Chiung-ju Liu

Progressive resistance strength training for improving physical function in older adults

BACKGROUNDnMuscle weakness in old age is associated with physical function decline. Progressive resistance strength training (PRT) exercises are designed to increase strength.nnnOBJECTIVESnTo assess the effects of PRT on older people and identify adverse events.nnnSEARCH STRATEGYnWe searched the Cochrane Bone, Joint and Muscle Trauma Group Specialized Register (to March 2007), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2007, Issue 2), MEDLINE (1966 to May 01, 2008), EMBASE (1980 to February 06 2007), CINAHL (1982 to July 01 2007) and two other electronic databases. We also searched reference lists of articles, reviewed conference abstracts and contacted authors.nnnSELECTION CRITERIAnRandomised controlled trials reporting physical outcomes of PRT for older people were included.nnnDATA COLLECTION AND ANALYSISnTwo review authors independently selected trials, assessed trial quality and extracted data. Data were pooled where appropriate.nnnMAIN RESULTSnOne hundred and twenty one trials with 6700 participants were included. In most trials, PRT was performed two to three times per week and at a high intensity. PRT resulted in a small but significant improvement in physical ability (33 trials, 2172 participants; SMD 0.14, 95% CI 0.05 to 0.22). Functional limitation measures also showed improvements: e.g. there was a modest improvement in gait speed (24 trials, 1179 participants, MD 0.08 m/s, 95% CI 0.04 to 0.12); and a moderate to large effect for getting out of a chair (11 trials, 384 participants, SMD -0.94, 95% CI -1.49 to -0.38). PRT had a large positive effect on muscle strength (73 trials, 3059 participants, SMD 0.84, 95% CI 0.67 to 1.00). Participants with osteoarthritis reported a reduction in pain following PRT(6 trials, 503 participants, SMD -0.30, 95% CI -0.48 to -0.13). There was no evidence from 10 other trials (587 participants) that PRT had an effect on bodily pain. Adverse events were poorly recorded but adverse events related to musculoskeletal complaints, such as joint pain and muscle soreness, were reported in many of the studies that prospectively defined and monitored these events. Serious adverse events were rare, and no serious events were reported to be directly related to the exercise programme.nnnAUTHORS CONCLUSIONSnThis review provides evidence that PRT is an effective intervention for improving physical functioning in older people, including improving strength and the performance of some simple and complex activities. However, some caution is needed with transferring these exercises for use with clinical populations because adverse events are not adequately reported.

Can progressive resistance strength training reduce physical disability in older adults? A meta-analysis study

Purpose.u2003The decline of muscle strength is associated with physical disability in late adulthood. Progressive resistance strength training has been demonstrated to be an effective intervention to increase muscle strength, however, its effect on reducing physical disability in older adults is unclear. The purpose of this study is to examine the effect of progressive resistance strength training on physical disability via meta-analysis. Method.u2003Two reviewers independently searched for qualified trials, assessed trial quality and extracted data. Trial inclusion criteria are: (1) Randomised controlled trials, (2) Mean age of participant sample is ≥60 years, (3) Progressive resistance strength training as the primary intervention and (4) the trial included outcome measures of physical disability (i.e. physical function domain of the Short-Form 36). Results.u2003Thirty-three trials were analysed. Although the effect size is small, the intervention groups showed reduced physical disability when compared to the control groups (SMDu2009=u20090.14, 95% CIu2009=u20090.05 to 0.22). Conclusions.u2003Progressive resistance strength training appears to be an effective intervention to reduce physical disability in older adults. To maximise the effect, we suggest therapists use responsive outcome measures and multi-component intervention approach.

Adverse Events Reported in Progressive Resistance Strength Training Trials in Older Adults: 2 Sides of a Coin

OBJECTIVESnTo summarize adverse events reported in randomized controlled trials that applied progressive resistance strength training in older adults and to examine factors that might be associated with these events.nnnDESIGNnAfter systematic searches of databases, 2 reviewers independently screened and extracted adverse event-related information from identified trials.nnnSETTINGnNot applicable.nnnPARTICIPANTSnOlder adults 60 years of age and above (N = 6700).nnnINTERVENTIONnMuscle strength training exercise that increases load gradually.nnnMAIN OUTCOME MEASURESnAdverse events and reasons for dropout. Adverse events include any undesirable outcomes that may be directly related or unrelated to the intervention.nnnRESULTSnAmong 121 trials identified, 53 trials provided no comments about adverse events, 25 trials reported no adverse events occurred, and 43 trials reported some types of adverse events. Most adverse events reported were musculoskeletal problems such as muscle strain or joint pain. Adverse events were reported more often in trials that recruited participants with certain health conditions, functional limitations, or sedentary lifestyle; in trials that applied high intensity; and in trials that were published after the 2001 Consolidated Standards of Reporting Trials statement had been published. Reasons reported for dropout in 58 trials might be related to adverse events. The most frequent reasons for dropout were illness or medical problems.nnnCONCLUSIONSnAdverse events may be underreported because there is no consensus on the definition. Reporting adverse events associated with progressive resistance strength training in older adults is informative for practitioners to translate clinical research to clinical practice by knowing both the benefits and risks. Future trials should clearly define adverse events and report them in the published article.

Eye movements of young and older adults during reading

The eye movements of young and older adults were tracked as they read sentences varying in syntactic complexity. In Experiment 1, cleft object and object relative clause sentences were more difficult to process than cleft subject and subject relative clause sentences; however, older adults made many more regressions, resulting in increased regression path fixation times and total fixation times, than young adults while processing cleft object and object relative clause sentences. In Experiment 2, older adults experienced more difficulty than young adults while reading cleft and relative clause sentences with temporary syntactic ambiguities created by deleting the that complementizers. Regression analyses indicated that readers with smaller working memories need more regressions and longer fixation times to process cleft object and object relative clause sentences. These results suggest that age-associated declines in working memory do affect syntactic processing.

Strength training in older adults: The benefits for osteoarthritis

This review summarizes the findings of randomized controlled trials of progressive resistance training (PRT) by older people with osteoarthritis (OA). A significant benefit was found in lower-extremity extensor strength, function, and pain reduction. Across all 3 outcomes, the estimated effect size was moderate, which contrasted with trials of PRT in non-OA-specific groups of older adults where a large effect was found in strength but a small effect on function. This suggests that strength training has strong functional benefits for older adults with OA. Older adults with OA benefit from a strength-training program that provides progressive overload to maintain intensity throughout an exercise program.

The use of illustration to improve older adults' comprehension of health-related information: is it helpful?

OBJECTIVEnTo examine whether explanatory illustrations can improve older adults comprehension of written health information.nnnMETHODSnSix short health-related texts were selected from websites and pamphlets. Young and older adults were randomly assigned to read health-related texts alone or texts accompanied by explanatory illustrations. Eye movements were recorded while reading. Word recognition, text comprehension, and comprehension of the illustrations were assessed after reading.nnnRESULTSnOlder adults performed as well as or better than young adults on the word recognition and text comprehension measures. However, older adults performed less well than young adults on the illustration comprehension measures. Analysis of readers eye movements showed that older adults spent more time reading illustration-related phrases and fixating on the illustrations than did young adults, yet had poorer comprehension of the illustrations.nnnCONCLUSIONnOlder adults might not benefit from text illustrations because illustrations can be difficult to integrate with the text.nnnPRACTICE IMPLICATIONSnHealth practitioners should not assume that illustrations will increase older adults comprehension of health information.

Occupational Therapy Interventions to Improve Performance of Daily Activities at Home for Older Adults With Low Vision: A Systematic Review

The impact of age-related vision loss on older adults independence at home is profound. The purpose of this systematic review was to identify the effectiveness of interventions within the scope of occupational therapy practice to maintain, restore, and improve performance in daily activities at home for older adults with low vision. We searched and screened abstracts from multiple electronic databases and identified 17 studies that fulfilled our inclusion and exclusion criteria. Three themes in intervention approaches emerged: multicomponent intervention, single-component intervention, and multidisciplinary intervention. Strong evidence of effectiveness was found in studies that applied a multicomponent approach; these interventions involved teaching knowledge and skills that older adults with low vision need to help overcome the disablement process. Evidence also suggests that multiple sessions of training with low vision devices and special viewing skills to compensate for vision loss are necessary to have a positive effect on daily activities. Finally, multidisciplinary intervention that focused on personal goals yielded greater positive outcomes than interventions that were not personalized.

Do unblinded assessors bias muscle strength outcomes in randomized controlled trials of progressive resistance strength training in older adults

Objective: Knowledge of treatment assignment and failing to analyze results by randomized treatment groups-an intention-to-treat analysis-may cause bias in the treatment effect estimate in randomized controlled trials. This study was undertaken to determine the difference in lower limb muscle strength measured by blinded vs. by unblinded outcome assessors in 73 progressive resistance strength training trials conducted in older adults. Design: Retrospective analysis of randomized controlled trials published before 2007. Results: Meta-regression analyses showed that trials that used blinded assessors (n = 18) tend to report smaller effect sizes than do those that used unblinded assessors (n = 55), with a difference of −0.80 (95% confidence interval, −1.35 to −0.25). This result still holds even after adjusting for the use of an intention-to-treat analysis, with an adjusted difference of −0.65 (95% confidence interval, −1.26 to −0.04). The reported effects were exaggerated in trials that used unblinded assessors. Conclusions: This study suggests that assessor blinding is important and is a safeguard to the internal validity of exercise trials in older adults.

Young and Older Adults' Reading of Distracters.

Eye-tracking technology was employed to examine young and older adults performance in the reading with distraction paradigm. Distracters of 1, 2, and 4 words that formed meaningful phrases were used. There were marked age differences in fixation patterns. Young adults fixations to the distracters and targets increased with distracter length. This suggests that they were attempting to integrate the distracters with the sentence and had more and more difficulty doing so as the distracters increased in length. Young adults did have better comprehension of the sentences than older adults, and they also had better recognition memory for target words and distracters.

Comprehension of Health-related Written Materials by Older Adults

This study examined how Flesch Reading Ease and text cohesion affect older adults comprehension of common health texts. All older adults benefited when high Flesh Reading Ease was combined with high cohesion. Older adults with small working memories had more difficulty understanding texts high in Flesch Reading Ease. Additionally, older adults with low verbal ability or older than 77 years of age had difficulty understanding texts high in text cohesion but low in Flesch Reading Ease. These results imply that writers must increase Flesch Reading Ease without disrupting text cohesion to ensure comprehension of health-related texts.