M. Elaine Cress

Continuous-scale physical functional performance in healthy older adults: A validation study

OBJECTIVE The continuous-scale physical functional performance test (CS-PFP) is an original instrument designed to provide a comprehensive, in-depth measure of physical function that reflects abilities in several separate physical domains. It is based on a concept of physical function as the integration of physiological capacity, physical performance, and psychosocial factors. SETTING The test was administered under standard conditions in a hospital facility with a neighborhood setting. The CS-PFP consists of a battery of 15 everyday tasks, ranging from easy to demanding, that sample the physical domains of upper and lower body strength, upper body flexibility, balance and coordination, and endurance. Participants are told to work safely but at maximal effort, and physical functional performance was measured as weight, time, or distance. Scores were standardized and scaled 0 to 12. The test yields a total score and separate physical domain scores. DESIGN The CS-PFP was evaluated using 148 older adults-78 community dwellers, 31 long-term care facility residents living independently, and 39 residents with some dependence. MAIN OUTCOME MEASURES Maximal physical performance assessment included measures of maximal oxygen consumption (VO2max), isokinetic strength, range of motion, gait, and balance. Psychosocial factors were measured as self-defined health status using the Sickness Impact Profile (SIP), self-perceived function using the Health Survey (SF36), and Instrumental Activities of Daily Living (IADL). RESULTS IADL scores were not significantly different among the groups. Test-retest correlations ranged from .84 to .97 and inter-rater reliability from .92 to .99 for the CS-PFP total and 5 domains. Internal consistency was high (Cronbachs alpha, .74 to .97). Both total and individual domain CS-PFP scores were significantly different for the three groups of study participants, increasing with higher levels of independence, supporting construct validity. CS-PFP domain scores were significantly correlated with measures of maximal physical performance (VO2max, strength, etc) and with physical but not emotional aspects of self-perceived function. CONCLUSION The CS-PFP is a valid, reliable measure of physical function, applicable to a wide range of functional levels, and having minimal floor and ceiling effect. The total and physical domains may be used to evaluate, discriminate, and predict physical functional performance for both research and clinical purposes.

Physical activity programs and behavior counseling in older adult populations

Physical activity offers one of the greatest opportunities for people to extend years of active independent life and reduce functional limitations. The purpose of this paper is to identify key practices for promoting physical activity in older adults, with a focus on older adults with chronic disease or low fitness and those with low levels of physical activity. Key practices identified in promotion activity in older adults include: 1) A multidimensional activity program that includes endurance, strength, balance, and flexibility training is optimal for health and functional benefits; 2) Principles of behavior change, including: social support, self-efficacy, active choices, health contracts, assurances of safety, and positive reinforcement enhance adherence; 3) Management of risk by beginning at low intensity but gradually increasing to moderate physical activity, which has a better risk-to-benefit ratio and should be the goal for older adults; 4) An emergency procedure plan is prudent for community based programs; and 5) Monitoring aerobic intensity is important for progression and for motivation. Selected content review of physical activity programming from major organizations and institutions are provided. Regular participation in physical activity is one of the most effective ways for older adults, including those with disabilities, to help prevent chronic disease, promote independence, and increase quality of life in old age.

Resistance training on physical performance in disabled older female cardiac patients

PURPOSE We evaluated the value of resistance training on measures of physical performance in disabled older women with coronary heart disease (CHD). METHODS The study intervention consisted of a 6-month program of resistance training in a randomized controlled trial format. Training intensity was at 80% of the single-repetition maximal lift. Control patients performed light yoga and breathing exercises. Study participants included 42 women with CHD, all >or= 65 yr of age and community dwelling. Subjects were screened by questionnaire to have low self-reported physical function. The primary study measurements related to the performance of 16 household activities of the Continuous Scale Physical Functional Performance test (CSPFP). These ranged from dressing, to kitchen and cleaning activities, to carrying groceries and walking onto a bus with luggage, and a 6-min walk. Activities were measured in time to complete a task, weight carried during a task, or distance walked. Other measures included body composition, measures of aerobic fitness and strength, and questionnaire-based measures of physical function and depression score. RESULTS Study groups were similar at baseline by age, aerobic capacity, strength, body composition, and in performing the CSPFP. After conditioning, 13 of 16 measured activities were performed more rapidly, or with increased weight carried, compared with the control group (all P < 0.05). Maximal power for activities that involved weight-bearing over a distance, increased by 40% (P < 0.05). CONCLUSIONS Disabled older women with CHD who participate in an intense resistance-training program improve physical capacity over a wide range of household physical activities. Benefits extend beyond strength-related activities, as endurance, balance, coordination, and flexibility all improved. Strength training should be considered an important component in the rehabilitation of older women with CHD.

A Comparison of Physical Functional Performance and Strength in Women With Fibromyalgia, Age- and Weight-Matched Controls, and Older Women Who Are Healthy

Background and Purpose. The purpose of this study was to compare functionality and strength among women with fibromyalgia (FM), women without FM, and older women. Subjects. Twenty-nine women with FM (age [X̅±SD]=46±7 years), 12 age- and weight-matched women without FM (age=44±8 years), and 38 older women who were healthy (age=71±7 years) participated. Methods. The Continuous Scale–Physical Functional Performance Test (CS-PFP) was used to assess functionality. Isokinetic leg strength was measured at 60°/s, and handgrip strength was measured using a handgrip dynamometer. Results. The women without FM had significantly higher functionality scores compared with women with FM and older women. There were no differences in functionality between women with FM and older women. Strength measures for the leg were higher in women without FM compared with women with FM and older women, and both women with and without FM had higher grip strengths compared with older women. Discussion and Conclusion. This study demonstrated that women with FM and older women who are healthy have similar lower-body strength and functionality, potentially enhancing the risk for premature age-associated disability.

Effects of Testosterone and Progressive Resistance Exercise in Healthy, Highly Functioning Older Men With Low-Normal Testosterone Levels

CONTEXT Aging in men is associated with reduced testosterone (T) levels and physiological changes leading to frailty, but the benefits of T supplementation are inconclusive. OBJECTIVE We studied the effects of T supplementation with and without progressive resistance training (PRT) on functional performance, strength, and body composition. DESIGN, SETTING, AND PARTICIPANTS We recruited 167 generally healthy community-dwelling older men (66 ± 5 years) with low-normal baseline total T levels (200-350 ng/dL). INTERVENTION Subjects were randomized to placebo or transdermal T gel [2 doses targeting either a lower (400-550 ng/dL) or higher (600-1000 ng/dL) T range] and to either PRT or no exercise for 12 months. MAIN OUTCOME MEASURE The primary outcome was functional performance, whereas secondary outcomes were strength and body composition. RESULTS A total of 143 men completed the study. At 12 months, total T was 528 ± 287 ng/dL in subjects receiving any T and 287 ± 65 ng/dL in the placebo group. In the PRT group, function and strength were not different between T- and placebo-treated subjects, despite greater improvements in fat mass (P = .04) and fat-free mass (P = .01) with T. In the non-PRT group, T did not improve function but improved fat mass (P = .005), fat-free mass (P = .03), and upper body strength (P = .03) compared with placebo. There were fewer cardiovascular events in the T-treated groups compared with placebo. CONCLUSIONS T supplementation was well tolerated and improved body composition but had no effect on functional performance. T supplementation improved upper body strength only in nonexercisers compared with placebo.

The relationship of joint symptoms with exercise performance in older adults.

OBJECTIVES: The objective of this study is to determine if exercise increases joint symptoms in older adults with a history of arthritis or produces symptoms in older adults without such history. In addition, we examine whether joint symptoms explain the large observed variation in strength gain in older adults undergoing vigorous strength training exercise, and report the incidence of musculoskeletal injuries upon initiation of an exercise program.

Aerobic reserve and physical functional performance in older adults

BACKGROUND older adults can be limited in their performance of daily tasks due to an inadequate aerobic capacity. Aerobic capacity below minimum physiological thresholds required to maintain independence leaves older adults with little, or no, aerobic reserve. OBJECTIVE the aim of this study was to measure functional performance and aerobic reserve in older adults during the serial performance of daily tasks. SUBJECTS twenty-nine (n = 29) men and women (n = 23 females) 70-92 years of age participated in this study. METHODS performance based physical function was assessed using the Continuous-Scale Physical Functional Performance test (CS-PFP). A Cosmed K4b(2) portable metabolic system was used to measure VO(2PEAK) and oxygen uptake during the serial performance of a battery of daily tasks (VO(2PFP)). Aerobic reserve was calculated as the difference between VO(2PEAK) and VO(2PFP). RESULTS the correlation coefficient between aerobic reserve and functional performance was r = 0.50(P = 0.006). Participants utilized 32.2 +/- 8.1%, 42.7 +/- 10.8%, and 50.3 +/- 12.3% of VO(2PEAK) for the low, moderate, and high workloads of the CS-PFP, respectively. CONCLUSIONS light housework and carrying groceries require 40 to 50% of peak oxygen consumption. This information can be used by clinicians and health professionals working with older adults as a guide to how much aerobic fitness is needed to perform ADLs and maintain independence. These can then be used as guides for assessment and for setting training goals in older adults.

Exercise efficiency is reduced by mitochondrial uncoupling in the elderly.

•  What is the central question of this study? A key part of the debilitation that comes with age is the decline in exercise efficiency. This study examines the role of metabolic efficiency in this decline. •  What is the main finding and its importance? Here we show that mitochondrial energy inefficiency is the basis of the decline in exercise efficiency with age. These findings identify mitochondrial dysfunction as a key factor in the reduced exercise efficiency with age and also identify mitochondria as the target for intervention to reverse this source of debilitation in the elderly.

Combined Aerobic and Resistance Exercise Program Improves Task Performance in Patients With Heart Failure

OBJECTIVES To assess the effects of a home-based aerobic and resistance training program on the physical function of adults with New York Heart Association (NYHA) class II and III patients and systolic heart failure (HF). DESIGN Randomized controlled trial. SETTING Home based. PARTICIPANTS Stable patients (N=24; mean age, 60 ± 10 y; left ventricular ejection fraction, 25% ± 9%; 50% white; 50% women) with New York Heart Association (NYHA) classes II and III (NYHA class III, 58%) systolic heart failure (HF). INTERVENTION A 12-week progressive home-based program of moderate-intensity aerobic and resistance exercise. Attention control wait list participants performed light stretching and flexibility exercises. MAIN OUTCOME MEASURES A 10-item performance-based physical function measure, the Continuous Scale Physical Functional Performance test (CS-PFP10), was the major outcome variable and included specific physical activities measured in time to complete a task, weight carried during a task, and distance walked. Other measures included muscle strength, HRQOL (Minnesota Living With Heart Failure Questionnaire, Epworth Sleepiness Scale), functional capacity (Duke Activity Status Index), and disease severity (brain natriuretic peptide) levels. RESULTS After the exercise intervention, 9 of 10 specific task activities were performed more rapidly, with increased weight carried by exercise participants compared with the attention control wait list group. Exercise participants also showed significant improvements in CS-PFP10 total score (P<.025), upper and lower muscle strength, and HRQOL (P<.001) compared with the attention control wait list group. Adherence rates were 83% and 99% for the aerobic and resistance training, respectively. CONCLUSIONS Patients with stable HF who participate in a moderate-intensity combined aerobic and resistance exercise program may improve performance of routine physical activities of daily living by using a home-based exercise approach. Performance-based measures such as the CS-PFP10 may provide additional insights into physical function in patients with HF that more commonly used exercise tests may not identify. Early detection of subtle changes that may signal declining physical function that are amenable to intervention potentially may slow further loss of function in this patient population.

Living Environment and Mobility of Older Adults

Background: Older adults often elect to move into smaller living environments. Smaller living space and the addition of services provided by a retirement community (RC) may make living easier for the individual, but it may also reduce the amount of daily physical activity and ultimately reduce functional ability. Objective: With home size as an independent variable, the primary purpose of this study was to evaluate daily physical activity and physical function of community dwellers (CD; n = 31) as compared to residents of an RC (n = 30). Methods: In this cross-sectional study design, assessments included: the Continuous Scale Physical Functional Performance – 10 test, with a possible range of 0–100, higher scores reflecting better function; Step Activity Monitor (StepWatch 3.1); a physical activity questionnaire, the area of the home (in square meters). Groups were compared by one-way ANOVA. A general linear regression model was used to predict the number of steps per day at home. The level of significance was p < 0.05. Results: Of the 61 volunteers (mean age: 79 ± 6.3 years; range: 65–94 years), the RC living space (68 ± 37.7 m2) was 62% smaller than the CD living space (182.8 ± 77.9 m2; p = 0.001). After correcting for age, the RC took fewer total steps per day excluding exercise (p = 0.03) and had lower function (p = 0.005) than the CD. Conclusion: On average, RC residents take 3,000 steps less per day and have approximately 60% of the living space of a CD. Home size and physical function were primary predictors of the number of steps taken at home, as found using a general linear regression analysis.