Gail M. Crowley

Two-Year Trends in Physical Performance following Supervised Exercise among Community-Dwelling Older Veterans

The extent to which exercise can delay the normal decline in physical performance associated with aging is unknown. We examined the impact of 2 years of supervised exercise on cardiovascular fitness, flexibility, and strength in a group of elderly (age 65–74) veterans. Seventy‐five patients exercised 3 days/week for 90‐minute sessions emphasizing aerobic, flexibility, and strength development. Thirty‐six (47%) completed 2 years of a voluntary supervised exercise program (n = 16–25 with complete data). Over a 2‐year follow‐up period, cardiovascular outcome variables improved significantly: metabolic equivalents increased 20% (7.4 ± 2.2 to 9.0 ± 2.4, P < 0.001) and submaximal heart rate decreased 7% (131.4 ± 14.8 to 121.0 ± 18.5 beats/minute, P = 0.06). Resting heart rate decreased 8% (68.5 ± 8.0 to 63.6 ± 8.4 beats/minute, P = 0.02) but this difference did not reach statistical significance. Flexibility, measured by hamstring length, improved 11% (57.5 ± 15.1 to 64.0 ± 11.1 degrees, P = 0.02). Strength variables did not improve. The study indicates that improvements in cardiovascular function and flexibility achieved by the elderly in the early stages of an exercise program can be maintained for at least 2 years.

Evaluation of a Supervised Exercise Program in a Geriatric Population

Most studies that assess the effects of exercise in the elderly involve subjects who are in good health. The objective of this prospective longitudinal study was to examine the impact of exercise on cardiovascular fitness, flexibility, and strength in an elderly population that included chronically ill individuals. Patients were recruited initially from a population of veterans over 64 years of age who use a VA outpatient clinic as their regular source of care. The exercise intervention consisted of 90 minutes of exercise 3 days per week at 70% of the patients maximal capacity. Activities included stationary cycling, stretching, weight training, and walking. Of 69 patients who began the program, 49 (71%) reached 4‐month follow‐up. Most patients completing follow‐up (76%) had at least one chronic disease, such as arthritis, hypertension, or heart disease. Patients who dropped out were more likely to have multiple chronic illnesses than those who remained in the program. Average weekly attendance was 65% and was stable over time. Improvements in cardiovascular fitness at 4‐month follow‐up were significant: Metabolic equivalents increased from 7.1 ± 2.3 to 8.3 ± 1.6 (P < .001), treadmill time increased from 8.5 ± 3.8 to 11.2 ± 4.1 minutes (P < .001), submaximal heart rate decreased from 123.7 ± 18.8 to 118.8 ± 19.4 beats per minute (P < .001) and resting heart rate decreased from 68.1 ± 10.6 to 63.3 ± 11.6 beats per minute (P = .005). Hip flexibility also increased significantly from 58.5 ± 13.8 to 67.7 ± 9.9 degrees (P < .001), and abdominal strength increased significantly from 88.8 ± 32.4 to 104 ± 28.4 foot‐pounds (P < .001). No major complications resulted from exercise. This study demonstrates that elderly individuals, including those with chronic diseases, will participate in an exercise program and experience improvements in cardiovascular fitness, strength, and flexibility. Whether these improvements will enable elderly individuals to live independently for a longer period of time and avoid or postpone the need for long‐term care requires additional study and follow‐up.

Exercise Adherence and 10-Year Mortality in Chronically Ill Older Adults

OBJECTIVES: To compare mortality of adherents and nonadherents of an exercise program.

The Veterans Learning to Improve Fitness and Function in Elders Study: A Randomized Trial of Primary Care–Based Physical Activity Counseling For Older Men

OBJECTIVES: To determine the effects of primary care–based, multicomponent physical activity counseling (PAC) promoting physical activity (PA) guidelines on gait speed and related measures of PA and function in older veterans.

Effect of Physical Activity Guidelines on Physical Function in Older Adults

OBJECTIVES: To determine whether elderly people who meet national guidelines have higher physical function (PF) scores than those who do not and the effect on functional trajectory when physical activity (PA) levels change from above to below this threshold, or vice versa.

The impact of supervised exercise on the psychological well-being and health status of older veterans

This study examined the impact of supervised exercise on the health status (measured by the Sickness Impact Profile [SIP]) and well-being (measured by the Psychological General Well- Being Index [PGWB]) of a sample of 43 elderly veterans. The intervention consisted of 90 minutes of exercise, 3 days per week at 70% of maximal capacity. Twenty-three (53%) partici pants completed a 1-year follow-up. The mean PGWB score increased significantly from 83.0 ± 15.8 to 89.4 ± 8.9 (p = .01). Cardiovascular fitness (measured by treadmill performance) increased significantly (p = .004). Baseline SIP scores were low (little dysfunction) and changed little. The study suggests that small but significant improvements in well-being accompany physiological benefits that the elderly experience with exercise.

Five-Year Performance Trends for Older Exercisers: A Hierarchical Model of Endurance, Strength, and Flexibility

OBJECTIVE: To examine 5‐year trends in measures of physical performance, and the impact of disease upon performance, in three domains: cardiovascular fitness, musculoskeletal strength, and flexibility among older adults participating in a medically supervised exercise program.

Long-term changes in physical activity following a one-year home-based physical activity counseling program in older adults with multiple morbidities.

This study assessed the sustained effect of a physical activity (PA) counseling intervention on PA one year after intervention, predictors of sustained PA participation, and three classes of post-intervention PA trajectories (improvers, maintainers, and decliners) in 238 older Veterans. Declines in minutes of PA from 12 to 24 months were observed for both the treatment and control arms of the study. PA at 12 months was the strongest predictor of post-intervention changes in PA. To our surprise, those who took up the intervention and increased PA levels the most, had significant declines in post-intervention PA. Analysis of the three post-intervention PA trajectories demonstrated that the maintenance group actually reflected a group of nonresponders to the intervention who had more comorbidities, lower self-efficacy, and worse physical function than the improvers or decliners. Results suggest that behavioral counseling/support must be ongoing to promote maintenance. Strategies to promote PA appropriately to subgroups of individuals are needed.

The Veterans LIFE Study: A Randomized Trial of Primary Care Based Physical Activity Counseling For Older Men

OBJECTIVES: To determine the effects of primary care–based, multicomponent physical activity counseling (PAC) promoting physical activity (PA) guidelines on gait speed and related measures of PA and function in older veterans.

The Veterans Learning to Improve Fitness and Function in Elders Study: A Randomized Trial of Primary CareâBased Physical Activity Counseling For Older Men: RCT OF PHYSICAL ACTIVITY COUNSELING

OBJECTIVES: To determine the effects of primary care–based, multicomponent physical activity counseling (PAC) promoting physical activity (PA) guidelines on gait speed and related measures of PA and function in older veterans.