Elizabeth V. Cyarto

Updating the evidence relating to physical activity intervention studies in older people

For older adults, physical activity (PA) plays a central role in the prevention and management of chronic disease, and has the potential to reduce physical decline, maintain functional ability and prevent injuries. This review provides an update of the evidence relating to the effectiveness of PA intervention studies (both general PA and trials specific to progressive resistance training (PRT)) for older adults. The following electronic databases were searched for articles published since 1999: Medline, PubMed, EMBASE, CINAHL and Sport Discus. For the PRT section, a 2002 Cochrane review was also used. Eight general PA intervention studies were included in this review, ranging from one-on-one counselling in general practice to the community-wide promotion of walking. The aim of most of the trials was to increase moderate and/or vigorous activity levels. Most of the studies reviewed had some degree of success in getting older people to be more active. However, a major limitation was the use of self-report measures of PA. The review of PRT interventions included 21 trials. Participants in half the studies had either functional limitations or a chronic condition. Most trials were conducted in a supervised setting using specialised equipment. Increased strength and improvement in basic functional tasks were generally reported, but there was a paucity of strong evidence linking PRT with reduced physical disability and improved health-related quality of life. While considerable progress is being made in this area, further population-based studies that include home and whole-community interventions are required.

Comparative Effects of Home-and Group-Based Exercise on Balance Confidence and Balance Ability in Older Adults : Cluster Randomized Trial

Background: Exercise can modify fall risk factors such as balance and mobility impairments. However, can exercise improve balance confidence? In one strength-training study, researchers reported that a change in balance confidence was not uniformly associated with changes in objective measures of fall risk or physical performance. In fact, some participants’ balance confidence decreased while their physical abilities increased and vice versa. Objective: The aim of this study was to compare changes in balance confidence and balance ability resulting from three exercise interventions (home-based resistance and balance training (RBT), group-based RBT and group-based walking), and the concomitant relationships between change in balance confidence and change in ability. It was hypothesized that participants in the group-based RBT program would improve their balance confidence and performance more than those in the home-based or walking programs. Methods: In a cluster-randomized design, nine retirement villages were assigned to one of the three exercise groups. One hundred and sixty-seven independent-living residents (aged 65–96 years) participated. Each group exercised twice weekly for 20 weeks. Objective balance ability was measured using timed tandem and one-leg stands (static balance), and the 8-foot (2.5 m) up-and-go test (dynamic balance/agility). Balance confidence was assessed using the self-report Activities-specific Balance Confidence (ABC) Scale. Results: Participants in the group-based RBT program improved their static balance scores more than those in the home-based program; however, improvements in balance confidence were greater among participants in the home-based program (all p < 0.05). Discordance between static balance and balance confidence change scores was evident for up to 20% of participants. Change in ABC score was weakly correlated with a change in the up-and-go test score. Conclusions: Exercise training can improve balance confidence and balance ability in retirement village residents. However, as has been shown previously, this study found that exercise interventions may improve balance ability without associated increases in balance confidence and vice versa. Whether the ABC score and balance ability can be enhanced by providing a tailored intervention to improve balance confidence in combination with a RBT program requires further study.

Comparison of the Effects of a Home-Based and Group-Based Resistance Training Program on Functional Ability in Older Adults

Purpose. To compare the effectiveness of home- and group-based, progressive resistance training programs and a group walking program in improving functional performance in older adults. Design. A quasi-experimental trial, in which retirement villages were assigned to one of three groups: home-based resistance training, group-based resistance training and group-based walking. Subjects. One hundred sixty-seven retirement village residents aged 65 to 96 years. Intervention. Nine resistance training exercises, using graded exercise bands and body weight, two balance exercises, and 10 stretches. Home-based participants were given an exercise booklet, 8 hours of instruction, and telephone support. Instructors supervised the group-based resistance training and walking programs. Each group exercised twice weekly for 20 weeks. Measures. Functional performance (strength, aerobic endurance, flexibility, and agility/dynamic balance) was assessed using the Senior Fitness Test. Analysis. Intervention effects were evaluated using mixed-model, repeated measures analysis of variance. Results. Significant between-group differences were observed only for the lower-body flexibility test. Group resistance training participants improved, but home resistance training and walking participants did not. However, strength, lower-body flexibility, and agility/dynamic balance improved in the group-based resistance training participants, and strength and upper-body flexibility improved in the home-based participants. No improvements were observed in the walking group. Conclusion. Findings support the implementation of both home- and group-based resistance training programs in retirement villages. Encouraging residents to adopt and maintain a resistance training program remains a research priority.