Effectiveness of exercise interventions on physical function in community-dwelling frail older people: an umbrella review of systematic reviews Physical activity and functional limitations in older adults: a systematic review related to Canada's Physical Activity Guidelines The effect of three different exercise training modalities on cognitive and physical function in a healthy older population Promotion of self-management in vulnerable older people: a narrative literature review of outcomes of the Chronic Disease Self-Management Program (CDSMP) Effect of physical interventions on physical performance and physical activity in older patients during hospitalization: a systematic review Exercise and well-being: a review of mental and physical health benefits associated with physical activity Walking football as sustainable exercise for older adults – A pilot investigation Aerobic and Cognitive Exercise (ACE) Pilot Study for Older Adults: Executive Function Improves with Cognitive Challenge While Exergaming. Physical activity outcomes of CHAMPS II: a physical activity promotion program for older adults. Benefits of physical exercise training on cognition and quality of life in frail older adults. Physical activity and mental well-being in older people participating in the Better Ageing Project Exercise: effects on physical functional performance in independent older adults. Impact of aerobic exercise on neurobehavioral outcomes. Effects of combined physical and cognitive training on fitness and neuropsychological outcomes in healthy older adults Prevalence of Physical Activity in the United States: Behavioral Risk Factor Surveillance System, 2001 The Effectiveness of Exercise Interventions for the Management of Frailty: A Systematic Review Exercise for fall risk reduction in community-dwelling older adults: a systematic review. Impact of an exercise intervention on physical activity during pregnancy: the behaviors affecting baby and you study. Exercise is medicine, for the body and the brain Promoting exercise behavior in older adults: using a cognitive behavioral intervention. Comparative effects of two physical activity programs on measured and perceived physical functioning and other health-related quality of life outcomes in older adults. Exercise Is Associated with Reduced Risk for Incident Dementia among Persons 65 Years of Age and Older Effect of a Dual-Task Net-Step Exercise on Cognitive and Gait Function in Older Adults Home-Based Exercise in Older Adults Recently Discharged From the Hospital for Cardiovascular Disease in China: Randomized Clinical Trial A 12-Week Physical and Cognitive Exercise Program Can Improve Cognitive Function and Neural Efficiency in Community-Dwelling Older Adults: A Randomized Controlled Trial. Predictive ability of social cognitive theory in exercise research: an integrated literature review. Group-mediated activity counseling and traditional exercise therapy programs: Effects on health-related quality of life among older adults in cardiac rehabilitation The Mental Activity and eXercise (MAX) trial: a randomized controlled trial to enhance cognitive function in older adults. The effects of exercise on cognition in Parkinson’s disease: a systematic review Changes in cognitive function in a randomized trial of physical activity: results of the lifestyle interventions and independence for elders pilot study. Energy Cost of Single‐Set Resistance Training in Older Adults Recommended Measures for the Assessment of Cognitive and Physical Performance in Older Patients with Dementia: A Systematic Review A randomized controlled clinical trial of the Seattle Protocol for Activity in older adults. Change in health-related quality of life and social cognitive outcomes in obese, older adults in a randomized controlled weight loss trial: Does physical activity behavior matter? Neuropsychological Benefits of Neuro-Exergaming for Older Adults: A Pilot Study of an Interactive Physical and Cognitive Exercise System (iPACES). Effect of a 24-Month Physical Activity Intervention vs Health Education on Cognitive Outcomes in Sedentary Older Adults: The LIFE Randomized Trial. Physical fitness and psychological benefits of strength training in community dwelling older adults.
Objectives : This umbrella review aim ed to determine the effectiveness of exercise interventions , alone or in combination with other interventions , in improving physical function in community-dwelling older people identified as pre-frail or frail . Introduction : Exercise is said to have a positive impact on muscle mass and strength which improves physical function and hence is beneficial for the treatment of frailty . Several systematic review s discuss the effects of exercise interventions on physical function parameters , such as strength , mobility , gait , balance and physical performance , and indicate that multi-component exercise , including resistance , aerobic , balance and flexibility training , appears to be the best way in which to improve physical function parameters in frail older people . However , there is still uncertainty as to which exercise characteristics ( type , frequency , intensity , duration and combinations ) are the most effective and sustainable over the long-term . Inclusion criteria : Participants were adults , 60 years or over , living in the community and identified as pre-frail or frail . Quantitative systematic review s , with or without meta- analysis that examined the effectiveness of exercise interventions of any form , duration , frequency and intensity , alone or in combination with other interventions design ed to alter physical function parameters in frail older people , were considered . The quantitative outcome measures were physical function , including muscular strength , gait , balance , mobility and physical performance . Methods : An iterative search strategy for ten bibliometric data bases and gray literature was developed . Critical appraisal of seven systematic review s was conducted independently by two review ers using a st and ard Joanna Briggs Institute tool . Data was extracted independently by two review ers using a st and ard Joanna Briggs Institute data extraction tool and summarized using a narrative synthesis approach . Results : Seven systematic review s were included in this umbrella review , with a total of 58 relevant r and omized controlled trials and 6927 participants . Five systematic review s examined the effects of exercise only , while two systematic review s reported on exercise in combination with a nutritional approach , including protein supplementations , as well as fruit and dairy products . The average  exercise frequency was 2–3 times per week ( mean 3.0 ± 1.5 times per week ; range 1–7 weekly ) for 10–90 minutes per session ( mean of 52.0 ± 16.5 mins ) and a total duration of 5–72 weeks with the majority lasting a minimum of 2.5 months ( mean 22.7 ± 17.7 weeks ) . Multi-component exercise interventions can currently be recommended for pre-frail and frail older adults to improve muscular strength , gait speed , balance and physical performance , including resistance , aerobic , balance and flexibility tasks . Resistance training alone also appeared to be beneficial , in particular for improving muscular strength , gait speed and physical performance . Other types of exercise were not sufficiently studied and their effectiveness is yet to be established . Conclusions : Interventions for pre-frail and frail older adults should include multi-component exercises , including in particular resistance training , as well as aerobic , balance and flexibility tasks . Future research should adopt a consistent definition of frailty and investigate the effects of other types of exercise alone or in combination with nutritional interventions so that more specific recommendations can be made Background The purpose was to conduct systematic review s of the relationship between physical activity of healthy community-dwelling older ( > 65 years ) adults and outcomes of  functional limitations , disability , or loss of independence .  Methods Prospect i ve cohort studies with an outcome related to functional independence or to cognitive function  were search ed , as well as exercise training interventions that reported a functional outcome . Electronic data base search strategies were used to identify citations which were screened ( title and abstract ) for inclusion . Included articles were review ed to complete st and ardized data extraction tables , and assess study quality . An established system of assessing the level and grade of evidence for recommendations was employed . Results Sixty-six studies met inclusion criteria for the relationship between physical activity and functional independence , and 34 were included with a cognitive function outcome . Greater physical activity of an aerobic nature ( categorized by a variety of methods ) was associated with higher functional status ( expressed by a host of outcome measures ) in older age . For functional independence , moderate ( and high ) levels of physical activity appeared effective in conferring a reduced risk ( odds ratio ~0.5 ) of functional limitations or disability . Limitation in higher level performance outcomes was reduced ( odds ratio ~0.5 ) with vigorous ( or high ) activity with an apparent dose-response of moderate through to high activity . Exercise training interventions ( including aerobic and resistance ) of older adults showed improvement in physiological and functional measures , and suggestion of longer-term reduction in incidence of mobility disability . A relatively high level of physical activity was related to better cognitive function and reduced risk of developing dementia ; however , there were mixed results of the effects of exercise interventions on cognitive function indices . Conclusions There is a consistency of findings across studies and a range of outcome measures related to functional independence ; regular aerobic activity and short-term exercise programmes confer a reduced risk of functional limitations and disability in older age . Although a precise characterization of a minimal or effective physical activity dose to maintain functional independence is difficult , it appears moderate to higher levels of activity are effective and there may be a threshold of at least moderate activity for significant outcomes Background Older adults are encouraged to participate in regular physical activity to counter the age-related declines in physical and cognitive health . Literature on the effect of different exercise training modalities ( aerobic vs resistance ) on these health-related outcomes is not only sparse , but results are inconsistent . In general , it is believed that exercise has a positive effect on executive cognitive function , possibly because of the physiological adaptations through increases in fitness . Indications are that high-intensity interval training is a potent stimulus to improve cardiovascular fitness , even in older adults ; however , its effect on cognitive function has not been studied before . Therefore , the purpose of this study was to compare the effects of resistance training , high-intensity aerobic interval training and moderate continuous aerobic training on the cognitive and physical functioning of healthy older adults . Methods Sixty-seven inactive individuals ( 55 to 75 years ) were r and omly assigned to a resistance training ( RT ) group ( n = 22 ) , high-intensity aerobic interval training ( HIIT ) group ( n = 13 ) , moderate continuous aerobic training ( MCT ) group ( n = 13 ) and a control ( CON ) group ( n = 19 ) for a period of 16 weeks . Cognitive function was assessed with a Stroop task and physical function with the Timed-Up- and -Go ( TUG ) and submaximal Bruce treadmill tests . Results No significant GROUP x TIME interaction was found for Stroop reaction time ( P > .05 ) . The HIIT group showed the greatest practical significant improvement in reaction time on the information processing task , i.e. Stroop Neutral ( ES = 1.11 ) . MCT group participants had very large practical significant improvements in reaction time on the executive cognitive tasks , i.e. Stroop Incongruent and Interference ( ES = 1.28 and 1.31 , respectively ) . The HIIT group showed the largest practically significant increase in measures of physical function , i.e. walking endurance ( ES = 0.91 ) and functional mobility ( ES = 0.36 ) . Conclusions MCT and RT proved to be superior to HIIT for the enhancement of older individuals ’ executive cognitive function ; whereas HIIT were most beneficial for improvement in information processing speed . HIIT also induced the largest gains in physical function With ageing , older people can become frail , and this has been shown to be associated with a decrease in well-being . Observational studies provide evidence of a positive effect of coping re sources on well-being . The question is : can coping re sources be improved in vulnerable older people ? The Chronic Disease Self-Management Program ( CDSMP ) is a target group-specific intervention which aims to promote the self-management of older people who are confronted with deteriorating health . The aim of this study was to review intervention studies focusing on the CDSMP and to draw conclusions on the benefits of the program . A systematic search was conducted in PubMed and PsychINFO to identify r and omized controlled trials ( RCTs ) focusing on the CDSMP .  Nine RCTs focusing on relatively young older adults , 75 % of whom with an average age between 49 and 65 years , were included . We found that the CDSMP was consistently beneficial for Health behaviour , especially with regard to the variables of exercise and self-care . For Health status , the majority of studies only showed improvement in the domain of health distress . Most of the studies that investigated Self-efficacy showed convincing improvement in self-efficacy , cognitive symptom management and mental stress management . In Health care utilization , there was no significant decrease . On the whole , the studies showed that CDSMP led to an increase in physical exercise , a decrease in health distress , an improvement in self-care , and it had a beneficial effect on self-efficacy Background To counteract decline in physical performance and physical activity in older patients during hospitalization , multiple physical interventions were developed . However , it is unknown whether these are effective in this particular population . This systematic review aim ed to identify the effect of physical interventions on physical performance and physical activity in older patients during hospitalization . Methods The systematic search included PubMed , EMBASE , Cinahl , the Trials data base of The Cochrane Library and SPORTd iscus from inception to 22 November 2017 . Studies were included if the mean age of the patient cohort was 65 years and older and the effect of physical interventions on  physical performance or physical activity  was evaluated during hospitalization . Results Fifteen r and omized controlled trials met the inclusion criteria . Overall , the effect of physical interventions on physical performance was inconsistent . Patient tailored interventions , i.e. continuously adapted to the capabilities of the patient were not found to be superior over interventions that were not . Physical activity as outcome measure was not addressed . Reporting of intensity of the interventions and adherence were frequently lacking . Conclusions Evidence for the effect of physical interventions on physical performance in older patients during hospitalization was found uncertain . Further research on the efficacy of the intervention is needed , comparing types of intervention with detailed reporting of frequency , intensity and duration Purpose of review This review highlights recent work evaluating the relationship between exercise , physical activity and physical and mental health . Both cross-sectional and longitudinal studies , as well as r and omized clinical trials , are included . Special attention is given to physical conditions , including obesity , cancer , cardiovascular disease and sexual dysfunction . Furthermore , studies relating physical activity to depression and other mood states are review ed . The studies include diverse ethnic population s , including men and women , as well as several age groups ( e.g. adolescents , middle-aged and older adults ) . Recent findings Results of the studies continue to support a growing literature suggesting that exercise , physical activity and physical-activity interventions have beneficial effects across several physical and mental-health outcomes . Generally , participants engaging in regular physical activity display more desirable health outcomes across a variety of physical conditions . Similarly , participants in r and omized clinical trials of physical-activity interventions show better health outcomes , including better general and health-related quality of life , better functional capacity and better mood states . Summary The studies have several implication s for clinical practice and research . Most work suggests that exercise and physical activity are associated with better quality of life and health outcomes . Therefore , assessment and promotion of exercise and physical activity may be beneficial in achieving desired benefits across several population s. Several limitations were noted , particularly in research involving r and omized clinical trials . These trials tend to involve limited sample sizes with short follow-up periods , thus limiting the clinical implication s of the benefits associated with physical activity . Abbreviations CAD : coronary artery disease ; COPD : chronic obstructive pulmonary disease ; CRP : cardiac rehabilitation program ; CVD : cardiovascular disease ; GMCB : group-mediated cognitive – behavioural ; HRQOL : health-related quality of life Abstract The health benefits of playing football and the importance of exercise and social contact for healthy ageing are well established , but few older adults in the UK take enough exercise . Football is popular , flexible in format and draws players into engrossing , effortful and social exercise , but the physical dem and s of play at full speed may make it unsustainable for some older adults . Restricted to walking pace , will play still be engaging ? Will health benefits be retained ? Will physical dem and s remain manageable ? This pilot study aims to investigate : ( 1 ) the experience of older adults playing walking football  every week , is it sustainable and rewarding , ( 2 ) the intensity and locomotor pattern of walking football , ( 3 ) the scale and nature of walking football  health benefits and ( 4 ) possible cognitive benefits of playing walking football through measures of processing speed , selective and divided attention and updating and inhibition components of executive function .  ‘ Walking football ’ and ‘ waiting list ’ groups were compared before and after 12 weeks of one-hour per week football . Walking football was found to be engaging , sustainable for older adults and moderately intensive ; however , selective health and cognitive benefits were not found from this brief intervention . Highlights Walking football is a lower impact but authentic form of football that enables older players to extend their active participation . Walking football is enjoyable and moderately dem and ing and may be a sustainable form of exercise for older adults . Health and cognitive benefits to playing walking football were not found Dementia cases are increasing worldwide ; thus , investigators seek to identify interventions that might prevent or ameliorate cognitive decline in later life . Extensive research confirms the benefits of physical exercise for brain health , yet only a fraction of older adults exercise regularly . Interactive mental and physical exercise , as in aerobic exergaming , not only motivates , but has also been found to yield cognitive benefit above and beyond traditional exercise . This pilot study sought to investigate whether greater cognitive challenge while exergaming would yield differential outcomes in executive function and generalize to everyday functioning . Sixty-four community based older adults ( mean age=82 ) were r and omly assigned to pedal a stationary bike , while interactively engaging on-screen with : ( 1 ) a low cognitive dem and task ( bike tour ) , or ( 2 ) a high cognitive dem and task ( video game ) .  Executive function ( indices from Trails , Stroop and Digit Span ) was assessed before and after a single-bout and 3-month exercise intervention . Significant group × time interactions were found after a single-bout ( Color Trails ) and after 3 months of exergaming ( Stroop ; among 20 adherents ) . Those in the high cognitive dem and group performed better than those in the low cognitive dose condition . Everyday function improved across both exercise conditions . Pilot data indicate that for older adults , cognitive benefit while exergaming increased concomitantly with higher doses of interactive mental challenge BACKGROUND Despite well-known benefits of physical activity for older adults , about two thirds are underactive . Community-based programs are needed to facilitate increased physical activity . We examine the effectiveness of CHAMPS II , an inclusive , choice-based physical activity promotion program to increase lifetime physical activity levels of seniors . CHAMPS guided participants to choose activities that took into account their health , preferences , and abilities . It offered information on ways for them to exercise safely , motivate themselves , overcome barriers , and develop a balanced exercise regimen . METHODS A 1-year r and omized controlled trial was conducted with physically underactive seniors in a multispecialty group practice . Changes in self-reported physical activity by group were evaluated using ANCOVA , controlling for age and sex . RESULTS Of 173 r and omized subjects , 164 ( 95 % ) completed the trial . Subjects were aged 65 to 90 years ( M = 74 , SD = 6 ) ; 66 % were female . The intervention group increased estimated caloric expenditure by 487 calories/week in moderate ( or greater ) intensity activities ( MET > /= 3.0 ; p < .001 ) and by 687 calories/week in physical activities of any intensity ( p < .001 ) . Control group changes were negligible . Between-group analyses found that the changes were significantly different in both measures ( p values < .05 ) . Overweight persons especially benefited from this program . The program was as effective for women , older adults ( 75 + ) , and those who did not set aside time to exercise at baseline . CONCLUSIONS The program led to meaningful physical activity increases . Individually tailored programs to encourage lifestyle changes in seniors may be effective and applicable to health care and community setting OBJECTIVES Frailty is a state of vulnerability associated with increased risks of fall , hospitalization , cognitive deficits , and psychological distress . Studies with healthy senior suggest that physical exercise can help improve cognition and quality of life . Whether frail older adults can show such benefits remains to be documented . METHOD A total of 83 participants aged 61 - 89 years were assigned to an exercise-training group ( 3 times a week for 12 weeks ) or a control group ( waiting list ) . Frailty was determined by a complete geriatric examination using specific criteria . Pre- and post-test measures assessed physical capacity , cognitive performance , and quality of life . RESULTS Compared with controls , the intervention group showed significant improvement in physical capacity ( functional capacities and physical endurance ) , cognitive performance ( executive functions , processing speed , and working memory ) , and quality of life ( global quality of life , leisure activities , physical capacity , social/family relationships , and physical health ) . Benefits were overall equivalent between frail and nonfrail participants . DISCUSSION Physical exercise training leads to improved cognitive functioning and psychological well-being in frail older adults Increasing evidence suggests that physical activity can prevent some aspects of mental illness in older people such as depression , dementia and Alzheimer ’s disease . Additionally , limited research has shown that engagement in structured exercise can improve aspects of psychological well-being such as mood and self-perceptions in older adults . However , the relationship between incidental daily activity such as walking or time spent sedentary , with psychological well-being has not been investigated . The Better Ageing Project provided an opportunity to assess well-being and quality of life using st and ardised question naires with 176 adults aged 70 and over .  Accelerometry was used to objective ly assess daily energy expended in physical activity at different levels of intensity . In addition , an assessment of the impact of the 12-month Better Ageing structured group exercise programme was assessed through question naires and interviews . Total daily physical activity energy expenditure ( joules/day ) and amount of time spent in activity of at least moderate intensity were weakly related ( r = 0.20–0.28 ) to quality of life , subjective well-being and physical self-perceptions . Time spent sedentary ( min/day ) was weakly and negatively related to several mental health indicators . The quantitative data showed only minor psychological benefits of the exercise intervention . In contrast , interviews with 27 research participants and 4 exercise leaders suggested that important improvements in perceived function and social benefits had been experienced BACKGROUND Age-related loss in physiologic capacities contributes to the decline in physical function in the elderly population . Despite the beneficial effects of exercise interventions on maximal physiologic capacity measures , the functional benefits have not been shown in independently living older adults . The objective of this study was to evaluate exercise in independent older adults for significant and meaningful improvements in physical function , not detected by commonly used measures of physical function . METHODS In a r and omized controlled study , 49 independently living men and women were assigned to either a nonexercise control group ( Control ; n = 26 ) or an exercise training group ( Exercise ; n = 23 ) . Participants ( age = 76+/-4 ) in good general health were recruited from retirement communities or apartments . The combined endurance and strength training was performed at 75 % to 80 % intensity ; the groups met 3 times/week for 6 months of supervised sessions . Outcome measures included physical capacity , health status , and physical function using a newly developed performance test -- the Continuous Scale-Physical Functional Performance test ( CS-PFP ) . RESULTS Compared to the Control group , the Exercise group showed significant increases in maximal oxygen consumption ( 11 % ) and muscle strength ( 33 % ) . No significant differences were found between groups for changes in the Sickness Impact Profile , SF-36 scales , or the 6-minute walk . However , the CS-PFP score improved significantly in the Exercise group ( 14 % , effect size 0.80 ) . CONCLUSIONS Independent older adults gain meaningful functional benefits from several months of exercise training . The public health importance of physical activity may relate not just to its role in preventing decline , but also to its role in enhancing physical function Numerous studies have examined the relationship between physical activity and cognitive function , demonstrating that greater physical activity is associated with lower incidence of cognitive impairment in later life . Due to an increasingly large number of older adults at risk for cognitive impairment , the relationship between physical activity and cognition has garnered increasing public health relevance and multiple r and omized trials have demonstrated that exercise interventions among sedentary adults improve cognitive performance in multiple domains of function . This article will examine the relationship between physical activity and cognitive function by review ing several different areas of literature , including the prevalence of cognitive impairment , assessment methods , observational studies examining physical activity and cognition , and intervention studies . The present review is intended to provide a historical tutorial of existing literature linking  physical activity , exercise , and cognitive function among both healthy and clinical population Purpose Physical exercise and cognitive training have been shown to enhance cognition among older adults . However , few studies have looked at the potential synergetic effects of combining physical and cognitive training in a single study . Prior trials on combined training have led to interesting yet equivocal results . The aim of this study was to examine the effects of combined physical and cognitive interventions on physical fitness and neuropsychological performance in healthy older adults . Methods Seventy-six participants were r and omly assigned to one of four training combinations using a 2 × 2 factorial design . The physical intervention was a mixed aerobic and resistance training program , and the cognitive intervention was a dual-task ( DT ) training program . Stretching and toning exercises and computer lessons were used as active control conditions  . Physical and cognitive measures were collected pre- and postintervention . Results All groups showed equivalent improvements in measures of functional mobility . The aerobic – strength condition led to larger effect size in lower body strength , independently of cognitive training . All groups showed improved speed of processing and inhibition abilities , but only participants who took part in the DT training , independently of physical training , showed increased task-switching abilities . The level of functional mobility after intervention was significantly associated with task-switching abilities . Conclusion Combined training did not yield synergetic effects . However , DT training did lead to transfer effects on executive performance in neuropsychological tests . Both aerobic-resistance training and stretching-toning exercises can improve functional mobility in older adults Introduction The health benefits of regular cardiovascular exercise are well-known . Such exercise , however , has traditionally been defined as vigorous physical activity , such as jogging , swimming , or aerobic dance . Exercise of moderate intensity also promotes health , and many U.S. adults may be experiencing the health benefits of exercise through lifestyle activities of moderate intensity , such as yard work , housework , or walking for transportation . Until recently , public health surveillance systems have not included assessment s of this type of physical activity , focusing on exercise of vigorous intensity . We used an enhanced surveillance tool to describe the prevalence and amount of both moderate-intensity and vigorous-intensity physical activity among U.S. adults . Methods We analyzed data from the 2001 Behavioral Risk Factor Surveillance System , a state-based , r and om-digit  – dialed telephone survey administered to U.S. adults aged 18 years and older ( n = 82,834 men and 120,286 women ) .  Physical activity behavior was assessed using questions design ed to quantify the frequency of participation in moderate- or vigorous-intensity physical activities performed during leisure time or for household chores and transportation . Results Overall , 45 % of adults ( 48 % of men and 43 % of women ) were active at recommended levels during nonworking hours ( at least 30 minutes five or more days per week in moderate-intensity activities , equivalent to brisk walking , or at least 20 minutes three or more days per week in vigorous activities , equivalent to running , heavy yard work , or aerobic dance ) . Less than 16 % of adults ( 15 % of men and 17 % of women ) reported no moderate or vigorous activity in a usual week . Conclusion Integrating surveillance of lifestyle activities into national systems is possible , and doing so may provide a more accurate representation of the prevalence of recommended levels of physical activity . These results , however , suggest that the majority of U.S. adults are not active at levels associated with the promotion and maintenance of health This systematic review examines the effectiveness of current exercise interventions for the management of frailty . Eight electronic data bases were search ed for r and omized controlled trials that identified their participants as “ frail ” either in the title , abstract , and /or text and included exercise as an independent component of the intervention . Three of the 47 included studies utilized a vali date d definition of frailty to categorize participants . Emerging evidence suggests that exercise  has a positive impact on some physical determinants and on all functional ability outcomes reported in this systematic review . Exercise programs that optimize the health of frail older adults seem to be different from those recommended for healthy older adults . There was a paucity of evidence to characterize the most beneficial exercise program for this population . However , multicomponent training interventions , of long duration ( ≥5 months ) , performed three times per week , for 30–45 minutes per session , generally had superior outcomes than other exercise programs . In conclusion , structured exercise training seems to have a positive impact on frail older adults and may be used for the management of frailty PURPOSE To evaluate the influence of exercise on falls and fall risk reduction  in community-dwelling older adults and to present an up date d synthesis of outcome measures for the assessment of fall risk in community-dwelling older adults . METHOD A systematic review was performed , considering English- language articles published from 2000 to 2006 and accessible through MEDLINE , CINAHL , PEDro , EMBASE , and /or AMED . Included were r and omized controlled clinical trials ( RCTs ) that used an exercise or physical activity intervention and involved participants over age 50 . Screening and method ological quality for internal validity were conducted by two independent review ers . RESULTS The search retrieved 156 abstract s ; 22 articles met the internal validity criteria . Both individualized and group exercise programmes were found to be effective in reducing falls and fall risk . The optimal type , frequency , and dose of exercise to achieve a positive effect have not been determined . A variety of outcome measures have been used to measure fall risk , especially for balance . CONCLUSIONS Falls and fall risk can be reduced with exercise interventions in the community-dwelling elderly , although the most effective exercise variables are unknown . Future studies in population s with comorbidities known to increase fall risk will help determine optimal , condition-specific fall-prevention programmes . Poor balance is a key risk factor for falls ; therefore , the best measure of this variable should be selected when evaluating patients at risk of falling OBJECTIVES We examined the impact of a prenatal exercise intervention on physical activity in 260 women at risk for gestational diabetes mellitus . METHODS We r and omized participants in the Behaviors Affecting Baby and You ( BABY ) Study , which took place from 2007 to 2012 , to either a 12-week individually tailored , motivationally matched exercise intervention ( n=132 ) or to a comparison health and wellness intervention ( n=128 ) . We assessed physical activity with the Pregnancy Physical Activity Question naire . We used linear mixed models to evaluate the impact of the interventions on change in physical activity according to intensity and type , total walking , and sedentary behavior . RESULTS Compared with the health and wellness arm , the exercise arm had significantly greater increases in sports or exercise activity ( 0.3 vs 5.3 metabolic equivalent of task [ MET ] hours/week ; P<.001 ) , and smaller declines in total activity ( -42.7 vs -2.1 MET hours/week ; P=.02 ) and activities of moderate to vigorous intensity ( -30.6 vs -10.6 MET hours/week ; P=.05 ) , and was more likely to achieve recommended guidelines for physical activity ( odds ratio=2.12 ; 95 % confidence interval=1.45 , 3.10 ) . CONCLUSIONS These findings extend the previous literature by demonstrating the benefits of a clinical ly feasible exercise intervention in an ethnically and socio-economically diverse population . Given the increased risk of adverse maternal health outcomes in ethnic minority groups , these findings may have important implication s for reducing health disparities Cognitive decline is one of the most pressing healthcare issues of the 21st century . Worldwide , one new case of major cognitive decline ( ie , dementia ) is detected every 4 s.1 Given that no effective pharmacological treatment to alter the progress of cognitive decline exists , there is much interest in lifestyle approaches for preventing or treating dementia . Ideally , such strategies should be cost-efficient and widely accessible at a societal level to have the largest benefit for older adults with varying income and functional status levels . One attractive solution that aligns with the above criteria is exercise . However , despite a large and consistent pool of evidence generated over the past five decades linking exercise to improved cognitive functions in older adults,2 there is a reluctance among academics , healthcare practitioners and the public alike to embrace exercise as a prevention and treatment strategy for cognitive decline . For example , the National Institutes of Health ( NIH ) consensus statement from 20103 concedes that there appears to be preliminary data to support the efficacy of exercise in improving cognitive function . However , they caution that there is currently no strong evidence to suggest that modifiable lifestyle factors can alter the trajectory of cognitive decline . Adding fuel to the fire are publications such as a 2013 systematic review of r and omised controlled trials ( RCTs ) ( prior to 31 October 2011 ) reporting ‘ weak ’ evidence for the effects of exercise on cognition.4 We must highlight that the search strategy used in that systematic review failed to capture many pertinent papers providing evidence from RCTs that exercise  promotes cognitive and brain plasticity not only in healthy older adults but also in those with cognitive impairment . Furthermore , there are a number of animal studies that provide insight into the molecular and cellular mechanisms by which exercise  promotes neuroplasticity.5 In a previous commentary , Health benefits associated with exercise are only obtained when exercise is maintained . The purpose of this pilot study was to examine the effects of a cognitive behavioral therapy ( CBT ) intervention on exercise behavior and physical outcomes in older adults . All participants were taught progressive flexibility , strength , and endurance exercises . The control group received no additional treatment . The experimental group was taught to recognize negative thoughts related to exercise and to counter these thoughts with more positive ones . Subsequent exercise behavior and physical outcomes were measured in all participants . Cognitive behavioral therapy was moderately to largely effective in improving the majority of physical outcomes assessed . In addition , CBT was moderately effective in improving several components of self-reported exercise behavior and mildly effective in improving exercise behavior overall . Results suggest that nurses can train older adults to identify and modify thoughts that interfere with or reduce their exercise behavior and thus improve physical functioning BACKGROUND Although inactivity is an important contributor to impaired functioning and disability with age , little is known concerning how improvements in physical functioning and well-being in older adults vary with the type of physical activity undertaken . METHODS One hundred three adults age 65 years and older , recruited via population -based methods , were r and omized to 12 months of community-based , moderate-intensity endurance and strengthening exercises ( Fit & Firm ) or stretching and flexibility exercises ( Stretch & Flex ) . A combination of class- and home-based exercise formats was used . Measured and self-rated physical performance along with perceived functioning and well-being were assessed pre- and postintervention . RESULTS Fit & Firm subjects showed greater 12-month improvements in both measured and self-rated endurance and strength compared to Stretch & Flex subjects . Stretch & Flex subjects reported greater improvements in bodily pain , and Stretch & Flex men evidence d greater improvements in flexibility relative to Fit & Firm subjects . Although overall exercise adherence was high in both exercise conditions ( approximately 80 % ) , subjects in both conditions showed better adherence to the home- versus class-based portions of their exercise prescriptions . CONCLUSIONS Community-based programs focusing on moderate-intensity endurance and strengthening exercises or flexibility exercises can be delivered through a combination of formats that result in improvement in important functional and well-being outcomes . This represents one of the first studies to report significant improvements in an important quality of life outcome -bodily pain-with a regular regimen of stretching and flexibility exercises in a community-based sample of older adults Context Some studies suggest that people with high levels of physical activity are less likely to develop dementia . Content All 1740 participants in this cohort study were 65 years of age or older and were cognitively intact at baseline . Over 6.2 years , the rate of dementia was 13.0 per 1000 person-years in those who exercised 3 or more times per week and 19.7 per 1000 person-years in those who exercised less than 3 times per week . Limitations The only measure of exercise intensity was self-reported frequency . The cohort was largely white and well-educated . Implication s This study adds to the evidence that regular exercise is associated with a lower risk for dementia . However , the existing evidence does not prove that regular exercise is associated with a lower dementia risk . The Editors Alzheimer disease and other dementing illnesses are major sources of morbidity and mortality ( 1 - 3 ) that affect millions of persons in the increasingly aging society of the United States . Research design ed to discover strategies to delay onset and progression of these potentially devastating illnesses is ongoing worldwide . Effective prevention strategies would result in substantial benefits through improved quality of life , prolonged independent life expectancy , and reduced economic cost and social burdens .  Regular physical exercise is an important element in overall health promotion ( 4 ) and might also be an effective strategy to delay onset of dementia ( 5 ) . A biological basis for how physical exercise might preserve brain function includes improved cerebral blood flow and oxygen delivery ( 6 ) and inducing fibroblast growth factor in the hippocampus ( 7 ) . More recent evidence suggests that reduced loss of hippocampal brain tissue in the aging brain is related to level of physical fitness ( 8) . Evidence from some longitudinal studies and r and omized trials suggests that physical exercise enhances cognitive function in older adults ( 9 - 15 ) , whereas other studies have failed to observe the benefits of physical exercise in preserving cognitive function ( 16 - 19 ) . Many people regard Alzheimer disease as one of the most dreaded consequences of aging . If regular physical exercise were shown to be effective in reducing the risk or delaying the onset of dementing illnesses , it would be another compelling reason to promote physical exercise . Few population -based longitudinal studies have examined the role of physical exercise on the risk for dementia in elderly persons . One recent longitudinal study showed that physical exercise was associated with decreased risk for decline in cognitive function ( odds ratio [ OR ] , 0.58 ) , Alzheimer disease ( OR , 0.50 ) , and any dementia ( OR , 0.63 ) ( 11 ) , whereas another longitudinal study showed no association between physical exercise and dementia ( 16 ) . More recent studies showed that walking was associated with a reduced risk for dementia and Alzheimer disease in a cohort of Japanese-American men ( 20 ) and that engaging in more diverse physical activities was associated with a reduced risk for dementia in the Cardiovascular Health Study ( 21 ) . The purpose of this study was 2-fold : 1 ) to determine whether regular exercise is associated with a reduced risk for incidence of dementia ( in particular , Alzheimer disease ) in a cohort followed biennially over 6 years and 2 ) to examine whether the association of physical exercise with incident dementia is modulated by other potential risk factors , such as depression , cardiovascular and cerebrovascular disease , diabetes , apolipoprotein E 4 allele , cognitive function , physical function , self-rated health , and lifestyle characteristics . Methods Study Sample The Adult Changes in Thought ( ACT ) study is a population -based , longitudinal study of aging and dementia . The ACT study was design ed to determine the incidence of Alzheimer disease , other types of dementia , and cognitive impairment as well as to determine risk factors for these conditions . The details of the ACT study have been described elsewhere ( 22 , 23 ) . Briefly , a r and om sample of 6782 individuals was drawn from Seattle-area members of Group Health Cooperative ( GHC ) , a consumer-governed health maintenance organization . The participants were 65 years of age and older when the study began in 1994 to 1996 . Those who had an existing diagnosis of dementia , were current residents of a nursing home , or were participating in other studies were ineligible ( n= 1360 ) . Of 5422 eligible persons , 2581 participated and 2841 declined participation . Age , sex , and ethnicity of the remaining 2581 participants did not differ significantly from those who were excluded . Nonresponse has been described elsewhere ( 22 ) . Declining to participate was more common among the oldest age group ( > 85 years ) , women , and African-American and minority groups ( 22 ) . Additional details regarding the incident rates of dementia and Alzheimer disease from the ACT study have been published elsewhere and are consistent with rates reported in U.S. and European cohort studies ( 22 ) . The institutional review boards of the University of Washington and Group Health Cooperative approved the ACT study . Participants received the  Cognitive Ability Screening Instrument ( CASI ) ( 24 ) as initial screening for cognitive function and were interviewed with structured question naires to obtain data , including demographic characteristics , medical history , memory and general functioning , and potential epidemiologic risk factors . Persons scoring 86 or higher on the CASI were entered directly into the ACT cohort as being cognitively intact . ( The CASI scores range from 0 to 100 ; a score of 86 corresponds to a Mini-Mental State Examination score of 25 to 26 . ) Persons with a score lower than 86 had additional medical record review and st and ardized clinical and neuropsychological evaluation for dementia . Persons who did not meet established criteria for dementia ( 25 ) were included in the ACT cohort . The current study sample was selected from the 2581 ACT participants to examine the temporal relationship of physical exercise preceding development of dementia . By design , we selected the 1895 persons whose CASI scores were above the 25th percentileCASI scores 91 to 100 . We excluded 686 persons whose CASI scores were in the lowest quartileCASI scores 62 to 90because the lowest quartile group might include persons who had mild cognitive impairment or impending dementia ( 26 ) . We did not collect information about the history of exercise before the participants entered the study . Therefore , in the group with low CASI scores , we could not be certain whether a reported low level of physical exercise preceded the development of dementia or was a consequence of the development of cognitive impairment or dementia . Of 1895 participants selected , 155 withdrew after the baseline visit and did not have a follow-up examination and were thus excluded from the analyses , leaving the analytic sample of 1740 persons . Incident Dementia We conducted biennial examinations to identify cases of incident dementia , when participants were rescreened with the CASI . Those who scored 86 or higher on the CASI remained in the ACT cohort . Scores on the CASI that were less than 86 at follow-up prompted a full st and ardized clinical examination . The results of rescreening by the CASI and by the clinical and neuropsychological examinations were review ed at a consensus diagnosis conference that included at least the examining physician , a neuropsychologist , another study physician , and the study nurse . Persons who did not meet the criteria for dementia were considered as not having dementia and were followed in the ACT cohort ( 22 , 23 ) . Persons who met the Diagnostic and Statistical Manual of Mental Disorders , fourth edition ( DSM-IV ) , criteria ( 25 ) for dementia were considered to have incident dementia . Dementia type was determined by the National Institute of Neurological and Communicative Diseases and Stroke-Alzheimer 's Disease and Related Disorders Association ( NINCDS-ADRDA ) criteria ( 27 ) for Alzheimer disease and by the DSM-IV criteria ( 25 ) for other types of dementia . Level of physical activity was not considered at the consensus conference . Physical Exercise Physical exercise was assessed at baseline by asking participants the number of days per week they did each of the following activities for at least 15 minutes at a time during the past year : walking , hiking , bicycling , aerobics or calisthenics , swimming , water aerobics , weight training or stretching , or other exercise . The frequency of exercise was calculated by the times per week that participants engaged in any of these forms of exercise . In this study , persons who exercised at least 3 times a week , above the lowest quartile , were classified as exercising regularly . Baseline Variables as Potential Confounders Numerous factors may influence the relationship between exercise and risk for dementia , including physical functioning , cognitive function , depression , health conditions , and lifestyle characteristics . Physical function was assessed by a performance-based physical function ( PPF ) test ( 23 ) , which consisted of 4 performance tests : 10-foot timed walk , time to st and from a seated position in a chair to a st and ing position 5 times , balance test , and grip strength in the dominant h and . Each test was scored from 0 to 4 points . The final PPF score was the sum of the scores for the 4 performance tests and ranged from 0 to 16 ; higher scores indicated better physical function . Details of the PPF test have been reported elsewhere ( 23 ) . Cognitive function was assessed by using the CASI , which provides quantitative assessment of attention , concentration , orientation , short-term memory , long-term memory , language ability , visual construction , list-generating fluency , abstract ion , and judgment ( 24 ) . At baseline , depression was measured by using the 11-item Center for Epidemiologic Studies Depression ( CES-D ) scale ( 28 ) . The CES-D scores ranged from 0 to 33 , with higher scores Background and Purpose : Participation in generally recommended aerobics or strength exercises may be challenging for older adults . Therefore , it is necessary to consider the types and levels of physical activities suited for them to improve their cognitive and gait function and adherence to exercise programs . This has prompted efforts to identify exercises that require less physical strength and frequency of performance , while still offering cognitive and health benefits . Here , we aim ed to assess the effect of a novel dual-task net-step exercise ( NSE ) performed once a week for 8 consecutive weeks on improvements in cognitive performance and gait function in an older population . Methods : In this pretest/posttest experimental case control study , 60 healthy older adults ( mean age 76.4 years ) were recruited from community-dwelling people and separated r and omly into 2 groups : a dual-task NSE group and a control group . The NSE group was asked to walk across a net without stepping on the ropes or being caught in the net . Two computer panel-type cognitive functional assessment s , the Touch-M and Touch Panel-Type Dementia Assessment Scale , were administered at baseline and after 8 weeks of intervention to determine the effects of NSE . Improvements in gait function were also evaluated using Timed Up and Go test scores . Mixed-effect models with repeated measures ( group × time ) ( analysis of variance , F test ) were used to test the effects of NSE . Adjustments were made for covariates including age and sex ( analysis of covariance ) . Results : The NSE group showed significant improvement in cognitive performance ( 6.8 % change ; total Touch-M score 5.4 points ; P = .04 ) and gait performance ( 11.5 % change ; Timed Up and Go time −0.98 second ; P < .001 ) over the 8-week period . In the control group , there was no significant improvement . Conclusions : This study shows that dual-task NSE is capable of improving cognitive and gait performance in healthy older adults . Our results indicate that NSE offers an option for a large segment of the older population who need an easier way to maintain their cognitive health and gait function Background Exercise is important for fitness and recovery of older adults after hospitalization for treatment of cardiovascular disease . Home-based , nurse-led exercise programs may be beneficial . Objective The aim of this study was to test the effects of a low-intensity , home-based exercise protocol led by an advanced practice nurse on health-related quality of life ( HRQOL ) , physical fitness , and left ventricular ejection fraction ( LVEF ) in older adults after hospital discharge with a cardiovascular disease diagnosis . Methods The study was r and omized and single blinded . Seventy-seven older adults ( ≥75 years old , mean = 80.68 years old ) were included ; 32 subjects in the intervention and 29 in the  control group completed the study . The low-intensity , home-based exercise protocol is composed of 14-type joint exercises and walking for 12 weeks . The main outcome measures were assessment s on the Medical Outcomes Study Short-Form-36 , the Senior Fitness Test , and LVEF at baseline and 12 weeks after hospital discharge . Results After 12 weeks , the intervention group showed significant improvements in HRQOL ( physical functioning , role-physical , bodily pain , and vitality ; p < .05 ) as well as on the Senior Fitness Test ( chair st and s , arm curls , Timed Up and Go , and 6-minute walk distance ; p < .05 ) ; there was no significant improvement in LVEF ( p = .56 ) . Conclusions The low-intensity , home-based exercise led by an advanced practice nurse was effective in improving HRQOL and physical fitness . Adherence was high , and there were no adverse events related to exercise OBJECTIVES To investigate whether a 12-week physical and cognitive exercise program can improve cognitive function and brain activation efficiency in community-dwelling older adults . DESIGN R and omized controlled trial . SETTING Kyoto , Japan . PARTICIPANTS Community-dwelling older adults ( N = 48 ) were r and omized into an exercise group ( n = 24 ) and a  control group ( n = 24 ) . INTERVENTION Exercise group participants received a weekly dual task-based multimodal exercise class in combination with pedometer-based daily walking exercise during the 12-week intervention phase . Control group  participants did not receive any intervention and were instructed to spend their time as usual during the intervention phase . MEASUREMENTS The outcome measures were global cognitive function , memory function , executive function , and brain activation ( measured using functional magnetic resonance imaging ) associated with visual short-term memory . RESULTS Exercise group participants had significantly greater postintervention improvement in memory and executive functions than the control group ( P < .05 ) . In addition , after the intervention , less activation was found in several brain regions associated with visual short-term memory , including the prefrontal cortex , in the exercise group ( P < .001 , uncorrected ) . CONCLUSION A 12-week physical and cognitive exercise program can improve the efficiency of brain activation during cognitive tasks in older adults , which is associated with improvements in memory and executive function The mechanisms that underlie successful initiation and adherence to physical activity regimens are not well understood . Few theoretical models have used consistent explanatory variables that are theory-driven and many findings that use extant models are equivocal . Social Cognitive Theory ( SCT ) as presented by B and ura ( 1986 , 1997 ) appears to have strong promise as a guide to underst and ing physical activity behaviors and developing clinical ly relevant interventions to promote the initiation and maintenance of physical activity . This critical systematic review of research using SCT was completed to determine the predictive ability of model constructs in explaining physical activity behavior and in identifying key intervention components found to enhance physical activity initiation and maintenance . Following review for quality and adequacy , published research during the years 1990 - 1998 contained 27 studies that examined the relationship between the construct of SCT , self-efficacy  , and physical activity .  All of the descriptive studies found a statistically significant relationship between self-efficacy and exercise behavior . Intervention studies demonstrated that participation in an exercise program promoted self-efficacy , and that programs design ed to increase outcome expectations and self-efficacy significantly increased exercise behavior . Due to the central ity of self-efficacy in many of the social psychological theories that help explain the attitude-intention-behavior triad , a strong need remains to design interventions to maximize its usefulness . Clear , generalizable , systematic and theoretically comprehensive , r and omized , controlled studies are needed to underst and the usefulness of the construct Background : Regular physical activity has been consistently related to improvements in health- related quality of life ( HRQL ) in older adults . Nevertheless , systematic investigations of the influence of exercise therapy on older men and women enrolled in cardiac rehabilitation remain sparse . Purpose : The primary purpose of this investigation was to compare the effects of a group-mediated cognitive behavioral physical activity intervention program ( GMCB ) to a traditional cardiac rehabilitation program ( CRP ) with regard to changes in HRQL in a community-dwelling sample of older adults . Methods : This r and omized clinical trial assigned 147 participants who were eligible for inclusion in cardiac rehabilitation to the GMCB or traditional CRP arms . Changes in HRQL at 3 and 12 months were assessed using the Short Form-36 ( SF-36 ) from the Medical Outcomes Study . Results : Mixed-model analyses yielded significant Baseline × Gender × Treatment interactions for the self-reported mental health component and the Vitality subscale of the SF-36 . Decomposition of these interactions revealed that men in both exercise therapy groups and women in the GMCB treatment with low baseline values demonstrated more favorable improvements in the HRQL perceived mental health measures than women in the CRP treatment . Conclusions : Improvements in HRQL among older adults enrolled in cardiac rehabilitation differ as a function of treatment , gender , and initial mental health status . Results are discussed in terms of the implication s for the design of future physical activity interventions among older adults with cardiovascular disease and the measurement of their HRQL IMPORTANCE The prevalence of cognitive impairment and dementia are projected to rise dramatically during the next 40 years , and strategies for maintaining cognitive function with age are critically needed . Physical or mental activity alone result in relatively small , domain-specific improvements in cognitive function in older adults ; combined interventions may have more global effects . OBJECTIVE To examine the combined effects of physical plus mental activity on cognitive function in older adults . DESIGN R and omized controlled trial with a factorial design . SETTING San Francisco , California . PARTICIPANTS A total of 126 inactive , community-residing older adults with cognitive complaints . INTERVENTIONS All participants engaged in home-based mental activity ( 1 h/d , 3 d/wk ) plus class-based physical activity ( 1 h/d , 3 d/wk ) for 12 weeks and were r and omized to either mental activity intervention ( MA-I ; intensive computer ) or mental activity control ( MA-C ; educational DVDs ) plus exercise intervention ( EX-I ; aerobic ) or exercise control ( EX-C ; stretching and toning ) ; a 2 × 2 factorial design was used so that there were 4 groups : MA-I/EX-I , MA-I/EX-C , MA-C/EX-1 , and MA-C/EX-C. MAIN OUTCOME MEASURES Global cognitive change based on a comprehensive neuropsychological test battery . RESULTS Participants had a mean age of 73.4 years ; 62.7 % were women , and 34.9 % were Hispanic or nonwhite . There were no significant differences between the groups at baseline . Global cognitive scores improved significantly over time ( mean , 0.16 SD ; P < .001 ) but did not differ between groups in the comparison between MA-I and MA-C ( ignoring exercise , P = .17 ) , the comparison between EX-I and EX-C ( ignoring mental activity , P = .74 ) , or across all 4 r and omization groups ( P = .26 ) . CONCLUSIONS AND RELEVANCE In inactive older adults with cognitive complaints , 12 weeks of physical plus mental activity was associated with significant improvements in global cognitive function with no evidence of difference between intervention and active control groups . These findings may reflect practice effects or may suggest that the amount of activity is more important than the type in this subject population . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00522899 Cognitive impairments are highly prevalent in Parkinson ’s disease ( PD ) and can substantially affect a patient ’s quality of life . These impairments remain difficult to manage with current clinical therapies , but exercise has been identified as a possible treatment . The objective of this systematic review was to accumulate and analyze evidence for the effects of exercise on cognition in both animal models of PD and human disease . This systematic review was conducted according to the Preferred Reporting Items for Systematic review s and Meta-Analyses ( PRISMA ) statement . Fourteen original reports were identified , including six pre- clinical animal studies and eight human clinical studies . These studies used various exercise interventions and evaluated many different outcome measures ; therefore , only a qualitative synthesis was performed . The evidence from animal studies supports the role of exercise to improve cognition in humans through the promotion of neuronal proliferation , neuroprotection and neurogenesis . These findings warrant more research to determine what roles these neural mechanisms play in clinical population s. The reports on cognitive changes in clinical studies demonstrate that a range of exercise programs can improve cognition in humans . While each clinical study demonstrated improvements in a marker of cognition , there were limitations in each study , including non-r and omized design s and risk of bias . The Grading of Recommendations Assessment , Development and Evaluation ( GRADE ) system was used and the quality of the evidence for human studies were rated from “ low ” to “ moderate ” and the strength of the recommendations were rated from “ weak ” to “ strong ” . Studies that assessed executive function , compared to general cognitive abilities , received a higher GRADE rating . Overall , this systematic review found that in animal models exercise  results in behavioral and corresponding neurobiological changes in the basal ganglia related to cognition . The clinical studies showed that various types of exercise , including aerobic , resistance and dance can improve cognitive function , although the optimal type , amount , mechanisms , and duration of exercise are unclear . With growing support for exercise to improve not only motor symptoms , but also cognitive impairments in PD , health care providers and policy makers should recommend exercise as part of routine management and neurorehabilitation for this disorder 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 & NA ; Phillips , W.T. , and J.R. Ziuraitis . Energy cost of single‐set resistance training in older adults . J. Strength Cond . Res . 18(3):606–609 . 2004.—The purpose of this study was ( a ) to assess the intensity and energy cost of a single‐set resistance training ( RT ) protocol as recommended by the recent American College of Sports Medicine ( ACSM ) guidelines for older adults and ( b ) to compare obtained values to those recently reported as eliciting health benefits via endurance‐based physical activity ( PA ) . Five males and 5 females ( 73.1 ± 5.5 years ) performed 1 set of 15 repetitions of 8 RT exercises while connected to a portable metabolic unit ( CosMed K4b2 ) . The RT intensity ( metabolic equivalents [ METs ] ) was 3.3 ± 0.7 ( males ) and 3.0 ± 0.6 ( females ) . Energy cost ( kcal ) was 84.2 ± 14.6 ( males ) and 69.7 ± 17.4 ( females ) . We conclude that a single‐set 8‐exercise RT protocol may be a feasible alternative for achieving moderate intensity ( 3–6 METs ) for older adults but that additional sets and /or repetitions appear to be necessary to accumulate moderate amounts ( 150–200 kcal ) of PA Aim / Goal : To recommend a set of neuropsychological and physical exercise tests for research ers to assess cognition and physical fitness in clinical trials with older patients with dementia ; to create consensus , decrease heterogeneity , and improve research quality . Methods : A literature search ( 2005–2011 ) yielded 89 r and omized controlled trials . To provide information on test recommendations the frequency of test use , effect size of the test outcome , study quality , and psychometric properties of tests were analyzed . Results : Fifty-nine neuropsychological tests ( cognitive domains : global cognition , executive functioning , memory , and attention ) and 10  exercise tests ( physical domains : endurance capacity , muscle strength , balance , and mobility ) were found . Conclusion : The Severe Impairment Battery , Mini Mental State Examination , and Alzheimer Disease Assessment Scale – cognitive subscale were recommended to measure global cognition . The Verbal Fluency Test Category/Letters , Clock Drawing Test , and Trail Making Test-B were recommended to measure executive functioning . No specific memory test could be recommended . The Digit Span Forward , Digit Span Backward , and Trail Making Test-A were recommended to measure attention . As physical exercise tests , the Timed Up and Go and Six Meter Walk for mobility , the Six Minute Walk Distance for endurance capacity , and the Tinetti Balance Scale were recommended OBJECTIVES To compare the efficacy of a physical activity program ( Seattle Protocol for Activity ( SPA ) ) for low-exercising older adults with that of an educational health promotion program ( HP ) , combination treatment ( SPA+HP ) , and routine medical care control conditions ( RMC ) . DESIGN Single-blind , r and omized controlled trial with two-by-two factorial design . SETTING Community centers in King County , Washington , from November 2001 to September 2004 . PARTICIPANTS Two hundred seventy-three community-residing , cognitively intact older adults ( mean age 79.2 ; 62 % women ) . INTERVENTIONS SPA ( in-class exercises with assistance setting weekly home exercise goals ) and HP ( information about age-appropriate topics relevant to enhancing health ) , with r and omization to four conditions : SPA only ( n=69 ) , HP only ( n=73 ) , SPA+HP ( n=67 ) , and RMC control ( n=64 ) . Active-treatment participants attended nine group classes over 3 months followed by five booster sessions over 1 year . MEASUREMENTS Self-rated health ( Medical Outcomes Study 36-item Short-Form Survey ) and depression ( Geriatric Depression Scale ) . Secondary ratings of physical performance , treatment adherence , and self-rated health and affective function were also collected . RESULTS At 3 months , participants in SPA exercised more and had significantly better self-reported health , strength , and general well-being ( P<.05 ) than participants in HP or RMC . Over 18 months , SPA participants maintained health and physical function benefits and had continued to exercise more than non-SPA participants . SPA+HP was not significantly better than SPA alone . Better adherence was associated with better outcomes . CONCLUSION Older adults participating in low levels of regular exercise can establish and maintain a home-based exercise program that yields immediate and long-term physical and affective benefits This article compared the effect of dietary weight loss administered alone ( WL ) or in combination with aerobic training ( WL + AT ) or resistance training ( WL + RT ) on health related quality of life , walking self-efficacy , stair climb self-efficacy , and satisfaction with physical function in older adults with cardiovascular disease or the metabolic syndrome . Participants ( N = 249 ; Mage = 66.9 ) engaged in baseline assessment s and were r and omly assigned to one of three interventions , each including a 6-month intensive phase and a 12-month follow-up . Those in WL + AT and WL + RT engaged in 4 days of exercise training weekly . All participants engaged in weekly group behavioral weight loss sessions with a goal of 7–10 % reduction in body weight . Participants in WL + AT and WL + RT reported better quality of life and satisfaction with physical function at 6- and 18-months relative to WL . At month 6 , WL + AT reported greater walking self-efficacy relative to WL + RT and WL , and maintained higher scores compared to WL at month 18 . WL + AT and WL + RT reported greater stair climbing efficacy at month 6 , and WL + RT remained significantly greater than WL at month 18 . The addition of either AT or RT to WL differentially improved HRQOL and key psychosocial outcomes associated with maintenance of physical activity and weight loss . This underscores the important role of exercise in WL for older adults , and suggests health care providers should give careful consideration to exercise mode when design ing interventions Dementia cases are on the rise and research ers seek innovative ways to prevent or ameliorate cognitive impairment  in later life . Some research has reported that combining mental and physical exercise may benefit cognition more than either alone . This r and omized pilot trial examined the feasibility and cognitive benefit for older adults ( n = 30 ) of a  single bout of neuro-exergaming ( physical activity with cognitive training ) using an interactive physical and cognitive exercise system ( iPACES ) , compared with that of exergaming or neurogaming alone . Intent-to-treat and sensitivity analyses were conducted using repeated- measures ANOVA , controlling for age , sex , and education . A significant interaction effect was found for executive function ( Color Trails 2 ) , with a significant improvement in the neuro-exergaming condition . Results demonstrate feasibility for older adults to use a novel and theoretically-derived neuro-exergame , and also provide promising new evidence that neuro-exergaming can yield greater cognitive benefit than either of its component parts IMPORTANCE Epidemiological evidence suggests that physical activity benefits cognition , but results from r and omized trials are limited and mixed . OBJECTIVE To determine whether a 24-month physical activity program results in better cognitive function , lower risk of mild cognitive impairment ( MCI )  or dementia , or both , compared with a health education program . DESIGN , SETTING , AND PARTICIPANTS A r and omized clinical trial , the Lifestyle Interventions and Independence for Elders ( LIFE ) study , enrolled 1635 community-living participants at 8 US centers from February 2010 until December 2011 . Participants were sedentary adults aged 70 to 89 years who were at risk for mobility disability but able to walk 400 m. INTERVENTIONS A structured , moderate-intensity physical activity program ( n = 818 ) that included walking , resistance training , and flexibility exercises or a health education program ( n = 817 ) of educational workshops and upper-extremity stretching . MAIN OUTCOMES AND MEASURES Prespecified secondary outcomes of the LIFE study included cognitive function measured by the Digit Symbol Coding ( DSC ) task subtest of the Wechsler Adult Intelligence Scale ( score range : 0 - 133 ; higher scores indicate better function ) and the revised Hopkins Verbal Learning Test ( HVLT-R ; 12-item word list recall task ) assessed in 1476 participants ( 90.3 % ) . Tertiary outcomes included global and executive cognitive function and incident MCI or dementia at 24 months . RESULTS At 24 months , DSC task and HVLT-R scores ( adjusted for clinic site , sex , and baseline values ) were not different between groups . The mean DSC task scores were 46.26 points for the physical activity group vs 46.28 for the health education group ( mean difference , -0.01 points [ 95 % CI , -0.80 to 0.77 points ] , P = .97 ) . The mean HVLT-R delayed recall scores were 7.22 for the physical activity group vs 7.25 for the health education group ( mean difference , -0.03 words [ 95 % CI , -0.29 to 0.24 words ] , P = .84 ) . No differences for any other cognitive or composite measures were observed . Participants in the physical activity group who were 80 years or older ( n = 307 ) and those with poorer baseline physical performance ( n = 328 ) had better changes in executive function composite scores compared with the health education group ( P = .01 for interaction for both comparisons ) . Incident MCI or dementia occurred in 98 participants ( 13.2 % ) in the physical activity group and 91 participants ( 12.1 % ) in the health education group ( odds ratio , 1.08 [ 95 % CI , 0.80 to 1.46 ] ) . CONCLUSIONS AND RELEVANCE Among sedentary older adults , a 24-month moderate-intensity physical activity program compared with a health education program did not result in improvements in global or domain-specific cognitive function . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01072500 Previous studies concerning psychological benefits of exercise among the elderly has focused predominantly on the effects of aerobic exercise . In the present study , psychological and behavioral adaptations in response to 12-weeks of strength training were examined in medically healthy but sedentary 42 older adults ( mean age = 68 years ) . The purpose of this study was to evaluate the effects of high and low intensity resistance training intensity on a ) muscular fitness , b ) psychological affect , and c ) neurocognitive functioning . Subjects were r and omly assigned to high intensity/low volume ( EXH : 2 sets of 8 to 10 repetitions for 75 to 85 % of 1 RM ) , low intensity/high volume ( EXL : 2 sets of 14 to 16 repetitions for 55 to 65 % of 1 RM ) , or no exercise control programs . Prior to and following the 12-week program , subjects underwent comprehensive physiological and psychological evaluations . Physiological assessment included measurements of blood pressure , heart rate , arm and leg muscle strength , body composition , and oxygen consumption ( VO2max ) . Psychological measures included evaluations of mood , anxiety , and physical self-efficacy as well as cognitive functioning . The results of this study indicated that both high and low intensity strength programs were associated with marked improvements in physiological fitness and psychological functioning . Specifically , subjects in the strength training programs increased overall muscle strength by 38.6 % and reduced percent body fat by 3.0 % . Favorable psychological changes in the strength-trained subjects included improvements in positive and negative mood , trait anxiety , and perceived confidence for physical capability . The treatment effects of neurocognitive functioning were not significant . In summary , this study demonstrated that participation in 12-weeks of high or low intensity strength training can improve overall physical fitness , mood , and physical self-efficacy in older adults while cognitive functioning remains constant
Conclusions The current literature suggests the effectiveness of low-intensity exercise on improved physical and cognitive health for older adults .
It may be a desired intensity level in promoting health among older adults with better compliance , lower risk of injuries , and long-term sustainability
Background It is well known that physical exercise is important to promote physical and cognitive health in older population .
However , inconsistent research findings were shown regarding exercise intensity , particularly on whether low-intensity exercise ( 1.5 metabolic equivalent tasks ( METs ) to 3.0 METs ) can improve physical and cognitive health of older adults .
This systematic review aim ed to fill this research gap .
The objective of this study is to conduct a systematic review of the effectiveness of low-intensity exercise interventions on physical and cognitive health of older adults .