Exercise
helps elderly regain physical function and avoid major disability
Regular structured
exercise may allow previously sedentary elderly people to attain
significant improvements in their physical functioning and reduce
the likelihood they will become disabled in the future, according to
findings from a multicenter pilot study being presented today at the
Gerontological Society of America's annual meeting in Dallas.
The results of the
study, known as the Lifestyle Interventions and Independence For
Elders Pilot (LIFE-P) study, also appear in the November issue of
the Journal of Gerontology: Medical Sciences.
The pilot
study, which included senior researchers from the University of
Pittsburgh Graduate School of Public Health (GSPH), the Cooper
Institute in Dallas, Stanford University, Wake Forest University and
the University of Florida, involved administering a structured
physical activity consisting primarily of walking at a moderate
intensity for at least 150 minutes a week, coupled with leg
stretches, balance exercises and leg-strengthening exercises, to a
group of sedentary elderly people ages 70 to 89.
A second
"control" group of elderly were given only instructions on
"successful aging," which included information on good nutrition and
the proper use of medications, foot care and preventive services.
The physical functioning of both groups was tested before the
interventions and twice during the one-year intervention.
Over the
follow-up period, participants in the structured physical activity
group increased their performance score on a test known as the Short
Physical Performance Battery, or SPPB, from a baseline average of
about 7.5 to about 8.5, whereas many participants in the "successful
aging" intervention group actually saw a decline in their score.
In addition,
participants in the physical activity group improved their
performance on a second assessment, a 400-meter walking test, and
had a lower incidence of a major mobility disability, defined as an
inability to walk a quarter mile, than did those in the control
group.
Even a small
improvement of a half point on the SPPB test score's scale of 0 to
12 may represent major improvement in an elder person's ability to
perform activities of daily living, such as walking across a room,
dressing, eating or bathing. A low score, between 0 and 4, is a
strong risk factor for disability and death. The LIFE-P study looked
at people with intermediate scores from 4 to 9 to see if exercise
could improve or prevent a decline in their scores.
According to
Anne B. Newman, M.D., M.P.H., professor of epidemiology and medicine
and director of the Center for Aging and Population Health, GSPH,
and the principal investigator for the University of Pittsburgh
field center, these findings confirm that even sedentary elderly can
be brought back from the precipice of disability by moderate,
structured exercise.
"This pilot
demonstrates the physical activity was extremely safe for the study
participants – elderly people at a high risk of becoming disabled,"
Dr. Newman said.
Previous
research has demonstrated that scores on the SPPB are highly
predictive of future health problems. People with lower scores are
more likely than others to die earlier, have health problems, be
institutionalized and become unable to get around. Furthermore, in
other studies, Dr. Newman's group has demonstrated that the
inability to walk 400 meters is a significant predictor of future
disability and premature death.
The LIFE-P
study principal investigator, Marco Pahor, M.D., professor and
chairman of the department of aging and geriatric research,
University of Florida (UF) College of Medicine, and director of the
UF Institute on Aging, emphasized that this is among the first
studies to demonstrate that physical decline in the elderly is
reversible. "Previously, we had no definitive empirical evidence
that the score on the SPPB test could be modified," he said.
"This
analysis showed that, compared with those who received health
education, participants in the physical activity group had a 29
percent lower risk of being unable to walk 400 meters," said Dr.
Pahor.
Jack M.
Guralnik, M.D., Ph.D., co-principal investigator for the study and
chief of the National Institute of Aging's (NIA) Laboratory of
Epidemiology, Demography and Biometry, added that the study is very
promising in regard to developing programs to keeping the elderly
fit and mobile.
"Lower-extremity functioning is a good reflection of overall
functioning and disability in older adults. So, we are encouraged by
these results, which demonstrate that a well-designed program
combining aerobic, strength, balance and flexibility exercises can
make a difference for those who are at high risk of losing mobility
function," said Dr. Guralnik.
UF
researchers are planning to conduct a full-scale study, testing
2,500 adults at 10 different sites over four years – the longest
study to date to assess whether structured exercise can delay the
inability to walk 400 meters, or a quarter mile.
"The results
from this pilot study are very promising and indicate that a
full-scale study is warranted," said Dr. Newman, whose center will
be involved in the larger study.