklet) per week for 12 weeks. The training stimulus was three sets of four to eight repetitions of each exercise, using rice bags (1–1.5 kg) or elastic tubing for resistance. The exercises were intended specifically to strengthen the muscles considered relevant for the functional tasks, but were not to mimic the functional measurements. No intervention was prescribed for the controls.

MEASUREMENTS: Pre‐ and posttraining measurements were made for isometric knee extensor strength (IKES), isometric elbow flexor strength (IEFS), handgrip strength (HGS), leg extensor power (LEP), and anthropometric indices (Body impedance analysis, arm muscle circumference, and body weight). Functional ability tests were chair rise, kneel rise, rise from lying on the floor, 118‐m self‐paced corridor walk, stair climbing, functional reach, stepping up, stepping down, and lifting weights onto a shelf. Pre‐ and posttraining comparisons were made using analysis of variance or analysis of covariance (using weight as a covariate) for normally distributed continuous data and one‐sided Fishers exact test (2times2 table) for discontinuous data.

ResultsImprovements in IKES (mean change 27%, P = .03), IEFS (22%, P = .05), HGS (4%, P = .05), LEP/kg (18%, P = .05) were associated with training, but the improvement in LEP (18%, P = .11) did not reach statistical significance. There was an association between training and a reduction in normal pace kneel rise time (median change 21%, P = .02) and a small improvement in step up height (median 5%, P = .005). The other functional tests did not improve.
ConclusionProgressive resistance exercise can produce substantial increases in muscle strength and in power standardized for body weight in healthy, very old women. However, isolated increases in strength and LEP/kg may confer only limited functional benefit in healthy, independent, very old women.
Study Name

Effects of long term Tai Chi practice and jogging exercise on muscle strength and endurance in older people

PublicationBMJ Journals
PurposeObjectives: To investigate the influence of regular Tai Chi (TC) practice and jogging on muscle strength and endurance in the lower extremities of older people.
MethodsTwenty one long term older TC practitioners were compared with 18 regular older joggers and 22 sedentary counterparts. Maximum concentric strength of knee flexors and extensors was tested at angular velocities of 30°/s and 120°/s. Ankle dorsiflexors and plantar flexors were tested at 30°/s and the dynamic endurance of the knee flexors and extensors was assessed at a speed of 180°/s.
ResultsThe differences in the muscle strength of the knee joint amongst the three experimental groups were significant at the higher velocity. The strengths of knee extensors and flexors in the control group were significantly lower than those in the jogging group and marginally lower than those in the TC group. For the ankle joint, the subjects in both the TC and jogging groups generated more torque in their ankle dorsiflexors. In addition, the muscle endurance of knee extensors was more pronounced in TC practitioners than in controls.
ConclusionRegular older TC practitioners and joggers showed better scores than the sedentary controls on most muscle strength and endurance measures. However, the magnitude of the exercise effects on muscles might depend on the characteristics of different types of exercise.
Study Name

Keep Seniors Standing Tall

PublicationMDedge Internal Medicine
PurposeThe aim of the article is to provide recommendation of exercises for seniors and a short description of the movement. The author of the article is DR. NAGLER, physiatrist-in-chief, emeritus, and professor of rehabilitation medicine at Weill Medical College of Cornell University,
New York.
Methods 
Results 
Conclusion

Recommended exercises for improving posture:

1. Scapular adductor stretch, 45-degree angle.
2. Scapular adductor stretch, 90-degree angle.
3. Upper back extensor strengthening.
4. Standing hip flexor stretch.

Other recommendations:

A regular form of weightbearing activity, such as walking, helps to maintain good posture as we age, and in order to continue weightbearing activity, regular stretching of the hip flexors and adductors is necessary.

If patients can lift light weights without pain, I recommend simple weight-lifting exercises. I do not recommend heavy weights, because senior patients often have difficulty raising their arms. Multiple repetitions (15 times) with a light weight are a good choice for senior patients because they are more aerobic than fewer repetitions with a heavier weight. Multiple repetitions also allow the muscles time to fill with blood, which happens more slowly with age.

For seniors, it is much better to do something moderate nearly every day than to do something more intense only twice a week.

Study Name

Movement Activities For The Improvement Of Seniors’ Balance

PublicationAnnual Conference Faculty Of Social Sciences Ucm Trnava: Social Policy and Services, Conference Proceeding
PurposeThe article points at an important role of movement which has a big impact on the quality of seniors’ life. The author has provided a set of exercises which can help improve the seniors’ balance.
Methods 
Results 
Conclusion

For seniors balance exercising is very important. Regular balance training helps prevent insuries and keeps body of seniors in a good condition. We start with easy kind of exercise without tools and graduate to more complex exercising, using different tools.

Exercises without tools:

1. Standing exercises;
2. Stright line walking;
3. Sitting and walking;
4. Squats.

Exercises with tools:

1. Posturomed;
2. Balance trainer (BOSU);
3. Training with overballs;
4. Training with fit balls.

Study Name

Changes in the body posture of elder women under the influence of various Nordic walking training programs

PublicationBaltic Journal of Health and Physical Activity 2018
PurposeThe aim of the study was to analyse changes in the body posture of elderly women who took part in diversified Nordic walking training.
MethodsThe study group comprised 90 elderly women divided into two experimental groups and control. The main method was an experiment. The tested women took part in a 6-month Nordic walking training cycle. Women from the control group did not take part in any organised form of physical activity. Evaluation of the body posture was made by the silhouette-based Staffel method.
ResultsNordic walking training has led to certain changes in the body posture. Women from experimental groups have improved their body posture. In the control some significant negative changes have been observed.
ConclusionNordic walking is extremely useful for modelling body posture of the elderly. When the programme is complemented with the strengthening and stretching exercises, which shape the postural muscles, the effects are intensified.
Study Name

Effects of Nordic Walking Compared to Conventional Walking and Band-Based Resistance Exercise on Fitness in Older Adults

PublicationJournal of Sports Science & Medicine
PurposeThe purpose of this study was to compare the effects of Nordic walking with conventional walking and band-based resistance exercise on functional fitness, static balance and dynamic balance in older adults.
MethodsVolunteers (n = 65) were divided into four groups: Nordic walking (NW), conventional walking (CW), resistance (RES), and control. Each group performed activity 50-70 min·day−1 (warm-up 10-15 min, main exercise 30-40, and cool down 10-15 min), 3 days·week−1 (NW and CW) or 2 day·week−1 (RES) for 12 wks.
ResultsUpper-body strength improved (p < 0. 05) in the RES (22.3%) and the NW (11.6%) groups compared to the CW and control groups. Cardio- respiratory fitness improved more in the NW (10.9%) and CW (10.6%) groups compared to the RES and control groups. Upper- and lower-body flexibility also improved in all exercise groups compared to the control group. There were no improvements in balance measures in any group.
ConclusionWhile all modes of exercise improved various components of fitness, Nordic walking provided the best well-rounded benefits by improving upper-body strength, cardiovascular endurance, and flexibility. Therefore, Nordic walking is recommended as an effective and efficient mode of concurrent exercise to improve overall functional fitness in older adults.
Study Name

A 1-year combined weight-bearing training program is beneficial for bone mineral density and neuromuscular function in older women

PublicationOsteoporosis International
PurposeThe aim was to determine if a combined weight-bearing training program twice a week would be beneficial to bone mineral density and neuromuscular function.
MethodsForty-eight community living women 66-87 years old volunteered to participate in a 12-month prospective, randomized, controlled, trial. The participants were pairwise age-matched and randomly assigned to either an exercise group (n=24) or a control group (n=24). Twenty-one subjects in the intervention group and 19 in the control group completed the study. The exercise program lasted for 50 min and consisted of a combination of strengthening, aerobic, balance and coordination exercises. The mean percentage of scheduled sessions attended for the exercise group was 67%.
ResultsAt the completion of the study, the intervention group showed significant increments in bone mineral density of the Ward’s triangle (8.4%, P<0.01) as well as improvement in maximum walking speed (11.4%, P<0.001) and isometric grip strength (9.9%, P<0.05), as compared to the control group.
ConclusionThe conclusion was that a combined weight-bearing training program might reduce fracture risk factors by improving bone density as well as muscle strength and walking ability. This program could be suitable for older community living women in general, and might, therefore, have important implications for fracture prevention.
Study Name

Seated Exercise Therapy Improves Posture and Balance in Hyperkyphotic Elderly Females, a Randomized Control Trail

PublicationWorld Applied Sciences Journal 24
PurposeThis study aimed to investigate the effect of seated exercise therapy on the posture and the balance in hyperkyphotic elder women.
Methods

In this study 23 hyperkyphotic females, aged 60 years and older, were randomly divided, into experimental group(n=12) and control group (n=11). The experimental group exercised 3 sessions per week for12 weeks, 60-90 minutes per session. Before and after exercise program their kyphosis angle was measured by using of flexible ruler. Their balance was measured by using of Berg balance scale.

Exercise therapy included of 12 weeks and 3 sessions per week. Exercise times per session were 40 minutes for first month, 60 minutes for second month and 90 minutes for third month. Ten minutes of exercise time were for warm up and 10 minutes were for cool down. The training program included of 10 exercises in sitting position. The exercises included of:

1) flexion and extension of thoracic spine,
2) closing door,
3) rowing,
4) spinal rotation to left and right,
5) lateral flexion with stretch arm,
6) arms hyperextension with towel,
7) cervical retraction,
8) cervical rotation to right and left,
9) chest press,
10) stretch truck with arms up.

Repetition of exercises was increased per week.

ResultsThe results showed no significant difference between two groups (experimental and control) in the balance, kyphosis angle, height and forward head at pretest (p 0.05). There was a significant difference between kyphosis angles from
pre (49.33±4.61) to post test (41.33±4.24) in experimental group (p 0.05). Moreover, the results showed that the seated exercise therapy causes significant changes on the height, the forward head and the balance of the elder people (p 0.05). However, there was no difference between the pretest and the post test in the control group in any variables.
ConclusionThe results of this study confirm the role of seated exercise therapy in reducing the angle of kyphosis and improving balance in older adults.
Study Name

Efficacy of Posture Awareness and Neck Exercise Program on Reducing Cervical Pain Among Elderly Patients at Assiut University Hospital, Egypt

PublicationAssiut Scientific Nursing Journal
PurposeStudy Aim: Evaluate the efficacy of posture awareness and neck exercise program on reducing cervical pain among elderly patients.
MethodsQuasi-experimental research design was used. The study was conducted in outpatient clinic of Rheumatology and Rehabilitation Department at Assiut University Hospital. The total sample size was 189 elderly.
Two tools were used. The 1st tool: An interview sheet including personal characteristics, medical history and elderly knowledge, the 2nd tool: The Northwick Park Neck Pain scale and jury were done by 3 expertise in erotological nursing.
ResultsThe present study showed that the majority of studied patients aged (60 – < 65) years, with mean age 62.48± 3.43 and there was a highly significant difference between pre and post-program of both isometric neck exercises and good neck posture (p=0.0001).
ConclusionIt was concluded that isometric neck exercises and good neck posture are effective in the management of neck pain in elderly population. Recommendation: Implementation of isometric exercise and good neck posture among elderly population should be expanded as a community based intervention.
Study Name

Yoga Decreases Kyphosis in Senior Women and Men with Adult‐Onset Hyperkyphosis: Results of a Randomized Controlled Trial

PublicationJournal of the American Geriatrics Society
PurposeOBJECTIVES: To assess whether a specifically designed yoga intervention can reduce hyperkyphosis.
Methods

DESIGN: A 6‐month, two‐group, randomized, controlled, single‐masked trial.

SETTING: Community research unit.

PARTICIPANTS: One hundred eighteen women and men aged 60 and older with a kyphosis angle of 40° or greater. Major exclusions were serious medical comorbidity, use of assistive device, inability to hear or see adequately for participation, and inability to pass a physical safety screen.

INTERVENTION: The active treatment group attended hour‐long yoga classes 3 days per week for 24 weeks. The control group attended a monthly luncheon and seminar and received mailings.

MEASUREMENTS: Primary outcomes were change (baseline to 6 months) in Debrunner kyphometer‐assessed kyphosis angle, standing height, timed chair stands, functional reach, and walking speed. Secondary outcomes were change in kyphosis index, flexicurve kyphosis angle, Rancho Bernardo Blocks posture assessment, and health‐related quality of life (HRQOL).

ResultsCompared with control participants, participants randomized to yoga experienced a 4.4% improvement in flexicurve kyphosis angle (P=.006) and a 5% improvement in kyphosis index (P=.004). The intervention did not result in statistically significant improvement in Debrunner kyphometer angle, measured physical performance, or self‐assessed HRQOL (each P>.1).
ConclusionThe decrease in flexicurve kyphosis angle in the yoga treatment group shows that hyperkyphosis is remediable, a critical first step in the pathway to treating or preventing this condition. Larger, more‐definitive studies of yoga or other interventions for hyperkyphosis should be considered. Targeting individuals with more‐malleable spines and using longitudinally precise measures of kyphosis could strengthen the treatment effect.
Study Name

Effects of 8-months yoga training on shaping the spine in people over 55

PublicationBiomedical Human Kinetics
PurposeStudy aim: The aim of this study was to evaluate the influence of hatha yoga practices on the shaping of the anteroposterior (AP) spinal curvatures in students of the University of the Third Age, who participated in hatha yoga classes.
Methods

Material and methods: 20 women and 5 men took part in the study. Hatha yoga classes were held once a week for 90 minutes over a period of 8 months along with additional exercises including basic positions of hatha yoga in home conditions 1-2 times a week for about 30 minutes. The inclination of the AP curvatures of the spine was measured twice, before and after the end of the classes. A Rippstein plurimeter was used for the measurements.

The study involved 20 women (age = 63.3 ± 6.2 min = 55, max = 78 years old, body height = 159.3 ± 5.44, body mass = 68.65 ± 11.11, BMI = 26.98 ± 3.78) and 5 men (age = 65.5 ± 6.08 min = 60, max = 75 years old, body height = 172.4 ± 2.51, body mass = 77.78 ± 5.49, BMI = 26.19 ± 2.08), students of the University of the Third Age.

The subjects were scheduled for one 90-minute session of yoga classes by the Iyengar method per week. The sessions began with the mountain pose (tadasana), a position which forms the habit of correct posture and then poses focusing on lengthening the spine, strengthening muscles, balance, stretching, and finished with relaxation.

ResultsMeasurements of the angle of thoracic kyphosis before starting the series of hatha yoga classes and after finishing them showed a decrease in thoracic curvature in female (p < 0.01). In case of the angle of lumbar lordosis, a reduction in this curvature as a result of yoga techniques has been observed in women (p < 0.01) too. Amounts of AP curvatures of the spine, measured after completing the series of hatha yoga classes, fluctuated around correct values better than before taking them up.
ConclusionThis study has shown that yoga training leads to an improvement in the habitual body posture in case of aggravating (excessive) AP curvatures of the spine. They are particularly beneficial for people with excessively deepened thoracic kyphosis.
Study Name

Reducing the Risk of Falls Through Proprioceptive Dynamic Posture Training in Osteoporotic Women with Kyphotic Posturing: A Randomized Pilot Study

PublicationAmerican Journal of Physical Medicine & Rehabilitation
PurposeObjective: To assess the effect of a proprioceptive dynamic posture training program on balance in osteoporotic women with kyphotic posture.
Methods

Design: Subjects were randomly assigned to either a proprioceptive dynamic posture training program or exercise only group. Anthropometric measurements, muscle strength, level of physical activity, computerized dynamic posturography, and spine radiography were performed at baseline and 1 mo.

The subjects were randomly assigned to one of two groups. One group received back extensor strengthening exercises only. The other group received the same exercise program plus PDP training with the use of a 2-pound weighted kyphoorthosis to be worn daily for 2 hr only during ambulatory activities (Posture Training Support) (Fig. 1).

ResultsAt the 1-mo follow-up, three groups were formed on the basis of the baseline computerized dynamic posturography results. In general, groups 1 and 2 had no significant change at 1 mo, whereas group 3 improved balance significantly at 1 mo.
ConclusionThe subjects who had abnormal balance and used the proprioceptive dynamic posture training program had the most significant improvement in balance. Improved balance could reduce the risk of falls.
Study Name

Effect of thorax correction exercises on flexed posture and chest function in older women with age-related hyperkyphosis

PublicationJournal of Physical Therapy Science
PurposeThe purpose of this study was to determine the effects of thorax correction exercises on flexed posture and chest function in older women with age-related hyperkyphosis.
MethodsThe study participants included 41 elderly women who were divided into a thorax correction exercise group (n = 20) and a control group (n = 21). Participants in the exercise group completed a specific exercise program that included breathing correction, thorax mobility, thorax stability, and thorax alignment training performed twice per week, 1 hour each session, for 8 weeks. Outcome measures included the flexed posture (thoracic kyphosis angle, forward head posture) and chest function (vital capacity, forced expiratory volume in a second, and chest expansion length).
ResultsParticipants in the thorax correction exercise group demonstrated significantly greater improvements in thoracic kyphosis angle, forward head, and chest expansion than those in the control group.
ConclusionThis study provides a promising exercise intervention that may improve flexed posture and chest function in older women with age-related hyperkyphosis.
Study Name

Effects of an adapted physical activity program in a group of elderly subjects with flexed posture: clinical and instrumental assessment

PublicationJournal of NeuroEngineering and Rehabilitation
PurposeThe purpose of this clinical study was to systematically compare the effects of a physical activity program that specifically address the flexed posture that marks a certain percentage of elderly individuals with a non specific exercise program for 3 months.
Methods

Participants were randomly divided into two groups: one followed an Adapted Physical Activity program for flexed posture and the other one completed a non-specific physical activity protocol for the elderly. A multidimensional clinical assessment was performed at baseline and at 3 months including anthropometric data, clinical profile, measures of musculoskeletal impairment and disability.

The instrumental assessment of posture was realized using a stereophotogrammetric system and a specific biomechanical model designed to describe the reciprocal position of the body segments on the sagittal plane in a upright posture.

ResultsThe Adapted Physical Activity program determined a significant improvement in several key parameters of the multidimensional assessment in comparison to the non-specific protocol: decreased occiput-to-wall distance, greater lower limb range of motion, better flexibility of pectoralis, hamstrings and hip flexor muscles, increased spine extensor muscles strength. Stereophotogrammetric analysis confirmed a reduced protrusion of the head and revealed a reduction in compensative postural adaptations to flexed posture characterized by knee flexion and ankle dorsiflexion in the participants of the specific program.
ConclusionThe Adapted Physical Activity program for flexed posture significantly improved postural alignment and musculoskeletal impairment of the elderly. The stereophotogrammetric evaluation of posture was useful to measure the global postural alignment and especially to analyse the possible compensatory strategies at lower limbs in flexed posture.
Study Name

Seated Exercise Therapy Improves Posture and Balance in Hyperkyphotic Elderly Females, a Randomized Control Trial

PublicationWorld Applied Sciences Journal 24
PurposeThis study aimed to investigate the effect of seated exercise therapy on the posture and the balance inhyperkyphotic elder women.
MethodsThis study aimed to investigate the effect of seated exercise therapy on the posture and the balance in hyperkyphotic elder women. In this study 23 hyperkyphotic females, aged 60 years and older, were randomly divided, into experimental group(n=12) and control group (n=11). The experimental group exercised 3 sessions per week for12 weeks, 60-90 minutes per session. Before and after exercise program their kyphosis angle was measured by using of flexible ruler. Their balance was measured by using of Berg balance scale.
ResultsThe results showed no significant difference between two groups (experimental and control) in the balance, kyphosis angle, height and forward head at pretest (p 0.05). There was a significant difference between kyphosis angles from
pre (49.33±4.61) to post test (41.33±4.24) in experimental group (p 0.05). Moreover, the results showed that the seated exercise therapy causes significant changes on the height, the forward headand the balance of the elder people (p 0.05). However, there was no difference between the pretest and the post test in the control group in any variables.
ConclusionThe results of this study confirm the role of seated exercise therapy in reducing the angle of kyphosis and improving balance in older adults.
Study Name

The Effect of Exercise Ball Training on Balance in Older Adults

PublicationMasters Theses. 1543, Eastern Illinois University
PurposeThe purpose of this study was to evaluate the efficacy of an exercise regimen involving the use of Swiss Balls to improve the balance of older adults.
Methods

Eleven apparently healthy subjects over the age of sixty who had no history of falls volunteered to participate in this study. Six subjects participated in the exercise group, which involved supervised participation in a Swiss Ball exercise program for a period of 10 weeks. Five subjects participated in the control group, which did not perform any form of exercise that was new to them during the 10-week training period.

Balance testing of all subjects was conducted before and after the 10-week training period. This testing included one-legged stance tests, tandem (heel-to-toe) stance tests, tandem (heel-to-toe) walking tests, a 30-meter timed walk, and 30-second chair stand test. Nine subjects completed the study. A MANOVA test was performed to determine any differences in change scores between the two groups. 

ResultsThe results of the MANOVA test indicated that there was a significant difference between the change scores of the exercise and control groups for the 30-meter timed walk and the chair stand tests (p= .010 and .004 respectively.)
Conclusion

The expectation of this study was to find a significant difference in change scores between the exercise and control groups. The exercise ball training was intended to improve the function of the muscles that regulate posture and upright stance, and therefore improve the balance of the subjects who participated in the ball exercises. Although the results of this study did not reveal any significant changes in the balance of either group, a significant improvement in walking speed and the number of chair stands performed within 30 seconds was found in the exercise group after the training period.

Because leg strength and walking speed are two factors that predict balance test scores, improvements in balance should have been expected. Some small improvements were found in the balance test scores of the exercise group after the training period, although the improvements were insignificant. This may be due in part to low power as the subject number in this study was small. Also, if the length of the training period had been longer, the results may have been more significant. Further study is warranted with larger population samples in order to determine if exercise ball training is an effective mode of improving balance.

Study Name

Effectiveness of Conventional Balance Training Exercise Versus Swiss Ball Exercise Program on Balance in Geriatric Population – A Randomized Controlled Trial

PublicationIndian Journal of Physiotherapy and Occupational Therapy
PurposeObjectives: To study and compare the effectiveness of conventional balance exercise training program and Swiss ball exercise training program on balance function in geriatric population.
Methods30 individuals were recruited and randomized into two groups A and B. 14 days intervention was given in which group A received the conventional core strengthening exercise and group B underwent Swiss ball balance training program. Pre-intervention and post intervention scores of Timed Up and Go (TUG) test and Functional Reach Test (FRT) was measured and data were analyzed using t test.
ResultsThe pre and post comparison of TUG and FRT showed significant change in balance in both the groups (p< 0.001). Comparison of group A and group B however showed no difference in the outcome measures (p> 0.001).
ConclusionBoth conventional and Swiss ball exercise program were proved to be equally effective in improving balance in geriatrics.
Study Name

The use of step aerobics and the stability ball to improve balance and quality of life in community-dwelling older adults – a randomized exploratory study

PublicationArchives of Gerontology and Geriatrics
PurposeObjective: To explore the use of step aerobics (SA) and the stability ball (SB) as tools for balance improvement in community-dwelling older adults.
MethodsForty-two women (age: 72.2 ± 5.8 years) who attended a community day center volunteered to participate in the study. Following the first assessment session, 28 women were assigned randomly to one of two experimental groups (the use of either SA or SB). The other 14 participants, who were engaged in a ceramic class, served as the control group. The study design was based on four assessment sessions and eight weeks of intervention. Assessment included four balance tests: Timed Up and Go (TUG), One-Leg Stand, Functional Reach, and the Performance-Oriented Assessment of Mobility (POMA). Quality of life was assessed by the use of the Short Form-36 Health Survey questionnaire.
ResultsThe TUG and POMA intervention improved significantly (d = .83 and d = .95, respectively) following the SA. In addition, general health perception following both the SA and SB interventions improved significantly relative to the control condition (d = .62 and d = .22, respectively).
ConclusionThe findings of this study may imply that trainers should consider the inclusion of SA and SB as components of physical activity programs for seniors, aimed at improving balance ability and quality of life.
Study Name

The Effects of 12 Weeks of Step Aerobics Training on Functional Fitness of Elderly Women

PublicationJournal of Strength and Conditioning Research
PurposeThe purpose of this study was to determine the effects of 12 weeks of step aerobics (SA) training on the functional fitness of apparently healthy older women.
MethodsThirteen previously sedentary elderly women (mean age 63.14 years) participated in this study. Subjects performed 3 training sessions per week for 30-60 minutes per session. All measurements were assessed at baseline, after 12 weeks of training (posttest), and after 1 month of detraining. Assessments included the evaluation of body mass index (BMI), waist circumference (WC), strength of the upper (arm-curl [AC] test) and lower body (30-second chair-stand test [CS]), dynamic balance and agility (8 foot up and go [8 ft]), flexibility (chair sit-and-reach [CSR]), and cardiorespiratory fitness (6-minute walk test [6MW]).
ResultsStep aerobics significantly improved all functional fitness components except for BMI. The 12 weeks of SA promoted a large effect size in the following measurements: WC (d = 1.6); CSR (d = 1.51); CS (d = 1.49); AC (d = 1.41); 8 ft (d = 1.32); and 6MW (d = 1.06) (p < 0.05). These results indicate that 12 weeks of SA had a positive effect on the functional fitness components of these older women. Furthermore, these findings were confirmed by the reverse effect observed after 1 month of detraining, except for upper body strength (AC test).
ConclusionIn conclusion, 12 weeks of SA training can promote improvements in the functional fitness of apparently healthy older women. Therefore, SA can be considered an effective exercise modality to prevent the loss of functional fitness and its associated consequences.
Study Name

Effects of dance on physical and psychological well-being in older persons

PublicationArchives of Gerontology and Geriatrics
PurposeThis study was aimed at determining the effects of dancing on the health status of older persons.
MethodsA pool of 111 community-dwelling subjects were allocated to either an intervention group (IG), which included 23 sessions of dance over 12 weeks, or a control group (CG). All participants were assessed at baseline and 12 weeks. Physical outcome measures included the 6-min timed walking test (6MWT), trunk flexibility, body composition, lower limb endurance and strength, balance, the timed up-and-go test (TUG), resting heart rate and blood pressure. Quality of life was assessed by the Medical Outcomes Survey Short Form (SF-36) questionnaire. The IG’s views toward dancing were also evaluated at 12 weeks.
ResultsSignificant difference was observed between the groups in six outcome measures: mean change in resting heart rate, 6MWT, TUG, lower limb endurance and the ‘general health’ and ‘bodily pain’ domains of SF-36. The majority of the dance group felt the intervention improved their health status.
Conclusion

These findings demonstrate that dancing has physical and psychological benefits, and should be promoted as a form of leisure activity for senior citizens.

This study provides evidence that a structured dance program is effective in improving aspects of physical and psychological health in community-dwelling Chinese older persons. With continued development, dancing may be an effective means for health promotion and disease prevention. Through social contact with other peers, dancing can also enhance psychosocial well-being.

Study Name

The impact of adding weight-bearing exercise versus nonweight bearing programs to the medical treatment of elderly patients with osteoporosis

PublicationJournal of Family & Community Medicine
PurposeThe objective of the study was to evaluate the effects of adding weight-bearing exercise as opposed to nonweight-bearing programs to the medical treatment of bone mineral density (BMD) and health-related quality of life (HRQoL) of elderly patients with osteoporosis.
MethodsParticipating in the study were 40 elderly osteoporotic patients (27 females and 13 males), with ages ranging from 60 to 67 years, who were receiving medical treatment for osteoporosis. They were assigned randomly into two groups: Group-I: Twenty patients practiced weight-bearing exercises. Group-II: Twenty patients did nonweight-bearing exercises. All patients trained for 45-60 min/session, two sessions/week for 6 months. BMD of the lumbar spine, right neck of femur, and right distal radial head of all patients were measured by dual-energy X-ray absorptiometry before and after both treatment programs. In addition, the QoL was measured by means of the HRQoL “ECOS-16” questionnaire.
ResultsT-tests proved that mean values of BMD of the lumbar spine, right neck of femur and right distal radial head were significantly increased in both groups with greater improvement in the weight-bearing group. The QoL was significantly improved in both groups, but the difference between them was not significant.
ConclusionAddition of weight-bearing exercise program to medical treatment increases BMD more than nonweight-bearing exercise in elderly subjects with osteoporosis. Furthermore, both weight-bearing and nonweight-bearing exercise programs significantly improved the QoL of patients with osteoporosis.
Study Name

A 1-year combined weight-bearing training program is beneficial for bone mineral density and neuromuscular function in older women

PublicationOsteoporosis International
PurposeThe aim was to determine if a combined weight-bearing training program twice a week would be beneficial to bone mineral density and neuromuscular function.
MethodsForty-eight community living women 66–87 years old volunteered to participate in a 12-month prospective, randomized, controlled, trial. The participants were pairwise age-matched and randomly assigned to either an exercise group (n=24) or a control group (n=24). Twenty-one subjects in the intervention group and 19 in the control group completed the study. The exercise program lasted for 50 min and consisted of a combination of strengthening, aerobic, balance and coordination exercises. The mean percentage of scheduled sessions attended for the exercise group was 67%.
ResultsAt the completion of the study, the intervention group showed significant increments in bone mineral density of the Ward’s triangle (8.4%, P<0.01) as well as improvement in maximum walking speed (11.4%, P<0.001) and isometric grip strength (9.9%, P<0.05), as compared to the control group.
ConclusionThe conclusion was that a combined weight-bearing training program might reduce fracture risk factors by improving bone density as well as muscle strength and walking ability. This program could be suitable for older community living women in general, and might, therefore, have important implications for fracture prevention.
Study Name

Weight bearing exercise can elicit similar peak muscle activation as medium–high intensity resistance exercise in elderly women

PublicationEuropean Journal of Applied Physiology
PurposePurpose: To assess whether stepping-based weight bearing exercise (WBE) can elicit peak activation of upper leg muscles similar to resistance exercise (RE) at an intensity required to induce strength gains in elderly women.
MethodsMuscular activation of several upper leg muscles was measured during RE and WBE in a cohort of 19 healthy elderly women (69.3 ± 3.4 years). WBE consisted of forward and lateral stepping with step heights of 10, 20 and 30 cm. Muscular activation was compared to 60% of one-repetition maximum (1-RM) of congruent RE.
ResultsPeak activation during WBE was higher than RE at 60% 1-RM during forward and lateral stepping in vastus lateralis starting at 20 cm (p = 0.049 and p = 0.001), and biceps femoris at 30 cm step height (p = 0.024 and p = 0.030). Gluteus maximus peak activation matched RE at 60% 1-RM at 20 and 30 cm step height regardless of step direction (p ≥ 0.077). Peak activation of the rectus femoris and gluteus medius matched RE activation at 60% 1-RM during lateral stepping at 30 cm (p = 0.355 and p = 0.243, respectively) but not during forward stepping. WBE did not induce similar activation as RE in the semitendinosus.
ConclusionIn WBE, most upper leg muscles were recruited at an equal or higher intensity than in RE at 60% 1-RM. Lateral stepping at 30 cm step height showed the highest training potential of all WBE’s applied.
Study Name
PublicationArchives of Physical Medicine and Rehabilitation
PurposeObjective: To investigate whether weight-bearing (WB) exercise enhances functional capacity to a greater extent than nonweight-bearing (NWB) exercise in participants with knee osteoarthritis.
Methods

Design: Randomized controlled trial.
Setting: Kinesiology laboratory.

Participants: Participants (N=106) were randomly assigned to WB exercise, NWB exercise, or a control group (no exercise).

Intervention: WB exercise and NWB exercise groups underwent an 8-week knee extension-flexion exercise program.

Main Outcome Measures: Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function scale, walking speed, muscle torque, and knee reposition error were assessed before and after intervention.

ResultsEqually significant improvements were apparent for all outcomes after WB exercise and NWB exercise, except for reposition error, for which improvement was greater in the WB exercise group. In contrast, there were no improvements in the control group.
ConclusionSimple knee flexion and extension exercises (WB and NWB) performed over 8 weeks resulted in significant improvement in the WOMAC function scale and knee strength compared with the control group. NWB exercise alone may be sufficient enough to improve function and muscle strength. The additional benefit of WB exercise was improved position sense, which may enhance complex walking tasks (walking on figure of 8 route and spongy surface).
Study Name

The effects of endurance and weight-bearing exercises on reaction time and postural balance in postmenopausal women

PublicationEdizioni Minerva Medica
PurposeThe purpose of this study was to investigate the effects of endurance and strength training on reaction time and postural balance in elderly females.
MethodsForty-three elderly women with the mean age of 60-74 years old were recruited and randomly allocated to three groups: aerobic training (3 d/wk for 12 wk), Strength training (3 d/wk for 2 months) or a control group. Postural balance of all subjects was measured by timed up and go test (TUG) and Berg balance scale (BBS). Body Mass Index (BMI), percentage of body fat (PBF), and lower extremities and trunk muscle mass were measured before and after training. Reaction time was measured with the reaction time measuring device.
ResultsThe results suggested that choice reaction time and postural balance were significantly improved in both experimental groups with greater improvement in the weight-bearing group.
ConclusionThe endurance and weight-bearing exercises improved reaction time and postural balance in elderly females.
Study Name
PublicationBiology, Engineering and Medicine
PurposeInspired by the proven capability to recover skeletal muscle contractility and strength by home-based Functional Electrical Stimulation even in the worse cases of neuromuscular traumatic injuries, but, guided by common sense, we suggest a short (15-20 minutes) daily routine of twelve easy-to-perform physical exercises that may be performed in bed (Full-body In-Bed Gym).
Methods 
Results

Active persons, i.e., those able to make 25 consecutive push-ups, do not need the exercises shown in Figure 1. All other persons may start with 5 repetitions of each suggested exercise of the In-Bed Gym Program: (Figure 1. A, B, Flexion and extension of ankles; C, Cycling movements; D, E, Arms up and down; F, Deep breathing; G and H, Forward bending; I, To raise your pelvis; J, K, L, Neck torsions; M, Lift the body; N, O, Lift the legs; P, stand up from bed; Q, Get up on his toes; R, Push up (Active person).

After every successive week, they may add groups of 5 additional exercises up to 30. The routine may last from 10 (at the beginning of the muscles’ training) to 30 minutes, when 30 repetitions of each exercise are reached. Figure 1 shows the series of safe and easy exercises that elderly persons could perform resting in bed.

Further, a video may be downloaded from the link: http://www.bio.unipd.it/bam/video/InterviewCarraro-tutorial.mp4

Conclusion

If borderline sedentary persons challenge themselves, within a few days of inpatient care, the Full-body In-Bed Gym may increase muscle strength, fatigue resistance and independence in daily life activities. In surgical units, this will permit standing of patients soon after the surgery, a mandatory measure to prevent risk of thromboembolism.

Full-body In-Bed Gym helps also to mitigate the bad mood that many times accompanies mobility limitations, strengthening patients’ confidence in recovering partial or total independence. Continued regularly, Full-body In-Bed Gym may help to maintain the independence of frail older people and to reduce the risks of the possible serious consequences of accidental falls.

Study Name

Randomized, Controlled, Six-Month Trial Of Yoga In Healthy Seniors: Effects On Cognition And Quality Of Life

PublicationAlternative Therapies in Health and Medicine
PurposeObjective: To determine the effect of yoga on cognitive function, fatigue, mood, and quality of life in seniors.
Methods

Design: Randomized, controlled trial comparing yoga, exercise, and wait-list control groups.
Participants: One hundred thirty-five generally healthy men and women aged 65–85 years.

Intervention: Participants were randomized to 6 months of Hatha yoga class, walking exercise class, or wait-list control. Subjects assigned to classes also were asked to practice at home.

Main Outcome Measures: Outcome assessments performed at baseline and after the 6-month period included a battery of cognitive measures focused on attention and alertness, the primary outcome measures being performance on the Stroop Test and a quantitative electroencephalogram (EEC) measure of alertness; SF-36 health-related quality of life; Profile of Mood States; Multi-Dimensional Fatigue Inventory; and physical measures related to the interventions.

ResultsOne hundred thirty-five subjects were recruited and randomized. Seventeen subjects did not finish the 6-month intervention. There were no effects from either of the active interventions on any of the cognitive and alertness outcome measures. The yoga intervention produced improvements in physical measures (eg, timed 1-legged standing, forward flexibility) as well as a number of quality-of-life measures related to sense of well-being and energy and fatigue compared to controls.
ConclusionThere were no relative improvements of cognitive function among healthy seniors in the yoga or exercise group compared to the wait-list control group. Those in the yoga group showed significant improvement in quality-of-life and physical measures compared to exercise and wait-list control groups.
Study Name

Physical-Performance Outcomes and Biomechanical Correlates from the 32-Week Yoga Empowers Seniors Study

PublicationEvidence-Based Complementary and Alternative Medicine
PurposeThis study evaluated the efficacy of the program on physical function outcomes.
MethodsTwenty community-dwelling older adults aged 70.7 ± 3.8 years attended biweekly 60-minute Hatha yoga classes for 32 weeks. Four domains of the physical measurements including (1) functional performance, (2) flexibility, (3) muscle strength, and (4) balance were taken at the baseline, 16-week and 32-week time points. Repeated-measures ANOVA omnibus tests and Tukey’s post hoc tests were employed to examine the differences in each outcome variable across the 3 time points.
ResultsImproved timed chair stands (p<0.01), 8-foot up and go (p<0.05), 2-min step test (p<0.05), and vertical reach (p=0.05) performance were evident. Isometric knee flexor strength (p<0.05) and repetitions of the heel rise test (p<0.001) also increased following the 32-week intervention. Both flexibility and balance performance remained unchanged.
ConclusionSignificant improvements in physical function and muscle-specific lower-extremity strength occur with the regular practice of a modified Hatha yoga program designed for seniors. These adaptations corresponded with the previously reported biomechanical demands of the poses.
Study Name

Evidence based effects of yoga practice on various health related problems of elderly people: A review

PublicationJournal of Bodywork and Movement Therapies
PurposeThis current review aims to provide a comprehensive review using the current available scientific literature on the effect of yoga in elderly.
MethodsHence, we performed PubMed/Medline search to review relevant articles, using keyword “yoga and elderly”. Relevant articles published since inception till 6th October 2016 were included for the review.
ResultsBased on the available scientific literature, this review suggests that the regular practice of Yoga can be considered as an effective intervention in improving physical (reduces heart rate, blood pressure, blood glucose, oxidative damage, fatigue, weakness, fear of fall, and improve heart rate variability, baroreflex sensitivity, insulin sensitivity, physical functions, mobility, flexibility, and urinary incontinence), mental (reduces depression, anxiety), emotional (reduces anger, stress, tension and improve self-efficacy), social (improve life satisfaction), and vital (improved vitality) planes of elderly individuals, offering a better quality of sleep and quality of life.
ConclusionBased on the available scientific literature, this review suggests that the regular practice of Yoga can be considered as an effective intervention in improving various health related problems of elderly people.
Study Name

Impact of long term Yoga practice on sleep quality and quality of life in the elderly

PublicationJournal of Ayurveda and Integrative Medicine
PurposeObjectives: To evaluate the effect of long-term Yoga exercises on sleep quality and quality of life (QOL) in the elderly.
MethodsThis was a cross-sectional study in which data were collected from elderly people aged 60 years or more living in Nagpur city. We employed two types of survey questionnaires: Pittsburgh sleep quality index (PSQI) and QOL Leiden-Padua (LEIPAD) Questionnaire. A total of 65 elderly men and women who signed an informed consent and completed questionnaires were included in the study. Sleep quality score PSQI and QOL (LEIPAD Questionnaire) score of the study group were evaluated and compared with the control group using Mann-Whitney U test.
ResultsTotal PSQI score in Yoga group was lower than that of the control group. Also various QOL scores of the Yoga groups were higher than the control group.
Conclusion

Addition of regular Yoga exercises in the daily routine of elderly people can help to achieve good sleep quality as well as improve the QOL.

Long-term practice of Yoga exercises by elderly people is associated with less sleep disturbances and good sleep quality and these results are in accordance with many studies involving Yoga intervention for 6 month duration only. Considering the limited sample size and subjective data of our study, further studies are required to substantiate the findings in this study.

Study Name

The Effect of Yoga on Balance and Fear of Falling in Older Adults

PublicationPhysical medicine and rehabilitation (PM&R)
PurposeObjective: To determine the effect of yoga on balance and fear of falling in older adults.
Methods

Design: Randomized controlled trial.
Setting: Jahandidegan Center in Shiraz, southern Iran.

Participants: Forty persons (17 men and 23 women) between the ages of 60-74 years with a Modified Falls Efficacy Scale (MFES) score <8 and a Berg Balance Scale (BBS) score <45. After completing the MFES questionnaire and BBS measurement, the participants were divided into intervention and control groups. BBS measurement and the MFES questionnaire were completed again immediately after the intervention.

Intervention: The intervention group participated in 2 yoga practice sessions per week for 8 weeks. The control group received no intervention.

Main Outcome Measurements: Fear of falling was measured with the MFES and balance was measured with the BBS.

ResultsWe found significant changes in both variables (P < .0001). Mean differences before and after the intervention for the BBS for yoga and control groups were 10.19 and –1.16, respectively. Mean differences before and after the intervention for the MFES for yoga and control groups were 1.62 and –0.21, respectively.
ConclusionYoga is a potential intervention to reduce fear of falling and improve balance in older adults.
Study Name

Effects of Yoga on Symptoms, Physical Function, and Psychosocial Outcomes in Adults with Osteoarthritis. A Focused Review

PublicationAmerican Journal of Physical Medicine & Rehabilitation
PurposeThe purpose of this focused review is to examine the effects of yoga on OA symptoms and physical and psychosocial outcomes.
MethodsA comprehensive search was conducted using seven electronic databases. Twelve reports met inclusion criteria involving a total of 589 participants with OA-related symptoms.
ResultsA variety of types, frequencies, and durations of yoga interventions were reported; Hatha and Iyengar yoga were the most commonly used types. Frequency of intervention ranged from once a week to 6 days a week. Duration of the interventions ranged from 45 to 90 mins per session for 6 to 12 wks.
ConclusionYoga intervention resulted in reductions in pain, stiffness, and swelling, but results on physical function and psychosocial well-being were inconclusive because of a variety of outcome measures being used.
Study Name

Effectiveness of the Pilates method versus aerobic exercises in the treatment of older adults with chronic low back pain: a randomized controlled trial protocol

PublicationBMC Musculoskeletal Disorders
PurposeThe objective of this study is to investigate the effectiveness of the Pilates method compared to aerobic exercises in the treatment of older adults with chronic nonspecific low back pain.
MethodsThis is a randomized controlled trial with blinded assessor, to be held in a physical therapy clinic in Sao Paulo, Brazil. Seventy four patients aged 65 to 85 years with chronic nonspecific pain will be randomized into Pilates Group (n = 37) with exercises based on the Pilates method and Aerobic Group (n = 37) with treadmill aerobic exercise.
ResultsThe primary outcomes will be pain intensity and general disability, assessed eight weeks after randomization. The secondary outcomes will be: pain intensity and general disability, assessed six months after randomization; and global perceived improvement, specific disability, dynamic balance, muscle strength (gluteus maximus, gluteus medius, and lateral hip rotators), and pressure pain threshold, assessed eight weeks and six months after randomization. Therapists and patients will not be blinded.
ConclusionThis study has the potential to reduce pain and, consequently, improve balance and function of older adults with chronic low back pain with both therapies. However, Pilates may be more effective because the exercises are more targeted to the trunk stabilization muscles. The results of this study may provide valuable information on the effects of Pilates and aerobic exercise in older adults with chronic low back pain and contribute to a better selection of the treatment program according to the patient preference.
Study Name

Effect of Pilates Exercise for Improving Balance in Older Adults: A Systematic Review With Meta-Analysis

PublicationArchives of Physical Medicine and Rehabilitation
PurposeTo investigate the effect of Pilates on balance and falls in older adults, and whether programs tested in prior studies met best-practice recommendations for exercise to prevent falls.
Methods

Data Sources: MEDLINE, SPORTDiscus, CINAHL, PubMed, Physiotherapy Evidence Database, and The Cochrane Library were searched from earliest record to July 2014.
Study Selection: Randomized and controlled clinical trials evaluating the effect of Pilates on balance and/or falls in older adults.

Data Extraction: Two reviewers independently extracted demographic, intervention, and outcome data. Six studies were included in this review.

ResultsHigh-quality studies in this area are lacking. When compared with nonactive control groups, Pilates was shown to improve balance (standardized mean difference [SMD]=.84; 95% confidence interval [CI], .44–1.23; 6 studies) and reduce the number of falls (SMD=−2.03; 95% CI, −2.66 to −1.40; 1 study). Three studies provided sufficient detail to enable assessment of compliance with the recommendation of exercises providing a moderate or high challenge to balance. In these studies, 2% to 36% of exercises were assessed as providing a moderate or high challenge to balance. All studies provided ≥2 hours of exercise per week, and 1 study provided >50 hours of exercise during the study period.
ConclusionThe evidence suggests Pilates can improve balance, an important risk factor for falls in older adults. However, there is limited data on the impact of Pilates on falls. Effects may have been overestimated because of the low methodological quality of studies. Best-practice recommendations were rarely applied in prior studies, indicating greater effects may have been achieved if recommendations were incorporated.
Study Name

Integrating Pilates Exercise into an Exercise Program for 65+ Year-Old Women to Reduce Falls

PublicationJournal of Sports Science & Medicine
PurposeThe purpose of this study was to determine if Pilates exercise could improve dynamic balance, flexibility, reaction time and muscle strength in order to reduce the number of falls among older women.
Methods60 female volunteers over the age of 65 from a residential home in Ankara participated in this study. Participants joined a 12-week series of 1-hour Pilates sessions three times per week. Dynamic balance, flexibility, reaction time and muscle strength were measured before and after the program. The number of falls before and during the 12-week period was also recorded.
ResultsDynamic balance, flexibility, reaction time and muscle strength improved (p < 0. 05) in the exercise group when compared to the non-exercise group.
Conclusion

In conclusion, Pilates exercises are effective in improving dynamic balance, flexibility, reaction time, and muscle strength as well as decreasing the propensity to fall in older women.

Pilates-based exercise was shown to improve dynamic balance, reaction time and muscle strength in the elderly. Our findings suggest that Pilates exercise may be a useful tool for people who are looking to improve these aspects of their physical health. Moreover, Pilates exercise may reduce the number of falls in elderly women by increasing these fitness parameters. From these results, we surmise that by performing Pilates exercises, even the elderly can increase their physical fitness abilities.

Moreover, Pilates exercise can be integrated into exercise programs for older adults in both fitness centers and rehabilitation centers. Residential homes may recommend Pilates exercises for their residents. Physiotherapist and geriatrics specialists might also find Pilates to be a useful tool in the rehabilitative and preventative areas of their practices.

Study Name

Pilates vs. Balance Training in Health Community-Dwelling Seniors: a 3-arm, Randomized Controlled Trial

PublicationInternational Journal of Sports Medicine
PurposeThe study examined effects of traditional balance vs. mat-based Pilates training on balance and trunk strength in healthy community dwellers.
MethodsForty-eight seniors were either stratified to a balance training group (BAL, n=16, 69.1 (SD 5.8) y), Pilates training group (PIL, n=17, 70.8 (6.5) y) or control group (CON, n=15, 69.2 (6.1) y). BAL performed traditional balance training, while PIL conducted mat-based Pilates-exercises (8 weeks, 2 sessions/week 66 min each). Balance performance (single limb stance and perturbed kneeling, Y-Balance test), dynamic and isometric trunk flexion and extension were assessed during pre- and post-testing.
ResultsAccording to the magnitude-based inference approach, substantial positive effects in favor of BAL compared to CON were found for the Y-balance score (right leg, effect size (d)=0.68; left leg, d=0.56), trunk extension (d=0.68) and single leg stance (right leg, d=0.61; left leg, d=0.38). Dynamic (d=0.32) and isometric (d=0.15) trunk flexion revealed unclear effects. For the Y-balance score (right leg, d=0.48, left leg, d=0.75) and single leg stance (right leg, +d=0.61%; left leg, d=0.67), interestingly, BAL substantially exceeded PIL. PIL vs. CON revealed unclear effects for most parameters (0.05<d<0.36).
ConclusionMat-based Pilates training did not cause relevant adaptations in trunk strength and balance performance, whereas balance training substantially improved balance and trunk strength.
Study Name

Elastic Band Exercises Improved Activities of Daily Living and Functional Fitness of Wheelchair-bound Older Adults with Cognitive Impairment. A Cluster Randomized Controlled Trial.

PublicationAmerican Journal of Physical Medicine & Rehabilitation
PurposeThe purpose of this study was to test the effects of a 6-month Wheelchair-bound Senior Elastic Band (WSEB) exercise program on the activities of daily living (ADL) and functional fitness of wheelchair-bound older adults with cognitive impairment.
MethodsCluster randomized controlled trial was used. A convenience sample of 138 wheelchair-bound older adults with cognitive impairment were recruited from 8 nursing homes in southern Taiwan and were randomly assigned based on the nursing homes they lived to the experimental (4 nursing homes; n = 73) or the control group (4 nursing homes; n = 65). The experimental group performed WSEB exercises 3 times per week and 40 minutes per session for 6 months. The ADL and functional fitness (cardiopulmonary function, body flexibility, range of joint motion, and muscle strength and endurance) were examined at baseline, 3 months, and the end of 6-month study.
ResultsThe ADL and functional fitness indicators of participants in the experimental group showed significant improvements compared to the control group (all P < 0.05).
ConclusionThe WSEB exercises have positive benefits for the ADL and functional fitness of wheelchair-bound older adults with cognitive impairment. It is suggested that WSEB exercises be included as a routine activity in nursing homes.
Study Name

An elastic band exercise program for older adults using wheelchairs in Taiwan nursing homes: A cluster randomized trial

Publication

International Journal of Nursing Studies

PurposeObjectives: To test the effectiveness of six-month Wheelchair-bound Senior Elastic Band exercises on the functional fitness of older adults in nursing homes.
Methods

Design: Cluster randomized trial.
Settings: Ten nursing homes, southern Taiwan.

Participants: 127 participants were recruited, and 114 of them completed the study. Inclusion criteria were: (1) aged 65 and over, (2) using wheelchairs for mobility, (3) living in the facility for at least three months, (4) cognitively intact, and (5) heavily or moderate dependency in their activities of daily living. The mean age of the participants was 79.15 (7.03) years, and 98.20% of them had chronic illnesses.


Methods: Participants were randomly assigned to the experimental (five nursing homes, n = 59) or the control (five nursing homes, n = 55) group based on the nursing homes where they stayed. A 40-min Wheelchair-bound Senior Elastic Band exercise program was implemented three times per week for six months for the experimental group participants. The functional fitness (activities of daily living, lung capacity, body flexibilities, muscle power and endurance) of the participants was examined at baseline, after three months, and at the end of the six months study.

The mixed-design, two-way analysis of variance was used to detect the interaction effects, and one-way repeated measures analysis of variance and analysis of covariance were performed to analyze the within-group and between-group differences.

ResultsAt the end of the six-month study, the Wheelchair-bound Senior Elastic Band group had better performances in all of the functional fitness indicators than the control group (all p < 0.05).
ConclusionThe Wheelchair-bound Senior Elastic Band exercises significantly improved the functional fitness of the older adults in wheelchairs. It is suggested that the program be incorporated as a part of daily activities for nursing home older adults in wheelchairs.
Study Name

Feasible modalities and long-term effects of elastic band exercises in nursing home older adults in wheelchairs: A cluster randomized controlled trial

PublicationInternational Journal of Nursing Studies
PurposeObjectives: To test the feasibility and effects of 12 months Wheelchair-bound Senior Elastic Band (WSEB) group-exercises that were led by volunteers for the first six months followed by the DVD-guided for another six months on functional fitness, activities of daily living (ADL), and sleep quality of nursing home older adults in wheelchairs.
Methods

Design: Cluster randomized controlled trial with two groups, pre-test and post-tests.
Settings: Ten nursing homes, Taiwan.

Participants: 127 participants participated voluntarily; 107 of them completed the study. Inclusion criteria: (1) aged 65 years and over, (2) using wheelchairs for mobility, (3) living in facility for at least three months, (4) cognitively intact, and (5) heavy or moderate dependency in ADL. Majority of participants were middle-old older adults (75–84 years old, 53.2%), female (51.4%), and had chronic illnesses (98.1%).

Methods: Participants were randomly assigned by facility to either the experimental (five nursing homes, n = 56) or control group (five nursing homes, n = 51). The WSEB program was conducted three times per week and 40 min per session in two stages: volunteer-led for the first six months (stage I) followed by the DVD-guided modality for another six months (stage II). The primary outcomes (functional fitness: lung capacity, body flexibility, range of joint motion, and muscle strength and endurance) and the secondary outcomes (ADL measured by the Barthel Index; sleep quality measured by the Pittsburgh Sleep Quality Index) of the participants were measured at three time points: pre-test, at the six-month interval, and at the end of 12 months of the study. No blinding was applied.

ResultsAll of the functional fitness indicators of the experimental group participants improved significantly (p < .05), and were all better than the control group at six-month and 12-month of the study (p < .05). No symptoms of discomfort occurred during interventions.
ConclusionNursing home older adults in wheelchairs who received WSEB exercise training had better functional fitness, ADL, and sleep quality than those who did not. It was a feasible way of carrying out this exercise program by using the volunteer-led followed by the DVD-guided modalities. The program can be applied in institutional settings routinely.
Study Name
PublicationSchool of Nursing and Midwifery Thesis (PhD Doctorate), Griffith University (Queensland, Australia)
PurposeThis study, using a randomized controlled trial (RCT) approach, explores the impact of a 26-week seated Simplified Tai Chi exercise program (STEP) (Chen et al., 2006) on QOL, depression, mood states and self-efficacy of Taiwanese older people living in LTC who use wheelchairs. The randomization, STEP seated Tai Chi intervention and RCT design are powerful methods to examine the effect of the seated Tai Chi exercise.
MethodsA sample of people was recruited, 30 in the experimental group and 30 in the control group. The baseline data were collected using the World Health Organization Quality of Life BREF (WHOQOL-BREF), Geriatric Depression Scale-Short Form (GDS-SF), Profile of Mood States Short Form (POMS-SF) and Self-efficacy for Exercise Scale (SEE), with follow up measurements collected in weeks 13 and 26.
ResultsThe results indicate a significant improvement from baseline on QOL using the World Health Organization Quality of Life BREF (WHOQOL-BREF) at week 26. The following changes in secondary outcomes were also found: a reduction in depression scores was found using the Geriatric Depression Scale-Short Form (GDS-SF); a lower mood state on the fatigue-inertia dimension was found using the Profile of Mood States Short Form (POMS-SF); and an improvement in self-efficacy level was found using the Self-Efficacy for Exercise (SEE) Scale.
Conclusion

In particular, this RCT study shows that a group of older people in wheelchairs living in LTC who undertook a seated Tai Chi intervention for 26 weeks had a significant improvement in QOL, a reduction in their level of depression and in the fatigue-inertia domain, and an increase in self-efficacy compared to those who received the usual standard care with no seated Tai Chi intervention.

This study does, however, have limitations: primarily its use of a convenience sample, the short follow-up assessment, and the researcher being unable to be blinded regarding the assessment of outcomes. Recommendations for further research, and associated aspects of education, clinical practice, and health policy in the context of an ageing population, and the rationale behind these have also been set out.

Study Name
PublicationResearch in Sports Medicine
PurposeThe purpose of this study was to examine the effect of a 12-week Wheelchair Tai Chi Ball (WTCB) intervention, a combination of mind-body exercise with strength training, on physical and mental health and functional abilities among elderly with disability.
MethodsTwenty-six elderly persons participated in the study, nine WTCB group participants and ten control group participants completed the study. The WTCB group practised WTCB12 twice/week for one hour each time. The control group did their daily routine without WTCB intervention. The outcomes measures were: Pain Self-Efficacy Questionnaire (PSEQ), SF-36v2 for physical and mental health, heart rate, blood pressure, range of motion and muscle strength of the dominant arm at the shoulder, elbow and wrist joints. The Mixed Model ANOVA was employed to examine the differences between and within the two groups using pre-test and post-test scores.
ResultsThe results demonstrated the WTCB group had significant improvements on PSEQ, general physical health and had positive effects on maintaining muscle strength at the shoulder, elbow and wrist joints as compared to the control group. The WTCB12 exercise had positive effects on self-efficacy for pain management, general physical health, and maintain upper extremity muscle strength and is a feasible exercise for elderly with disability.
ConclusionThe WTCB12 exercise had positive effects on self-efficacy for pain management, general physical health, and maintain upper extremity muscle strength and is a feasible exercise for elderly with disability.
Study Name

Effects of wheelchair Tai Chi on physical and mental health among elderly with disability

PublicationResearch in Sports Medicine
PurposeA 12-week Wheelchair Tai Chi 10 Form (WTC10) intervention was conducted among elderly with disability to examine the effect of this WTC10 intervention on selected physical and mental health variables.
MethodsThirteen (age 87.23 ± 6.71) in the WTC10 intervention group and 15 (age 89.73 ± 6.31) in the control group completed the study. Independent t-tests and paired t-tests were employed to examine the differences between groups and within groups, respectively, at pretest and post-test.
ResultsThe WTC10 intervention group showed significant improvements in systolic and diastolic blood pressure, shoulder external rotation, left trunk rotation and total trunk rotation after the intervention.
ConclusionA 12-week WTC10 intervention had positive effects on blood pressure, range of motion at the shoulder and trunk, physical activity, and mental health among the elderly with disability. WTC10 is a feasible and safe exercise for the elderly with disability.
Study Name

Sleep quality and depression of nursing home older adults in wheelchairs after exercises

PublicationNursing Outlook v.63
PurposeThe purpose of this study was to test the effectiveness of 6 months of elastic band exercises on sleep quality and depression of wheelchair-bound older adults in nursing homes.
MethodsOne hundred twenty-seven older adults from 10 nursing homes participated in this cluster randomized controlled trial, and 114 completed the study. Participants were randomly assigned to two groups: experimental group (five nursing homes, n = 59) and control group (five nursing homes, n = 55). A 40-minute wheelchair-bound senior elastic band exercise program was implemented 3 times per week for 6 months.
Sleep quality and depression of the participants were examined at baseline, after 3 months, and at the end of the 6-month study.
ResultsParticipants in the experimental group had longer sleep durations, better habitual sleep efficiencies, and less depression than the control group at 3 months of the study and maintained them throughout the rest of the 6-month study.
ConclusionParticipants in the experimental group had longer sleep durations, better habitual sleep efficiencies, and less depression than the control group at 3 months of the study and maintained them throughout the rest of the 6-month study. Nursing home directors could recruit volunteers to learn the program and lead the elderly residents in wheelchairs in practicing the wheelchair-bound senior elastic band exercises regularly in the facilities.
Study Name

Functional vs. Strength Training in Disabled Elderly Outpatients

PublicationAmerican Journal of Physical Medicine & Rehabilitation
PurposeObjective: To determine whether high-intensity functional training (FT) or strength training (ST) better enables impairment, disability, and functional gains among disabled community-dwelling elders.
MethodsDesign: Randomized, blinded, prospective clinical trial in a large, tertiary care outpatient rehabilitation department. Fifteen elders (62–85 yrs old) referred for physical therapy with one or more impairments, including lower-limb arthritis, participated in 6 wks of FT (weekly outpatient and three to five times per week of home practice in rapid and correct execution of locomotor activities of daily living, including gait, stepping, and sit to stand) or progressive resistive ST using elastic bands with intensity, therapist contact, and home practice similar to those of FT.
ResultsBoth groups significantly improved their combined lower-extremity strength (hip abduction, ankle dorsiflexion, knee flexion, ankle plantarflexion, and knee extension) (P = 0.003), but no statistical difference between the ST and FT group gains (P = 0.203) was found. Subjects in both interventions improved their gait speed, but the FT group improved more than the ST group (P = 0.001). During chair rise, the FT group improved their maximum knee torque more than the ST group (P = 0.033), indicating that they employed a more controlled and efficient movement strategy.
ConclusionThese data suggest that an intensive FT intervention results in strength improvements of comparable magnitude as those attained from ST and that FT also confers greater improvements in dynamic balance control and coordination while performing daily life tasks.
Study Name

Effects of Exercise Training on Handgrip Strength in Older Adults: A Meta-Analytical Review

PublicationGerontology
PurposeThe objective of this meta-analytical review is to examine the effects of different exercise training on handgrip strength in healthy community-dwelling older adults of 60 years or older.
MethodsThe literature search was conducted in three databases (PubMed, Web of Science, SPORTDiscus) using the following search terms with Boolean conjunctions: (hand grip* OR grip strength OR grip power) AND (sport* OR train* OR exercis* OR strength OR intervention OR endurance OR resistance OR balance OR aerob*) AND (old* OR elder* OR senior*). Non-randomized and randomized controlled trials with an exercise training and handgrip strength as the outcome parameter were screened. Study quality was independently assessed by two researchers using the PEDro scale. Comparison of handgrip strength between the intervention and control groups was conducted by using the hedges g (including adjustment for small sample sizes), calculating standardized mean differences (SMDs). A random effects inverse-variance model was applied for statistical analysis.
ResultsTwenty-four trials (mean PEDro score 5.8 ± 0.9) with a total of 3,018 participants (mean age 73.3 ± 6.0 years) were included. Small but significant effects (p < 0.001) on handgrip strength were observed (SMD 0.28, 95% CI 0.13–0.44). Study heterogeneity (I2 56%) and the funnel shape for publication bias analyses were acceptable.
ConclusionMeaningful but small transfer effects of a multitude of different training approaches on handgrip strength occurred in healthy community-dwelling older adults. Handgrip strength cannot clearly be recommended to assess general functional performance for all kinds of exercise programs, whereas task-specific training and multimodal training modes seem to provide an appropriate stimulus to also improve handgrip strength.
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Benefits of home-based rocking-chair exercise for physical performance in community-dwelling elderly women: a randomized controlled trial

PublicationAging Clinical and Experimental Research
PurposeThe aim of this study was to investigate the benefits of home-based rocking-chair training, and its effects on the physical performance of elderly women.
MethodsCommunity- dwelling women (n=51) aged 73-87 years were randomly assigned to the rocking-chair group (RCG, n=26) or control group (CG, n=25) by drawing lots. Baseline and outcome measurements were hand grip strength, maximal isometric knee extension, maximal walking speed over 10 meters, rising from a chair five times, and the Berg Balance Scale (BBS). The RCG carried out a six-week rocking-chair training program at home, involving ten sessions per week, twice a day for 15 minutes per session, and ten different movements. The CG continued their usual daily lives. After three months, the RCG responded to a mail questionnaire.
ResultsAfter the intervention, the RCG improved and the CG declined. The data showed significant interactions of group by time in the BBS score (p=0.001), maximal knee extension strength (p=0.006) and maximal walking speed (p=0.046), which indicates that the change between groups during the follow-up period was significant. Adherence to the training protocol was high (96%). After three months, the exercise program had become a regular home exercise habit for 88.5% of the subjects.
ConclusionResults indicate that home-based elderly women benefit from this easily implemented rocking-chair exercise program. The subjects became motivated to participate in training and continued the exercises. This is a promising alternative exercise method for maintaining physical activity and leads to improvements in physical performance.
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PublicationInternational Journal of Sports Medicine
PurposeThis study aimed to present a suspension exercise training program suitable for older adults and to verify the effect of 12 weeks of training on handgrip strength (HS) and anthropometric and bioelectrical impedance parameters in older adults.
MethodsThirty older women (age 66.1±4.7 years, BMI 30.6±5.3 kg/m2) were randomly assigned to one of two groups: a training group (TG, n=15) or a control group (CG, n=15). The TG participated in a 12-week suspension training program, while the CG maintained their normal physical activity habits for the duration of the study. Anthropometric, bioelectrical impedance and strength parameters were evaluated before and after the intervention period.
ResultsThere was a significant group by time interaction (p<0.05) for triceps, biceps, subscapular skinfold, percentage of fat mass, phase angle (PhA), resistance, reactance, specific resistance, specific reactance and HS, with significant improvements in the TG after the intervention period (p<0.05) even after adjusting for age and BMI.
ConclusionThe results suggest that suspension training promotes increases in PhA and HS in older women.
Study Name

Positive adaptations to weight-lifting training in the elderly

PublicationJournal of Applied Physiology
PurposeThe present work was designed to extend previous observations by investigating the effects of strength training on muscle strength, whole muscle and muscle fiber cross-sectional areas, muscle contractile properties, and the completeness of motor unit activation in older men.
MethodsMaximal weight-lifting performance, isometric strength, isokinetic torque, whole muscle and individual fiber cross-sectional areas, and muscle evoked contractile properties were assessed in 14 elderly males before and after 12 wk of weight-lifting training.
Results

Dynamic elbow flexion training of one arm resulted in a significant 48% mean increase in the maximal load that could be lifted once (1 RM) and a smaller improvement in isokinetic torque (8.8%) but no change in isometric strength.

In the contralateral control arm, 1 RM and isokinetic torque increased by 12.7 and 6.5%, respectively, but isometric strength did not change. The interpolated twitch technique confirmed complete motor unit activation during a maximal isometric contraction of the elbow flexors before and after the training. Bilateral leg press training effected mean increases of 17 and 23% in isokinetic torque and dynamic lifting capacity, respectively.

The mean maximal cross-sectional area of the elbow flexors (biceps brachii and brachialis) increased by 17.4% in the trained arm but did not change the control arm. The increase in the mean area of type II fibers in the biceps brachii muscle in the trained arm (30.2%) was greater than the corresponding change in the control arm (10.7%, P less than 0.05). The most significant change in the evoked contractile properties of the trained elbow flexors was the increase in twitch half-relaxation time.

ConclusionIt is concluded that older individuals retain the potential for significant increases in strength performance and upper limb muscle hypertrophy in response to overload training.
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A novel exercise for improving lower-extremity functional fitness in the elderly

PublicationAging Clinical and Experimental Research
PurposeThe purpose of this study was to test whether our new exercise program (a square-stepping exercise: SSE) would improve lower-extremity functional fitness in the elderly.
MethodsFifty-two individuals aged 60–80 years were divided into two groups (non-randomized control design); SSE (n=26) and controls (n=26). Lower-extremity functional fitness was defined as standing up from a lying position (agility), chair-stand in ten seconds (leg power), walking round two cones (locomotion speed), sit-and-reach (flexibility) and single-leg balance with eyes closed (balance). The SSE group participated in a six-month regimen of SSE once a week. SSE was performed on a thin mat of 250 cm by 100 cm, partitioned into 40 small squares (25 cm each side). SSE included not only forward steps but also backward, lateral and oblique steps, and step patterns were progressively made more complicated. Controls maintained their usual lifestyles.
ResultsIn the SSE group, significant improvements were observed in agility, leg power, locomotion speed, flexibility and balance. No significant changes were detected in any tests in the control group.
ConclusionThe SSE program improved lower-extremity functional fitness, lack of which constitutes a risk factor for falls in the elderly. This program should be tested further to determine if it can effectively reduce the incidence of falls in the elderly.
Study Name

Traditional Versus Functional Strength Training: Effects on Muscle Strength and Power in the Elderly

PublicationJournal of Aging and Physical Activity
PurposeThe aim was to determine whether strength training with machines vs. functional strength training at 80% of one-repetition maximum improves muscle strength and power among the elderly.
MethodsSixty-three subjects (69.9 ± 4.1 yr) were randomized to a high-power strength group (HPSG), a functional strength group (FSG), or a nonrandomized control group (CG). Data were collected using a force platform and linear encoder. The training dose was 2 times/wk, 3 sets × 8 reps, for 11 wk.
ResultsThere were no differences in effect between HPSG and FSG concerning sit-to-stand power, box-lift power, and bench-press maximum force. Leg-press maximum force improved in HPSG (19.8%) and FSG (19.7%) compared with CG (4.3%; p = .026). Bench-press power improved in HPSG (25.1%) compared with FSG (0.5%, p = .02) and CG (2%, p = .04).
ConclusionExcept for bench-press power there were no differences in the effect of the training interventions on functional power and maximal body strength.
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The Effects of Functional Training, Bicycle Exercise, and Exergaming on Walking Capacity of Elderly Patients With Parkinson Disease: A Pilot Randomized Controlled Single-blinded Trial

PublicationArchives of Physical Medicine and Rehabilitation
PurposeObjectives: To compare the effects of functional training, bicycle exercise, and exergaming on walking capacity of elderly with Parkinson disease (PD).
MethodsDesign: A pilot randomized, controlled, single-blinded trial.
Setting: A state reference health care center for elderly, a public reference outpatient clinic for the elderly.
Participants: Elderly individuals (≥60 years of age; N=62) with idiopathic PD (stage 2 to 3 of modified Hoehn and Yahr staging scale) according to the London Brain Bank.
Intervention: The participants were randomly assigned to three groups. Group 1 (G1) participated in functional training (n=22); group 2 (G2) performed bicycle exercise (n=20), and group 3 (G3) trained with Kinect Adventures (Microsoft, Redmond, WA) exergames (n=20).
Main Outcome Measures: The primary outcome measure was the 6-minute walk test (6MWT); secondary outcome measures were the 10-m walk test (10MWT), sitting-rising test (SRT), body mass index, Parkinson Disease Questionnaire-39, World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), and 15-item Geriatric Depression Scale.
ResultsAll groups showed significant improvements in 6MWT (G1 P=.008; G2 P=.001; G3 P=.005), SRT (G1 P<.001; G2 P=.001; G3 P=.003), and WHODAS 2.0 (G1 P=.018; G2 P=.019; G3 P=.041). Only G3 improved gait speed in 10MWT (P=.11). G1 (P=.014) and G3 (P=.004) improved quality of life. No difference was found between groups.
ConclusionEight weeks of exergaming can improve the walking capacity of elderly patients with PD. Exergame training had similar outcomes compared with functional training and bicycle exercise. The three physical exercise modalities presented significant improvements on walking capacity, ability to stand up and sit, and functionality of the participants.
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Effects Of Different Neuromuscular Training Protocols On The Functional Capacity Of Elderly Women

PublicationRevista Brasileira de Medicina do Esporte
PurposeObjective: To compare the effects of eight weeks of functional training with traditional strength training on the physical fitness of sedentary elderly women.
Methods

Methods: Thirty-two elderly women were divided into functional training group (FT, n=16) and traditional training group (TT, n=16). For the verification of functional responses, the Senior Fitness Test battery was used, as well as complementary tests of strength and muscular power. The data were analyzed using a 2×2 ANOVA with post hoc Sidak test to verify the differences between the groups.

The FT group of older women performed multifunctional, integrated and multi-articular exercises, specific to daily needs. Each session was divided into four blocks, as follows: 1st – 5 minutes of joint mobility; 2nd – 15 minutes of intermittent activities organized in a circuit that required agility, coordination, velocity and muscle power of a set of complex motor systems; 3rd – 25 minutes of multi-articular exercises for lower and upper limbs with intense activation of stabilizing muscles of the spine, organized in a circuit; and 4th – 5 minutes of intermittent high-intensity activities.

TT subjects performed traditional exercises in machines, predominantly analytical exercises with isolated neuromuscular work. Each session was also divided into four blocks: 1st – 5 minutes of joint mobility; 2nd – 15 minutes of continuous aerobic rhythmic gymnastics requiring coordination, muscular and cardiorespiratory endurance; 3rd – 25 minutes of analytical exercises for lower and upper limbs, organized in a circuit; and 4th – 5 minutes of intermittent high-intensity activities.

ResultsAt the end of eight weeks, when compared to TT group, the FT group showed significant increases in balance/agility variables (p=0.01; +7.6%), lower limbs strength (p=0.04; +15.3%), upper limbs strength (p=0.05; +11.7%), and cardiorespiratory power (p=0.05; +10.7%). However, in relation to flexibility tests and conventional tests of maximum dynamic force and muscular strength, there were no statistically significant differences between the groups.
ConclusionBoth interventions are efficient to improve physical fitness of sedentary elderly women; however, functional training induces better adaptive responses to functionality when compared with traditional training. Level of Evidence I; Randomized clinical trial.
Study Name

Geriatric Cyclists: Assessing Risks, Safety, and Benefits

PublicationGeriatric Orthopaedic Surgery & Rehabilitation
Purpose

Nearly 1 in every 3 Americans ride bicycles each year, but only 20% of the reported 100 million cyclists ride on a weekly basis. Bicycling is a common form of transportation and recreation and has gained popularity among the elderly patients. In recent years, the number of elderly cyclists has increased steadily and studies have cited ease of use, need for exercise, and enjoyment as important contributing factors. The benefits of physical activity on health is well-documented, and elderly individuals are encouraged to remain active to reduce the progression of age-related weakness and loss of muscle mass.

Safety concerns, however, have been a prevalent public health issue. According to the Center for Disease Control and Prevention, elderly and teenage cyclists account for the highest number of head injuries and fatalities among all cyclists. Safety measures that include wearing protective gear such as helmets and choosing the appropriate bicycle have been recommended to minimize the risk of sustaining injuries while riding. Despite these concerns, bicycling has remained a popular and exciting activity for the elderly patients.

Methods 
Results 
Conclusion 
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Increasing Active Transportation Through E-Bike Use: Pilot Study Comparing the Health Benefits, Attitudes, and Beliefs Surrounding E-Bikes and Conventional Bikes

PublicationJMIR Public Health and Surveillance
PurposeThe aim of this study was to assess the beliefs of individuals using e-bikes for active transport and report preliminary biometric measurements while using e-bikes for physical activity compared with conventional bikes.
MethodsParticipants used both conventional bicycles and e-bikes to compare energy expenditure while riding on the study route. Apple smart watches were used to track each participant’s heart rate, distance, speed, and time while riding both bicycles. A total of 3 survey instruments were used to estimate beliefs: one administered before riding the bicycles, a second administered after riding a conventional bike, and the final survey completed after riding an e-bike. Survey instruments were constructed using constructs from the theory of planned behavior
ResultsThe study sample (N=33) included adults aged between 19 and 28 years. Paired t test analysis revealed that participants believed a conventional bike was more likely than an e-bike to benefit their physical health (P=.002) and save them money (P=.005), while an e-bike was perceived to be more likely than a conventional bike to save them time (P<.001). Paired t test analysis revealed participants significantly agreed more with the statement that they could ride an e-bike most days (P=.006) compared with a conventional bike. After participants traveled approximately 10 miles on each type of bicycle, participants’ mean average heart rate while riding the e-bike was 6.21 beats per minute lower than when riding the conventional bike (P=.04), but both were significantly higher than resting heart rate (P<.001).
ConclusionThis pilot study suggests that e-bikes are an active form of transportation capable of providing much of the cardiovascular health benefits obtained during conventional bike use. E-bikes may help reduce some of the obstacles to conventional bike use, such as increased transportation time, decreased convenience, and physical fatigue.
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Extending life on the bike: Electric bike use by older Australians

PublicationJournal of Transport & Health
PurposeIn this study we identified the characteristics of older people who own and ride an electric bike in Australian and understand their motivations for purchase, their electric bike use and safety issues.
MethodsWe conducted an online study of electric bike owners in Australia (n=529). In this analysis, we focused on responses from participants aged 65 years and older (n=69). Respondents were aged from 65 to 88 years (71 years), most were retired (73.9%) and had been regular cyclists prior to purchasing an electric bike (80.3%).
ResultsAlmost half (42.6%) purchased their electric bike in a specialist electric bike shop and the two most reported motivations for purchase were to ride with less effort and replace car trips. The majority of respondents rode their electric bike weekly (88.0%) including people who rode it daily (34.3%). The most frequently cited mode shift was from private motor vehicle (car) to electric bike across all trip purposes. Respondents typically felt safer riding an electric bike than a pedal bike and the majority had not experienced an electric bike crash (84.1%).
ConclusionThis initial, exploratory study provides the first insights into older Australian electric bike riders. Electric bikes provide a fun, practical option for people to incorporate active travel into their most frequent trips. Mode shift from car trips suggest that electric bikes increase regular (weekly, daily) physical activity. Initiatives and public policies that support electric bike use may increase the uptake of electric bikes by older people in Australia.
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E-bikes among older adults: benefits, disadvantages, usage and crash characteristics

PublicationTransportation
PurposeThe promotion of sustainable and healthy mobility among older adults (≥ 65 years) is an important challenge. E-bikes may be part of the solution, but research about e-bike use among older adults is scarce. The current study aims to examine e-bikes’ purchase reasons, benefits and disadvantages, purposes and amount of use, substitution effects and crash characteristics among older e-bike users. Additionally, it examines differences between men and women.
MethodsIn Flanders (Belgium), 357 older e-bike users completed an online- or interview-version of the same questionnaire
ResultsAmong men and women, the most prevalent reason for e-bike purchase was to bike with less effort (24.1%). The most important benefit of e-bike use was to be able to bike longer distances (35.0%). E-bikes’ heavy weight was the most frequently reported disadvantage (33.3%). Men more frequently reported battery issues, but also that they do not experience any disadvantage. Women more frequently reported fear of falling/injuries. Participants used their e-bikes for various purposes. Men more frequently reported to cycle for recreation alone while women used the e-bike more for social reasons. E-bikes predominantly replaced trips by conventional bike (72.0%) and car (50.7%). About one quarter (27.5%) had experienced an e-bike crash, most frequently caused by an uneven or slippery surface (26.5%).
ConclusionTo promote active ageing, policy initiatives could include strategies aimed at stimulating e-bike use. These strategies should focus on emphasizing the identified benefits, reducing the disadvantages and increasing e-bike safety. Research in countries with less favorable cycling cultures is necessary to confirm current findings.
Study Name

“If I had a regular bicycle, I wouldn’t be out riding anymore”: Perspectives on the potential of e-bikes to support active living and independent mobility among older adults in Waterloo, Canada

PublicationTransportation Research Part A: Policy and Practice
PurposeThis study explores the potential for e-bikes to support independent mobility and active aging among the older adult population in Canada’s auto-dependent context.
MethodsGuided by a conceptual framework for older adult mobility, this study used qualitative methods to gather perceptual and experiential data from 17 community stakeholders and 37 older adults in the Region of Waterloo, Ontario.
ResultsThe findings highlight the importance of cycling life histories, social connection and physical limitations to adopting cycling later in life. Specific individual and structural factors were discussed in relation to e-bike adoption including facilitators such as increased convenience, reduced physical exertion, reduced reliance on a vehicle and fun. Barriers included cycling infrastructure and road safety, regulation, and stigmatization barriers. E-bikes as a more convenient and supportive mode of transit for older adults is discussed alongside the importance of e-bikes as a replacement for traditional bicycles in a subset of this population.
Conclusion 

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