Physical training in institutionalized elderly people with multiple diagnoses--a controlled pilot study. Effects of a physical and nutritional intervention program for frail elderly people over age 75. A randomized controlled pilot treatment trial The Physical Effect of Exergames in Healthy Elderly-A Systematic Review. Effectiveness of exercise interventions on physical function in community-dwelling frail older people: an umbrella review of systematic reviews [Effectiveness of falls prevention strategies for elderly subjects who live in the community with performance assessment of physical activities (before-after)]. An impairment and disability assessment and treatment protocol for community-living elderly persons. Physical Activity in Depressed Elderly. A Systematic Review Effects of a 12-Month Multicomponent Exercise Program on Physical Performance, Daily Physical Activity, and Quality of Life in Very Elderly People With Minor Disabilities: An Intervention Study Exploiting the systematic review protocol for classification of medical abstracts Physical function predicts improvement in quality of life in elderly icelanders after 12 weeks of resistance exercise Protein supplementation increases muscle mass gain during prolonged resistance-type exercise training in frail elderly people: a randomized, double-blind, placebo-controlled trial. Once a week not enough, twice a week not feasible? A randomised controlled exercise trial in long-term care facilities [ISRCTN87177281]. Effects of elastic band resistance training and nutritional supplementation on physical performance of institutionalised elderly — A randomized controlled trial Improvement in the face/name association performance after three months of physical training in elderly women. Effects of resistance and functional-skills training on habitual activity and constipation among older adults living in long-term care facilities: a randomized controlled trial [Strength and coordination training for prevention of falls in the elderly].
Reduction in muscle mass and physical function depends on a variety of interacting factors : age , physical activity level , nutritional state and the type and impact of disease . The aim of this study was to investigate the effect of an individualized moderate intensity physical training program on muscle strength , balance , mobility , ambulation and activities of daily living ( ADL ) in institutionalized elderly people aged 65 and over with multiple diagnoses . Baseline assessment s consisted of strength , balance , mobility/ambulation , and ADL .  Twenty-one subjects were included in the intervention program . A control group ( 21 subjects ) was first matched in pairs according to gender , age , ADL and mobility , and then by balance , ambulation and strength . The intervention program was individualized and included strength , mobility , balance and endurance training . Follow-up measures were conducted directly after the intervention and 10 weeks later . After drop-out , 20 subjects in the intervention group and 15 subjects in the control group remained for analyses . Balance and mobility improved significantly in the intervention group while declining in the control group . This pilot study indicates that a physical training program may improve functional capacity for institutionalized elderly persons with multiple diagnoses Background and aims : There are few studies published that combine the interventions of physical training and nutrition . The aim of the present study was to describe the impact of a physical and nutritional intervention program for frail community-dwelling elderly people over the age of 75 . Methods : Ninety-six community-dwelling elderly people ( 58 women ) were r and omized to four different groups : i ) a physical training program ( aerobic , muscle strength , balance ) , ii ) a nutritional intervention program ( individually targeted advice and group sessions ) , iii ) a combination of these interventions , and iv ) a control group . At baseline subjects were screened for physical performance such as muscle strength , balance , mobility and activities of daily living , as well as nutritional aspects such as energy intake , body weight and fat-free mass . These measurements were repeated immediately after the intervention , which lasted for 12 weeks , and after another 6 months . Results : The intention-to-treat analysis indicated significant improvements in lower-extremity muscle strength in both training groups compared with the nutrition group at 1st follow-up . There were small significant changes for some of the balance measurements in the training group without nutrition treatment . The nutrition intervention did not show any significant results . Conclusions : This study shows the positive effect on lower-extremity muscle strength directly after the intervention . Balance training most probably needs to be more individualized in order to be effective for frail elderly people . Further studies are needed , with larger sample sizes , to investigate the effects of these types of interventions before any further conclusions can be drawn Exergames have been suggested as an innovative approach to enhance physical activity in the elderly . The objective of this review was to determine the effectiveness of exergames on vali date d quantitative physical outcomes in healthy elderly individuals . We used Centre for Review and Disseminations guidance to conduct systematic review s. Four electronic data bases were search ed . We included r and omized controlled trials ( RCTs ) , the study participants were healthy elderly individuals , and the intervention of interest was exergaming . The title and abstract screening of the 1861 citations identified 36 studies as potentially eligible for this review , and an additional nine were identified from reference lists . The full text screening identified seven studies with a total of 311 participants , all reporting RCTs with low-to-moderate method ological quality . Six of the seven studies found a positive effect of exergaming on the health of the elderly . However , the variation of intervention approaches and outcome data collected limited the extent to which studies could be compared . This review demonstrates how exergames have a potential to improve physical health in the elderly . However , there is a need for additional and better- design ed studies that assess the effectiveness and long-term adherence of exergames design ed specifically for the elderly 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 OBJECTIVES The development of falls prevention strategies is an essential health concern in elderly people . However , a global consensus does not exist for elderly subjects who live independently in the community . The aim of the study was to evaluate the benefit of an exercises program . MATERIAL S AND METHODS A control group ( 153 subjects ) and an " Intervention " group ( 150 subjects ) were tested before and after a 1-year prospect i ve study . The " Intervention " group performed ten training sessions of physical activity , based on balance , muscular activity and coordination . We compared the incidence of falls , and the performances in several tests between the two groups . RESULTS The clinical features were similar between the two groups : mean age 71 years , 83 % of females , subjects who were independent for activities of daily living . However , all subjects presented risk for factors for falls : 38 % were not able to maintain the unipodal position more than five seconds , 29 % had already fallen during the previous year . For the " Intervention " group , the comparison of the performances before and after the physical activity program showed significant increases ( p < 0.001 ) for all the tests , and specifically for the unipodal position and for the exercises performed with eyes closed . After one year follow-up , the incidence rate of falls was lower in the " Intervention " group compared with the control group , but the difference was not significant ( p = 0.32 ) . However , falls occurred significantly latter in the " Intervention " group ( p = 0.02 ) . CONCLUSION Ten training sessions of physical activity allowed to improve the performance of elderly people in several tests . This result suggests that a fall prevention program based on collective and regular exercises , may be efficient for elderly subjects who still have an active and independent way of live BACKGROUND AND PURPOSE Falls and immobility are common among community-living elderly persons and result from the accumulated effect of multiple impairments and disabilities as well as environmental hazards . We developed and tested a simple assessment and intervention protocol for use in prevention and treatment programs among community-living elderly persons . This article presents the components of the assessment ; the criteria for intervening on diagnosed impairments contributing to falls and immobility ; and the recommended treatments , environmental adaptations , training , and exercise programs targeting the diagnosed problems . SUBJECTS A convenience sample of 11 residents of a senior housing complex who were cognitively intact and ambulatory were chosen for reliability testing of the assessment protocol . A r and om sample of 20 of the 153 elderly subjects involved in a multiple risk factor trial for fall prevention then were chosen to test the reliability of the intervention recommendations . METHODS The assessment and intervention protocol was developed by a consensus approach among a group consisting of a geriatric physician , two nurses , and three physical therapists . The interrater reliability of both the assessment and the intervention components of the protocol was determined by comparing the results of two of the study physical therapists . RESULTS There was excellent agreement in assessment and intervention results by the two physical therapists . The assessment required approximately 45 minutes to complete , suggesting it is feasible for use in clinical practice . CONCLUSION AND DISCUSSION A simple , st and ardized assessment and intervention protocol , such as the one described , could aid physical therapists in evaluating and treating community-living elderly persons by improving communication among care providers , providing better documentation for reimbursers , and ensuring a direct linkage between assessment and intervention , thus simplifying the development of a treatment plan for elderly persons with complicated or multiple impairments . The ultimate test of this assessment and intervention protocol will be ascertainment of the goal of the protocol , namely a reduction in falls and improvement in mobility among multiply and chronically ill elderly persons Background : exercise may reduce depressive symptoms both in healthy aged population s and in old patients diagnosed with MDD , but few specific analysis were conducted on the efficacy of exercise as an adjunctive treatment with antidepressants , which may be probably more useful in clinical practice , considered the high prevalence of treatment resistant depression in late life , the low cost and safety of physical activity interventions . Objective : to establish the new findings on the effectiveness of  exercise  on  depression in elderlies , with particular focus on the efficacy of the exercise as an adjunctive treatment with antidepressants drug therapy . Method : the search of significant articles was carried out in PubMed / Medline with the following key words : “ exercise ” , “ physical activity ” , “ physical fitness ” , “ depressive disorder ” , “ depression ” , “ depressive symptoms ” , “ late life ” , “ old people ” , and “ elderly ” . Results : 44 papers were retrieved by the search . Among the 10 included r and omized controlled trials , treatment allocation was adequately conceived in 4 studies , intention-to-treat analysis was performed in 6 studies , but no study had a double-blinded assessment . We examined and discussed the results of all these trials . Conclusion : in the last 20 years , few progresses were done in showing the efficacy of exercise  on depression , due in part to the persistent lack of high quality research , in part to clinical issues of management of depression in late life , in part to the difficult to establish the real effectiveness of  exercise  on depressive symptoms in elderlies . However , there are some promising findings on physical activity combined with antidepressants in treatment resistant late life depression Background Although studies suggest that exercise training improves physical performance and health-related quality of life ( HRQOL ) among elderly people , most of these studies have investigated relatively healthy persons . The objective of the present study was to determine the effects of a 12-month multicomponent exercise program on physical performance , daily physical activity , and HRQOL among very elderly people with minor disabilities . Methods The subjects consisted of 65 elders ( median age : 84 years ) who were certified to receive long-term care in the form of support only or Level 1 care ( the lowest level of care required ) ; 31 were allocated to the intervention group and 34 to the control group . The intervention group participated in supervised exercises once a week for 12 months and in home-based exercises . The exercise program consisted of various exercises related to flexibility , muscle strength , balance , and aerobic performance . Results After 12 months of exercise training , the intervention group had significant improvements in lower-limb strength and on the sit- and -reach test ; these effects were not observed in the control group . The control group had significant decreases in grip strength , 6-minute walking distance , walking speed , and stride length ; these decreases were not observed in the intervention group . No clear differences in HRQOL measurements or changes in physical activity were detected between groups . Conclusions The 12-month multicomponent exercise program may effectively improve and maintain the physical performance of very elderly individuals with minor disabilities OBJECTIVE To determine whether the automatic classification of documents can be useful in systematic review s on medical topics , and specifically if the performance of the automatic classification can be enhanced by using the particular protocol of questions employed by the human review ers to create multiple classifiers . METHODS AND MATERIAL S The test collection is the data used in large-scale systematic review on the topic of the dissemination strategy of health care services for elderly people . From a group of 47,274 abstract s marked by human review ers to be included in or excluded from further screening , we r and omly selected 20,000 as a training set , with the remaining 27,274 becoming a separate test set . As a machine learning algorithm we used complement naïve Bayes . We tested both a global classification method , where a single classifier is trained on instances of abstract s and their classification ( i.e. , included or excluded ) , and a novel per- question classification method that trains multiple classifiers for each abstract , exploiting the specific protocol ( questions ) of the systematic review . For the per- question method we tested four ways of combining the results of the classifiers trained for the individual questions . As evaluation measures , we calculated precision and recall for several setting s of the two methods . It is most important not to exclude any relevant documents ( i.e. , to attain high recall for the class of interest ) but also desirable to exclude most of the non-relevant documents ( i.e. , to attain high precision on the class of interest ) in order to reduce human workload . RESULTS For the global method , the highest recall was 67.8 % and the highest precision was 37.9 % . For the per- question method , the highest recall was 99.2 % , and the highest precision was 63 % . The human-machine workflow proposed in this paper achieved a recall value of 99.6 % , and a precision value of 17.8 % . CONCLUSION The per- question method that combines classifiers following the specific protocol of the review leads to better results than the global method in terms of recall . Because neither method is efficient enough to classify abstract s reliably by itself , the technology should be applied in a semi-automatic way , with a human expert still involved . When the workflow includes one human expert and the trained automatic classifier , recall improves to an acceptable level , showing that automatic classification techniques can reduce the human workload in the process of building a systematic review Background Little is known about the effects of resistance training on health related quality of life ( HRQL )  in the elderly . Aim The main purpose of the study was to investigate the effects of resistance training on strength , body composition , functional capacity and HRQL in independent living elderly people . We hypothesised that resistance training would improve lean mass , muscle strength , physical function and HRQL . Methods Subjects ( N = 237 , 73.7±5.7yrs , 58.2 % female ) participated in a 12-week resistance exercise program ( 3 times/week ; 3 sets , 6–8 repetitions at 75–80 % of the 1-repetition maximum ) design ed to increase strength and muscle mass of major muscle groups . Body composition , quadriceps- and grip strength , timed up and go test ( TUG ) , six minute walk for distance ( 6MW ) and HRQL were measured at baseline and endpoint . Results Two hundred- and -four participants completed the study . Although the increase in lean mass was small ( + 0.8 kg , P<0.01 ) , quadriceps strength ( + 53.5N ) , grip strength ( + 3.0 lb ) , TUG ( -0.6sec ) , 6MW ( + 33.6 m ) and HRQL ( + 1.2 t-score ) improved significantly ( all P<0.01 ) . Changes in 6MW predicted improvement in HRQL after 12 weeks . Conclusions Our study shows that a 12-week resistance exercise program  significantly improves lean mass , muscle strength , physical function and HRQL  in elderly individuals , and that improvements in physical function predict improvements in HRQL . Our study indicates that resistance training should be promoted for the elderly as it has the potential to improve physical performance , thereby prolonging healthy , independent aging OBJECTIVES Protein supplementation has been proposed as an effective dietary strategy to augment the skeletal muscle adaptive response to prolonged resistance-type exercise training in elderly people . Our objective was to assess the impact of protein supplementation on muscle mass , strength , and physical performance during prolonged resistance-type exercise training in frail elderly men and women . DESIGN / SETTING / PARTICIPANTS A r and omized , double-blind , placebo-controlled trial with 2 arms in parallel among 62 frail elderly subjects ( 78 ± 1 year ) . These elderly subjects participated in a progressive resistance-type exercise training program ( 2 sessions per week for 24 weeks ) during which they were supplemented twice daily with either protein ( 2 * 15 g ) or a placebo .  MEASUREMENTS Lean body mass ( DXA ) , strength ( 1-RM ) , and physical performance ( SPPB ) were assessed at baseline , and after 12 and 24 weeks of intervention . RESULTS Lean body mass increased from 47.2 kg ( 95 % CI , 43.5 - 50.9 ) to 48.5 kg ( 95 % CI , 44.8 - 52.1 ) in the protein group and did not change in the placebo group ( from 45.7 kg , 95 % CI , 42.1 - 49.2 to 45.4 kg , 95 % CI , 41.8 - 48.9 ) following the intervention ( P value for treatment × time interaction = .006 ) . Strength and physical performance improved significantly in both groups ( P = .000 ) with no interaction effect of dietary protein supplementation . CONCLUSIONS Prolonged resistance-type exercise training represents an effective strategy to improve strength and physical performance in frail elderly people  . Dietary protein supplementation is required to allow muscle mass gain during exercise training in frail elderly people . TRIAL REGISTRATION clinical trials.gov identifier : NCT01110369 OBJECTIVE To evaluate the effectiveness of three different training protocol s on physical function of older adults living in long-term care facilities . Emphasis was placed on feasibility in real-life situations . METHODS Subjects ( N=224 ) were r and omised to 6 months of twice weekly ( 1 ) resistance training ; ( 2 ) all-round functional-skills training ; ( 3 ) a combination of both ; or ( 4 ) a control program .  Fitness and performance measures and self-reported disability were measured at baseline and after 24 weeks intervention . RESULTS Attendance to the strength training was 76 % , to the functional-skills training 70 % and to the combined training 73 % . In those who attended at least 75 % of all classes ( n=97 ) the functional-skills and combined training program improved several fitness and performance measures compared to the control group . CONCLUSION Twice weekly functional-skills training , or a combination of resistance and functional-skills training can improve several fitness and performance measures of institutionalised older people . PRACTICE IMPLICATION S An important finding from our study was that less than twice a week exercise training is not enough for functional improvement , while it proved difficult for the elderly subjects to exercise twice weekly . Education on the health benefits of regular exercise , and a larger availability of classes in long-term care facilities may improve attendance OBJECTIVES To evaluate the effects of elastic b and resistance training in combination with nutrient supplementation on muscular strength and the ability to perform mobility-related activities of daily living in older adults living in retirement care facilities . DESIGN R and omized controlled trial , with a 6-month intervention period . SETTING A retirement care facility , Vienna , Austria . PARTICIPANTS One hundred and seventeen older adults ( 14 males ( 12 % ) and 103 females ( 88 % ) ) , aged 65 to 97 years ( mean age : 82.8 ± 6.0 ) , having a mini-mental state examination score ≥ 23 and no chronic diseases posing a medical contraindication to training therapy . INTERVENTION Participants were r and omly assigned , but stratified by sex , to one of three intervention groups : supervised resistance exercise training ( RT ) , RT in combination with nutrient supplementation ( RTS ) , or cognitive training group ( CT ) . All interventions were performed two times a week for 6 months . RT was design ed to train all major muscle groups using elastic b and s. The nutrient supplement ( rich in proteins , vitamin D , B2 , B12 ) was distributed every morning as well as after each RT session . MEASUREMENTS A battery of motor ability tests and functional test were performed prior to as well as following 3 months and finally after 6 months of intervention . These tests included isokinetic torque measurements of the knee extensors and flexors in concentric mode at 60 and 120 ° /s , isometric h and grip strength , senior arm-lifting test , chair st and test , maximum walking speed and a 6-minute walking test ( 6 MWT ) . RESULTS A repeated- measures ANOVA analysis revealed significant improvements in physical function of lower ( p=0.002 ) and upper extremities ( p=0.006 ) for RT and /or RTS in comparison to CT . For isokinetic measurements , 6 MWT , and gait speed time effects ( p<0.05 ) were detected without any group × time interaction effects . Dropouts showed lower performance in chair st and test ( p=0.012 ) , 6 MWT ( p=0.003 ) , and gait speed ( p=0.013 ) at baseline than that of the finishers of the study . CONCLUSION Six months of a low intensity resistance exercise using elastic b and s and own body weight is safe and beneficial in improving functional performance of institutionalised older people . Multinutrient supplementation did not offer additional benefits to the effects of RT in improving muscular performance Several lines of evidence suggest that physical exercise not only influences the development of muscles , cardiovascular and respiratory systems , but also exerts a significant influence on the central nervous system . We examined the influence of strength and endurance training on cognitive performance in 33 healthy elderly volunteers ( women , mean age 63.5 + /-4.5 yr ) over a 3-month period of supervised training program . A control group consisted of 8 age-matched ( mean age 66.3 + /-4.6 ) healthy volunteers who did not participate in any exercise training program .  To evaluate the cognitive performance in our subjects we used two tests : face/name association test and Stroop test . The tests were applied shortly before and immediately after the training program . In the experimental group , a significant improvement in the association test performance , on average , from 71.6 + /-7.3 % to 79.7 + /-7.2 % ( P<0.0001 ) was observed over the 3-month training period . There were no changes in the Stroop test results over the same time . Likewise , there were no changes in the control groups . Our data demonstrate that the training regime that is strictly followed over a relatively short period of time may improve the performance in associative memory tasks in elderly subjects . The study supports the notion that physical exercise influences cognitive performance and extend this notion to be valid for healthy elderly subjects Background Large-scale RCTs comparing different types of exercise training in institutionalised older people are scarce , especially regarding effects on habitual physical activity and constipation . This study investigated the effects of different training protocol s on habitual physical activity and constipation of older adults living in long-term care facilities . Methods A r and omized controlled trial with 157 participants , aged 64 to 94 years , who were r and omly assigned to 1 ) resistance training ; 2 ) all-round functional-skills training ; 3 ) both ; or 4 ) an ' educational ' control condition .  Habitual physical activity was assessed with a physical activity question naire and accelerometers . Constipation was assessed by a question naire . Measurements were performed at baseline and after six months of training . Results At baseline the median time spent sitting was 8.2 hr/d , the median time spent on activity of at least moderate intensity was 32 min/d . At baseline , about 22 % of the subjects were diagnosed with constipation and 23 % were taking laxatives . There were no between-group differences for changes in habitual physical activity or constipation over 6-months . ConclusionS ix months of moderate intensity exercise training neither enhances habitual physical activity nor affects complaints of constipation among older people living in long-term care facilities Since muscle strength and coordination training in healthy elderly people has been effective in the primary prevention , a program for geriatric patients with falls is presented . Its aim is safer walking by an increase in muscular strength and improved coordination . The exclusion criteria and the size of the training program define a group of over 75 year old patients , who will be compared with a group with light physical exercise in a r and omized fashion . The first results show a remarkable increase in strength and a low complication rate . The functional relevance of our program remains to be proven
There was a large heterogeneity in the studies concerning sample size , types of interventions and types of assessment s. There is strong evidence for a positive effect of  physical training  on muscle strength and mobility ; moderate evidence for an effect on range of motion ; and contradictory evidence regarding gait , activities of daily living , balance and endurance .
OBJECTIVE the positive effect of physical training in healthy elderly people is well documented .
The aim of this systematic review was to describe the effect of physical training on physical performance in institutionalised elderly patients with multiple diagnoses .