Structured exercise program provides mobility benefits to all older patients, regardless of frailty status

Physicians should prescribe physical activity to all older patients, regardless of frailty status. A structured, moderate-intensity physical activity program was not associated with a reduced risk for frailty over 2 years among sedentary older adults; however, it did reduce major mobility disability in both frail and nonfrail patients. Findings from a secondary analysis of the LIFE (Lifestyle Interventions and Independence for Elders) trial are published in Annals of Internal Medicine.

09 jan 2017--Researchers from the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University and Geneva University Hospitals analyzed data for 1,635 community-dwelling adults, aged 70 to 89 years, with functional limitations to determine whether a long-term, structured, moderate-intensity physical activity program is associated with a lower risk for frailty and whether frailty status alters the effect of physical activity on the reduction in major mobility disability risk.
Participants were randomly assigned to a program consisting of aerobic, resistance, and flexibility activities or a health education program consisting of workshops and stretching exercise. Over 2 years follow-up, the risk for frailty was not statistically significantly different in the physical activity versus the health education group. Using a defined measure of frailty, the physical activity intervention was associated with improvement in the inability to rise from a chair.
These findings suggest that physical activity can benefit all older patients
.
More information: Study: http://annals.org/aim/article/doi/10.7326/M16-2011
Editorial: http://annals.org/aim/article/doi/10.7326/M17-3048
Summary for Patients: http://annals.org/aim/article/doi/10.7326/P17-9052


Provided by American College of Physicians

The best exercise programs benefit the elderly

By Megan Rauscher

NEW YORK, 17 dec 2008– Older adults who regularly take part in top-rated, low-cost physical activity programs offered by their local senior center or YMCA can see noticeable improvement in physical functioning and lower their risk of becoming disabled, research shows.

"Older adults can benefit greatly from these programs," Susan L. Hughes told Reuters Health.

Hughes, co-director at the Center for Research on Health and Aging, Institute for Health Research and Policy, Chicago, and colleagues studied the impact of participating in flexibility, aerobic and strength training exercise classes provided by community organizations that were designated "best-practice" providers in a national competition conducted by the Center for Healthy Aging of the National Council on Aging.

"These sites were judged to be best practice because they had a long history of providing service to substantial numbers of participants, hired nationally Certified Exercise Instructors, provided ongoing training to them, and provided multiple component programs," Hughes noted.

In a study published in the American Journal of Public Health, a total of 544 adults aged 50 years or older who were not currently engaged in a regular program of exercise were randomly assigned to participate in one of the programs (the "treatment" group) or to a comparison "control" group that did not participate.

At 5 and 10 months, treatment group participants showed significant improvements (vs controls) on several outcomes including confidence in their ability to continue to exercise over time and in the face of barriers, increased upper and lower extremity strength based on performance tests, and increased participation in total physical activity.

"Increased lower extremity strength was a particularly important finding because lower extremity weakness is a risk factor for future disability and nursing home admission," Hughes noted.

"Our findings indicate that the low-cost health promotion programs should be expanded with public funding from programs like the Administration on Aging, and that health promotion for older adults should be included in the national health care reform agenda that is now focusing on prevention," Hughes concluded.

SOURCE: American Journal of Public Health, January 2009.

Older people who diet without exercising lose valuable muscle mass

Exercise improves fitness, reduces fat

BETHESDA, Md. , 18 sept 2008- A group of sedentary and overweight older people placed on a four-month exercise program not only became more fit, but burned off more fat, compared to older sedentary people who were placed on a diet but did not exercise.
The new study also showed that when older people diet without exercising, they lose more lean muscle compared to those who exercise, said senior researcher Bret H. Goodpaster. When they combined weight loss with exercise, it nearly completely prevented the loss of lean muscle mass. The results are important because older people tend to lose muscle mass as they age and too much muscle loss may interfere with activities of daily living.
The study, "Separate and combined effects of exercise training and weight loss on exercise efficiency and substrate oxidation," appears in the current issue of the Journal of Applied Physiology, published by The American Physiological Society. Francesca Amati, John J. Dube, Chris Shay and Goodpaster, all of the University of Pittsburgh, carried out the study.
Study looks at exercise efficiency
The researchers wanted to know the best way to get better (more efficient) at completing a defined exercise task. In particular, they wanted to know if greater fitness could be achieved through exercise training, weight loss (through dieting), or both. In addition, they wanted to know which fuel source the body would draw upon, carbohydrates or fats, under these different conditions.
The 64 participants were 60-75 years of age and were either overweight or obese. All of the participants were sedentary at the outset of the study. The researchers divided the participants into three groups:
exercise only
diet only
exercise plus diet
Those who exercised could either walk on a treadmill or ride a stationary bicycle, although most chose to walk. The dieters reduced their caloric intake to achieve a 10% weight loss by the end of the four-month study period. The final group combined both the daily exercise and the diet.
Exercise increases efficiency, burns more fat
The researchers measured how many calories the participants expended during a set work load on a stationary bicycle at the beginning and at the end of the experiment. They found that the:
Exercise group expended fewer calories (became more efficient) on the exercise task at the end of the study compared to the beginning.
Exercise group drew more on fat stores as the source of their body's fuel.
Diet-only group did not gain efficiency in performing the exercise task, even though they weighed less at the end of the experiment.
Diet-only group's weight loss resulted from a loss of both muscle and fat.
Exercise plus diet group was the most efficient at the exercise task at the end of the experiment. This shows an additive effect of both dieting and exercise, but most of that benefit was due to exercise.
Exercise plus diet group, like the exercise-only group, drew more on fat stores as an energy source.
"The take-home message is that, even among older people and during a fairly short period of time, exercise produces metabolic changes that require the expenditure of fewer calories during physical activity," Goodpaster said. Exercise also allowed older people to more preferentially burn fat, which may be healthier metabolically."
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NOTE TO EDITORS: To interview Dr. Goodpaster, please contact Christine Guilfoy at (301) 634-7253 or at cguilfoy@the-aps.org.
Physiology is the study of how molecules, cells, tissues and organs function to create health or disease. The American Physiological Society (www.The-APS.org/press) has been an integral part of this discovery process since it was established in 1887.

Study: Arrhythmia riskier in athletes

By MARIA CHENG
Cardiac problems like an abnormal heartbeat are exacerbated by rigorous exercise in a way that can be fatal in athletes, and regular testing for the problem could save lives, doctors at a heart conference said Sunday.
Italy is the only country that mandates heart screening of all its professional athletes, Dr. Domenico Corrado of the University of Padua said at the European Society for Cardiology meeting in Vienna.
Since 1981, Italian authorities have run heart checks on all competing athletes. The incidence of sudden, fatal heart attacks has dropped from four cases per 100,000 to 0.4 cases per 100,000.
Without testing, athletes genetically predisposed to having an irregular heartbeat might not be aware of their condition until it's too late, doctors said. Adrenaline produced during exercise may overstimulate the heart, causing it to essentially short-circuit.
"Sport acts as a trigger," Corrado said in research presented at the meeting.
Corrado said he had no ties to companies involved in screening athletes. The research was funded by the Italian government.
Last week, Antonio Puerta became the latest high-profile soccer player to die while competing.
After the 22-year-old Sevilla midfielder lost consciousness and fell, doctors treated him on the field and he walked off, but then had a heart attack in the locker room and another in the emergency room of a Seville hospital.
He died three days later.
A day after Puerta's death, former Zambia striker Chaswe Nsofwa died minutes after collapsing on the field during a training session with Israeli club Hapoel Beersheba. The 27-year-old Nsofwa was given electric shocks and an external pacemaker but could not be revived by paramedics.
On Aug. 24, 16-year-old Anton Reid of English League One team Walsall died after collapsing on the field.
Because they have been exercising vigorously, many athletes who collapse during competition do not have enough oxygen in their bodies to allow the heart to start pumping again, even if a defibrillator is used to try to restart their heart.
FIFA, world soccer's governing body, deemed the risk of irregular heartbeats to be so great that before last year's World Cup in Berlin, its medical committee demanded that all players undergo heart scans. Following the recent deaths, FIFA said it was considering expanding health checks.
"Athletes may have a silent but important heart disease that's not ... manifest," said Dr. Douglas Zipes, a cardiologist at Indiana University School of Medicine. Though little data exist, Zipes said that a genetic disorder may cause some athletes' hearts to get abnormally big when they train.
Corrado estimated that the cost of Italy's heart screening program is about $82 per athlete. Other countries are not convinced that screening is worth the cost, given how few athletes are at risk. Concerns have been raised about the effectiveness of the scan, which relies largely on echocardiograms, a test that shows if the heart is pumping normally.
"As a screening test, it's very imperfect," said Dr. Gordon Tomaselli, chief of cardiology at Johns Hopkins University and spokesman for the American Heart Association. "It can pick up many of the things that cause sudden death, but not all of them."
Doctors said that more awareness about the potential dangers is key to preventing future deaths, though not all athletes with suspicious tests will collapse on the field.
"Coaches should pay more attention to their players' symptoms," Zipes said. "If an athlete is complaining about chest pains or shortness of breath, those are warning signs that should not be ignored."
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Associated Press sports writer Chris Lehourites in London contributed to this report.

See Jane Run. See Her Run Faster and Faster

By GINA KOLATA
ONE day, about two years ago, my son asked me a probing question. “Are you running just to run,” he asked, “or do you have some purpose in mind?” I’d been running for years but never thought to ask myself why. His question made me realize I wanted a goal. And it led me to pick one that now sounds kind of ludicrous, a five-kilometer race that was to be run in two weeks.
I started to train.
It was a revelation — I got much faster with that little bit of training. I ran the race, won my age group, came home with a trophy, and decided to race again.
Of course, there are lots of reasons to run, and not everyone cares about winning a race or winning his or her age group. There is nothing wrong with running for fun or to clear your head after a long day. But serious running is very different from the more casual running I used to do. And now that I’ve grown more committed, I am starting to notice something odd about women and running.
Men, as might be expected, get slower as they age. At a recent five-kilometer race in Pine Beach, N.J., which drew nearly 1,000 runners, the fastest man was 24 years old and the men’s times increased with each five-year age group.
But the women were different — their times were all over the place with older women beating younger women in almost every age category. The fastest woman was 37 years old; the fastest woman in the 45 to 49 age group beat the fastest woman in the 20 to 24 and the 40 to 44 age groups.
The same thing happened in another five-kilometer local race, the Eden Family Run, in Princeton, N.J.
There, the top female runner in the 50 to 54 age group beat the top females in the 20 to 24, 25 to 29, and 40 to 44 age groups.
And it’s not just a New Jersey effect. Others have noticed it elsewhere and when I did a random check of race results in California, I saw it there too. On Aug. 8, in a 10-kilometer race in Alameda, the 53-year-old woman who won in the 50 to 54 age group was faster than the woman who won in the 25 to 29 group. A 38-year-old woman beat every other woman in the race.
Results like those made me wonder, Are women really trying in these races and, if they are, why are older women beating younger women?
Mary Wittenberg, president of New York Road Runners, thinks part of the answer is that most female runners shortchange themselves. Look at them before races she said. Men warm up and do strides, short runs to prepare to take off at the starting line. A lot of women hang back, often because they are embarrassed to be out there with the men, acting like determined athletes, Ms. Wittenberg said.
“They are too inhibited to put their full passion out there,” she said. “They are almost afraid to be serious about a sport. They think that if they’re not the best, they shouldn’t care so much.”
Other women have no idea what they are capable of or how to get faster, said Dr. Vonda Wright, an orthopedic surgeon at the University of Pittsburgh Medical Center.
Dr. Wright, who holds running clinics for beginners and for those who want to compete, said women often get the impression that they should not put much effort into runs. That’s the message of some ads and magazine articles telling people to run easy, and that, Dr. Wright said, “can be negative information” for women who might like to compete. It is too tempting, she said, “to be lulled into thinking that’s enough.”
Ms. Wittenberg feels the same way. A run-easy message is fine if it helps get people started in the sport. But, she added, there is also a risk, “in that it sneers at hard work and pushing to limits.”
Dr. Wright said she knows from experience the difference between going easy and challenging training. A few years ago, Dr. Wright, 40, was living in New York and running in Central Park. “I was jogging around at 9 ½ to 10 minutes a mile,” she said, and she had been doing the same unhurried run for years.
One day, she says, she asked herself, “What am I capable of?” In a few months of training, she got much stronger and faster and ended up running a 10-kilometer race at a speed of 7:44 a mile.
“After 10 years of running at 9:30 I felt so amazing when I realized my time,” she said.
Ralph Vernacchia, who directs the Center for Performance Excellence at Western Washington University in Bellingham, Wash., has worked with elite runners including Olympians. And with elite runners, there is no question about competitive drive.
But with average runners, he said, older women may be faster because, oddly enough, they are trying harder than younger women and discovering for the first time what they are capable of.
Most middle-aged women grew up when track and cross-country teams were for men only. Some of those women, who had no opportunity to race when they were young, are just learning to be athletes and are running faster than younger women who may not care as much.
He described the experience for women as “a kind of wakening, an epiphany.”
That is not to say that training is easy, he added. Being an athlete requires dedication and training, Dr. Vernacchia explained.
“It’s a mindset and once you know the method, it’s a real achievement. It takes emotional energy, spiritual energy and physical energy. There’s a difference between being involved and being committed. To be an athlete you must be committed.”
“Commitment is a state you find yourself in when the gun goes off,” Dr. Vernacchia said.
Then, if you are lucky, you beat all those younger women.

A Little Brisk Walking Gives Benefits to the Sedentary

BELFAST, Ireland, Aug. 14 -- Sedentary adults who took a brisk half-hour walk on only three days a week lost weight and were rewarded with improved fitness and cardiovascular benefits, researchers reported.
The three-day walking program produced a significant reduction in systolic blood pressure, weight, and an increase in functional capacity after 12 weeks, Mark A. Tully, Ph.D., of Queen's University in Belfast, and colleagues, reported in the Journal of Epidemiology and Community Health.
Few meet the current minimum exercise recommendation of 30 minutes of exercise five days a week, citing lack of time, the investigators noted. But the unsupervised three-month home-based program of brisk walking for 30 minutes three days a week demonstrated that less may be better than nothing.
Those who walked five days a week, the current recommended level, improved in these measures as well, and also had a decrease in diastolic blood pressure, the researchers reported.
To determine the short-term effects of walking at and below the current recommended exercise levels, the researchers randomized 106 healthy, sedentary men and women, ages 40 to 61, to a three-month walking program.
There were 44 participants taking a brisk walk for 30 minutes three days a week, 42 doing so five days a week, and 20 in a sedentary control group.
Participants could choose to walk in bouts of at least 10 minutes, and used pedometers to record the number of steps taken.
Blood samples were analyzed for lipid levels, while waist and hip circumferences were measured with standard procedures.
Functional capacity was measured by a 10-meter shuttle walk test. Participants walked between two cones in response to a series of beeps of increasing frequency until they could no longer achieve the pace set.
Of the 106 participants, 93 completed the study, the researchers wrote.
Systolic blood pressure and waist and hip circumferences fell significantly both in the three-day group (5 mm Hg, 2.6 cm, and 2.4 cm, respectively) and in the five day group (6 mm Hg, 2.5 cm, and 2.2 cm) (P<0.05).
Weight (-0.97 kg) and BMI (-0.32 kg/m2) also decreased for the three-day walkers but, strangely, not for the five-day walkers.
Total cholesterol-to-HDL ratio also decreased significantly in the three-day group, although at baseline, these individuals had a larger waist circumference and a higher total cholesterol-HDL ratio.
Unlike three-day walkers, five-day walkers also recorded a decrease in diastolic blood pressure of 3.4 mm Hg (P<0.05).
Functional capacity, a substitute measure for fitness, increased in both groups (15%; 11%).
Finally, no changes occurred in the non-walking control group, the researchers reported.
To determine whether the significant changes in weight and BMI seen in the three-day group, but not in the five-day group, were a result of sex imbalance within the groups, the researchers did an analysis and found no significant differences.
Analysis of the food frequency diaries also showed no changes in any of the groups. Future studies, the researchers said, might use stratification by sex to avoid potential confounding effects.
Also, no significant changes in waist-hip ratios, associated with a risk of myocardial infarction, were found, possibly because of lack of powering in an insufficient sample size.
The reductions in systolic and diastolic blood pressure in the five-day group are similar to those reported in a meta-analysis of 16 studies, the researchers wrote.
The findings from this study, they added, indicate that the reduction in systolic blood pressure (6 mm Hg in the five-day group, and 4.5 mm Hg in the three-day group) are in themselves clinically significant in reducing the risk of vascular mortality.
Study limitations included the fact that walking was self-reported and the pace was self-selected. It was also possible that the three-day group did more exercise than they reported as the study design did not include an objective measure of all activity undertaken during the study, and this would require further exploration.
The walkers' motivation to demonstrate improvement may also have influenced their performance, the researchers said.
The results of this study may encourage people who feel they do not have time to exercise five days a week to consider a lower weekly target of exercise, or of taking an opportunity for short bouts of physical activity.
Further studies are needed of the longer effects of low levels of exercise and of unsupervised home-based walking for a wider community and should be large enough to allow detection of meaningful changes in a spectrum of cardiovascular risk factors, the researcher wrote.
No financial conflicts were reported. Dr. Tully was supported by funding from the Department of Education and Learning NI.Primary source: Journal of Epidemiology and Community HealthSource reference: Tully MA, et al "Randomised controlled trial of home-based walking programmes at and below current recommended levels of exercise in sedentary adults" J Epidemiol Community Health 2007; 61:778-783.

AHA Says Weight Training May Benefit Cardiac Patients

DALLAS, July 17 -- For cardiac patients, weight training twice a week may be a good adjunct to aerobic conditioning, according to an updated scientific statement from the American Heart Association.
The statement, published online by Circulation, Journal of the American Heart Association, recommends one set of 10 to 15 repetitions for those with cardiovascular disease versus the usual prescription of three sets of 10 repetitions given to healthy adults.
Exercises can include chest press, shoulder press, triceps extension, bicep curl, lower-back extension, abdominal crunch/curl, quad extension, leg press, and calf raises.
Traditionally cardiac rehabilitation has focused on aerobic training, but the AHA issued recommendations for resistance training in 2000. This updated statement acknowledged that weight training has benefits such as increased strength and improved bone mineral density that may reduce disability associated with heart disease. But, the AHA pointed out that weight training should be considered as an adjunct to aerobic conditioning, not a substitute.
The training should be done in a "rhythmical manner at a moderate to slow controlled speed," wrote Mark A. Williams, Ph.D., of Creighton University in Omaha, who co-chaired the AHA committee that wrote the statement.
Among the recommendations:
Exercises should include a full range of motion, avoiding breath holding and straining by exhaling during the contraction or exertion phase of the lift and inhaling during the relaxation phase.
Alternate upper and lower body work to allow for adequate rest between exercises.
Limit initial weight load to eight to 10 repetitions per set for healthy sedentary adults; and 10 to 15 repetitions at a low level of resistance for cardiac patients.
Limit workout to a single set, two days per week.
But the use of resistance training in cardiac patients will require "good clinical judgment and close monitoring," according to the AHA statement.
There are, for example, a number of absolute and relative contraindications to weight training.
Absolute contraindications are not surprising -- unstable coronary heart disease, decompensated heart failure, uncontrolled arrhythmias, mean pulmonary arterial pressure of more than 55 mm Hg, severe and symptomatic aortic stenosis, acute myocarditis, endocarditis, or pericarditis, uncontrolled hypertension or more than 180/110 mm Hg, and Marfan's syndrome.
Additionally high intensity resistance training is absolutely contraindicated in patients with proliferative retinopathy or moderate nonproliferative diabetic retinopathy.
The AHA said relative contraindications -- meaning that the patient should consult a physician before starting a weight training program -- included diabetes, pacemaker and ICD patients, patients with uncontrolled hypertension of more than 160/100 mmHg and patients who have major risk factors for coronary disease.
Dr. Williams disclosed no conflicts.Additional source: Circulation, Journal of the American Heart AssociationSource reference: Williams, MA "Resistance Exercise in Individuals With and Without Cardiovascular Disease: 2007 Update A Scientific Statement from the American Heart Association Council on Clinical Cardiology and Council on Nutrition, Physical Activity, and Metabolism." Circulation. 2007; 116:&NA;-,