High-Intensity Resistance Training Improves Muscle Strength, Self-Reported Function, and Disability in Long-Term Stroke Survivors The effect of resistance training on muscle strength and physical function in older, postmenopausal breast cancer survivors: a randomized controlled trial Effects of home-based resistance training and neuromuscular electrical stimulation in knee osteoarthritis: a randomized controlled trial Changes in Function and Disability After Resistance Training: Does Velocity Matter?: A Pilot Study Effect of Physical Activity versus Health Education on Physical Function, Grip Strength and Mobility Resistance training reduces disability in prostate cancer survivors on androgen deprivation therapy: evidence from a randomized controlled trial. Physiological and functional responses to low-moderate versus high-intensity progressive resistance training in frail elders. Effect of resistance training on physical disability in chronic heart failure. Midlife hand grip strength as a predictor of old age disability. Self-efficacy and the progression of functional limitations and self-reported disability in older adults with knee pain. Strength measures are better than muscle mass measures in predicting health-related outcomes in older people: time to abandon the term sarcopenia? Does monitoring change in function in community-dwelling older adults alter outcome? A randomized controlled trial Change in muscle strength explains accelerated decline of physical function in older women with high interleukin-6 serum levels. Impact of Exercise to Improve Gait Efficiency on Activity and Participation in Older Adults With Mobility Limitations: A Randomized Controlled Trial Preclinical mobility disability predicts incident mobility disability in older women. Efficacy of percutaneous electrical nerve stimulation for the treatment of chronic low back pain in older adults. Self-paced resistance training and walking exercise in community-dwelling older adults: effects on neuromotor performance. Changes in cognitive function in a randomized trial of physical activity: results of the lifestyle interventions and independence for elders pilot study. Persistent mobility deficit in the absence of deficits in activities of daily living: a risk factor for mortality. Preventing disability and managing chronic illness in frail older adults: a randomized trial of a community-based partnership with primary care. The Arthritis, Diet and Activity Promotion Trial (ADAPT): design, rationale, and baseline results. Effects of a progressive resistance exercise program with high-speed component on the physical function of older women with sarcopenic obesity: a randomized controlled trial Project LIFE--Learning to Improve Fitness and Function in Elders: methods, design, and baseline characteristics of randomized trial. Performance-Based Versus Patient-Reported Physical Function: What Are the Underlying Predictors? Hand grip strength and incident ADL disability in elderly Mexican Americans over a seven-year period
Background and Purpose — To evaluate the efficacy of supervised high-intensity progressive resistance training ( PRT ) on lower extremity strength , function , and disability in older , long-term stroke survivors . Methods — Forty-two volunteers aged 50 years and above , 6 months to 6 years after a single mild to moderate stroke , were r and omized into either a control group of upper extremity stretching or a PRT group that received a 12-week supervised high-intensity resistance training program consisting of bilateral leg press ( LP ) , unilateral paretic and nonparetic knee extension ( KE ) , ankle dorsiflexion ( DF ) , and plantarflexion ( PF ) exercises .  Functional performance was assessed using the 6-minute walk , stair-climb time , repeated chair-rise time , and habitual and maximal gait velocities . Self-reported changes in function and disability were evaluated using the Late Life Function and Disability Instrument ( LLFDI ) . Results — Single-repetition maximum strength significantly improved in the PRT group for LP ( 16.2 % ) , paretic KE ( 31.4 % ) , and nonparetic KE ( 38.2 % ) with no change in the control group . Paretic ankle DF ( 66.7 % versus −24.0 % ) , paretic ankle PF ( 35.5 % versus −20.3 % ) , and nonparetic ankle PF ( 14.7 % versus −13.8 % ) significantly improved in the PRT group compared with the control . The PRT group showed significant improvement in self-reported function and disability with no change in the control . There was no significant difference between groups for any performance-based measure of function . Conclusions — High-intensity PRT improves both paretic and nonparetic lower extremity strength after stroke , and results in reductions in functional limitations and disability Introduction Older breast cancer survivors ( BCS ) report more falls and functional limitations than women with no cancer history .  Exercise training could reduce risk factors for future falls and disability . Methods We conducted a r and omized , controlled trial in 106 early-stage , postmenopausal BCS who were ≥50 years old at diagnosis and post-treatment . Women were r and omly assigned to a 1-year resistance + impact exercise program or a stretching placebo program . Endpoints were one repetition maximum bench press and leg press strength , timed five chair st and s , 4 m usual walk speed , timed stance tests , h and grip strength , self-report physical function , and fatigue . We also examined the influence of age , adjuvant hormone therapy use , and exercise adherence on study outcomes . Results Women in the resistance + impact training program significantly improved maximal leg ( p < 0 .02 ) and bench ( p < 0 .02 ) press strength compared to the stretching group . Women who attended 50 % or more of prescribed resistance training sessions had significantly better changes in maximal strength measures compared to less adherent women . Conclusions Resistance + impact exercise is superior to stretching at improving maximal muscle strength and exercise adherence contributes to the degree of improvement . Implication s for cancer survivorsOlder BCS can safely engage in resistance exercise that improves lower and upper body strength , thereby reducing a risk factor for falls and future disability . However , the ability of resistance training to shift other indices of fall and disability risk , i.e. , balance and function , is unclear . Strategies to promote adherence to resistance training could lead to greater improvements in strength Background Quadriceps femoris muscle ( QFM ) weakness is a feature of knee osteoarthritis ( OA ) and exercise programs that strengthen this muscle group can improve function , disability and pain . Traditional supervised resistance exercise is however re source intensive and dependent on good adherence which can be challenging to achieve in patients with significant knee OA . Because of the limitations of traditional exercise programs , interest has been shown in the use of neuromuscular electrical stimulation ( NMES ) to strengthen the QFM . We conducted a single-blind , prospect i ve r and omized controlled study to compare the effects of home-based resistance training ( RT ) and NMES on patients with moderate to severe knee OA . Methods 41 patients aged 55 to 75 years were r and omised to 6 week programs of RT , NMES or a control group receiving st and ard care . The primary outcome was functional capacity measured using a walk test , stair climb test and chair rise test . Additional outcomes were self-reported disability , quadriceps strength and cross-sectional area . Outcomes were assessed pre- and post-intervention and at 6 weeks post-intervention ( weeks 1 , 8 and 14 respectively ) . Results There were similar , significant improvements in functional capacity for the RT and NMES groups at week 8 compared to week 1 ( p≤0.001 ) and compared to the control group ( p < 0.005 ) , and the improvements were maintained at week 14 ( p≤0.001 ) . Cross sectional area of the QFM increased in both training groups ( NMES : + 5.4 % ; RT : + 4.3 % ; p = 0.404 ) . Adherence was 91 % and 83 % in the NMES and RT groups respectively ( p = 0.324 ) . Conclusions Home-based NMES is an acceptable alternative to exercise therapy in the management of knee OA , producing similar improvements in functional capacity . Trial registration : Current Controlled Trials IS RCT Sayers SP , Bean J , Cuoco A , LeBrasseur NK , Jette A , Fielding RA : Changes in function and disability after resistance training : Does velocity matter ? A pilot study . Am J Phys Med Rehabil 2003;82:605–613 . Objective To compare the effects of high- and low-velocity resistance training on functional performance and disability outcomes in physically limited older women . Design A total of 16 wk of high-velocity resistance training or traditional low-velocity resistance training consisting of knee extension and leg press exercises was performed three times per week by 30 women with self-reported disability to compare their effect on functional performance and disability . Tests of dynamic balance , stair-climb time , chair-rise time , and gait velocity were used to assess changes in functional performance . Changes in disability were assessed using the Medical Outcomes Study Short Form . Results Dynamic balance and stair-climb time improved 8 % and 10 % , respectively , with training . Self-reported disability , physical functioning , role physical , and mental health improved 11 , 9 , and 5 % with training , respectively . There were no significant differences between high- and low-velocity training groups . Conclusions High- and low-velocity training achieved similar improvements in functional performance and disability . Improvements in functional performance and disability were modest compared with robust increases in strength and power . Specific modes of training or behavioral strategies may be necessary to optimize improvements in these outcomes BACKGROUND : Physical activity ( PA ) reduces the rate of mobility disability , compared with health education ( HE ) , in at risk older adults . It is important to underst and aspects of performance contributing to this benefit . OBJECTIVE : To evaluate intervention effects on tertiary physical performance outcomes . DESIGN : The Lifestyle Interventions and Independence for Elders ( LIFE ) was a multi‐centered , single‐blind r and omized trial of older adults . SETTING : Eight field centers throughout the United States . PARTICIPANTS : 1635 adults aged 78.9 ± 5.2 years , 67.2 % women at risk for mobility disability ( Short Physical Performance Battery [ SPPB ] < 10 ) . INTERVENTIONS : Moderate PA including walking , resistance and balance training compared with HE consisting of topics relevant to older adults . OUTCOMES : Grip strength , SPPB score and its components ( balance , 4 m gait speed , and chair‐st and s ) , as well as 400 m walking speed . RESULTS : Total SPPB score was higher in PA versus HE across all follow‐up times ( overall P = .04 ) as was the chair‐st and component ( overall P < .001 ) . No intervention effects were observed for balance ( overall P = .12 ) , 4 m gait speed ( overall P = .78 ) , or grip strength ( overall P = .62 ) . However , 400 m walking speed was faster in PA versus HE group ( overall P = < .001 ) . In separate models , 29 % of the rate reduction of major mobility disability in the PA versus HE group was explained by change in SPPB score , while 39 % was explained by change in the chair st and component . CONCLUSION : Lower extremity performance ( SPPB ) was significantly higher in the PA compared with HE group . Changes in chair‐st and score explained a considerable portion of the effect of PA on the reduction of major mobility disability‐consistent with the idea that preserving muscle strength/power may be important for the prevention of major mobility disability OBJECTIVES To investigate whether functionally based resistance exercise could improve strength , physical function , and disability among prostate cancer survivors ( PCS ) on and rogen deprivation therapy ( ADT ) ; and to explore potential mediators of changes in outcomes from exercise . DESIGN R and omized controlled trial . SETTING Academic medical center . PARTICIPANTS PCS ( N=51 ; mean age , 70.2y ) on ADT . INTERVENTION PCS were r and omized to moderate to vigorous intensity resistance training or stretching ( placebo control ) for 1 year . MAIN OUTCOME MEASURES Maximal leg press and bench press strength , objective and self-reported physical function , and self-reported disability . Hierarchical linear modeling was used to test for significant group × time differences adjusting for covariates . RESULTS Retention in the study was 84 % , and median attendance to supervised classes was 84 % in the resistance group . No study -related injuries occurred . Maximal leg strength ( P=.032 ) and bench press strength ( P=.027 ) were improved after 1 year of resistance training , whereas little change occurred from stretching .  Self-reported physical function improved with resistance training , whereas decreases occurred from stretching ( P=.016 ) . Disability lessened more with resistance training than stretching ( P=.018 ) . One-year change in leg press strength mediated the relation between groups ( resistance or stretching ) and 1-year change in self-reported disability ( P<.05 ) . CONCLUSIONS One year of resistance training improved muscle strength in and rogen-deprived PCS . Strengthening muscles using functional movement patterns may be an important feature of exercise programs design ed to improve perceptions of physical function and disability . Findings from this study contribute to the mounting evidence that exercise should become a routine part of clinical care in older men with advanced prostate cancer BACKGROUND The purpose of this efficacy study was to measure the dose-response effect of a free weight-based resistance training program by comparing the effects of two training intensities ( low-moderate and high ) of the knee extensor ( KE ) muscles on muscle function , functional limitations , and self-reported disability . METHODS The authors conducted a single-blinded , r and omized , placebo-controlled trial . Twenty-two institutionalized elders ( mean age , 81.5 years ) were assigned to either high-intensity strength training ( HI ; n = 8) , low-moderate intensity strength training ( LI ; n = 6 ) , or weight-free placebo-control training ( PC ; n = 8) . The HI group trained at 80 % of their 1-repetition maximum and the LI group trained at 40 % . All groups performed 3 sets of 8 repetitions , 3 times per week for 10 weeks . Outcome measures included KE maximal strength , KE endurance , and functional performance as assessed by 6-minute walking , chair-rising , and stair-climbing tests , and by self-reported disability . RESULTS KE strength and endurance , stair-climbing power , and chair-rising time improved significantly in the HI and LI groups compared with the PC group . Six-minute walking distance improved significantly in the HI group but not in the LI group compared with the PC group . Changes observed in HI were significantly different from those observed in the LI group for KE strength and endurance and the 6-minute walking test , with a trend in the same direction for chair-rising and stair-climbing . Changes in strength were significantly related to changes in functional outcomes , explaining 37 % to 61 % of the variance . CONCLUSIONS These results show strong dose-response relationships between resistance training intensity and strength gains , and between strength gains and functional improvements after resistance training . Low-moderate intensity resistance training of the KE muscles may not be sufficiently robust from a physiologic perspective to achieve optimal improvement of functional performance . Supervised HI , free weight-based training for frail elders appears to be as safe as lower intensity training but is more effective physiologically and functionally PURPOSE Patients with chronic heart failure ( CHF ) report difficulty performing activities of daily living . To our knowledge , however , no study has directly measured performance in activities of daily living in these patients to systematic ally assess their level of physical disability . Moreover , the contribution of skeletal muscle weakness to physical disability in CHF remains unclear . Thus , we measured performance in activities of daily living in CHF patients and controls , its relationship to aerobic capacity and muscle strength , and the effect of resistance exercise training to improve muscle strength and physical disability . METHODS Patients and controls were assessed for performance in activities of daily living , self-reported physical function , peak aerobic capacity , body composition , and muscle strength before and after an 18-wk resistance training program . To remove the confounding effects of several disease-related factors ( muscle disuse , hospitalization , acute illness ) , we recruited controls with similar activity levels as CHF patients and tested patients > 6 months after any disease exacerbation/hospitalization . RESULTS Performance in activities of daily living was 30 % lower ( P < 0.05 ) in CHF patients versus controls and was related to both reduced aerobic capacity ( P < 0.001 ) and muscle strength ( P < 0.01 ) . Moreover , resistance training improved ( P < 0.05 to P < 0.001 ) physical function and muscle strength in patients and controls similarly , without altering aerobic capacity . CONCLUSIONS CHF patients are characterized by marked physical disability compared with age- and physical activity-matched controls , which is related to reduced aerobic capacity and muscle strength . CHF patients respond to resistance training with normal strength/functional adaptations . Our results support muscle weakness as a determinant of physical disability in CHF and show that interventions that increase muscle strength  ( resistance training ) reduce physical disability CONTEXT Poor muscle strength , functional limitations , and disability often coexist , but whether muscle strength during midlife predicts old age functional ability is not known . OBJECTIVE To determine whether h and grip strength measured during midlife predicts old age functional limitations and disability in initially healthy men . DESIGN AND SETTING A 25-year prospect i ve cohort study , the Honolulu Heart Program , which began in 1965 among Japanese-American men living on Oahu , Hawaii . PARTICIPANTS A total of 608945- to 68-year-old men who were healthy at baseline and whose maximal h and grip strength was measured from 1965 through 1970 . Altogether , 2259 men died over the follow-up period and 3218 survivors participated in the  disability assessment  in 1991 through 1993 . MAIN OUTCOME MEASURES Functional limitations including slow customary walking speed ( < or = 0.4 m/s ) and inability to rise from a seated position without using the arms , and multiple self-reported upper extremity , mobility , and self-care disability outcomes . RESULTS After adjustment for multiple potential confounders , risk of functional limitations and disability 25 years later increased as baseline h and grip strength , divided into tertiles , declined . The odds ratio ( OR ) of walking speed of 0.4 m/s or slower was 2.87 ( 95 % confidence interval [ CI ] , 1.76 - 4.67 ) in those in the lowest third and 1.79 ( 95 % CI , 1.14 - 2.81 ) in the middle third of grip strength vs those in the highest third . The risk of self-care disability was more than 2 times greater in the lowest vs the highest grip strength tertile . Adding chronic conditions identified at follow-up to the models predicting disability reduced the ORs related to grip strength only minimally . CONCLUSIONS Among healthy 45- to 68-year-old men , h and grip strength was highly predictive of functional limitations and disability 25 years later . Good muscle strength in midlife may protect people from old age disability by providing a greater safety margin above the threshold of disability OBJECTIVES The prospect i ve relationships between self-efficacy beliefs , in conjunction with measures of knee pain and knee strength , and subsequent decline in both physical performance and self-reported disability among older adults with knee pain were examined . METHODS In this prospect i ve epidemiological trial , 480 men and women aged 65 years and older who had knee pain on most days of the week and difficulty with daily activity were followed for 30 months . RESULTS There was a significant interaction of baseline self-efficacy with baseline knee strength in predicting both self-reported disability and stair climb performance . Participants who had low self-efficacy and low strength at baseline had the largest 30-month decline in these outcomes . DISCUSSION These data underscore the important role that self-efficacy beliefs play in underst and ing functional decline with chronic disease and aging . Self-efficacy beliefs appear to be most important to functional decline in older adults when they are challenged by muscular weakness in the lower extremities Summary There is no clear consensus on definition , cut-points or st and ardised assessment s of sarcopenia . We found a lower limb strength assessment  was at least as effective in predicting balance , mobility and falls in 419 older people as muscle mass-based measures of sarcopenia . Introduction There is currently no consensus on the definition , cut-points or st and ardised assessment s of sarcopenia . This study aim ed to investigate whether several published definitions of sarcopenia differentiate between older people with respect to important functional and health outcomes . Methods Four hundred nineteen community-living older adults ( mean age 81.2 ± 4.5 , 49 % female ) completed assessment s of body composition ( dual-energy X-ray absorptiometry ) , strength , balance , mobility and disability . Falls were recorded prospect ively for a year using monthly calendars . Sarcopenia was defined according to four skeletal mass-based definitions , two strength-based definitions ( h and grip or knee extensor force ) and a consensus algorithm ( low mass and low strength or slow gait speed ) . Obesity was defined according to percentage fat mass or waist circumference . Results The four skeletal mass-based definitions varied considerably with respect to the percentage of participants classified as sarcopenic and their predictive accuracy for functional and health outcomes . The knee extension strength-based definition was equivalent to or better than the mass-based and consensus algorithm definitions ; i.e. weaker participants performed poorly in tests of leaning balance , stepping reaction time , gait speed and mobility . They also had higher physiological fall risk scores and were 43 % more likely to fall at home than their stronger counterparts . Adding obesity to sarcopenia definitions identified participants with greater self-reported disability . Conclusions A simple lower limb strength assessment was at least as effective in predicting balance , functional mobility and falls in older people as more expensive and time-consuming muscle mass-based measures . These findings imply that functional terms such as muscle weakness or motor impairment are preferable to sarcopenia Objective : To determine whether information about an older person 's physical functioning provided to the patient and his or her physician delays functional decline and improves health outcomes . Design : A r and omized controlled trial was undertaken ; the assessors were not blinded to the group allocation . Setting : The study took place in a clinic within a hospital setting . Participants : Two hundred and sixty-five community-dwelling people over 65 years were recruited from family practice units . Interventions : The intervention group received assessment s of physical function with feedback to the participant and the participant 's family physician or functional assessment s alone over 18 months .  Self-report measures for health status using the Short Form-36 ( SF-36 ) and pre clinical disability were used together with performance measures which included the lower extremity performance test and muscle strength . Results : There were small , statistically significant group/time interactions which included disability scores , F=4.78 , P ≤0.05 ) , and the vitality subscale of the SF-36 , F=7.47 , P ≤0.01 ) . Conclusion : Providing information about the results of detailed assessment of physical functioning to older adults and their physicians did not show significant differences in function scores between the intervention and control groups OBJECTIVES To test whether accelerated sarcopenia in older persons with high interleukin (IL)-6 serum levels plays a role in the prospect i ve association between inflammation and disability found in many studies . DESIGN Cohort study of older women with moderate to severe disability . PARTICIPANTS Six hundred twenty older women from the Women 's Health and Aging Study in whom information on baseline IL-6 serum level was available . MEASUREMENTS Self-report of functional status , objective measures of walking performance , and knee extensor strength were assessed at baseline and over six semiannual follow-up visits . Potential confounders were baseline age , race , body mass index , smoking , depression , and medical conditions . RESULTS At baseline , women with high IL-6 were more often disabled and had lower walking speed . After adjusting for confounders , women in the highest IL-6 tertile ( IL-6>3.10 pg/mL ) were at higher risk of developing incident mobility disability ( risk ratio ( RR ) = 1.50 , 95 % confidence interval ( CI ) = 1.01 - 2.27 ) , disability in activities of daily living ( RR = 1.41 , 95 % CI = 1.01 - 1.98 ) , and severe limitation in walking ( RR = 1.61 , 95 % CI = 1.09 - 2.38 ) and experienced steeper declines in walking speed ( P < .001 ) than women in the lowest IL-6 tertile ( IL-6 < or = 1.78 pg/mL ) . Decline in knee extensor strength was also steeper , but differences across IL-6 tertiles were not significant . After adjusting for change over time in knee extensor strength , the association between high IL-6 and accelerated decline of physical function was no longer statistically significant . CONCLUSIONS Older women with high IL-6 serum levels have a higher risk of developing physical disability and experience a steeper decline in walking ability than those with lower levels , which are partially explained by a parallel decline in muscle strength Background Definitive evidence that exercise interventions that improve gait also reduce disability is lacking . A task-oriented , motor sequence learning exercise intervention has been shown to reduce the energy cost of walking and improve gait speed , but whether the intervention also improves activity and participation has not been demonstrated . Objective The objective of this study was to compare the impact of a task-oriented , motor sequence learning exercise ( TO ) intervention and the impact of an impairment-oriented , multicomponent exercise ( IO ) intervention on activity and participation outcomes in older adults with mobility limitations . The mediating effects of a change in the energy cost of walking on changes in activity and participation also were determined . Design This study was a single-blind , r and omized controlled trial . Setting The study was conducted in an ambulatory clinical research training center . Participants The study participants were 47 older adults ( mean age=77.2 years , SD=5.5 ) with slow and variable gait . Intervention The intervention was a 12-week , physical therapist – guided program of TO or IO . Measurements Measures of activity ( gait speed over an instrumented walkway ; daily physical activity measured with an accelerometer ; confidence in walking determined with the Gait Efficacy Scale ; and physical function determined with the total , basic lower-extremity , and advanced lower-extremity components of the Late-Life Function and Disability Instrument [ Late-Life FDI ] ) and participation ( disability limitation dimension and instrumental role [ home and community task performance ] domain components of the Late-Life FDI ) were recorded before and after the intervention . The energy cost of walking was determined from the rate of oxygen consumption during self-paced treadmill walking at the physiological steady state st and ardized by walking speed . An adjusted comparison of activity and participation outcomes in the treatment arms was made by use of an analysis of covariance model , with baseline and change in energy cost of walking added to the model to test for mediation . Tests were used to determine the significance of the mediating effects . Results Activity improved in TO but not in IO for confidence in walking ( Gait Efficacy Scale ; mean adjusted difference=9.8 [ SD=3.5 ] ) and physical function ( Late-Life FDI basic lower-extremity component ; mean adjusted difference=3.5 [ SD=1.7 ] ) . Improvements in TO were marginally greater than those in IO for gait speed , physical activity , and total physical function . Participation improved marginally more in TO than in IO for disability limitations and instrumental role . Limitations The older adults were r and omized to the intervention group , but differences in baseline measures had to be accounted for in the analyses . Conclusions A TO intervention that improved gait also led to improvements in some activity and participation outcomes in older adults with mobility limitations BACKGROUND Physical disability and dependency are serious , and frequent , adverse health outcomes associated with aging and result ing from chronic disease . Reasoning has suggested that there might be a pre clinical , intermediate phase of disablement which might develop in parallel with progression of underlying disease and precede and predict disability . Definition of this stage could provide a basis for screening and early intervention to prevent disability . The objective of this study was to determine pre clinical functional predictors of incident mobility difficulty and provide evidence for a pre clinical stage of disability . METHODS A prospect i ve , population -based cohort study was carried out in Baltimore , Maryl and , with two evaluations 18 months apart . The participants were 436 community-dwelling women , 70 - 80 years of age at baseline , not cognitively impaired , and reporting difficulty in no areas , or only one area , of physical function ( primarily mobility ) , who were participating in the Women 's Health and Aging Study II . Participants were recruited from a population -based , age-stratified r and om sample .  Incident mobility disability was studied in the subset without such disability at baseline . The main outcome measure was self-reported incident difficulty walking 1/2 mile or climbing up 10 steps . RESULTS At baseline , 69.3 % of the cohort reported no difficulty with mobility . After 18 months , 16.0 and 11.7 % of this group reported incident difficulty walking 1/2 mile or climbing up 10 steps , respectively . Those reporting baseline task modification due to underlying health problems , our measure of pre clinical disability , were at three- to fourfold higher odds of progressing to difficulty than were those without such modification . In multivariate logistic regression analyses , this self-report measure , task modification without difficulty , and objective measures of performance were independently and jointly predictive of incident mobility difficulty . Specifically , for incident difficulty walking 1/2 mile , self-reported task modification odds ratio ( OR ) = 3.67 , walking speed ( .5 m/s difference ) OR = 2.16 ; for incident difficulty climbing up 10 stairs , OR for task modification = 3.84 , for stair climb speed ( 1/3 step/s difference ) = 2.08 ( 95 % CI did not include 1 for any ) . Covariates , age , living alone , number of chronic diseases , depression score , knee strength , and balance by functional reach , were not significant predictors in either model . CONCLUSIONS Two indicators of functional changes in older women without mobility difficulty , self-report of modification of method of doing a task in the absence of difficulty and performance measures , are independent and strong predictors of risk of incident mobility disability . The self-report measure provides substantial strength in predicting risk of incident disability across the full range of performance , and may identify a vulnerable point at which other risk factors act to cause transitions to disability . Together , the pre clinical indicators identify a subset of high-functioning older women who are at high risk of mobility disability , and provide a potential basis for screening for disability risk and targeting interventions to prevent mobility disability OBJECTIVES To determine the efficacy of a complementary analgesic modality , percutaneous electrical nerve stimulation ( PENS ) , for the treatment of chronic low back pain ( CLBP ) in community-dwelling older adults . DESIGN R and omized , controlled clinical trial . SETTING University of Pittsburgh Pain Evaluation and Treatment Institute . PARTICIPANTS Thirty-four English speaking , community-dwelling adults aged 65 and older with CLBP of at least moderate intensity experienced every day or almost every day . INTERVENTION Subjects were r and omized to receive twice-weekly PENS and physical therapy ( PT ) or sham PENS and physical therapy for 6 weeks . MEASUREMENTS At baseline , immediately after the 6-week intervention period , and 3 months later , the primary outcome measures pain intensity and pain-related disability were assessed . The secondary outcome measures physical performance ( timed chair rise , functional reach , gait speed , static and isoinertial lifting ) , psychosocial factors ( mood , sleep , and life control ) , and cognitive function ( measures of attention , concentration , and mental flexibility ) were also collected . RESULTS Subjects r and omized to PENS plus PT displayed significant reductions in pain intensity measures from pre- to posttreatment ( P < .001 ) , but the sham PENS plus PT group did not ( P = .94 ) . These pain reduction effects were maintained at 3-month follow-up . Similarly , significant reductions in pain-related disability were observed at posttreatment ( P = .002 ) for the PENS plus PT group and were maintained at follow-up , but the sham PENS plus PT group did not show reductions in pain-related disability ( P = .81 ) . Of the secondary outcome measures , psychosocial function , timed chair rise , and isoinertial lifting endurance also improved significantly at posttreatment for the PENS plus PT group , and their improvement was sustained at 3-month follow-up , but the sham PENS plus PT did not display significant changes on these measures after treatment . CONCLUSION This preliminary study suggests that PENS may be a promising treatment modality for community-dwelling older adults with CLBP , as demonstrated by reduction in pain intensity and self-reported disability , and improvement in mood , life control , and physical performance . Larger studies with longer duration of follow-up are needed to vali date these findings and support the use of PENS in clinical practice BACKGROUND Resistance-training intervention studies have demonstrated meaningful health benefits in older adults ; however , most have used exercises performed at specific intensities on expensive equipment , which limit their widespread applicability . We tested whether two self-paced , less expensive exercise protocol s could be effective and safe for modifying neuromotor performance and functional capacity in community-dwelling adults 65 - 95 years of age . METHODS One hundred and thirty-one subjects were r and omized to a  novel resistance training , walking , or control group .  Subjects determined their level of resistance or walking intensity ( self-paced ) on a session-by-session basis . Muscle strength , balance , reaction time , stair climbing speed , and a timed pen pickup task were measured before and after the intervention period . Exercisers met three times per week for 10 months . RESULTS Significant improvements in t and em stance and single-legged stance with eyes open times and stair climbing speed were seen in both exercise groups . In addition , resistance trainers improved their muscle strength and ability to pick up an object from the floor and reduced the number of missteps taken during t and em walking , and walkers reduced t and em walking time . Controls showed no significant improvement in any variable . CONCLUSIONS The two self-paced exercise protocol s were effective at improving neuromotor performance and functional capacity in the study sample and show promise as a safe , effective , cost-efficient , acceptable exercise model for primary and secondary prevention in the general population of community-dwelling older adults BACKGROUND Cognitive impairment is an important contributor to disability . Limited clinical trial evidence exists regarding the impact of physical exercise on cognitive function ( CF ) . We report results of a pilot study to provide estimates of the relative impact of physical activity ( PA ) on 1-year changes in cognitive outcomes and to characterize relationships between changes in mobility disability and changes in cognition in older adults at increased risk for disability . METHODS Sedentary persons ( 102 ) at increased risk for disability ( aged 70 - 89 years ) were r and omized to moderate-intensity PA or health education .  Participants were administered the  Digit Symbol Substitution Test ( DSST ) , Rey Auditory Verbal Learning Test ( RAVLT ) , modified Stroop test , and Modified Mini-Mental State Examination  at baseline and 1 year . RESULTS Group differences were not significant but improvements in cognitive scores were associated with improvements in physical function . Specifically , the DSST significantly correlated with change in the Short Physical Performance Battery score ( r = .38 , p = .0002 ) , in chair st and score ( r = .26 , p = .012 ) , in balance score ( r = .21 , p = .046 ) , and in 400-m gait speed ( r = .15 , p = .147 ) . Change recall on the RAVLT and in the Stroop test was also positively correlated with changes in chair st and and balance , respectively . CONCLUSIONS These results provide further support for the benefits of exercise on CF in older adults . An adequately powered clinical trial of PA involving older adults at increased risk for cognitive disability is needed to exp and the indications for prescribing exercise for prevention of decline in brain function OBJECTIVES To investigate the extent to which self-reported mobility deficit in the absence of impairment in activities of daily living ( ADL ) is associated with elevated mortality risk . DESIGN Prospect i ve cohort study , with annual assessment s of mobility and ADL status and ongoing monitoring of vital status . SETTING Population -based cohort drawn from Medicare enrollees in New York City . PARTICIPANTS One thous and two hundred ninety-eight older adults reporting functional status at baseline ( 1992 - 1994 ) and 2 years later . MEASUREMENTS Subjects reported  mobility ( e.g. ,  walking , climbing stairs , and rising from a chair )  and  ADL ( e.g. ,  bathing , toilet use , dressing , grooming , and feeding )  limitations . Two-year functional status trajectories were noted . We used two additional follow-up periods , at 2 and 4 years , to examine the likelihood that older people with mobility deficit may face an increased risk of death without first passing through a state of enduring ADL disability . RESULTS At 2 years , 12.7 % had incident mobility deficit without ADL disability , and 21.3 % were persistently disabled in mobility without ADL disability . Relative to subjects free of disability at baseline and follow-up , risk of mortality in the incident mobility deficit group was elevated at 2 and 4 years but did not achieve statistical significance . By contrast , for subjects with persistent mobility impairment who did not report ADL impairment , the mortality risk was significantly elevated both at 2 years ( relative risk ( RR ) = 2.5 ; 95 % confidence interval ( CI ) = 1.1 - 5.7 ) ) and 4 years ( RR = 2.9 ; 95 % CI = 1.7 - 4.9 ) ) of follow-up . Mortality was significantly elevated in this group in analyses restricted to respondents with no or only one comorbid condition . CONCLUSION Continuing , self-reported mobility impairment in the absence of ADL deficit is a risk factor for mortality . Older people with self-reported mobility deficit face an increased risk of mortality without first passing through enduring states of ADL disability BACKGROUND Effective new strategies that complement primary care are needed to reduce disability risks and improve self-management of chronic illness in frail older people living in the community . OBJECTIVE To evaluate the impact of a 1-year , senior center-based chronic illness self-management and disability prevention program on health , functioning , and healthcare utilization in frail older adults . DESIGN A r and omized controlled trial . SETTING A large senior center located in a northeast Seattle suburb . The trial was conducted in collaboration with primary care providers of two large managed care organizations . PARTICIPANTS A total of 201 chronically ill older adults seniors aged 70 and older recruited through medical practice s. INTERVENTION A targeted , multi-component disability prevention and disease self-management program led by a geriatric nurse practitioner ( GNP ) . MEASUREMENTS Self-reported Physical function , physical performance tests , health care utilization , and health behaviors . RESULTS Each of 101 intervention participants met with the GNP from 1 to 8 times ( median = 3 ) during the study year . The intervention group showed less decline in function , as measured by disability days and lower scores on the Health Assessment Question naire . Other measures of function , including the SF-36 and a battery of physical performance tests , did not change with the intervention . The number of hospitalized participants increased by 69 % among the controls and decreased by 38 % in the intervention group ( P = .083 ) . The total number of inpatient hospital days during the study year was significantly less in the intervention group compared with controls ( total days = 33 vs 116 , P = .049 ) . The intervention led to significantly higher levels of physical activity and senior center participation and significant reductions in the use of psychoactive medications . CONCLUSIONS This project provides evidence that a community-based collaboration with primary care providers can improve function and reduce inpatient utilization in chronically ill older adults . Linking organized medical care with complementary community-based interventions may be a promising direction for research and practice Osteoarthritis ( OA ) of the knee leads to restrictions of physical activity and ability to perform activities of daily living . Obesity is a risk factor for knee OA and it appears to exacerbate knee pain and disability . The Arthritis , Diet , and Activity Promotion Trial ( ADAPT ) was developed to test the efficacy of lifestyle behavioral changes on physical function , pain , and disability in obese , sedentary older adults with knee OA . This controlled trial r and omized 316 sedentary overweight and obese older adults in a two-by-two factorial design into one of four 18-month duration intervention groups : Healthy Lifestyle Control ; Dietary Weight Loss ; Structured Exercise ; or Combined Exercise and Dietary Weight Loss . The weight-loss goal for the diet groups was a 5 % loss at 18 months . The intervention was modeled from principles derived from the group dynamics literature and social cognitive theory . Exercise training consisted of aerobic and strength training for 60 minutes , three times per week in a group and home-based setting . The primary outcome measure was self-report of physical function using the Western Ontario and McMaster University Osteoarthritis Index . Other measurements included timed stair climb , distance walked in 6 minutes , strength , gait , knee pain , health-related quality of life , knee radiographs , body weight , dietary intake , and cost-effectiveness of the interventions . We report baseline data stratified by level of overweight and obesity focusing on self-reported physical function and physical performance tasks . The results from ADAPT will provide approaches clinicians should recommend for behavioral therapies that effectively reduce the incidence of disability associated with knee OA ABSTRACT Background Sarcopenic obesity is associated with disability in older people , especially in women .  Resistance exercises are recommended for this population , but their efficacy is not clear . Objective To evaluate the effects of a progressive resistance exercise program with high-speed component on the physical function of older women with sarcopenic obesity . Method Twenty-eight women 65 to 80 years old , with a body mass index ≥30kg/m2 and h and grip strength ≤21 kg were r and omly allocated to two groups . The experimental group underwent a 10-week resistance exercise program design ed to improve strength , power , and endurance of lower-limb muscles , with open chain and closed chain exercises . The control group had their health status monitored through telephone calls . The primary outcomes were lower limb muscle performance measured by knee extensor strength , power and fatigue by isokinetic dynamometry , and mobility measured by the Short Physical Performance Battery and by gait velocity . The secondary outcome was health-related quality of life assessed by the SF-36 Question naire . Results The average rate of adherence was 85 % , with few mild adverse effects . There were no significant between-group differences for any of the outcomes . Conclusion In this study , a progressive resistance exercise program with high-speed component was not effective for improving the physical function of older women with sarcopenic obesity Insufficient levels of physical activity have significant clinical consequences . Primary care setting s typically do not emphasize physical activity counseling . We describe the design , methods , and baseline characteristics of " Learning to Improve Fitness and Function in Elders , " a two-armed r and omized controlled trial that assesses whether physical activity counseling improves the physical function of older veterans . A physical activity counseling program , partially administered by primary care providers , advocating 30 min of walking 5 days a week and 15 min of lower-limb strength training 3 days a week will be compared with usual care . The multicomponent counseling program consists of yearlong ( 1 ) telephone counseling , ( 2 ) automated and in-person provider counseling , and ( 3 ) tailored mailed material s. Physical activity will be assessed with the Community Healthy Activities Model Program for Seniors . Physical function will be assessed by gait speed ( primary end point ) , 400 m walk time , chair st and s , balance tests , and self-reported physical function and disability . Self-reports of chronic illness , symptoms , pain , health-related quality of life , self-efficacy , and motivation will also be assessed . A total of 400 veterans , aged 70 to 92 , have enrolled and are currently receiving multicomponent physical activity counseling or usual care Background Functional limitations have been operationally defined for studies of rehabilitation science through measures of physical performance and patient-reported function . Although conceived as representing similar concepts , differences between these 2 modes of measuring physical functioning have not been adequately characterized scientifically . Objective The purpose of this study was to compare the Short Physical Performance Battery ( SPPB ) with the function component of the Late-Life Function and Disability Instrument ( LLFDI ) with respect to their association with physiologic factors and other psychosocial and health factors potentially influencing rehabilitative care . Design This study was a cross-sectional analysis of baseline data from a sample of community-dwelling older adults ( N=137 ) with mobility limitations enrolled in a r and omized controlled trial of exercise . Methods A performance-based measure of function ( the SPPB ) and a self-report measure of function ( the LLFDI ) served as functional outcomes . Physiologic factors included measures of leg strength , leg velocity , and exercise tolerance test ( ETT ) duration , which served as a surrogate measure of aerobic capacity . Psychosocial and health factors included age , sex , height , body mass index , number of chronic conditions , depression , and falls efficacy . Results Separate multivariable regression models predicting SPPB and LLFDI scores described 33 % and 42 % of the variance in each outcome ( R2 ) , respectively . Leg velocity and ETT duration were positively associated with both performance-based and patient-reported functional measures . Leg strength and age were positively associated with SPPB scores , whereas number of chronic conditions , sex , and falls efficacy were associated with the LLFDI scores . Limitations This study included older adults with mobility limitations and may not generalize to other population s. Conclusions Performance-based and patient-reported measures of physical function appear to assess different aspects of an older person 's functioning . The SPPB was associated with age and physiologic factors , whereas patient-reported function measured by the LLFDI was associated with these factors as well as with psychosocial and health factors Background and aims : Little is known about muscle strength as a predictor of  disability among older Mexican Americans . The aim of this study was to examine the association between h and grip strength  and 7-year incidence of ADL disability in older Mexican American men and women . Methods : A 7-year prospect i ve cohort study of 2493 non-institutionalized Mexican American men and women aged 65 or older residing in five south-western states .  Maximal h and grip strength test , body mass index , cognitive function , activities of daily living , self-reports of medical conditions ( arthritis , diabetes , heart attack , stroke , cancer , hip fracture ) , and depressive symptoms were obtained . Results : In a Cox proportional regression analysis , there was a linear relationship between h and grip strength at baseline and risk of incident ADL disability over a 7-year follow-up . Among non-disabled men at baseline , the hazard ratio of any new ADL limitation was 1.90(95 % CI 1.14–3.17 ) for those in the lowest quartile , when compared with men in the highest h and grip strength quartile , after controlling for age , marital status , medical conditions , high depressive symptoms , MMSE score , and BMI at baseline . Among non-disabled women at baseline , the hazard ratio of any new ADL limitation was 2.28 ( 95 % CI 1.59–3.27 ) for those in the lowest quartile , when compared with women in the highest h and grip strength quartile . Conclusions : H and grip strength is an independent predictor of ADL disability  among older Mexican American men and women . The h and grip strength test is an easy , reliable , valid , inexpensive method of screening to identify older adults at risk of disability
Conclusions This review provides evidence that RT has a moderate positive effect on self-reported disability/function  in old people with or at risk for disability .
The effects are strongly associated with effects on objective measures of lower body functional capacity
Background Self-reported disability has a strong negative impact on older people ’s  quality of life and is often associated with the need for assistance and health care services .
Resistance training ( RT ) has been repeatedly shown to improve muscle function ( e.g. strength ) and functional capacity ( e.g. gait speed , chair-rise ) in older adults with functional limitations .
Nevertheless , it is unclear whether such objective ly assessed improvements translate into a reduction in self-reported disability .
Objectives To assess : i ) whether and to what extent RT interventions have an effect on self-reported disability in older adults ( ≥65 years ) with functional limitations or disability ; and ii ) whether the effects on self-reported disability are associated with changes in objective measures of muscle strength and functional capacity across studies .