GSA: Exercise Improves Capabilities of the Sedentary Elderly

DALLAS, Nov. 17 -- Once roused into action, sedentary elderly patients getting regular physical exercise can improve their physical functioning and decrease the risk of future disability, reported investigators in a multicenter study.

With 424 sedentary men and women, 70 to 89 years old, a pilot study testing the validity of a structured exercise program showed that those randomized off the couch had significantly improved scores on a physical performance test compared with non-exercising controls.

They were introduced to a combination of aerobics, strength, balance, and flexibility.

Results of the Lifestyle Interventions and Independence for Elders pilot (LIFE-P) study were reported by Marco Pahor, M.D., of the University of Florida in Gainesville, and colleagues, at the Gerontological Society of America meeting here, and will appear in the November issue of Journal of Gerontology: Medical Sciences.

"This pilot demonstrates the physical activity was extremely safe for the study participants - elderly people at a high risk of becoming disabled," said co-investigator Anne B. Newman, M.D., M.P.H., of the University of Pittsburgh, one of the participating centers.

The goal was to see whether a program of comprehensive physical activity could have a positive effect on the scores of the Short Physical Performance Battery (SPPB), which includes walking, balance, and chair stands tests. It independently predicts mobility, disability, and activities of daily living disability.

The participants were randomly assigned to either a moderate intensity physical activity intervention, or to a "successful aging" intervention in which participants would receive counseling and information on health for older adults. The information provided included tips on nutrition, medication use, foot care, and preventive services.

The exercise regimen involved a structured program 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.

The participants were scored at baseline and six and 12 months from 0 to 4, with 4 representing strongest performance, on three measures: standing balance, walking speed over 400 meters, and ability to rise from a chair. The scores were added to determine a summary SPPB score with a maximum of 12.

Summary scores of 0 to 4 are associated with a high-risk for disability or death, while higher scores indicate strong physical performance and little or no interference with activities of daily living.

At six months follow-up, the mean score among the exercisers was 8.7 + 0.1, compared with 8.0 + 0.1 for controls (P<0.001). At 12 months, the mean score was 8.5 + 0.1 for the physical activity group, vs. 7.9 + 0.2 for the sedentary seniors (P<0.001).

They authors also found that participants in the physical activity group improved their performance on a 400-meter walk test, and had a lower incidence of major mobility disability, defined as an inability to walk a quarter mile, than did those in the control group. The hazard ratio for walking performance in the exercise vs. control groups was 0.71 (95% confidence interval, 0.44-1.20).

"Lower-extremity functioning is a good reflection of overall functioning and disability in older adults," said Jack M. Guralnik, M.D., Ph.D., co-principal investigator and chief of the National Institute of Aging's Laboratory of Epidemiology, Demography and Biometry.

"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," Dr. Guralnik continued.

The overall incidences of both serious and non-serious events were similar between the groups, although significantly more of the exercisers sought medical advice for an abnormal heart rhythm (P=0.016).

The investigators noted that "the study was not powered to detect significant effects on major mobility disability, and it remains to be proven whether improvement in performance also translate into benefits on such clinically relevant health outcomes."

"In this regard, our study provides promising preliminary evidence that physical activity may prevent major mobility disability. However, a larger and longer-term trial is needed on this important topic," they wrote.

The LIFE-P study was funded by the National Institute on Aging.