title: Velocity training induces power-specific adaptations in highly functioning older adults. The relationship among physical activity, obesity, and physical function in community-dwelling older women. On a happier note: validation of musical exercise for older persons in long-term care settings. Once-weekly resistance exercise improves muscle strength and neuromuscular performance in older adults. A randomized walking trial in postmenopausal women: effects on physical activity and health 10 years later. Effects of moderate and low intensity long-term exercise by older adults. Effects of resistance training on strength, power, and selected functional abilities of women aged 75 and older. Activity adherence and physical function in older adults with functional limitations. Randomized trial of exercise in sedentary middle aged women: effects on quality of life A community-based walking trial to improve neighborhood quality of life in older adults: a multilevel analysis Successful aging: predictors and associated activities. The impact of nutritional supplementation and resistance training on the health functioning of free-living Chilean elders: results of 18 months of follow-up. Walking and dementia in physically capable elderly men. Hand grip strength and incident ADL disability in elderly Mexican Americans over a seven-year period Physical activity and leg strength predict decline in mobility performance in older persons. Randomized, controlled, six-month trial of yoga in healthy seniors: effects on cognition and quality of life. Effects of group exercise on cognitive functioning and mood in older women The impact of resistance exercise on the cognitive function of the elderly. Midlife hand grip strength as a predictor of old age disability. Functional impact of unvarying exercise program in women after menopause. Effects of a physical activity intervention on measures of physical performance: Results of the lifestyle interventions and independence for Elders Pilot (LIFE-P) study. Associations of changes in exercise level with subsequent disability among seniors: a 16-year longitudinal study. Physical activity and risk of cognitive impairment and dementia in elderly persons. Physical fitness and lifetime cognitive change Risk factors for Alzheimer's disease: a prospective analysis from the Canadian Study of Health and Aging. Physical activity, APOE genotype, and dementia risk: findings from the Cardiovascular Health Cognition Study. The relationship of age and cardiovascular fitness to cognitive and motor processes. The effect of strength and endurance training on gait, balance, fall risk, and health services use in community-living older adults. Aging successfully until death in old age: opportunities for increasing active life expectancy. Physical activity is associated with incident disability in community-based older persons. Physical activity in middle-aged adults reduces risks of functional impairment independent of its effect on weight. Physical activity and functional status in community-dwelling older women: a 14-year prospective study. Exercise Is Associated with Reduced Risk for Incident Dementia among Persons 65 Years of Age and Older The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. Incidence of and predictors for chronic disability in activities of daily living among older people in Taiwan. Physical activity in an ageing population. Association Between Lifestyle Factors and Mental Health Measures Among Community-Dwelling Older Women Type and intensity of activity and risk of mobility limitation: the mediating role of muscle parameters. Effect of strength and power training on physical function in community-dwelling older adults. Cardiovascular and behavioral effects of aerobic exercise training in healthy older men and women. Hand-grip strength predicts incident disability in non-disabled older men. Exercise: effects on physical functional performance in independent older adults. Functional and Neuromotor Performance in Older Adults: Effect of 12 Wks of Aerobic Exercise Age responses to multicomponent training programme in older adults Physical disability in older runners: prevalence, risk factors, and progression with age. Postponed development of disability in elderly runners: a 13-year longitudinal study. Fat mass rather than muscle strength is the major determinant of physical function and disability in postmenopausal women younger than 75 years of age Joint effects of adiposity and physical activity on incident mobility limitation in older adults. Resistance exercise and physical performance in adults aged 60 to 83. Mobility difficulties and physical activity as predictors of mortality and loss of independence in the community-living older population. Weight Training Improves Walking Endurance in Healthy Elderly Persons The effect of 6 months training on leg power, balance, and functional mobility of independently living adults over 70 years old. Effects of training on functional performance in 65, 75 and 85 year-old women: experiences deriving from community based studies in Odense, Denmark. The benefits of exercise in postmenopausal women. A longitudinal study of cardiorespiratory fitness and cognitive function in healthy older adults.
abstract: OBJECTIVE To test the efficacy of high-velocity training in healthy older persons . DESIGN A 12-week r and omized trial , with subjects blocked for gender and residence , comparing high-velocity resistance training with a self-paced walking program . SETTING Retirement community . PARTICIPANTS Forty-three volunteers over the age of 70 years . INTERVENTION Power group : high-velocity leg exercises 3 times weekly with weekly increases in resistance combined with 45 minutes of moderate , nonresistance exercise weekly . Walking group : moderate intensity exercise 30 minutes daily , 6 days weekly . MAIN OUTCOME MEASURES Variables measured included leg press peak power and leg extensor strength . Functional performance outcomes included : 6-minute walk distance , Short Physical Performance Battery , Physical Performance Test , and Medical Outcomes Study Short-Form Health Survey . RESULTS Peak power improved 22 % ( p = .004 ) in the power group ( 3.7 + /- 1.0 W/kg to 4.5 + /- 1.4 W/kg ) but did not change in the walking group ( 3.99 + /-.76 W/kg to 3.65 + /-.94 W/kg ) . Leg extensor power at resistance of 50 % , 60 % , and 70 % of body weight increased 50 % , 77 % , and 141 % , respectively , in the power group ( p < .0001 , repeated- measures analysis of variance ) . Strength improved 22 % in the power-trained individuals and 12 % in the walkers ( p < .0001 ) . Training did not improve functional task performance in either group . One subject developed a radiculopathy during training . CONCLUSIONS Resistance training focusing on speed of movement improved leg power and maximal strength substantially , but did not improve functional performance in healthy high-functioning older volunteers BACKGROUND The relationship between obesity and physical function is not well understood . Physical activity may be a key factor impacting on the relationship between obesity and physical function . METHODS Subjects included 171 community-dwelling women ( mean age = 74.3 , SD = 4.3 ) participating in a 14-year follow-up study to a walking intervention trial .  Measures of obesity [ body mass index ( BMI ) ] and physical activity ( Modified Paffenbarger Question naire ) were collected in 1982 , 1985 , 1995 , and 1999 . Physical function was assessed in 1999 using the Functional Status Question naire ( FSQ ) and gait speed . RESULTS Measures of obesity from 1982 to 1995 and measures of physical activity from 1982 to 1995 were related to physical function in 1999 . However , hierarchical regression analysis to predict physical function in 1999 controlling for the presence of chronic conditions indicated that physical activity from 1982 to 1995 , and not obesity from 1982 to 1995 , was an independent predictor of physical function ( FSQ : adjusted R2 = 0.09 , F = 4.68 , P < 0.001 ; gait speed : adjusted R2 = 18.0 , F = 9.41 , P < 0.0001 . CONCLUSION  Physical activity  appears to be as important if not more important than body weight in predicting future physical function This paper describes a quasi-experimental study of a musical exercise intervention to improve the physical , cognitive , behavioral status and life satisfaction of older residents in a long-term care facility in the United Kingdom . Twenty long-term care residents from three different units ( n=60 ) were recruited and assigned to one of three groups : a control ( C ) group ( no intervention ) , an occupational therapy ( OT ) group ( comparison group ) and a music exercise group ( intervention group ) . Assessment s of physical and cognitive status were made pre-intervention and repeated at the end of the 10-week exercise program and again 10 weeks after the completion of the program . The results show that both OT and exercise participation is associated with improvement in physical and cognitive function . However , the exercise group showed significant improvement in more areas than the OT group . The functional benefits from OT and exercise were not sustainable after these activities ceased and showed significant decline 10 weeks after the end of the programs OBJECTIVE To determine the effect of frequency of resistive training on gain in muscle strength and neuromuscular performance in healthy older adults . DESIGN A r and omized controlled trial with subjects assigned either to high-intensity resistance training 1 ( EX1 ) , 2 ( EX2 ) , or 3 ( EX3 ) days per week for 24 weeks or to a control group ( CO ) . SETTING An exercise facility at an academic medical center . SUBJECTS Forty-six community-dwelling healthy men ( n = 29 ) and women ( n = 17 ) aged 65 to 79 years . INTERVENTION Progressive resistance training consisting of three sets of eight exercises targeting major muscle groups of the upper and lower body , at 80 % of one-repetition maximum ( 1-RM ) for eight repetitions , either 1 , 2 , or 3 days per week . MEASURES Dynamic muscle strength ( 1-RM ) using isotonic equipment every 4 weeks , bone mineral density and body composition by dual energy X-ray absorptiometry ( DXA ) , and neuromuscular performance by timed chair rise and 6-meter backward t and em walk . RESULTS For each of the eight exercises , muscle strength increased in the exercise groups relative to CO ( P < .01 ) , with no difference among EX1 , EX2 and EX3 groups at any measurement interval . Percent change averaged 3.9 + /- 2.4 ( CO ) , 37.0 + /- 15.2 ( EX1 ) , 41.9 + /- 18.2 ( EX2 ) , and 39.7 + /- 9.8 ( EX3 ) . The time to rise successfully from the chair 5 times decreased significantly ( P < .01 ) at 24 weeks , whereas improvement in the 6-meter backward t and em walk approached significance ( P = .10 ) in the three exercise groups compared with CO . Changes in chair rise ability were correlated to percent changes in quadriceps strength ( r = -0.40 , P < .01 ) and lean mass ( r = -0.40 , P < .01 ) . CONCLUSIONS A program of once or twice weekly resistance exercise achieves muscle strength gains similar to 3 days per week training in older adults and is associated with improved neuromuscular performance . Such improvement could potentially reduce the risk of falls and fracture in older adults BACKGROUND It is important to determine if permanent lifestyle changes may result from physical activity interventions and whether health may be affected by these changes . OBJECTIVE To conduct a 10-year follow-up of physical activity and self-reported health status in participants of a r and omized clinical trial of walking intervention .  METHODS Of the original 229 volunteer postmenopausal women who participated in the original clinical trial , 196 ( N = 96 intervention and 100 controls ) completed the 10-year follow-up telephone interview . The interview protocol included questions on  self-reported walking for exercise  and purpose s other than exercise , the Paffenbarger sport and exercise index , functional status , and various chronic diseases and conditions . RESULTS The median values for both usual walking for exercise and total walking  were significantly higher for walkers compared with controls ( for both , P = .01 ) , with median differences of 706 and 420 kcal/wk , respectively . After excluding women who reported heart disease during the original trial , 2 women in the walking group ( 2 % ) and 11 women in the control group ( 12 % ) reported physician-diagnosed heart disease over the last 10 years ( P = .07 ) . There were also fewer hospitalizations , surgeries , and falls among women in the walking group , although these differences were not statistically significant ( P>.05 ) . CONCLUSIONS Although limited by self-report , this study may be the first to demonstrate long-term exercise compliance to a r and omized control trial in older women and to suggest that health benefits may have ensued as a result of these increased activity levels The goal was to determine the existence of differential effects of long-term moderate- or low-intensity exercise on selected bio-behavioral variables in 72 community-dwelling persons over 60 years of age . After screening , subjects were r and omly assigned to a moderate ( n = 39 , 60 - 70 % heart rate reserve [ HRR ] ) or low ( n = 33 , 30 - 40 % HRR ) intensity exercise protocol . Both groups exercised three times per week for 9 months and dependent measures were taken at baseline , 4.5 months and after 9 months . Repeated measures ANOVA with Tukey post hoc comparisons constituted the analysis approach . Moderate exercise showed no superiority over low-intensity exercise ; both groups improved about equally . Variables that significantly improved included : self-reported sleep ( sleep quantity and dream recall ) , mental status ( attention/concentration , short-term memory and higher cognitive functioning ) , health perceptions ( health outlook , health worry , rejection of the sick role ) , and cardiovascular fitness indicators ( submaximum stress test heart rate , maximum oxygen consumption ( VO2max ) , maximum work capacity and maximum exercise time ) . Similarity of outcomes in both groups may mean that the moderate exercise protocol was too conservative . Conversely , the findings may indicate that lower levels of exercise , which may be safer and more feasible over time , do improve fitness levels , prolong independent functioning , and promote positive perceptions of well-being in older adults OBJECTIVE To determine the effects of 12 weeks of progressive resistance strength training on the isometric strength , explosive power , and selected functional abilities of healthy women aged 75 and over . DESIGN Subjects were matched for age and habitual physical activity and then r and omly assigned into either a control or an exercise group . SETTING The Muscle Function Laboratory , Royal Free Hospital School of Medicine , London . PARTICIPANTS Fifty-two healthy women were recruited through local and national newspapers . Five dropped out before and seven ( 4 exercisers and 3 controls ) during the study . Pre- and posttraining measurements were obtained from 20 exercisers ( median age 79.5 , range 76 to 93 years ) and 20 controls ( median age 79.5 , range 75 to 90 years ) . INTERVENTIONS Training comprised one supervised session ( 1 hour ) at the Medical School and two unsupervised home sessions ( supported by an exercise tape and booklet ) per week for 12 weeks . The training stimulus was three sets of four to eight repetitions of each exercise , using rice bags ( 1 - 1.5 kg ) or elastic tubing for resistance . The exercises were intended specifically to strengthen the muscles considered relevant for the functional tasks , but were not to mimic the functional measurements . No intervention was prescribed for the controls . MEASUREMENTS Pre- and posttraining measurements were made for isometric knee extensor strength ( IKES ) , isometric elbow flexor strength ( IEFS ) , h and grip strength ( HGS ) , leg extensor power ( LEP ) , and anthropometric indices ( Body impedance analysis , arm muscle circumference , and body weight ) . Functional ability tests were chair rise , kneel rise , rise from lying on the floor , 118-m self-paced corridor walk , stair climbing , functional reach , stepping up , stepping down , and lifting weights onto a shelf . Pre- and posttraining comparisons were made using analysis of variance or analysis of covariance ( using weight as a covariate ) for normally distributed continuous data and one-sided Fishers exact test ( 2 x 2 table ) for discontinuous data . RESULTS Improvements in IKES ( mean change 27 % , P = .03 ) , IEFS ( 22 % , P = .05 ) , HGS ( 4 % , P = .05 ) , LEP/kg ( 18 % , P = .05 ) were associated with training , but the improvement in LEP ( 18 % , P = .11 ) did not reach statistical significance . There was an association between training and a reduction in normal pace kneel rise time ( median change 21 % , P = .02 ) and a small improvement in step up height ( median 5 % , P = .005 ) . The other functional tests did not improve . CONCLUSIONS Progressive resistance exercise can produce substantial increases in muscle strength and in power st and ardized for body weight in healthy , very old women . However , isolated increases in strength and LEP/kg may confer only limited functional benefit in healthy , independent , very old women PURPOSE Lifestyle Interventions and Independence for Elders Pilot ( LIFE-P ) was a trial to examine the effects of a physical activity intervention ( PA ) compared with a health education control ( SA ) on measures of disability risk in sedentary older adults ( N = 424 ) . We examined adherence to the LIFE-P PA intervention for the first 12 months of the trial . METHODS The PA intervention consisted of walking , strength , flexibility , and balance training supplemented with behavioral skills training modules , and it used a phased , center-based schedule of adoption ( 3x wk(-1 ) , weeks 1 - 8 ) , transition ( 2x wk(-1 ) , weeks 9 - 24 ) , and maintenance ( 1x wk(-1 ) , weeks 25 to end of trial ) while transitioning to primarily home-based physical activity . SA consisted of weekly ( weeks 1 - 26 ) transitioning to monthly health education workshops . RESULTS Participation in moderate-intensity physical activity increased from baseline to months 6 and 12 in PA compared with SA ( P < 0.001 ) . At 12 months , PA participants who reported > or = 150 min x wk(-1 ) of moderate activity demonstrated a significantly greater improvement in their Short Physical Performance Battery score compared with participants who reported < 150 min.wk of moderate activity ( P < 0.017 ) . For the PA arm , center-based attendance was 76.3 + /- 24.5 , 65.4 + /- 28.6 , and 49.8 + /- 35.8 % in the adoption , transition , and maintenance phases , respectively . CONCLUSIONS Adherence to physical activity in LIFE-P was associated with greater improvement in SPPB score and was consistent with adherence in physical activity trials of shorter duration in this subgroup of older adults . Older individuals at risk for disability can adhere to a regular program of physical activity in a long-term r and omized trial Increasing physical activity is currently considered to be a possible prevention strategy for cancer , obesity , and cardiovascular disease , either alone or in combination with dietary changes . This paper presents results of a r and omized trial of moderate-to-vigorous intensity exercise in middle aged , sedentary women ; specifically , we report changes in and correlates of quality of life and functional status of this exercise intervention program for both the short ( three months ) and longer term ( 12 months ) . The intervention group showed a significant increase in Mental Health score from baseline to 3 months ( p < .01 ) , significantly greater than the change in the control group at 3 months ( p < .01 ) . A similar trend among exercisers was observed for the General Health score ( p < .01 ) , and this finding was significantly greater than the change in control group at 3 months ( p = .01 ) . Change in Social Support – Affection were predictors of the changes in quality of life variables . This study documented improvements in quality of life and general functioning that occurred as a result of participating in an exercise intervention in sedentary middle-aged women Background : Few studies have considered the neighborhood as a context in which to examine the physical activity and quality of life relationship . Purpose : The goal of this study was to evaluate the effects of a neighborhood walking program on  quality of life among older adults . It was design ed as a r and omized trial involving a multilevel design with neighborhoods corresponding to primary sampling units and residents to secondary units . Methods : Five hundred eighty-two communitydwelling senior residents ( 65 years of age or older ) in neighborhoods in the northeast metropolitan area of Portl and , Oregon , were recruited through telephone , direct mail , and referrals . The walking intervention was delivered at the neighborhood level . Neighborhoods ( N = 56 ) were r and omly assigned to a 6-month , 3 times per week , leader-led walking group activity ( n = 28 ) or an information-only control group ( n = 28 ) . Primary outcome measures included SF-12 ( Physical , Mental summary scores ) and life satisfaction ( SWLS ) ; the secondary outcome measure was neighborhood walking activity , assessed at baseline , 3 months , and 6 months of the study period . Results : Compared to the control neighborhoods , results from multilevel , longitudinal analyses indicated significant improvements in the primary outcomes of SF-12 Physical ( p < .05 ) , SF-12 Mental ( p < .05 ) summary scores , and SWLS ( p < .05 ) , over the course of the 6-month intervention . A significant increase was also observed in the secondary outcome of walking activity ( p < .05 ) . Conclusions : Implementing a neighborhood-based walking program of low to moderate intensity is feasible and beneficial for promoting quality of life among senior residents at a community level Six-year predictors of successful aging were analyzed for 356 Alameda County Study men and women aged 65 - 95 years measured prospect ively in 1984 and followed to 1990 . Successful aging was defined as needing no assistance nor having difficulty on any of 13 activity/mobility measures plus little or no difficulty on five physical performance measures . After adjusting for baseline successful aging , sex , and age , the authors found that 1984 predictors of 1990 successful aging included income above the lowest quintile ( odds ratio ( OR ) = 2.01 , 95 % confidence interval ( CI ) 0.99 - 4.11 ) , > or = 12 years of education ( OR = 1.67 , 95 % CI 0.98 - 2.84 ) , white ethnicity ( OR = 2.12 , 95 % CI 0.93 - 4.86 ) , diabetes ( OR = 0.10 , 95 % CI 0.01 - 0.79 ) , chronic obstructive pulmonary disease ( OR = 0.41 , 95 % CI 0.17 - 0.97 ) , arthritis ( OR = 0.43 , 95 % CI 0.26 - 0.71 ) , and hearing problems ( OR = 0.48 , 95 % CI 0.25 - 0.89 ) . Adjusting for all variables , the authors found that behavioral and psychosocial predictors included the absence of depression ( OR = 1.94 , 95 % CI 1.10 - 3.42 ) , having close personal contacts ( OR = 1.82 , 95 % CI 1.05 - 3.18 ) , and often walks for exercise ( OR = 1.77 , 95 % CI 1.00 - 3.12 ) . Cross-sectional comparisons at follow-up revealed significantly higher community involvement , physical activity , and mental health for those aging successfully Body composition changes and loss of functionality in the elderly are related to subst and ard diets and progressive sedentariness . The aim of this study was to assess the impact of an 18-mo nutritional supplementation and resistance training program on health functioning of elders . Healthy elders aged > or = 70 y were studied . Half of the subjects received a nutritional supplement . Half of the supplemented and nonsupplemented subjects were r and omly assigned to a resistance exercise training program . Every 6 mo , a full assessment was performed . A total of 149 subjects were considered eligible for the study and 98 ( 31 supplemented and trained , 26 supplemented , 16 trained and 25 without supplementation or training ) completed 18 mo of follow-up .  Compliance with the supplement was 48 % , and trained subjects attended 56 % of programmed sessions . Activities of daily living remained constant in the supplemented subjects and decreased in the other groups . Body weight and fat-free mass did not change . Fat mass increased from 22.2 + /- 7.6 to 24.1 + /- 7.7 kg in all groups . Bone mineral density decreased less in both supplemented groups than in the nonsupplemented groups ( ANOVA , P < 0.01 ) . Serum cholesterol remained constant in both supplemented groups and in the trained groups , but it increased in the control group ( ANOVA , P < 0.05 ) . Upper and lower limb strength , walking capacity and maximal inspiratory pressure increased in trained subjects . In conclusion , patients who were receiving nutritional supplementation and resistance training  maintained functionality , bone mineral density and serum cholesterol levels and improved their muscle strength CONTEXT Evidence suggests that physical activity may be related to the clinical expression of dementia . Whether the association includes low-intensity activity such as walking is not known . OBJECTIVE To examine the association between walking and future risk of dementia in older men . DESIGN Prospect i ve cohort study . SETTING AND PARTICIPANTS Distance walked per day was assessed from 1991 to 1993 in 2257 physically capable men aged 71 to 93 years in the Honolulu-Asia Aging Study . Follow-up for incident dementia was based on neurological assessment at 2 repeat examinations ( 1994 - 1996 and 1997 - 1999 ) . MAIN OUTCOME MEASURES Overall dementia , Alzheimer disease , and vascular dementia . RESULTS During the course of follow-up , 158 cases of dementia were identified ( 15.6/1000 person-years ) . After adjusting for age , men who walked the least ( < 0.25 mile/d ) experienced a 1.8-fold excess risk of dementia compared with those who walked more than 2 mile/d ( 17.8 vs 10.3/1000 person-years ; relative hazard [ RH ] , 1.77 ; 95 % confidence interval [ CI ] , 1.04 - 3.01 ) . Compared with men who walked the most ( > 2 mile/d ) , an excess risk of dementia was also observed in those who walked 0.25 to 1 mile/d ( 17.6 vs 10.3/1000 person-years ; RH , 1.71 ; 95 % CI , 1.02 - 2.86 ) . These associations persisted after accounting for other factors , including the possibility that limited amounts of walking could be the result of a decline in physical function due to pre clinical dementia . CONCLUSIONS Findings suggest that walking is associated with a reduced risk of dementia . Promoting active lifestyles in physically capable men could help late-life cognitive function Background and aims : Little is known about muscle strength as a predictor of  disability among older Mexican Americans . The aim of this study was to examine the association between h and grip strength  and 7-year incidence of ADL disability in older Mexican American men and women . Methods : A 7-year prospect i ve cohort study of 2493 non-institutionalized Mexican American men and women aged 65 or older residing in five south-western states .  Maximal h and grip strength test , body mass index , cognitive function , activities of daily living , self-reports of medical conditions ( arthritis , diabetes , heart attack , stroke , cancer , hip fracture ) , and depressive symptoms were obtained . Results : In a Cox proportional regression analysis , there was a linear relationship between h and grip strength at baseline and risk of incident ADL disability over a 7-year follow-up . Among non-disabled men at baseline , the hazard ratio of any new ADL limitation was 1.90(95 % CI 1.14–3.17 ) for those in the lowest quartile , when compared with men in the highest h and grip strength quartile , after controlling for age , marital status , medical conditions , high depressive symptoms , MMSE score , and BMI at baseline . Among non-disabled women at baseline , the hazard ratio of any new ADL limitation was 2.28 ( 95 % CI 1.59–3.27 ) for those in the lowest quartile , when compared with women in the highest h and grip strength quartile . Conclusions : H and grip strength is an independent predictor of ADL disability  among older Mexican American men and women . The h and grip strength test is an easy , reliable , valid , inexpensive method of screening to identify older adults at risk of disability OBJECTIVES To assess the extent to which physical activity and leg strength are associated with change in mobility  in older persons . DESIGN Prospect i ve , observational cohort study . SETTING Retirement communities across the Chicago metropolitan area participating in the Rush Memory and Aging Project . PARTICIPANTS Eight hundred eighty-six ambulatory older persons without dementia . MEASUREMENT Rate of change in mobility . RESULTS In a linear mixed-effects model that controlled for age , sex , education , and a term for baseline physical activity , a higher level of physical activity was associated with a slower rate of mobility decline ( estimate=0.006 , st and ard error (SE)=0.003 , P=.03 ) ; each additional hour of physical activity at baseline was associated with an approximately 3 % decrease in the rate of mobility decline . In a similar model , a higher level of baseline leg strength was associated with a slower rate of mobility decline ( estimate=0.031 , SE=0.132 , P=.02 ) ; each additional unit of leg strength at baseline was associated with an approximately 20 % decrease in the rate of mobility decline . In a final model , which included terms for physical activity and leg strength together , both were associated with decline in mobility . Furthermore , both remained associated with mobility even after controlling for body composition , balance , pulmonary function , cognition , history of joint pain , cardiovascular diseases and risk factors , and medications . CONCLUSION Physical activity and leg strength are relatively independent predictors of mobility decline  in older persons . Although physical activity may improve strength , the beneficial effect of physical activity on mobility is likely to involve other pathways CONTEXT There are potential benefits of mind-body techniques on cognitive function because the techniques involve an active attentional or mindfulness component , but this has not been fully explored . OBJECTIVE To determine the effect of yoga on cognitive function , fatigue , mood , and quality of life in seniors . DESIGN R and omized , controlled trial comparing yoga , exercise , and wait-list control groups . PARTICIPANTS One hundred thirty-five generally healthy men and women aged 65 - 85 years . INTERVENTION Participants were r and omized to 6 months of Hatha yoga class , walking exercise class , or wait-list control . Subjects assigned to classes also were asked to practice at home . MAIN OUTCOME MEASURES Outcome assessment s performed at baseline and after the 6-month period included a battery of cognitive measures focused on attention and alertness , the primary outcome measures being performance on the Stroop Test and a quantitative electroencephalogram ( EEG ) measure of alertness ; SF-36 health-related quality of life ; Profile of Mood States ; Multi-Dimensional Fatigue Inventory ; and physical measures related to the interventions . RESULTS One hundred thirty-five subjects were recruited and r and omized . Seventeen subjects did not finish the 6-month intervention . There were no effects from either of the active interventions on any of the cognitive and alertness outcome measures . The yoga intervention produced improvements in physical measures ( eg , timed 1-legged st and ing , forward flexibility ) as well as a number of quality -of-life measures related to sense of well-being and energy and fatigue compared to controls . CONCLUSIONS There were no relative improvements of cognitive function among healthy seniors in the yoga or exercise group compared to the wait-list control group . Those in the yoga group showed significant improvement in quality -of-life and physical measures compared to exercise and wait-list control groups Abstract : A r and omised controlled trial was conducted to determine whether a 12–month program of group exercise had beneficial effects on physiological and cognitive functioning and mood in 187 older community – dwelling women . The  exercisers ( n= 94 ) and controls ( n= 93 ) were well matched in terms of the test measures and a number of health and life – style assessment s. The mean number of classes attended by the 71 exercise subjects who completed the program was 59.0 ( range 26 to 82 ) . At the end of the trial , the exercisers showed significant improvements in reaction time , strength , memory span and measures of wellbeing when compared with the controls . There was also an indication that anxiety had been reduced in the exercisers . Within the exercise group , improvements in memory span were associated with concomitant improvements in both reaction time and muscle strength . Also , within this group , initial mood measures were significantly inversely associated with improvements at retest , which suggests that the program may have normalised mood states in subjects who had high initial depression , anxiety and stress levels , rather than inducing improvements in all subjects . These findings suggest that group exercise has beneficial effects on physiological and cognitive functioning and wellbeing in older people PURPOSE The purpose of this study was to assess the impact of 24 wk of resistance training at two different intensities on cognitive functions in the elderly . METHODS Sixty-two elderly individuals were r and omly assigned to three groups : CONTROL ( N = 23 ) , experimental moderate ( EMODERATE ; N = 19 ) , and experimental high ( EHIGH ; N = 20 ) . The volunteers were assessed on physical , hemodynamic , cognitive , and mood parameters before and after the program . RESULTS On the 1 RM test ( P < 0.001 ) , the two experimental groups performed better than the CONTROL group , but they did not show differences between themselves . The EHIGH group gained more lean mass ( P = 0.05 ) than the CONTROL group and performed better on the following tests : digit span forward ( P < 0.001 ) , Corsi 's block-tapping task backward ( P = 0.001 ) , similarities ( P = 0.03 ) , Rey-Osterrieth complex figure immediate recall ( P = 0.02 ) , Toulouse-Pieron concentration test errors ( P = 0.01 ) , SF-36 ( general health ) ( P = 0.04 ) , POMS ( tension-anxiety , P = 0.04 ; depression-dejection , P = 0.03 ; and total mood disorder , P = 0.03 ) . The EMODERATE group scored higher means than the CONTROL group on digit span forward ( P < 0.001 ) , Corsi 's block-tapping task backward ( P = 0.01 ) , similarities ( P = 0.02 ) , Rey-Osterrieth complex figure immediate recall ( P = 0.02 ) , SF-36 ( general health , P = 0.005 ; vitality , P = 0.006 ) , POMS ( tension-anxiety , P = 0.001 ; depression-dejection , P = 0.006 ; anger-hostility , P = 0.006 ; fatigue-inertia , P = 0.02 ; confusion-bewilderment , P = 0.02 ; and total mood disorder , P = 0.001 ) . We also found that IGF-1 serum levels were higher in the experimental groups ( EMODERATE , P = 0.02 ; EHIGH , P < 0.001 ) . CONCLUSIONS Moderate- and high-intensity resistance exercise programs had equally beneficial effects on cognitive functioning CONTEXT Poor muscle strength , functional limitations , and disability often coexist , but whether muscle strength during midlife predicts old age functional ability is not known . OBJECTIVE To determine whether h and grip strength measured during midlife predicts old age functional limitations and disability in initially healthy men . DESIGN AND SETTING A 25-year prospect i ve cohort study , the Honolulu Heart Program , which began in 1965 among Japanese-American men living on Oahu , Hawaii . PARTICIPANTS A total of 608945- to 68-year-old men who were healthy at baseline and whose maximal h and grip strength was measured from 1965 through 1970 . Altogether , 2259 men died over the follow-up period and 3218 survivors participated in the  disability assessment  in 1991 through 1993 . MAIN OUTCOME MEASURES Functional limitations including slow customary walking speed ( < or = 0.4 m/s ) and inability to rise from a seated position without using the arms , and multiple self-reported upper extremity , mobility , and self-care disability outcomes . RESULTS After adjustment for multiple potential confounders , risk of functional limitations and disability 25 years later increased as baseline h and grip strength , divided into tertiles , declined . The odds ratio ( OR ) of walking speed of 0.4 m/s or slower was 2.87 ( 95 % confidence interval [ CI ] , 1.76 - 4.67 ) in those in the lowest third and 1.79 ( 95 % CI , 1.14 - 2.81 ) in the middle third of grip strength vs those in the highest third . The risk of self-care disability was more than 2 times greater in the lowest vs the highest grip strength tertile . Adding chronic conditions identified at follow-up to the models predicting disability reduced the ORs related to grip strength only minimally . CONCLUSIONS Among healthy 45- to 68-year-old men , h and grip strength was highly predictive of functional limitations and disability 25 years later . Good muscle strength in midlife may protect people from old age disability by providing a greater safety margin above the threshold of disability Low bone mass , functional impairment , low muscle strength , and postural instability are predictors of the risk of fracture in an elderly person . The purpose of this study was to investigate the functional impact of an unvarying long-term exercise program to be carried out at home . The exercises had been shown to delay bone loss in an elderly population . At the Department of Physical Medicine and Rehabilitation , University of Vienna , postmenopausal women who had been stratified into exercise or control groups 5 to 10 yr ago were called in for a follow-up examination . Frequency of training , habits , and pain causing disability in activities of daily living were recorded . Walking velocity , muscle strength , and postural stability were measured . Functional assessment , blood analysis , and x-rays of the spine were performed additionally . One hundred twenty-four women aged 68.3 + /- 6.8 yr ( mean + /- SD ) underwent a follow-up investigation at the outpatient clinic . After 7.7 + /- 1.1 yr the compliance of the training group was still 36 % . Self-chosen gait velocity was slightly higher in the regular exercisers than in the controls . No intergroup differences were found for pain induced disability , muscle strength , body sway , and fracture rate . The pain disability index was significantly associated with corrected self-chosen gait velocity . The results suggest that an unvarying home-based exercise program may support general agility but does not yield enough force to improve muscle strength and postural stability in healthy , nondisabled , postmenopausal women who start exercising at the age of 60 yr . Further studies are needed to define more appropriate exercise programs for a comprehensive improvement of functional outcome in a population at high risk for osteoporosis BACKGROUND The Short Physical Performance Battery ( SPPB ) , which includes walking , balance , and chair st and s tests , independently predicts mobility disability and activities of daily living disability . To date , however , there is no definitive evidence from r and omized controlled trials that SPPB scores can be improved . Our objective was to assess the effect of a comprehensive physical activity ( PA ) intervention on the SPPB and other physical performance measures . METHODS A total of 424 sedentary persons at risk for disability ( ages 70 - 89 years ) were r and omized to a moderate-intensity PA intervention or a successful aging ( SA ) health education intervention and were followed for an average of 1.2 years . RESULTS The mean baseline SPPB score on a scale of 0 - 12 , with 12 corresponding to highest performance , was 7.5 . At 6 and 12 months , the PA versus SA group adjusted SPPB ( + /- st and ard error ) scores were 8.7 + /- 0.1 versus 8.0 + /- 0.1 , and 8.5 + /- 0.1 versus 7.9 + /- 0.2 , respectively ( p < .001 ) . The 400-meter walking speed was also significantly improved in the PA group . The PA group had a lower incidence of major mobility disability defined as incapacity to complete a 400-meter walk ( hazard ratio = 0.71 , 95 % confidence interval = 0.44 - 1.20 ) . CONCLUSIONS A structured PA intervention improved the SPPB score and other measures of physical performance . An intervention that improves the SPPB performance may also offer benefit on more distal health outcomes , such as mobility disability BACKGROUND The effect of changes in physical exercise on progression of  musculoskeletal disability in seniors has rarely been studied . METHODS We studied a prospect i ve cohort annually from 1984 to 2000 using the Health Assessment Question naire Disability Index ( HAQ-DI ) .  The cohort included 549 participants , 73 % men , with average end-of- study age of 74 years . At baseline and at the end of the study , participants were classified as " High " or " Low " vigorous exercisers using a cut-point of 60 min/wk . Four groups were formed : " Sedentary " ( Low-->Low ; N = 71 ) , " Exercise Increasers " ( Low-->High ; N = 27 ) , " Exercise Decreasers " ( High-->Low ; N = 73 ) , and " Exercisers " ( High-->High ; N = 378 ) . The primary dependent variable was change in HAQ-DI score ( scored 0 - 3 ) from 1984 to 2000 . Multivariate statistical adjustments using analysis of covariance included age , gender , and changes in three risk factors , body mass index , smoking status , and number of comorbid conditions . Participants also prospect ively provided reasons for exercise changes . RESULTS At baseline , Sedentary and Increasers averaged little exercise ( 16 and 22 exercise min/wk ) , whereas Exercisers and Decreasers averaged over 10 times more ( 285 and 212 exercise min/wk ; p < .001 ) . All groups had low initial HAQ-DI scores , ranging from 0.03 to 0.08 . Increasers and Exercisers achieved the smallest increments in HAQ-DI score ( 0.17 and 0.11 ) over 16 years , whereas Decreasers and Sedentary fared more poorly ( increments 0.27 and 0.37 ) . Changes in HAQ-DI score for Increasers compared to Sedentary were significantly more favorable ( p < .05 ) even after multivariate statistical adjustment . CONCLUSIONS Inactive participants who increased exercise achieved excellent end-of- study values with increments in disability similar to those participants who were more active throughout . These results suggest a beneficial effect of exercise , even when begun later in life , on postponement of disability CONTEXT Dementia is common , costly , and highly age related . Little attention has been paid to the identification of modifiable lifestyle habits for its prevention . OBJECTIVE To explore the association between physical activity and the risk of cognitive impairment and dementia .  DESIGN , SETTING , AND SUBJECTS Data come from a community sample of 9008 r and omly selected men and women 65 years or older , who were evaluated in the 1991 - 1992 Canadian Study of Health and Aging , a prospect i ve cohort study of dementia . Of the 6434 eligible subjects who were cognitively normal at baseline , 4615 completed a 5-year follow-up .  Screening and clinical evaluations were done at both waves of the study . In 1996 - 1997 , 3894 remained without cognitive impairment , 436 were diagnosed as having cognitive impairment-no dementia , and 285 were diagnosed as having dementia . MAIN OUTCOME MEASURE Incident cognitive impairment and dementia by levels of physical activity at baseline . RESULTS Compared with no exercise , physical activity was associated with lower risks of cognitive impairment , Alzheimer disease , and dementia of any type . Significant trends for increased protection with greater physical activity were observed . High levels of physical activity were associated with reduced risks of cognitive impairment ( age- , sex- , and education-adjusted odds ratio , 0.58 ; 95 % confidence interval , 0.41 - 0.83 ) , Alzheimer disease ( odds ratio , 0.50 ; 95 % confidence interval , 0.28 - 0.90 ) , and dementia of any type ( odds ratio , 0.63 ; 95 % confidence interval , 0.40 - 0.98 ) . CONCLUSION Regular physical activity could represent an important and potent protective factor for cognitive decline and dementia in elderly persons Objective : To test the hypothesis that physical fitness is associated with more successful cognitive aging . Methods : Surviving participants ( N = 460 ) of the Scottish Mental Survey of 1932 were tested on the same general cognitive test at age 11 and 79 years . Measures of grip strength , 6-meter walk time , and lung function ( forced expiratory volume from the lungs in 1 second [ FEV1 ] ) were assessed at age 79 years . Results : A latent physical fitness trait , derived by principal components analysis of the three fitness measures , was significantly associated with successful cognitive aging . Cognitive score at age 11 , sex , social class , and APOE-ε4 genotype were included as covariables . Higher childhood IQ was associated with better lung function in old age . Conclusions : Physical fitness is associated with cognitive reserve . Intervention studies aim ed at making older people fitter are good c and i date s to improve cognitive aging A prospect i ve analysis of risk factors for Alzheimer 's disease was a major objective of the Canadian Study of Health and Aging , a nationwide , population -based study . Of 6,434 eligible subjects aged 65 years or older in 1991 , 4,615 were alive in 1996 and participated in the follow-up study . All participants were cognitively normal in 1991 when they completed a risk factor question naire . Their cognitive status was reassessed 5 years later by using a similar two-phase procedure , including a screening interview , followed by a clinical examination when indicated . The analysis included 194 Alzheimer 's disease cases and 3,894 cognitively normal controls . Increasing age , fewer years of education , and the apolipoprotein E epsilon4 allele were significantly associated with increased risk of Alzheimer 's disease . Use of nonsteroidal anti-inflammatory drugs  ,  wine consumption , coffee consumption  , and  regular physical activity  were associated with a reduced risk of Alzheimer 's disease . No statistically significant association was found for family history of dementia , sex , history of depression , estrogen replacement therapy , head trauma , antiperspirant or antacid use , smoking , high blood pressure , heart disease , or stroke . The protective associations warrant further study . In particular , regular physical activity could be an important component of a preventive strategy against Alzheimer 's disease and many other conditions Physical activity may help preserve cognitive function and decrease dementia risk , but epidemiologic findings are inconsistent . The authors conducted a prospect i ve study to determine the association between physical activity and risk of  dementia , Alzheimer 's disease , and vascular dementia . The US study population comprised 3,375 men and women aged 65 years or older , free of dementia at baseline , who participated in the Cardiovascular Health Cognition Study in 1992 - 2000 .  Leisure-time energy expenditure and an activity index reflecting number of different physical activities were calculated . Analyses were based on Cox proportional hazards models . There were 480 incident cases of dementia over an average of 5.4 years of follow-up . After multivariate adjustment , participants in the highest quartile of physical energy expenditure had a relative risk of dementia of 0.85 ( 95 % confidence interval : 0.61 , 1.19 ) compared with those in the lowest quartile , and participants engaging in > or=4 activities had a relative risk of dementia of 0.51 ( 95 % confidence interval : 0.33 , 0.79 ) compared with those engaging in 0 - 1 activity . These associations were more marked in apolipoprotein E genotype ( APOE ) epsilon4 allele noncarriers but were absent in carriers . A similar pattern was observed for Alzheimer 's disease and vascular dementia . Mechanisms to explain the observed relations deserve further study Older and younger aerobically trained and sedentary adults participated in an S1-S2-S3 paradigm design ed to elicit event-related potential ( ERP ) and behavioral responses to determine the influence of cardiovascular fitness on cognitive and motor processes . The paradigm provided warning ( S1 ) as to the difficulty level of an upcoming decision task ( S2 ) . Participants had to decide the taller of two bars on presentation of S2 but hold their response until S3 , to which they indicated their choice motorically . Results revealed age-related differences for ERP measures as older participants showed increased amplitude of the stimulus preceding negativity ( SPN ) prior to S2 , and longer latencies and equipotentiality of P3 in response to S2 . Fitness effects were also observed for the contingent negative variation ( CNV ) with decreased amplitude for fit relative to sedentary individuals . Age interacted with fitness for P3 latency to S2 as older sedentary individuals showed the longest latency followed by older fit and both younger groups . No significant group differences were observed for reaction time ( RT ) to S3 . Therefore , physical fitness is associated with attenuation of cognitive decline in older individuals and greater economy of motor preparation for both young and older participants BACKGROUND The study tested the effect of strength and endurance training on gait , balance , physical health status , fall risk , and  health services use in older adults . METHODS The study was a single-blinded , r and omized controlled trial with intention-to-treat analysis . Adults ( n = 105 ) age 68 - 85 with at least mild deficits in strength and balance were selected from a r and om sample of enrollees in a health maintenance organization . The intervention was supervised exercise ( 1-h sessions , three per week , for 24 - 26 weeks ) , followed by self-supervised exercise . Exercise groups included strength training using weight machines ( n = 25 ) , endurance training using bicycles ( n = 25 ) , and strength and endurance training ( n = 25 ) . Study outcomes included gait tests , balance tests , physical health status measures , self-reported falls ( up to 25 months of follow-up ) , and inpatient and outpatient use and costs . RESULTS There were no effects of exercise on gait , balance , or physical health status . Exercise had a protective effect on risk of falling ( relative hazard = .53 , 95 % CI = .30-.91 ) . Between 7 and 18 months after r and omization , control subjects had more outpatient clinic visits ( p < .06 ) and were more likely to sustain hospital costs over $ 5000 ( p < .05 ) . CONCLUSIONS Exercise may have beneficial effects on fall rates and health care use in some subgroups of older adults . In community-living adults with mainly mild impairments in gait , balance , and physical health status , short-term exercise may not have a restorative effect on these impairments The purpose of this study was to estimate the prevalence of having no disability in the year prior to death in very old age and to examine factors associated with this outcome . Participants were men and women aged 65 years and older who were followed prospect ively between 1981 and 1991 from three communities : New Haven , Connecticut ; Iowa and Washington counties , Iowa ; and East Boston , Massachusetts . Persons who died in late old age with known disability status within 15 months of death ( n = 1,097 ) were studied for predictors of dying without disability at the last follow-up interview prior to death . The probability of a nondisabled 65-year-old man 's surviving to age 80 and then being nondisabled prior to death was 26 % and , for a 65-year-old woman , the probability of surviving to age 85 and being nondisabled before death was 18 % .  Physical activity  was a key factor predicting nondisability before death . There was nearly a twofold increased likelihood of dying without disability among the most physically active group compared with sedentary adults ( adjusted odds ratio = 1.86 , 95 % confidence interval 1.24 - 2.79 ) . These findings provide encouraging evidence that disability prior to death is not an inevitable part of a long life but may be prevented by moderate physical activity OBJECTIVES To examine the association between physical activity and the risk of incident disability , including impairment in activities of daily living ( ADLs ) and instrumental activities of daily living ( IADLs ) , in community-based older persons free of dementia . DESIGN Prospect i ve , observational cohort study . SETTING Approximately 40 retirement communities across the Chicago metropolitan area . PARTICIPANTS More than 1,000 older persons from the Rush Memory and Aging Project , an ongoing longitudinal clinical -pathological study of common chronic conditions of old age . MEASUREMENTS All participants underwent detailed annual clinical evaluations that included assessment s of  physical activity , ADLs , IADLs , and gait performance . The associations between  physical activity , mortality , and incident disability were examined using a series of Cox proportional hazards models controlled for age , sex , education , and baseline gait . RESULTS At baseline , participants spent a mean+/-st and ard deviation of 3.0+/-3.5 hours per week engaging in physical activity ( range 0 - 35 ) . In a proportional hazards model , the risk of death decreased 11 % ( hazard ratio (HR)=0.89 , 95 % confidence interval (CI)=0.83 - 0.95 ) for each additional hour of physical activity per week . For those who were not disabled at baseline , the risk of developing disability in ADLs decreased 7 % ( HR=0.93 , 95 % CI=0.88 - 0.98 ) for each additional hour of physical activity per week . Similarly , the risk of disability in IADLs decreased 7 % ( HR=0.93 , 95 % CI=0.89 - 0.99 ) for each additional hour of physical activity . CONCLUSION For community-based older persons without dementia , physical activity is associated with maintenance of functional status , including a reduced risk of developing impairment in ADLs and IADLs OBJECTIVES To assess the association between physical activity and subsequent physical functioning in middle-aged adults across a range of body mass index ( BMI ) categories . DESIGN Prospect i ve nationally representative cohort studies . SETTING The United States and Engl and . PARTICIPANTS Eight thous and seven hundred two individuals in the United States and 1,507 in Engl and aged 50 to 69 and free of impairment at baseline , followed up for 6 years . MEASUREMENTS Self-reported and measured BMI and self-reported level of physical activity .  Outcome measures were score on a physical performance battery and self-reported mobility impairment . RESULTS In both studies , being overweight and being obese were associated with greater risk of impairment ( than being of recommended weight ) . In all weight categories and both countries , higher levels of physical activity were associated with lower risks of mobility impairment . For example , U.S. respondents of recommended weight ( BMI 20 - 25 ) who were active on 3 or more days per week had a relative risk ( RR ) of incident mobility difficulties , compared with those who were less active , of 0.56 ( 95 % confidence interval (CI)=0.40 - 0.78 ) ; for those who were obese ( BMI > /=30 ) the corresponding RR was 0.59 ( 95 % CI=0.45 - 0.76 ) . CONCLUSION Excess bodyweight is a risk factor for impaired physical function  in middle-aged and older people .  Physical activity is protective of impaired physical functioning in this age group in subjects with recommended weight , overweight , and obesity . Older adults should be encouraged to engage in appropriate levels of physical activity irrespective of their weight BACKGROUND Short-term prospect i ve studies have shown physical activity to be related to functional status . To our knowledge , the association between physical activity levels and functional status over a longer period has not been established . METHODS Two hundred twenty-nine older women ( mean age , 74.2 years ) who were involved in a r and omized controlled walking intervention from 1982 to 1985 were subsequently followed up until December 1999 .  Physical activity  was assessed in 1985 , 1995 , and 1999 using a physical activity question naire and a physical activity monitor . In 1999 , functional status was assessed by self-report and performance-based measures . RESULTS Subjective and objective measures of physical activity in 1985 independently predicted gait speed in 1999 after controlling for age , chronic conditions , and activity limitation ( subjective model-adjusted R2 = 0.09 [ P=.03 ] ; and objective model-adjusted R2 = 0.13 [ P=.008 ] ) . The consistency of physical activity participation from 1985 to 1995 was also related to functional status in 1999 . Women who were always active had the best functional status and women who were always inactive had the worst functional status . For difficulty with activities of daily living : those always active , 17 ( 37.8 % ) of 45 women ; those inconsistently active , 24 ( 40.0 % ) of 60 women ; and those always inactive , 39 ( 59.1 % ) of 66 women ( chi2 for trend P=.02 ) . For score on the Physical Performance Test : those always active , 24.9 ; those inconsistently active , 24.5 ; and those always inactive , 23.8 ( analysis of variance with linear contrasts P=.04 ) . For gait speed : those always active , 1.17 m/s ; those inconsistently active , 1.15 m/s ; and those always inactive , 1.03 m/s ( analysis of variance with linear contrasts P=.002 ) . CONCLUSION We demonstrated a significant relation between physical activity during a 14-year period and current functional status in older women , thus suggesting that physical activity plays a role in maintaining functional ability later in life 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 OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity OBJECTIVES To estimate the incidence of chronic activities of daily living ( ADL ) disability and to analyze the sociodemographic , health status , adverse lifestyle , and leisure-time physical activity predictors for chronic ADL disability . DESIGN We recruited a cohort of community-dwelling older people in Taipei , Taiwan , who were not ADL disabled in August 1993 , and we followed them until August 1996 . SETTING S AND PARTICIPANTS The study subjects were 1321 community-dwelling people aged 65 years or older who were ADL intact at the initial interview in August 1993 . The study sample was a subset of a probability sample ( n = 1583 ) r and omly selected from household registration s in the four districts of the Taipei metropolitan area . MEASUREMENTS Baseline information regarding various factors potentially associated with the development of chronic ADL disability was assessed and collected at the beginning of the study . Study participants were assessed annually for ADL function by a structured home interview using a six-item scale . Participants who were unable to perform independently at least one of the six items -- eating , bathing , dressing , toileting ,  transfers , and walking inside the house -- for more than 3 months were considered chronically ADL disabled . Cox proportional hazard regression models were utilized to examine the independent effect of the potential predictors on risk of chronic ADL disability . RESULTS During the 3-year study period , 145 ( 11.0 % ) participants developed chronic ADL disability , 58 ( 4.4 % ) participants were lost to follow-up , and 83 ( 6.3 % ) participants died . Multiple hazard regression analysis showed that individuals aged 70 to 79 years or older than age 80 had increased risk of ADL disability ( relative risk : 2.05 ( 95 % confidence interval ( CI ) , 1.35 - 3.11 ) and 3.89 ( 95%CI , 2.33 - 6.50 ) , respectively ) compared with those participants younger than age 70 . Risk of chronic ADL disability was inversely associated with routine exercise ( RR = 0.52 ; 95 % CI , 0.39 - 0.68 ) . CONCLUSIONS Age is the most significant predictor of chronic ADL disability . Lack of routine exercise is also a significant predictor of ADL disability in older adults UNLABELLED This review over previously published articles , describes physical activity changes during ageing from age 50 - 85 in the 1914-cohort in Glostrup , Denmark , and analyses the association between physical activity and mortality , myocardial infa rct ion , hip fractures and functional ability .  The 1914-cohort in Glostrup was examined at age 50 in 1964 and re-examined 1974 , 1984 , 1989 , 1994 and 1999 . Some analyses were based on pooled data ( CCPPS : Copenhagen Centre for Prospect i ve Population Studies ) from three longitudinal population studies conducted in Copenhagen , Denmark : The Copenhagen County Centre for Preventive Medicine in Glostrup , The Copenhagen City Heart Study and The Copenhagen Male Study .  Physical activity of work and leisure time was classified into four levels based on questions originally constructed by Saltin and Grimby . MAIN OUTCOME MEASURES all-cause mortality , fatal and non-fatal myocardial infa rct ion , hip fracture and functional ability ( Avlund mobility index of dependency ) . The lifetime risk from a  sedentary leisure time  was analysed in multivariate regression analyses controlling for covariates describing gender , age , life style , education and chronic diseases . Less than one third of the population had a sedentary leisure time . Physical activity definitely influenced health and quality of life over the life course in a positive way : compared to the group of inactive men and women , the mortality was about 60 % , the incidence of myocardial infa rct ion 70 % and the incidence of hip fractures 75 % in the moderate active groups . On top the physically active persons gained independency in activities of daily living Objective : To investigate the association between potentially modifiable lifestyle factors and cognitive abilities/depressive symptoms in community-dwelling women aged 70 years and over . Method : Cross-sectional study of community-dwelling women aged 70 years and over ( n = 278 ; mean age = 74.6 years ) .  Lifestyle variables assessed included smoking , alcohol consumption , physical activity , nutrition and education . The mental health measures of interest were depression , anxiety , quality of life and cognitive function , as assessed by the Beck Depression Inventory ( BDI ) , Beck Anxiety Inventory ( BAI ) , SF-36 , and the Cambridge Cognitive Examination for Mental Disorders of the Elderly ( CAMCOG ) , respectively . Results : Physically active women were half as likely to be depressed ( BDI score ≥ 10 ) and anxious ( BAI score ≥ 8) when compared to their physically inactive counterparts ( OR = 0.5 , 95 % CI = 0.3–0.8 for both , adjusted for marital status and smoking in the case of depression ) . Having ever smoked more than 20 cigarettes per day was associated with increased risk of depression ( OR = 2.8 , 95 % CI = 1.4–5.5 , adjusted for marital status and physical activity ) . Moderate alcohol use was associated with increased likelihood of having a CAMCOG score within the highest 50 percentile ( OR = 2.0 , 95 % CI = 1.1–3.5 , adjusted for age and education ) , as was more than minimum statutory education ( OR = 2.0 , 95 % CI = 1.1–3.5 , adjusted for age and alcohol consumption ) . There was no obvious association between vitamin B12/folate deficiency or obesity with any of the measures of interest . Conclusions : The results of this study are consistent with the hypothesis that depression is directly associated with heavy smoking and inversely associated with physical activity . They also support the idea that non-harmful alcohol consumption is associated with better cognitive performance . R and omised clinical trials should be now design ed to clarify whether management of lifestyle factors reduces the incidence of mood disorders and cognitive impairment in later life OBJECTIVES To investigate the association between different types of physical activity behavior and  incident mobility limitation in older men and women and to examine whether muscle parameters mediate these associations . DESIGN Cohort study with 4.5-year follow-up . SETTING Metropolitan areas surrounding Pittsburgh , Pennsylvania , and Memphis , Tennessee . A r and om sample of white Medicare beneficiaries and all age-eligible blacks . PARTICIPANTS Three thous and seventy-five black and white men and women aged 70 to 79 with no self-reported difficulty walking one-quarter of a mile or climbing 10 steps , enrolled in the Health , Aging and Body Composition ( Health ABC ) Study . MEASUREMENTS Participants were classified as exercisers ( reporting > or = 1,000 kcal/wk of exercise activity ) , lifestyle active ( reporting < 1,000 kcal/wk of exercise activity and > or = 2,719 kcal/wk of total physical activity ) , or inactive ( reporting < 1,000 kcal/wk of exercise activity and < 2,719 kcal/wk of total physical activity ) . The study outcome , incident mobility limitation , was defined as two consecutive , semiannual self-reports of any difficulty walking one quarter of a mile or climbing 10 steps . Thigh muscle area , thigh muscle attenuation ( a marker of fat infiltration in muscle ) , appendicular lean soft tissue mass , and isokinetic knee extensor strength were examined as potential mediators . RESULTS Over 4.5 years , 34.3 % of men and 47.4 % of women developed mobility limitation . Inactive persons had twice the risk of incident mobility limitation as exercisers ( hazard ratio (HR)=2.08 , 95 % confidence interval (CI)=1.60 - 2.70 , for men , HR=1.98 , 95 % CI=1.51 - 2.60 , for women ) . Lifestyle-active men and women had an intermediate risk ( HR=1.47 and 1.44 , respectively ) . For the lifestyle active and inactive , absence of walking activity conferred an additional risk of mobility limitation . Muscle parameters did not mediate the relationship between physical activity and mobility limitation , except for knee extensor strength in men . CONCLUSION Exercise and an active lifestyle that includes walking protect against mobility loss in older men and women . Activity effects on muscle parameters do not explain this association BACKGROUND The performance of daily tasks , such as stair climbing or lifting an object , requires both muscle strength and power . Age-associated reductions in strength and power can affect an older adult 's ability to complete daily tasks such as stair climbing and lifting a child . METHODS The purpose s of this study were to determine whether power training was more efficacious than strength training for improving whole-body physical function in older adults and to examine the relationship between changes in anaerobic power and muscle strength and changes in physical function . Thirty-nine men and women ( mean age + /- SD = 72.5 + /- 6.3 years ) with below-average leg extensor power were r and omly assigned to control ( C , n = 15 ) , strength-training ( ST , n = 13 ) or power-training ( PT , n = 11 ) groups . The ST and PT groups met 3 days per week for 16 weeks ; the C group maintained usual activity and attended three lectures during the course of the study . Primary outcome measures included the Continuous Scale Physical Functional Performance test , maximal strength , and anaerobic power . RESULTS After baseline was controlled for , the Continuous Scale Physical Functional Performance test total score was significantly greater for the PT group than for the ST ( p = .033 ) and C ( p = .016 ) groups . Maximal strength was significantly greater for the ST group than for the C group ( p = .015 ) after the intervention . There was no significant difference between groups for peak anaerobic power . CONCLUSIONS Power training was more effective than strength training for improving physical function in community-dwelling older adults The cardiovascular and behavioral adaptations associated with a 4-month program of aerobic exercise training were examined in 101 older men and women ( mean age = 67 years ) . Subjects were r and omly assigned to an Aerobic Exercise group , a Yoga and Flexibility control group , or a Waiting List control group . Prior to and following the 4-month program , subjects underwent comprehensive physiological and psychological evaluations . Physiological measures included measurement of blood pressure , lipids , bone density , and cardiorespiratory fitness including direct measurements of peak oxygen consumption ( VO2 ) and anaerobic threshold . Psychological measures included measures of mood , psychiatric symptoms , and neuropsychological functioning . This study demonstrated that 4 months of aerobic exercise training produced an overall 11.6 % improvement in peak VO2 and a 13 % increase in anaerobic threshold . In contrast , the Yoga and Waiting List control groups experienced no change in cardiorespiratory fitness . Other favorable physiological changes observed among aerobic exercise participants included lower cholesterol levels , diastolic blood pressure levels , and for subjects at risk for bone fracture , a trend toward an increase in bone mineral content . Although few significant psychological changes could be attributed to aerobic exercise training , participants in the two active treatment groups perceived themselves as improving on a number of psychological and behavioral dimensions OBJECTIVES To verify if h and -grip performance in older men is a predictor of disability . DESIGN Population -based prospect i ve study . SETTING A sample from the Italian rural cohorts of the FINE study ( Finl and , Italy , Netherl and s Elderly ) , representative of the general population of elderly men surveyed in 1991 and 1995 . PARTICIPANTS 140 men aged 71 - 91 years who reported no disability in performing activities of daily living ( ADLs ) , instrumental activity of daily living ( IADLs ) and mobility activities at baseline examination and provided information on their functional status at follow-up 4 years later . MEASUREMENTS Disability was defined as needing help in performing ADLs , IADLs and mobility . H and -grip strength  was evaluated at baseline by a mechanical dynamometer . RESULTS After adjusting for potential confounding variables , a lower concentration of high-density lipoprotein cholesterol was the only factor predicting disability in men aged 76 years or younger and only reduced h and -grip strength predicted incident disability in men 77 years or older . CONCLUSION Poor h and strength as measured by h and -grip is a predictor of  disability  in older people . The h and -grip test is an easy and inexpensive screening tool to identify elderly people at risk of disability 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 Kalapotharakos VI , Michalopoulos M , Strimpakos N , Diamantopoulos K , Tokmakidis SP : Functional and neuromotor performance in older adults : Effect of 12 wks of aerobic exercise . Am J Phys Med Rehabil 2006;85:61–67 . Objective : There is little information regarding the effect of aerobic exercise on physical and neuromotor performance in older adults . The aim of this r and omized , controlled trial was to determine the effects of a 12-wk aerobic exercise program on functional and neuromotor performance in inactive healthy older adults . Design : A total of 22 inactive healthy older adults , aged 60–75 yrs , voluntarily participated in the study and were r and omly assigned to a progressively increased high-intensity aerobic exercise group ( n = 12 ) or to a control group ( n = 10 ) . The aerobic exercise group exercised three times per week for 12 wks on nonconsecutive days . Both groups were evaluated before and after the exercise period in the one-repetition maximum of knee extensors and flexors , 6-min walk distance , chair-rising time , and whole-body reaction time . Results : Multivariate analysis of variance repeated measures ( 2 × 2 ) revealed significant ( P < 0.05 ) time by group interaction for one-repetition maximum knee extension and flexion strength , 6-min walk distance , chair-rising time , and whole-body reaction time . For the aerobic exercise group , the following variables improved significantly ( P < 0.05 ) after the exercise period : the one-repetition maximum knee extensors ( 12 % ) and flexors ( 19 % ) muscle strength , 6-min walk distance ( 17 % ) , chair-rising time ( 8 % ) , and whole-body reaction time ( 20 % ) . No significant differences were observed in the control group . Conclusions : The results of the present study show that short-term progressively increased high-intensity aerobic exercise improved the physical and neuromotor performance in inactive healthy older adults . These findings suggest that the participation in a progressively increased high-intensity aerobic exercise program may improve mobility and ability to carry out activities of daily living in older adults Purpose : The purpose of this study was to determine the effects of 9-week multicomponent training on the functional fitness of healthy older adults in different age groups . Method : Forty-two participants were r and omly assigned and stratified by their age group : Training and Control Young Old Groups ( TYOG , CYOG ) ( between 60 – 73 years ) , Training and Control Old Groups ( TOG , COG ) ( between 74 – 86 years ) . The training programme consisted of three sessions per week of walking , strengthening , and flexibility exercises . A recently developed Functional Fitness Test battery to assess the physical parameters associated with independent functioning in older adults was performed before and after training . Results : Training caused significant increases in all functional fitness tests in the TYOG and also in the TOG . There was no difference according to the absolute changes between TYOG and TOG due to the training ( p > 0.05 ) . Training produced a significant improvement in chair sit and reach , arm curl , chair st and and 6 min walk test scores in the TYOG and TOG when they were compared to the control groups ( p < 0.05 ) . Conclusion : Multicomponent training can produce substantial increase in functional fitness tests in young old adults and older adults and the rate of restoration of function is approximately similar in the two old age groups BACKGROUND Concern exists that certain types of exercise , particularly vigorous activity , may increase physical disability among older individuals . We investigated the prevalence of , and risk factors for , physical disability in active older persons ( runners ) , and examined factors influencing the progression of physical disability with age . METHODS Physical disability , measured using the  Health Assessment Question naire Disability Index , was assessed prospect ively in 454 runners , age 50 or greater , over five to seven years by annual mailed question naires .  Baseline sociodemographic , clinical , and life-style characteristics associated with the presence of any disability over the course of the study were determined and contrasted with those in 292 older non-runners who had been similarly followed . RESULTS Two hundred twenty-two runners ( 49 % ) reported some physical disability during the study . The presence of arthritis symptoms at baseline was the most important risk factor for physical disability ; older age , greater body mass index , strenuous work-related physical activity , and the use of more medications were also associated with a greater likelihood of physical disability . Among the non-runners , 224 ( 77 % ) reported some physical disability , and the presence of arthritis symptoms was also the most important risk factor for physical disability in this group . Age-related changes in physical disability differed between those with and without arthritis symptoms in both the runner and non-runner groups . CONCLUSIONS The presence of arthritis symptoms was an important risk factor for physical disability among both older runners and non-runners , and also identified subgroups of individuals with different progressions of disability with age BACKGROUND The magnitude and duration of the benefit of running and other aerobic exercise on  disability and mortality in elderly persons are not well understood . We sought to quantify the benefits of aerobic exercise , including running , on disability and mortality in elderly persons and to examine whether morbidity can be compressed into later years of life by regular exercise . METHODS A 13-year prospect i ve cohort study of 370 members of a runners ' club for persons aged 50 and older and 249 control subjects initially aged 50 to 72 years ( mean , 59 years ) , with annual ascertainment of the Health Assessment Question  naire  disability score , noting any deaths and their causes . Linear mixed models were used to compute postponement in disability , and survival analysis was conducted to determine the time to and causes of death . RESULTS Significantly ( P<.001 ) lower disability levels in runners ' club members vs controls and in ever runners vs never runners were sustained for at least 13 years . Reaching a Health Assessment Question naire disability level of 0.075 was postponed by 8.7 ( 95 % confidence interval [ CI ] , 5.5 - 13.7 ) years in runners ' club members vs controls . Running club membership and participation in other aerobic exercise protected against mortality ( rate ratio , 0.36 [ 95 % CI , 0.20 - 0.65 ] and 0.88 [ 95 % CI , 0.77 - 0.99 ] , respectively ) , while male sex and smoking were detrimental ( rate ratio , 2.4 [ 95 % CI , 1.4 - 4.2 ] and 2.2 [ 95 % CI , 1.1 - 4.6 ] , respectively ) . Controls had a 3.3 times higher rate of death than runners ' club members , with higher death rates in every disease category . Accelerated rates of disability and mortality were still not seen in the runners ' club members ; true compression of morbidity was not yet observable through an average age of 72 years . CONCLUSION Running and other aerobic exercise in elderly persons protect against disability and early mortality , and are associated with prolongation of a disability-free life Objective : Few studies have investigated the relationships between body composition , functional ability , and age-related disability in postmenopausal women . We investigated the relative role of fat mass , lean mass , and muscle strength in the development of disability in a group of healthy postmenopausal women younger than 75 years . Design : We performed a cross-sectional study among 396 independently living women aged 56 - 73 years , r and omly selected between 8 and 30 years after menopause .  Lean mass and fat mass were assessed by dual-energy x-ray absorptiometry . Muscle strength ( grip and leg extensors ) was assessed using dynamometry . Functional ability was estimated by Physical Performance Score , physical activity during the preceding year , and impairment in activities of daily living . Results : Of the participants , 43.7 % were overweight ( 25 ≥ BMI < 30 kg/m2 ) , and 17.7 % were obese ( BM I ≥ 30 kg/m2 ) . Higher muscle strength was observed with increasing lean body mass , and participants with higher muscle strength scored better in the physical performance score and activities of daily living . Higher fat mass was significantly associated with a lower physical performance score , lower physical activity , and a higher frequency of disability . Increasing fat mass was associated with increasing lean mass and decreasing lean/fat ratio . The increase in lean mass and muscle strength associated with higher fat mass was mainly localized in the legs . Conclusions : Our results support the role of fat mass as the primary risk marker for disability , which might later accelerate by the age-related decrease in lean mass and the development of sarcopenia after the age of 75 years OBJECTIVES To examine joint associations of physical activity and adiposity measures ( body mass index ( BMI ) , waist circumference , percentage body fat ) with incident mobility limitation . DESIGN Prospect i ve observational cohort study . SETTING Memphis , Tennessee and Pittsburgh , Pennsylvania . PARTICIPANTS Two thous and nine hundred and eighty-two black and white men and women aged 70 to 79 participating in the Health , Aging and Body Composition ( Health ABC ) study . MEASUREMENTS Mobility limitation was defined as reported difficulty walking one-quarter of a mile or climbing 10 steps during two consecutive semiannual assessment s over 6.5 years . Three measures of adiposity were included in this study : BMI , total percentage body fat , and waist circumference . Physical activity  was assessed using a modified leisure-time physical activity question naire . RESULTS Forty-six percent of the cohort developed mobility limitation .  White and black men with a high BMI ( > or = 30 kg/m(2 ) ) , high total percentage body fat ( > 31.3 % ) , or high waist circumference ( > or = 102 cm ) had an approximately 60 % , 40 % , and 40 % , respectively , higher risk of incident mobility limitation than those with low adiposity . In women , high adiposity was also associated with a significantly higher mobility limitation risk than in those with low adiposity . Low physical activity ( lowest quartile ) was associated with a 70 % higher risk of mobility limitation in all groups . Persons with high adiposity and low physical activity were at particularly high risk of mobility limitation .  People with high adiposity who were physically active had an equally high risk of mobility limitation as inactive people with low adiposity . CONCLUSION High adiposity and low self-reported physical activity predicted the onset of mobility limitation in well-functioning older persons . Preventing weight gain in old age and promoting physical activity in obese and non-obese older persons may therefore be effective strategies to prevent mobility loss and future disability OBJECTIVES This investigation examined the effect of 6 months of high- or low-intensity resistance exercise on muscular strength and endurance and stair climbing ability in adults aged 60 to 83 . DESIGN A r and omized controlled trial . SETTING University of Florida Center for Exercise Science . PARTICIPANTS Sixty-two men and women completed the study protocol . Subjects were matched for strength and r and omly assigned to a control ( n = 16 ) , low-intensity ( LEX , n = 24 ) , or high-intensity ( HEX , n = 22 ) group . INTERVENTION Six months of progressive , whole-body resistance training . Subjects trained at 50 % of their one-repetition maximum ( 1RM ) for 13 repetitions ( LEX ) or 80 % of 1RM for eight repetitions ( HEX ) three times per week for 24 weeks using resistance machines . One set each of 12 exercises was performed . MEASUREMENTS One-repetition maximum was measured for eight different exercises . Muscular endurance was measured using leg press and chest press machines . Low back strength was measured using a lumbar extension machine . Stair climbing ability was assessed as the time to ascend one flight of stairs . RESULTS 1RM significantly increased for all exercises tested for the HEX and LEX groups ( P < or = .050 ) . The increases in total strength ( sum of all eight 1RMs ) were 17.2 % and 17.8 % for the LEX and HEX groups , respectively . Muscular endurance improved by 79.2 % and 105.0 % for the leg press , and 75.5 % and 68.0 % for the chest press for the LEX and HEX groups , respectively . The time to ascend one flight of stairs significantly decreased for both the LEX and HEX groups ( P < or = .050 ) . Lumbar extension strength increased by 62.6 % and 39.5 % for the LEX and HEX groups , respectively . CONCLUSIONS These data indicate that significant and similar improvements in strength , endurance , and stair climbing time can be obtained in older adults as a consequence of high- or low-intensity resistance exercise training . These findings may have an effect on how resistance exercise is prescribed to older adults OBJECTIVE In older people , mobility impairments and physical inactivity are risk factors for further disability and death . We studied the interaction of physical activity and mobility impairment as a predictor of dependence and mortality . DESIGN A population -based , prospect i ve study . The data were collected in structured interviews in the year 1988 and 8 years later in the year 1996 as part of the Evergreen Project . PARTICIPANTS Subjects were 1109 independently living , at baseline 65- to 84-year-old people in the city of Jyvaskyla , in central Finl and . METHODS Participants were ranked into four groups : ( 1 ) Intact mobility and physically active ( Mobile-Active ) , ( 2 ) Intact mobility and sedentary ( Mobile-Sedentary ) , ( 3 ) Impaired mobility and physically active ( Impaired-Active ) , and ( 4 ) Impaired mobility and sedentary ( Impaired-Sedentary ) . The confounders adjusted for in the models included age , marital status , education , chronic conditions , smoking , and physical exercise earlier in life . RESULTS In men and women , the relative risk of death was two times greater in Impaired-Active and three times greater in Impaired-Sedentary groups than the risk of death in Mobile-Active groups . However , the risk of death did not differ between Mobile-Active and Mobile-Sedentary groups . The odds ratio for dependency ( 95 % confidence interval ) in Impaired-Sedentary men was 5.21 ( 1.44 - 18.70 ) and in Impaired-Sedentary women was 2.92 ( 1.52 - 5.60 ) compared to Mobile-Active groups . The risk of dependence did not differ significantly between Mobile-Active , Mobile-Sedentary , and Impaired-Active groups . CONCLUSIONS Mobility impairments predicted mortality and dependence . However , among people with impaired mobility , physical activity was associated with lower risks , whereas the risk did not differ according to activity level among those with intact mobility . Despite of their overall greater risk , mobility-impaired people may be able to prevent further disability and mortality by physical exercise Physical disability is common among older persons living within the community . The Framingham Disability Study [ 1 , 2 ] reported that , among community-dwelling persons older than 70 years of age , 49 % of women and 27 % of men have substantial mobility or work limitations . More recently , a 4-year prospect i ve trial of healthy elderly persons with no disability at baseline showed that lower-extremity physical performance at baseline was highly predictive for the subsequent development of disability [ 3 ] . Muscle mass , strength , and endurance decrease with age , and a close correlation between short-course walking speed and the size and strength of leg muscles has been shown in institutionalized nonagenarians [ 4 ] . Furthermore , resistance training in this population has been shown to result in increased measures of physical performance and corresponding increases in muscle strength , size , and short-course walking speed [ 4 , 5 ] . Our goal was to determine whether resistance training would improve walking endurance and lower-limb strength in nondisabled , community-dwelling elderly persons . Methods Twenty-four sedentary , healthy persons ( 11 men and 13 women ) were r and omly assigned within sex groups either to a 12-week resistance-training program or to sedentary control status .  The mean age of the participants was 70.4 4 years ( range , 65 to 79 years ) , and no differences in mean age were seen between groups ( 69.9 4 years in the resistance-training group ; 70.7 5 years in the control group [ P > 0.2 ] ) . The  resistance-training group was composed of 6 men and 6 women ; the control group consisted of 5 men and 7 women . Participants did symptom-limited treadmill stress tests at baseline , and we collected expired gas to determine peak aerobic capacity . We used a Horizon Metabolic Measurement Cart ( Sensormedics , Yorba Linda , California ) to analyze expired air .  Participants were excluded if they had angina or electrocardiographic ischemia ( defined as ST-segment depression more than 1 mm ) during the exercise test ( n = 2 ) , if their resting blood pressure was higher than 160/90 mm Hg ( n = 4 ) , or if they had a noncardiopulmonary limitation of exercise capacity , such as claudication , arthritis , or cerebrovascular disease ( n = 1 ) . We tested 29 participants to arrive at the final study sample of 24 persons . No participants were receiving calcium- or -blocking medications or estrogen-replacement therapy , and none had diabetes . We determined body composition by using underwater weighing and correcting for residual volume [ 6 ] . Leg-muscle mass was determined by dual-energy x-ray absorptiometry [ 7 ] . Strength was evaluated on a Universal Gym apparatus ( Universal , Cedar Rapids , Iowa ) by measuring the single repetition maximal lift for leg extension , leg flexion , and bench press . We measured submaximal endurance capacity on the treadmill by first having participants walk for 5 minutes at an intensity of 50 % of their previously determined peak aerobic capacity . Participants then gradually increased their walking intensity to 80 % of peak aerobic capacity by 10 minutes of the continuous protocol and proceeded until exhaustion ( n = 24 ) or 45 minutes , at which time the test was terminated . Because none of the participants had angina , claudication , or exercise-limiting arthritis , exhaustion was defined as a combination of leg fatigue , dyspnea , and overall body fatigue . During endurance testing , heart rate , blood pressure , oxygen uptake , and perceived exertion [ 8 ] were measured at 5-minute intervals until exhaustion . After 12 weeks , variables were measured again , and walking endurance was measured at the same absolute workload as before conditioning . The weight-training regimen consisted of three sets of eight repetitions of seven exercises done using a Universal Gym apparatus 3 days per week . The exercises ( and primary muscles exercised ) were leg extension ( quadriceps ) , leg curl ( hamstrings ) , arm extension ( triceps ) , arm curl ( biceps ) , lateral pull-down ( latissimus dorsi and biceps ) , bench press ( pectoralis major and triceps ) , and squat ( gluteals and quadriceps ) . A rest period of 1 to 2 minutes was taken between sets . The participants began at a resistance of 50 % of their single repetition maximum . The resistance was then increased progressively until participants were exercising at 80 % of their single repetition maximum by week 9 . Strength was retested intermittently , and the training loads were adjusted as required . The participants did not train aerobically . Controls were instructed not to alter their home activity habits . A two-factor analysis of variance was done on baseline measures , with sex and training groups as the factors [ 9 ] . Women differed from men in baseline measures of fitness , strength , and body composition , but no sex-group interactions were seen . Pre- to postconditioning measures were analyzed using repeated-measure analysis of variance with results separated by sex . Data collected during the submaximal endurance study were analyzed for perceived exertion , heart rate , and systolic blood pressure ( excluding rest and exhaustion values ) by repeated-measure analysis of variance . Relations between variables were studied by linear regression analysis . Data are presented as mean SD . Analyses were done using BMDP New System for Windows , Version 1.0 ( BMDP Statistical Software , Los Angeles , California ) . Results After the 12-week resistance-training program , strength increased substantially in the  resistance-training group . The single repetition maximums increased by 29 % 24 % for leg extension , 65 % 79 % for leg flexion , and 29 % 15 % for bench press . When results were analyzed separately by sex and compared with results in controls , single repetition maximums for leg extension increased significantly among women ( P < 0.01 ) but not among men ( P = 0.12 ) ( Table 1 ) . Similarly , single repetition maximums for bench press increased significantly among women ( P < 0.01 ) but not among men ( P = 0.12 ) . Both women and men had increased single repetition maximums for leg flexion compared with controls ( P < 0.01 for women and P < 0.05 for men ) . It should be noted that the study was not design ed to fully address sex-specific outcomes . The control group showed no change in strength measures over the 12-week period , and the strength changes for each of the exercises in the intervention group when sexes were combined were significantly greater than the measures in the controls ( P < 0.005 ) ( Table 1 ) . Table 1 . Resistance-Training and Control Groups at Baseline and 12 Weeks Women in our study had lower measures of peak aerobic capacity at baseline than men ( 21.5 1.1 mL/kg min1 compared with 28.8 1.5 mL/kg min1 ; P = 0.03 ) and lower measures of strength as measured by single repetition maximum for leg extension ( 23.5 1.0 kg compared with 42.8 4 kg ; P = 0.001 ) , leg curl ( 5.3 0.4 kg compared with 14.4 1.5 kg ; P = 0.003 ) , and bench press ( 20.9 1.1 kg compared with 31.3 2.2 kg ; P = 0.008 ) . Neither women nor men showed changes in peak aerobic capacity after resistance training . No participant had significant changes in body weight , percentage of body fat , fat mass , or fat-free mass as measured by underwater weighing ( Table 1 ) . Analysis of regional body composition measured by dual-energy x-ray absorptiometry scanning showed an increased lean mass of the leg with weight training when compared with controls ( P = 0.02 ) ( Table 1 ) . This was due to an increase among women ( P < 0.02 ) ; no increase was seen among men ( P > 0.2 ) . Peak aerobic capacity was unaltered in both groups , regardless of sex . The primary outcome variable of interest was walking endurance time . After the resistance-training program , mean walking time until exhaustion for the resistance-training group increased by 38 % , from 25 4 minutes to 34 9 minutes . In contrast , no change was seen in the control group ( 20 5 minutes to 19 10 minutes ; P = 0.005 for comparison between groups ) . The increase in endurance time was due primarily to increases seen among men ( P < 0.02 ) rather than among women ( P > 0.2 ) . Mean exercise intensity , measured at 10 minutes of the endurance protocol at baseline , was 82 % of peak aerobic capacity in both the training group and the control group ( P > 0.2 between groups ) . Before the study intervention , none of the 24 participants completed the full 45-minute endurance protocol . After conditioning , 3 of the 12 participants who received resistance training and 1 of 12 controls completed the entire protocol . After conditioning , mean scores for perceived exertion for all submaximal data points from 10 minutes until the end of the walking endurance protocol ( not including the exhaustion point ) were lower in the resistance-training group than in the control group ( P = 0.03 ) ( Figure 1 ) . Mean submaximal heart rate and systolic blood pressure measures were lower after conditioning ; however , when groups were compared by repeated-measure analysis of variance , differences between groups were not significant ( Figure 1 ) . Submaximal or peak exercise oxygen consumption did not change during the endurance testing . Figure 1 . Conditioning data in the resistance-training group . For all 24 participants , significant relations were seen between change in walking endurance and change in strength measures for leg extension ( r = 0.48 [ 95 % CI , 0.10 to 0.74 ] ; P = 0.02 ) and leg flexion ( r = 0.46 [ CI , 0.07 to 0.73 ] ; P = 0.03 ) . Baseline peak aerobic capacity ( r = 0.10 [ CI , 0.48 to 0.3 ] ; P > 0.2 ) and baseline endurance time ( r = 0.41 [ CI , 0.22 to 0.73 ] ; P = 0.13 ) were not significantly related to change in endurance capacity in the resistance-training group of 12 participants . Discussion We show that healthy , community-dwelling elders can improve walking endurance and leg strength by participating in a resistance-training program . This finding is relevant to persons at risk for disability because walking endurance and leg strength are important components of physical functioning [ 3 ] . Resistance training improves walking endurance in at Where strength training has been used in conjunction with functional-task training in older people , not only have there been improvements in leg strength but also improved function has been measured ( e.g. , Skelton & McLaughlin , 1996 ) . Many studies use participants from care homes rather than community dwellers . We investigated changes in leg power , balance , and functional mobility in community-dwelling sedentary men and women over 70 years of age ( n = 6 for training group [ TR ] ; n = 10 for control group [ CN ] ) .  Progressive training took place over 24 weeks using seated and nonseated exercise . For TR , leg power increased 40 % , from 108 + /- 40 to 141 + /- 53 W ( p < .01 ) ; dynamic balance increased 48 % , from 22.3 + /- 7.9 to 33.1 + /- 6.1 cm ( p < .01 ; functional reach ) ; and functional mobility increased 12 % , from 7.46 + /- 1.32 to 6.54 + /- 1.41 s ( p < .05 ; timed walk ) . CN showed no significant change . In conclusion , a community-based exercise program led to large improvements in leg-extensor power , dynamic balance , and functional mobility The aim of the Odense training studies is to eluci date if regular physical training influences the expected decline in physical functional ability in order to assess capacity for postponing dependence in old age . All participants were healthy community-dwelling women representing three different age-cohorts of 65 , 75 and 85 year-old subjects . The 65 and 85 year-old participants of the training group took part in physical class-based exercises for eight months with one session of 60 min a week , whereas the 75 year-old women trained twice a week over eight months . The multicomponent training consisted of various exercises typically involving body awareness , rhythm , aerobic performance ( walking ) , muscle strength and muscle endurance , flexibility , reaction and balance exercises . Physical ability was measured as physical performance test ( PPT ) , isometric muscle strength of the trunk , hip and leg , aerobic capacity and walking speed . This shows that regular training can significantly improve physical ability of elderly women with regard to PPT , maximal oxygen uptake and maximal walking speed , suggesting that both young-old and old-old women are able to benefit from regular tailored exercise training . Thus , physical training of old community-dwelling women appears to represent a prophylactic remedy that merits further research aim ed at evaluating the preliminary findings of the present studies in larger , less selective groups of participants Physical exercise is commonly promoted as a panacea . However many of the cl aim ed benefits , in particular any positive effects on bone density , have not been scientifically proved . We assessed the effects of a twice-weekly aerobic weight-bearing exercise program on bone density in postmenopausal women . We tested bone density at the spine and hip in 19 exercisers with a mean age of 66.4 years ( SEM + /- 1.2 ) before and after a two-year exercise program , and in 11 controls , mean age 65.4 years ( SEM + /- 1.5 ) . We also assessed risk factors for cardiovascular disease and tested wellbeing and cognitive function . The mean percentage change in lumbar bone mineral density was -0.8 in exercisers and -3.8 in controls ( difference 3.0 per cent ; 95 per cent confidence interval ( CI ) 0.3 to 5.7 per cent ; P = 0.031 ) . The mean percentage change in trochanteric bone mineral concentration was + 9.6 in exercisers and -4.4 in controls ( difference 14.0 per cent ; CI 4.6 to 23.5 ; P = 0.0049 ) . The exercisers also had significantly higher wellbeing and diastolic blood pressure . This study adds strong evidence that twice-weekly weight-bearing aerobic exercise has a protective effect on bone density  in postmenopausal women as well as being associated with other measurable benefits OBJECTIVES To determine whether cardiorespiratory fitness at baseline is associated with maintenance of cognitive function over 6 years or with level of cognitive function on tests performed 6 years later in a longitudinal study of healthy older people . DESIGN Prospect i ve cohort . SETTING Community-based study of noninstitutionalized adults aged 55 and older living in Sonoma , California . PARTICIPANTS Three hundred forty-nine cohort members without evidence of cardiovascular disease , musculoskeletal disability , or cognitive impairment at baseline . MEASUREMENTS Cardiorespiratory fitness measures were based on a st and ard treadmill exercise test protocol and included peak oxygen consumption ( peak VO2 ) , treadmill exercise duration , and oxygen uptake efficiency slope ( OUES ) . Cognitive function was evaluated at baseline with a modified Mini-Mental State Examination ( mMMSE ) and after 6 years of follow-up with a detailed cognitive test battery that included the full MMSE , three tests of attention/executive function , two measures of verbal memory , and two tests of verbal fluency . RESULTS Participants with worse cardiorespiratory fitness at baseline experienced greater decline on the mMMSE over 6 years ( mean mMMSE decline ( 95 % confidence interval ) by baseline peak VO2 tertile : lowest = -0.5 ( -0.8 to -0.3 ) , middle = -0.2 ( -0.5 - 0.0 ) , highest = 0.0 ( -0.3 - 0.2 ) , P = .002 for trend over tertiles ) . Participants with worse baseline cardiorespiratory fitness also performed worse on all cognitive tests conducted 6 years later . Results were similar for analyses based on peak VO2 , treadmill exercise duration , and OUES . After adjustment for demographic and health-related covariates , measures of cardiorespiratory fitness were associated most strongly with measures of global cognitive function and attention/executive function . CONCLUSION Baseline measures of cardiorespiratory fitness are positively associated with preservation of cognitive function over a 6-year period and with levels of performance on cognitive tests conducted 6 years later in healthy older adults . High cardiorespiratory fitness may protect against cognitive dysfunction in older people
target: 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: 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 .