title: Exploring the feasibility of a community-based strength training program for older people with depressive symptoms and its impact on depressive symptoms A randomized controlled trial of high versus low intensity weight training versus general practitioner care for clinical depression in older adults. Prevention of falls in the elderly trial (PROFET): a randomised controlled trial Effects of a group exercise program on strength, mobility, and falls among fall-prone elderly men. Depressive Symptoms Among Older Adults: Long-Term Reduction After a Physical Activity Intervention Effects of exercise training on older patients with major depression. Interim follow-up of a randomized controlled trial comparing Chinese style mind body (Tai Chi) and stretching exercises on cognitive function in subjects at risk of progressive cognitive decline. A Five-Week Exercise Program Can Reduce Falls and Improve Obstacle Avoidance in the Elderly Prevalence of Cognitive Impairment without Dementia in the United States Community-based group exercise improves balance and reduces falls in at-risk older people: a randomised controlled trial. Attempts to prevent falls and injury: a prospective community study. The effects of high-intensity and low-intensity cycle ergometry in older adults with knee osteoarthritis. Balance and strength training in older adults: intervention gains and Tai Chi maintenance. Low-intensity exercise and reduction of the risk for falls among at-risk elders. Tai Chi and fall reductions in older adults: a randomized controlled trial. Physiological and functional responses to low-moderate versus high-intensity progressive resistance training in frail elders. Gait variability and fall risk in community-living older adults: a 1-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. Memory Decline and Depressive Symptoms in a Nationally Representative Sample of Older Adults: The Health and Retirement Study (1998–2004) Does an exercise and incontinence intervention save healthcare costs in a nursing home population? Fear of falling and restriction of mobility in elderly fallers. Investigating terminal decline: results from a UK population-based study of aging. Effects of exercise on depressive symptoms in older adults with poorly responsive depressive disorder: randomised controlled trial. A prospective study of walking as compared with vigorous exercise in the prevention of coronary heart disease in women. Risk factors for falls among elderly persons living in the community. Rehabilitation of elderly fallers: pilot study of a low to moderate intensity exercise program. Low-intensity, range-of-motion exercise: invaluable nursing care for elderly patients. Prevalence of depression and its correlates in Hong Kong's Chinese older adults. Effects of home-based diet and exercise on functional outcomes among older, overweight long-term cancer survivors: RENEW: a randomized controlled trial. The efficacy of exercise as a long-term antidepressant in elderly subjects: a randomized, controlled trial. Sit-to-stand as home exercise for mobility-limited adults over 80 years of age--GrandStand System may keep you standing? Physical Performance Effects of Low-Intensity Exercise among Clinically Defined High-Risk Elders Low-intensity exercise as a modifier of physical frailty in older adults. Low-intensity exercise exerts beneficial effects on plasma lipids via PPARgamma. The effect of exercise on depressive symptoms in the moderately depressed elderly. Exercise treatment for depression: efficacy and dose response.
abstract: Background Depression is a disabling , prevalent condition . Physical activity programs may assist depression management in older people , ameliorate co-morbid conditions and reduce the need for antidepressants . The UPLIFT pilot study assessed the feasibility of older depressed people attending a community-based progressive resistance training ( PRT ) program .  The study also aim ed to determine whether PRT improves depressive status in older depressed patients . Methods A r and omised controlled trial was conducted . People aged ≥ 65 years with depressive symptoms were recruited via general practice s. Following baseline assessment , subjects were r and omly allocated to attend a local PRT program three times per week for 10 weeks or a brief advice control group . Follow-up assessment of depressive status , physical and psychological health , functional and quality of life status occurred post intervention and at six months . Results Three hundred and forty six people responded to the study invitation , of whom 22 % had depressive symptoms ( Geriatric Depression Scale , GDS-30 score ≥ 11 ) . Thirty two people entered the trial . There were no significant group differences on the GDS at follow-up . At six months there was a trend for the PRT intervention group to have lower GDS scores than the comparison group , but this finding did not reach significance ( p = 0.08 ) . More of the PRT group ( 57 % ) had a reduction in depressive symptoms post program , compared to 44 % of the control group . It was not possible to discern which specific components of the program influenced its impact , but in post hoc analyses , improvement in depressive status appeared to be associated with the number of exercise sessions completed ( r = -0.8 , p < 0.01 ) . Conclusion The UPLIFT pilot study confirmed that older people with depression can be successfully recruited to a community based PRT program . The program can be offered by existing community-based facilities , enabling its ongoing implementation for the potential benefit of other older people BACKGROUND Although exercise has been shown to relieve depression , little is known about its mechanism or dose-response characteristics . We hypothesized that high intensity progressive resistance training ( PRT ) would be more effective than either low intensity PRT or st and ard care by a general practitioner ( GP ) in depressed elderly persons , and that high intensity PRT would provide superior benefits in quality of life , sleep quality , and self-efficacy . METHODS Sixty community-dwelling adults > 60 years with major or minor depression were r and omized to supervised high intensity PRT ( 80 % maximum load ) or low intensity PRT ( 20 % maximum load ) 3 days per week for 8 weeks , or GP care . RESULTS A 50 % reduction in the Hamilton Rating Scale of Depression score was achieved in 61 % of the high intensity , 29 % of the low intensity , and 21 % of the GP care group ( p = .03 ) . Strength gain was directly associated with reduction in depressive symptoms ( r = 0.40 , p = .004 ) , as was baseline social support network type ( F = 3.52 , p = .015 ) , whereas personality type , self-efficacy , and locus of control were unrelated to the antidepressant effect . Vitality quality -of-life scale improved more in the high intensity group than in the others ( p = .04 ) . Sleep quality improved significantly in all participants ( p < .0001 ) , with the greatest relative change in high intensity PRT ( p = .05 ) . CONCLUSIONS High intensity PRT is more effective than is low intensity PRT or GP care for the treatment of older depressed patients BACKGROUND Falls in elderly people are a common presenting complaint to accident and emergency departments . Current practice commonly focuses on the injury , with little systematic assessment of the underlying cause , functional consequences , and possibilities for future prevention . We undertook a r and omised controlled study to assess the benefit of a structured inderdisciplinary assessment of people who have fallen in terms of further falls . METHODS Eligible patients were aged 65 years and older , lived in the community , and presented to an accident and emergency department with a fall . Patients assigned to the intervention group ( n=184 ) underwent a detailed medical and occupational-therapy assessment with referral to relevant services if indicated ; those assigned to the control group ( n=213 ) received usual care only . The analyses were by intention to treat . Follow-up data were collected every 4 months for 1 year . FINDINGS At 12-month follow-up , 77 % of both groups remained in the study . The total reported number of falls during this period was 183 in the intervention group compared with 510 in the control group ( p=0.0002 ) . The risk of falling was significantly reduced in the intervention group ( odds ratio 0.39 [ 95 % CI 0.23 - 0.66 ] ) as was the risk of recurrent falls ( 0.33 [ 0.16 - 0.68 ] ) . In addition , the odds of admission to hospital were lower in the intervention group ( 0.61 [ 0.35 - 1.05 ] ) whereas the decline in Barthel score with time was greater in the control group ( p<0.00001 ) . INTERPRETATION The study shows that an interdisciplinary approach to this high-risk population can significantly decrease the risk of further falls and limit functional impairment OBJECTIVES This r and omized controlled trial studied the effects of a low- to moderate-intensity group exercise program on strength , endurance , mobility , and fall rates in fall-prone elderly men with chronic impairments . METHODS Fifty-nine community-living men ( mean age = 74 years ) with specific fall risk factors ( i.e. , leg weakness , impaired gait or balance , previous falls ) were r and omly assigned to a control group ( n = 28 ) or to a 12-week group exercise program ( n = 31 ) . Exercise sessions ( 90 minutes , three times per week ) focused on increasing strength and endurance and improving mobility and balance . Outcome measures included isokinetic strength and endurance , five physical performance measures , and self-reported physical functioning , health perception , activity level , and falls . RESULTS Exercisers showed significant improvement in measures of endurance and gait . Isokinetic endurance increased 21 % for right knee flexion and 26 % for extension . Exercisers had a 10 % increase ( p < .05 ) in distance walked in six minutes , and improved ( p < .05 ) scores on an observational gait scale . Isokinetic strength improved only for right knee flexion . Exercise achieved no significant effect on hip or ankle strength , balance , self-reported physical functioning , or number of falls . Activity level increased within the exercise group . When fall rates were adjusted for activity level , the exercisers had a lower 3-month fall rate than controls ( 6 falls/1000 hours of activity vs 16.2 falls/1000 hours , p < .05 ) . DISCUSSION These findings suggest that exercise can improve endurance , strength , gait , and function in chronically impaired , fall-prone elderly persons . In addition , increased physical activity was associated with reduced fall rates when adjusted for level of activity We examined the effects of two physical activity modes on depressive symptoms over a 5-year period among older adults and change in physical self-esteem as a mediator of changes in depressive symptoms . Formerly sedentary , older adults ( N = 174 ) were r and omly assigned into 6-month conditions of either walking or low-intensity resistance/flexibility training .  Depressive symptoms and physical self-esteem were measured before and after the 6-month intervention , and 12 and 60 months after intervention initiation . Depressive symptoms scores were decreased immediately after the intervention , followed by a sustained reduction for 12 and 60 months after intervention initiation ; there was no differential pattern of change between the physical activity modes . Change in physical self-esteem predicted change in depressive symptoms . This study supports the effectiveness of an exercise intervention for the sustained reduction of depressive symptoms among sedentary older adults and physical self-esteem as a potential mediator of this effect BACKGROUND Previous observational and interventional studies have suggested that regular physical exercise may be associated with reduced symptoms of depression . However , the extent to which exercise training may reduce depressive symptoms in older patients with major depressive disorder ( MDD ) has not been systematic ally evaluated . OBJECTIVE To assess the effectiveness of an aerobic exercise program compared with st and ard medication ( ie , antidepressants ) for treatment of MDD in older patients , we conducted a 16-week r and omized controlled trial . METHODS One hundred fifty-six men and women with MDD ( age , > or = 50 years ) were assigned r and omly to a program of aerobic exercise , antidepressants ( sertraline hydrochloride ) , or combined exercise and medication . Subjects underwent comprehensive evaluations of depression , including the presence and severity of MDD using Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition criteria and Hamilton Rating Scale for Depression ( HAM-D ) and Beck Depression Inventory ( BDI ) scores before and after treatment . Secondary outcome measures included aerobic capacity , life satisfaction , self-esteem , anxiety , and dysfunctional cognitions . RESULTS After 16 weeks of treatment , the groups did not differ statistically on HAM-D or BDI scores ( P = .67 ) ; adjustment for baseline levels of depression yielded an essentially identical result . Growth curve models revealed that all groups exhibited statistically and clinical ly significant reductions on HAM-D and BDI scores . However , patients receiving medication alone exhibited the fastest initial response ; among patients receiving combination therapy , those with less severe depressive symptoms initially showed a more rapid response than those with initially more severe depressive symptoms . CONCLUSIONS An exercise training program may be considered an alternative to antidepressants for treatment of  depression in older persons . Although antidepressants may facilitate a more rapid initial therapeutic response than exercise , after 16 weeks of treatment exercise was equally effective in reducing depression among patients with MDD OBJECTIVES We reported the interim findings of a r and omized controlled trial ( RCT ) to examine the effects of a mind body physical exercise ( Tai Chi ) on cognitive function in Chinese subjects at risk of cognitive decline . SUBJECTS 389 Chinese older persons with either a Clinical Dementia Rating ( CDR 0.5 ) or amnestic-MCI participated in an exercise program . The exercise intervention lasted for 1 year ; 171 subjects were trained with 24 forms simplified Tai Chi ( Intervention , I ) and 218 were trained with stretching and toning exercise ( Control , C ) . The exercise comprised of advised exercise sessions of at least three times per week . RESULTS At 5th months ( 2 months after completion of training ) , both I and C subjects showed an improvement in global cognitive function , delayed recall and subjective cognitive complaints ( paired t-tests , p < 0.05 ) . Improvements in visual spans and CDR sum of boxes scores were observed in I group ( paired t-tests , p < 0.001 ) . Three ( 2.2 % ) and 21(10.8 % ) subjects from the I and C groups progressed to dementia ( Pearson chi square = 8.71 , OR = 5.34 , 95 % CI 1.56 - 18.29 ) . Logistic regression analysis controlled for baseline group differences in education and cognitive function suggested I group was associated with stable CDR ( OR = 0.14 , 95%CI = 0.03 - 0.71 , p = 0.02 ) . CONCLUSIONS Our interim findings showed that Chinese style mind body ( Tai Chi ) exercise may offer specific benefits to cognition , potential clinical interests should be further explored with longer observation period Background : Falls in the elderly are a major health problem . Although exercise programs have been shown to reduce the risk of falls , the optimal exercise components , as well as the working mechanisms that underlie the effectiveness of these programs , have not yet been established . Objective : To test whether the Nijmegen Falls Prevention Program was effective in reducing falls and improving st and ing balance , balance confidence , and obstacle avoidance performance in community-dwelling elderly people . Methods : A total of 113 elderly with a history of falls participated in this study ( exercise group , n = 79 ; control group , n = 28 ; dropouts before r and omization , n = 6 ) .  Exercise sessions were held twice weekly for 5 weeks . Pre- and post-intervention fall monitoring and quantitative motor control assessment s were performed . The outcome measures were the number of falls , st and ing balance and obstacle avoidance performance , and balance confidence scores . Results : The number of falls in the exercise group decreased by 46 % ( incidence rate ratio ( IRR ) 0.54 , 95 % confidence interval ( CI ) 0.36–0.79 ) compared to the number of falls during the baseline period and by 46 % ( IRR 0.54 , 95 % CI 0.34–0.86 ) compared to the control group . Obstacle avoidance success rates improved significantly more in the exercise group ( on average 12 % ) compared to the control group ( on average 6 % ) . Quiet stance and weight-shifting measures did not show significant effects of exercise . The exercise group also had a 6 % increase of balance confidence scores . Conclusion : The Nijmegen Falls Prevention Program was effective in reducing the incidence of falls in otherwise healthy elderly . There was no evidence of improved control of posture as a mechanism underlying this result . In contrast , an obstacle avoidance task indicated that subjects improved their performance . Laboratory obstacle avoidance tests may therefore be better instruments to evaluate future fall prevention studies than posturographic balance assessment Context How common is mild cognitive impairment in older adults ? Contribution This study of 856 individuals from the national Health and Retirement Study found that 22 % of adults age 71 or older had cognitive impairment that did not reach the threshold for dementia . Annually , about 8 % of those with cognitive impairment without dementia died and about 12 % progressed to dementia . Caution Criteria that differentiate mild impairment from dementia are imperfect . Only 856 of 1770 and 180 of 241 selected individuals completed baseline and follow-up  cognitive examinations , respectively . Implication Cognitive impairment without dementia probably affects a large segment of the elderly population . The Editors Cognitive impairment that does not reach the threshold for dementia diagnosis is associated with increased risk for progression to dementia in most studies , with progression rates of 10 % to 15 % per year compared with 1 % to 2.5 % among cognitively healthy older adults ( 13 ) . However , even among those without dementia , cognitive impairment contributes to decreased quality of life , increased neuropsychiatric symptoms , and increased disability ( 4 , 5 ) , as well as increased health care costs ( 6 , 7 ) . All of these negative outcomes make accurate national estimates of the prevalence of cognitive impairment without dementia essential for determining the full societal impact of cognitive impairment on patients , families , and health care programs . However , previous estimates of the prevalence of this condition from regional and non-U.S. sample s have varied from 3 % to 29 % ( 810 ) , a range that is most likely due to differences in diagnostic criteria and sample characteristics . Estimates of the total number of people with cognitive impairment without dementia in the United States are not available . We conducted ADAMS ( Aging , Demographics , and Memory Study ) to determine the national prevalence of dementia and cognitive impairment without dementia in the United States . We previously ( 11 ) reported our estimates of the prevalence of dementia . In this article , we report prevalence rates from what we believe to be the first population -based study of cognitive impairment without dementia to include individuals from all regions of the country , as well as rates of progression from cognitive impairment without dementia to dementia and death . Methods Participants We drew the ADAMS sample from the larger HRS ( Health and Retirement Study ) , an ongoing nationally representative cohort study of individuals born before 1954 that was design ed to investigate the health , social , and economic implication s of aging in the U.S. population ( 1214 ) . The HRS began in 1992 , and the current sample includes approximately 22000 participants . The ADAMS sample began with a stratified r and om sub sample of 1770 individuals age 70 years or older from 5 cognitive strata based on participants ' scores on a self-reported or proxy-reported cognitive measure ( 15 ) from the most recent HRS interview ( either 2000 or 2002 ) . We further stratified the 3 highest cognitive strata by age ( age 70 to 79 years vs. 80 years ) and sex to ensure adequate numbers in each subgroup . Full details of the ADAMS sample design and selection procedures are described elsewhere ( 16 , 17 ) . The ADAMS initial assessment s occurred between July 2001 and December 2003 , on average , 13.3 months ( SD , 6.9 ) after the HRS interview . Thus , participants were 71 years of age or older at the initial assessment . As part of the ADAMS assessment , proxies ( usually a spouse or adult child ) provided information about the participant 's cognitive and functional decline , neuropsychiatric symptoms , and medical history . Use of proxies to collect this information is preferred , because self-reporting of this type of information may not be reliable , particularly among cognitively impaired individuals . The Figure summarizes the number of participants at each phase of the study ; additional details on participation rates are reported elsewhere ( 17 ) . A total of 856 individuals , 56 % of the nondeceased target sample , participated in all phases of the dementia assessment . A major concern in ADAMS , as in similar population -based studies , is the potential for selective nonparticipation to bias prevalence estimates . However , because the ADAMS sample was derived from the HRS sample , a wide range of health and social information was available to assess and correct for potential selection bias due to nonparticipation in our sample . Using logistic regression , we modeled the probability that a sample individual participated in the ADAMS assessment as a function of covariates , such as age , sex , education , marital status , HRS cognition scores , nursing home residency , and indicators of past or existing major health conditions . We used the results of this response propensity analysis to develop nonresponse adjustments to the ADAMS sample selection weights ( 18 ) . We then constructed population sample weights to take into account the probabilities of selection in the stratified sample design and to adjust for differential nonparticipation in ADAMS ( 16 ) . Figure . Study flow diagram . ADAMS = Aging , Demographics , and Memory Study . The ADAMS data are publicly available and can be obtained from the HRS Web site ( hrsonline.isr.umich.edu ) . The institutional review boards at Duke University Medical Center and the University of Michigan approved all study procedures , and study participants or their surrogates provided informed consent . Measurements A nurse and a neuropsychology technician assessed all participants at their residence for cognitive impairment . The full details of the assessment and diagnostic procedures are described elsewhere ( 17 ) . In brief , the following information about the participant was collected from a knowledgeable informant : chronological history of cognitive symptoms , medical history , current medications , current neuropsychiatric symptoms , measures of severity of cognitive and functional impairment , and family history of memory problems . During the assessment , the participant completed a battery of  neuropsychological measures  ; a  self-reported depression measure ; a st and ardized neurologic examination ; a blood pressure measurement  ; collection of buccal DNA sample s for apolipoprotein E ( APOE ) genotyping ; and a 7-minute , videotaped segment covering portions of the cognitive status and neurologic examinations . Specific assessment measures reported here are the  Mini-Mental State Examination  ( 19 ) and the  Dementia Severity Rating Scale ( 20 ) . The Dementia Severity Rating Scale is completed by an informant and assesses the presence and severity of impairment in 12 cognitive and functional domains . Scores range from 0 to 54 , with higher scores reflecting more impairment . We also sought medical record releases to obtain relevant neuroimaging and laboratory results from participants ' physicians . A consensus expert panel of neuropsychologists , neurologists , geropsychiatrists , and internists review ed all information collected during the in-home assessment and assigned final diagnoses . The consensus panel review ed each case and assigned a diagnosis in 2 stages , first without and then with medical records . For most cases , the consensus panel reached agreement with little discussion ; however , diagnostic agreement was more challenging for participants with little or no education or with substantial sensory or physical impairment . The medical records often provided the necessary neuroimaging results to change a diagnosis from possible Alzheimer disease or vascular dementia to probable Alzheimer disease or vascular dementia . Except for these situations , the diagnoses seldom changed after the consensus panel review ed the additional information in the medical records . Diagnoses were divided within the 3 general categories : normal cognitive function , cognitive impairment without dementia , and dementia . The consensus panel used clinical judgment to assign the final diagnosis , based on the following criteria . Dementia diagnosis was based on guidelines from the Diagnostic and Statistical Manual of Mental Disorders , Revised Third Edition ( 21 ) , and the Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition ( 22 ) ; diagnoses of Alzheimer disease and other types of dementia were based on currently accepted criteria ( 2326 ) . The definition of cognitive impairment without dementia and its subtypes has been developed over 17 years , primarily on the basis of the accumulated clinical experience of a group of research ers common to ADAMS and 3 other epidemiologic studies of dementia ( 2729 ) . Before ADAMS , we operationalized the definition for cognitive impairment without dementia on the basis of analyses of both neuropsychological data and an objective measure of daily function from participants with this diagnosis in our other studies ( 27 , 28 ) . We defined cognitive impairment without dementia as mild cognitive or functional impairment , reported by the participant or informant , that did not meet criteria for dementia ( that is , Dementia Severity Rating Scale score of 6 to 11 ) , or performance on neuropsychological measures that was both below expectation and at least 1.5 SDs below published norms on any test . To reflect the variation in clinical presentation and potential differences in the cause of the impairment we used 12 diagnostic subcategories for cognitive impairment without dementia , unspecified cognitive impairment without dementia : prodromal Alzheimer disease , amnestic mild cognitive impairment ( 30 , 31 ) , vascular cognitive impairment without dementia , stroke , medical conditions or sensory impairment , neurologic conditions , depression , other psychiatric disorders , low baseline intellect or learning disorder , past alcohol abuse , and current alcohol abuse ( Appendix Table 1 ) . In population -based sample s , few individuals meet the criteria typically used for  amnestic mild cognitive impairment  ( 30 , 31 ) . For this reason , we used the additional category of BACKGROUND recent studies have found that moderate intensity exercise is an effective intervention strategy for preventing falls  in older people . However , research is required to determine whether supervised group exercise programmes , conducted in community setting s with at-risk older people referred by their health care practitioner are also effective in improving physical functioning and preventing falls in this group . OBJECTIVES to determine whether participation in a weekly group exercise programme with ancillary home exercises over one year improves balance , muscle strength , reaction time , physical functioning , health status and prevents falls in at-risk community-dwelling older people . METHODS the sample comprised 163 people aged over 65 years identified as at risk of falling using a st and ardised assessment screen by their general practitioner or hospital-based physiotherapist , residing in South Western Sydney , Australia . Subjects were r and omised into either an exercise intervention group or a control group .  Physical performance and general health measures were assessed at baseline and repeated 6-months into the trial . Falls were measured over a 12-month follow-up period using monthly postal surveys . RESULTS at baseline both groups were well matched in their physical performance , health and activity levels . The intervention subjects attended a median of 23 exercise classes over the year , and most undertook the home exercise sessions at least weekly . At retest , the exercise group performed significantly better than the controls in three of six balance measures ; postural sway on the floor with eyes open and eyes closed and coordinated stability . The groups did not differ at retest in measures of strength , reaction time and walking speed or on Short-Form 36 , Physical Activity Scale for the Elderly or fear of falling scales . Within the 12-month trial period , the rate of falls in the intervention group was 40 % lower than that of the control group ( IRR=0.60 , 95 % CI 0.36 - 0.99 ) . CONCLUSIONS these findings indicate that participation in a weekly group exercise programme with ancillary home exercises can improve balance and reduce the rate of falling in at-risk community dwelling older people At 16 senior centers , we studied the effectiveness of exercise and cognitive-behavioral programs , compared with a discussion control program , in reducing falls and injuries among 230 older adults . After 1 year of the programs , we observed no significant difference in time to first fall . Even though a relatively high percentage ( 38.6 % ) suffered at least one fall , only 7.8 % of these community-residing elderly required medical attention . Secondary outcome measures such as strength , balance , fear of falling , and perceived health did not significantly change BACKGROUND People with osteoarthritis ( OA ) of the knee experience pain and deconditioning that lead to disability . This study challenged the clinical belief that repetitive lower extremity exercise is not indicated in persons with knee OA . The effects of high-intensity and low-intensity stationary cycling on functional status , gait , overall and acute pain , and aerobic capacity were examined . METHODS Thirty-nine adults ( 71+/-6.9 years old ) with complaints of knee pain and diagnosis of OA were r and omized to either a high-intensity ( 70 % heart rate reserve [ HRR ] ) or low-intensity ( 40 % HRR ) exercise group for 10 weeks of stationary cycling . Participants cycled for 25 minutes , 3 times per week . Before and after the exercise intervention they completed the Arthritis Impact Measurement Scale 2 for overall pain assessment , underwent timed chair rise , 6-minute walk test , gait , and  grade d exercise treadmill tests . Acute pain was reported daily with a visual analog scale and the Western Ontario and McMaster Universities Osteoarthritis Index scale . RESULTS Analysis of variance revealed that participants in both groups significantly improved in the timed chair rise , in the 6-minute walk test , in the range of walking speeds , in the amount of overall pain relief , and in aerobic capacity . No differences between groups were found . Daily pain reports suggested that cycling did not increase acute pain in either group . CONCLUSIONS Cycling may be considered as an alternative exercise modality for patients with knee OA .  Low-intensity cycling was as effective as high-intensity cycling in improving function and gait , decreasing pain , and increasing aerobic capacity OBJECTIVE To determine the effect on balance and strength of 3 months of intensive balance and /or weight training followed by 6 months of low intensity Tai Chi training for maintenance of gains . DESIGN R and omized control intervention . Four groups in 2 x 2 design : Control , Balance , Strength , Balance + Strength , using blinded testers . SETTING Exercise and balance laboratory at University of Connecticut Health Center . PARTICIPANTS Subjects were 110 healthy community dwellers ( mean age 80 ) who were free of dementia , neurological disease , and serious cardiovascular or musculoskeletal conditions . INTERVENTIONS Short-term training ( 3 months ) occurred 3 times/week ( 45 minutes Balance and Strength , 90 minutes Balance + Strength ) . Balance training included equilibrium control exercises of firm and foam surfaces and center-of-pressure biofeedback . Strengthening consisted of lower extremity weight-lifting . All subjects than received long-term group Tai Chi instruction ( 6 months , 1 hour , 1 time/week ) . MEASUREMENTS Losses of balance during Sensory Organization Testing ( LOB ) , single stance time ( SST ) , voluntary limits of stability ( FBOS ) , summed isokinetic torque of eight lower extremity movements ( ISOK ) , and usual gait velocity ( GVU ) . RESULTS AND CONCLUSIONS Balance training meaningfully improved all balance measures by restoring performance to a level analogous to an individual 3 to 10 years younger : LOB = -2.0 + /- 0.3 ( adjusted paired differences , P < .005 ANOVA ) ; SST = 7.0 + /- 1.2 sec ; and FBOS = 9.0 + /- 2.0 % of foot length ( P < .05 ) . Strengthening increased ISOK by 1.1 + /- 0.1 Nm kg-1 ( P < .005 ) . There was no interaction between balance and strength training . Significant gains persisted after 6 months of Tai Chi , although there was some decrement BACKGROUND Among elderly persons , falls account for 87 % of all fractures and are contributing factors in many nursing home admissions . This study evaluated the effect of an easily implemented , low-intensity exercise program on the incidence of falls  and the time to first fall among a clinical ly defined population of elderly men and women . METHODS This community-based , r and omized trial compared the exercise intervention with a no-intervention control .  The participants were 294 men and women , aged 60 years or older , who had either a hospital admission or bed rest for 2 days or more within the previous month .  Exercise participants were scheduled to attend exercise sessions lasting 45 minutes , including warm-up and cool-down , 3 times a week for 8 weeks ( 24 sessions ) . Assessment s included gait and balance measures , self-reported physical function , the number of medications being taking at baseline , participant age , sex , and history of falling . Falls were tracked for 1 year after each participant 's baseline assessment . RESULTS 29 % of the study participants reported a fall during the study period . The effect of  exercise  in preventing falls varied significantly by baseline physical function level ( p < or = .002 ) . The risk for falls decreased for exercise participants with low baseline physical functioning ( hazard ratio,.51 ) but increased for exercise participants with high baseline physical functioning ( hazard ratio , 3.51 ) . CONCLUSIONS This easily implemented , low-intensity exercise program appears to reduce the risk for falls among elderly men and women recovering from recent hospitalizations , bed rest , or both who have low levels of physical functioning BACKGROUND The authors ' objective was to evaluate the efficacy of a 6-month Tai Chi intervention for decreasing the number of falls and the risk for falling in older persons . METHODS This r and omized controlled trial involved a sample of 256 physically inactive , community-dwelling adults aged 70 to 92 ( mean age , 77.48 years ; st and ard deviation , 4.95 years ) who were recruited through a patient data base in Portl and , Oregon . Participants were r and omized to participate in a three-times-per-week Tai Chi group or to a stretching control group for 6 months . The primary outcome measure was the number of falls ; the secondary outcome measures included functional balance ( Berg Balance Scale , Dynamic Gait Index , Functional Reach , and single-leg st and ing ) , physical performance ( 50-foot speed walk , Up&Go ) , and fear of falling , assessed at baseline , 3 months , 6 months ( intervention termination ) , and at a 6-month postintervention follow-up . RESULTS At the end of the 6-month intervention , significantly fewer falls ( n=38 vs 73 ; p=.007 ) , lower proportions of fallers ( 28 % vs 46 % ; p=.01 ) , and fewer injurious falls ( 7 % vs 18 % ; p=.03 ) were observed in the Tai Chi group compared with the stretching control group . After adjusting for baseline covariates , the risk for multiple falls in the Tai Chi group was 55 % lower than that of the stretching control group ( risk ratio,.45 ; 95 % confidence interval , 0.30 to 0.70 ) . Compared with the stretching control participants , the Tai Chi participants showed significant improvements ( p<.001 ) in all measures of functional balance , physical performance , and reduced fear of falling . Intervention gains in these measures were maintained at a 6-month postintervention follow-up in the Tai Chi group . CONCLUSIONS A three-times-per-week , 6-month Tai Chi program is effective in decreasing the number of falls , the risk for falling , and the fear of falling , and it improves functional balance and physical performance in physically inactive persons aged 70 years or older BACKGROUND The purpose of this efficacy study was to measure the dose-response effect of a free weight-based resistance training program by comparing the effects of two training intensities ( low-moderate and high ) of the knee extensor ( KE ) muscles on muscle function , functional limitations , and self-reported disability . METHODS The authors conducted a single-blinded , r and omized , placebo-controlled trial . Twenty-two institutionalized elders ( mean age , 81.5 years ) were assigned to either high-intensity strength training ( HI ; n = 8) , low-moderate intensity strength training ( LI ; n = 6 ) , or weight-free placebo-control training ( PC ; n = 8) . The HI group trained at 80 % of their 1-repetition maximum and the LI group trained at 40 % . All groups performed 3 sets of 8 repetitions , 3 times per week for 10 weeks . Outcome measures included KE maximal strength , KE endurance , and functional performance as assessed by 6-minute walking , chair-rising , and stair-climbing tests , and by self-reported disability . RESULTS KE strength and endurance , stair-climbing power , and chair-rising time improved significantly in the HI and LI groups compared with the PC group . Six-minute walking distance improved significantly in the HI group but not in the LI group compared with the PC group . Changes observed in HI were significantly different from those observed in the LI group for KE strength and endurance and the 6-minute walking test , with a trend in the same direction for chair-rising and stair-climbing . Changes in strength were significantly related to changes in functional outcomes , explaining 37 % to 61 % of the variance . CONCLUSIONS These results show strong dose-response relationships between resistance training intensity and strength gains , and between strength gains and functional improvements after resistance training . Low-moderate intensity resistance training of the KE muscles may not be sufficiently robust from a physiologic perspective to achieve optimal improvement of functional performance . Supervised HI , free weight-based training for frail elders appears to be as safe as lower intensity training but is more effective physiologically and functionally OBJECTIVE To test the hypothesis that increased gait variability predicts falls among community-living older adults attending an outpatient clinic . DESIGN Prospect i ve , cohort study . SETTING Three outpatient geriatric clinics . PARTICIPANTS Fifty-two community-living , ambulatory men and women aged > or = 70 years . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Subjects walked at a normal pace for up to 6 minutes wearing force-sensitive insoles that measured the gait rhythm on a stride-to-stride basis . Afterward , subjects reported fall status on a weekly basis for 1 year . The primary outcomes were the association between measures of the stride-to-stride fluctuations in gait rhythm and ( 1 ) subsequent falls during a 12-month follow-up period and ( 2 ) potential contributing factors . RESULTS Almost 40 % of the subjects reported falling during the 12-month follow-up period . Stride time variability was 106 + /- 30 ms in subjects who subsequently fell ( n = 20 ) and 49 + /- 4 ms in those who did not experience a fall ( n = 32 ) during the 12-month follow-up period ( p < .04 ) . Logistic regression also showed that stride time variability predicted falls ( p < .05 ) . Stride time variability correlated significantly with multiple factors including strength , balance , gait speed , functional status , and even mental health , but these other measures did not discriminate future fallers from nonfallers . CONCLUSIONS These findings show both the feasibility of obtaining stride-to-stride measures of gait timing in the ambulatory setting and the potential use of gait variability measures in augmenting the prospect i ve evaluation of fall risk in community-living older adults Context Some studies suggest that people with high levels of physical activity are less likely to develop dementia . Content All 1740 participants in this cohort study were 65 years of age or older and were cognitively intact at baseline . Over 6.2 years , the rate of dementia was 13.0 per 1000 person-years in those who exercised 3 or more times per week and 19.7 per 1000 person-years in those who exercised less than 3 times per week . Limitations The only measure of exercise intensity was self-reported frequency . The cohort was largely white and well-educated . Implication s This study adds to the evidence that regular exercise is associated with a lower risk for dementia . However , the existing evidence does not prove that regular exercise is associated with a lower dementia risk . The Editors Alzheimer disease and other dementing illnesses are major sources of morbidity and mortality ( 1 - 3 ) that affect millions of persons in the increasingly aging society of the United States . Research design ed to discover strategies to delay onset and progression of these potentially devastating illnesses is ongoing worldwide . Effective prevention strategies would result in substantial benefits through improved quality of life , prolonged independent life expectancy , and reduced economic cost and social burdens .  Regular physical exercise is an important element in overall health promotion ( 4 ) and might also be an effective strategy to delay onset of dementia ( 5 ) . A biological basis for how physical exercise might preserve brain function includes improved cerebral blood flow and oxygen delivery ( 6 ) and inducing fibroblast growth factor in the hippocampus ( 7 ) . More recent evidence suggests that reduced loss of hippocampal brain tissue in the aging brain is related to level of physical fitness ( 8) . Evidence from some longitudinal studies and r and omized trials suggests that physical exercise enhances cognitive function in older adults ( 9 - 15 ) , whereas other studies have failed to observe the benefits of physical exercise in preserving cognitive function ( 16 - 19 ) . Many people regard Alzheimer disease as one of the most dreaded consequences of aging . If regular physical exercise were shown to be effective in reducing the risk or delaying the onset of dementing illnesses , it would be another compelling reason to promote physical exercise . Few population -based longitudinal studies have examined the role of physical exercise on the risk for dementia in elderly persons . One recent longitudinal study showed that physical exercise was associated with decreased risk for decline in cognitive function ( odds ratio [ OR ] , 0.58 ) , Alzheimer disease ( OR , 0.50 ) , and any dementia ( OR , 0.63 ) ( 11 ) , whereas another longitudinal study showed no association between physical exercise and dementia ( 16 ) . More recent studies showed that walking was associated with a reduced risk for dementia and Alzheimer disease in a cohort of Japanese-American men ( 20 ) and that engaging in more diverse physical activities was associated with a reduced risk for dementia in the Cardiovascular Health Study ( 21 ) . The purpose of this study was 2-fold : 1 ) to determine whether regular exercise is associated with a reduced risk for incidence of dementia ( in particular , Alzheimer disease ) in a cohort followed biennially over 6 years and 2 ) to examine whether the association of physical exercise with incident dementia is modulated by other potential risk factors , such as depression , cardiovascular and cerebrovascular disease , diabetes , apolipoprotein E 4 allele , cognitive function , physical function , self-rated health , and lifestyle characteristics . Methods Study Sample The Adult Changes in Thought ( ACT ) study is a population -based , longitudinal study of aging and dementia . The ACT study was design ed to determine the incidence of Alzheimer disease , other types of dementia , and cognitive impairment as well as to determine risk factors for these conditions . The details of the ACT study have been described elsewhere ( 22 , 23 ) . Briefly , a r and om sample of 6782 individuals was drawn from Seattle-area members of Group Health Cooperative ( GHC ) , a consumer-governed health maintenance organization . The participants were 65 years of age and older when the study began in 1994 to 1996 . Those who had an existing diagnosis of dementia , were current residents of a nursing home , or were participating in other studies were ineligible ( n= 1360 ) . Of 5422 eligible persons , 2581 participated and 2841 declined participation . Age , sex , and ethnicity of the remaining 2581 participants did not differ significantly from those who were excluded . Nonresponse has been described elsewhere ( 22 ) . Declining to participate was more common among the oldest age group ( > 85 years ) , women , and African-American and minority groups ( 22 ) . Additional details regarding the incident rates of dementia and Alzheimer disease from the ACT study have been published elsewhere and are consistent with rates reported in U.S. and European cohort studies ( 22 ) . The institutional review boards of the University of Washington and Group Health Cooperative approved the ACT study . Participants received the  Cognitive Ability Screening Instrument ( CASI ) ( 24 ) as initial screening for cognitive function and were interviewed with structured question naires to obtain data , including demographic characteristics , medical history , memory and general functioning , and potential epidemiologic risk factors . Persons scoring 86 or higher on the CASI were entered directly into the ACT cohort as being cognitively intact . ( The CASI scores range from 0 to 100 ; a score of 86 corresponds to a Mini-Mental State Examination score of 25 to 26 . ) Persons with a score lower than 86 had additional medical record review and st and ardized clinical and neuropsychological evaluation for dementia . Persons who did not meet established criteria for dementia ( 25 ) were included in the ACT cohort . The current study sample was selected from the 2581 ACT participants to examine the temporal relationship of physical exercise preceding development of dementia . By design , we selected the 1895 persons whose CASI scores were above the 25th percentileCASI scores 91 to 100 . We excluded 686 persons whose CASI scores were in the lowest quartileCASI scores 62 to 90because the lowest quartile group might include persons who had mild cognitive impairment or impending dementia ( 26 ) . We did not collect information about the history of exercise before the participants entered the study . Therefore , in the group with low CASI scores , we could not be certain whether a reported low level of physical exercise preceded the development of dementia or was a consequence of the development of cognitive impairment or dementia . Of 1895 participants selected , 155 withdrew after the baseline visit and did not have a follow-up examination and were thus excluded from the analyses , leaving the analytic sample of 1740 persons . Incident Dementia We conducted biennial examinations to identify cases of incident dementia , when participants were rescreened with the CASI . Those who scored 86 or higher on the CASI remained in the ACT cohort . Scores on the CASI that were less than 86 at follow-up prompted a full st and ardized clinical examination . The results of rescreening by the CASI and by the clinical and neuropsychological examinations were review ed at a consensus diagnosis conference that included at least the examining physician , a neuropsychologist , another study physician , and the study nurse . Persons who did not meet the criteria for dementia were considered as not having dementia and were followed in the ACT cohort ( 22 , 23 ) . Persons who met the Diagnostic and Statistical Manual of Mental Disorders , fourth edition ( DSM-IV ) , criteria ( 25 ) for dementia were considered to have incident dementia . Dementia type was determined by the National Institute of Neurological and Communicative Diseases and Stroke-Alzheimer 's Disease and Related Disorders Association ( NINCDS-ADRDA ) criteria ( 27 ) for Alzheimer disease and by the DSM-IV criteria ( 25 ) for other types of dementia . Level of physical activity was not considered at the consensus conference . Physical Exercise Physical exercise was assessed at baseline by asking participants the number of days per week they did each of the following activities for at least 15 minutes at a time during the past year : walking , hiking , bicycling , aerobics or calisthenics , swimming , water aerobics , weight training or stretching , or other exercise . The frequency of exercise was calculated by the times per week that participants engaged in any of these forms of exercise . In this study , persons who exercised at least 3 times a week , above the lowest quartile , were classified as exercising regularly . Baseline Variables as Potential Confounders Numerous factors may influence the relationship between exercise and risk for dementia , including physical functioning , cognitive function , depression , health conditions , and lifestyle characteristics . Physical function was assessed by a performance-based physical function ( PPF ) test ( 23 ) , which consisted of 4 performance tests : 10-foot timed walk , time to st and from a seated position in a chair to a st and ing position 5 times , balance test , and grip strength in the dominant h and . Each test was scored from 0 to 4 points . The final PPF score was the sum of the scores for the 4 performance tests and ranged from 0 to 16 ; higher scores indicated better physical function . Details of the PPF test have been reported elsewhere ( 23 ) . Cognitive function was assessed by using the CASI , which provides quantitative assessment of attention , concentration , orientation , short-term memory , long-term memory , language ability , visual construction , list-generating fluency , abstract ion , and judgment ( 24 ) . At baseline , depression was measured by using the 11-item Center for Epidemiologic Studies Depression ( CES-D ) scale ( 28 ) . The CES-D scores ranged from 0 to 33 , with higher scores 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 Background / Aims : Inconsistencies in the relationship between depression and cognitive decline  may exist because the expected cognitive domains at risk have not been specified in previous study design s. We aim ed to examine the relationship between depressive symptoms and verbal episodic memory functioning over time . Methods : Data from a prospect i ve cohort study ( Health and Retirement Study ; 1998–2004 ; n = 18,465 ) , a multistage national probability sample of older adults in the United States , were analyzed . Verbal learning and memory of a 10-word list learning task were the main outcomes . Depressive symptoms ( Center for Epidemiologic Studies – Depression Scale ) constituted the main predictor . Results : Depressive symptoms were associated with significantly lower immediate ( –0.05 ; p < 0.001 ) and delayed ( –0.06 ; p < 0.001 ) word list recall scores after controlling for demographics and baseline and time-varying cardiovascular disease risks and diseases . Conclusions : In this US national study of older adults , elevated depressive symptoms were associated with declines in episodic learning and memory over time . These associations were little affected by the demographic or medical conditions considered in this study . The results suggest that learning and memory decline may be a long-term feature associated with depressive symptoms among the nation ’s older adult population OBJECTIVES To determine whether an intervention that combines low-intensity exercise and incontinence care offsets some of its costs by reducing the incidence of selected health conditions in nursing home residents . DESIGN R and omized , controlled trial with the incidence and costs of selected , acute conditions compared between a 6-month baseline and an 8-month intervention phase . SETTING Four nursing homes . PARTICIPANTS One hundred ninety incontinent , long-stay nursing home residents . INTERVENTION Low-intensity , functionally oriented exercise and incontinence care were provided every 2 hours from 8:00 a.m. to 4:00 p.m. for 5 days a week for 8 months . MEASUREMENTS Predefined acute conditions hypothesized to be related to physical inactivity , incontinence , or immobility were abstract ed from residents ' medical records by blinded observers during a 6-month baseline period and throughout the 8-month intervention . Conditions included those in the dermatological , genitourinary , gastrointestinal , respiratory and cardiovascular systems ; falls ; pain ; and psychiatric and nutritional disturbances . Costs were determined using Current Procedural Terminology Center and Medicare allowable cost reimbursement at a rate of 80 % . RESULTS The intervention group had significantly better functional outcomes than the control group ( strength , mobility endurance , urinary and fecal incontinence ) and a reduction of 10 % in the incidence of the acute conditions , which was not significant . There were no significant differences between groups in the cost of assessing and treating these acute conditions between baseline and intervention . CONCLUSION The intervention , which is consistent with federal and clinical practice guidelines , significantly improved functional outcomes but did not reduce the incidence and costs of selected acute health conditions . The cost of implementing these labor-intensive interventions for frail nursing home residents will have to be justified based on functional and quality -of-life outcomes and are unlikely to be offset by savings in medical care costs in this population OBJECTIVES To identify the characteristics of elderly persons who develop a fear of falling after experiencing a fall and to investigate the association of this fear with changes in health status over time . DESIGN A prospect i ve study of falls over a 2-year period ( 1991 - 92 ) . Falls were ascertained using bimonthly postcards plus telephone interview with a st and ardized ( World Health Organisation ) question naire for circumstances , fear of falling and consequences of each reported fall . Each participant underwent a physical exam and subjective health assessment each year form 1990 to 1993 . SETTING New-Mexico Aging Process Study , USA . SUBJECTS 487 elderly subjects ( > 60 years ) living independently in the community . MAIN OUTCOME MEASURES Fear of falling after experiencing a fall . RESULTS 70 ( 32 % ) of 219 subjects who experienced a fall during the 2 year study period reported a fear of falling . Women were more likely than men to report fear of falling ( 74 % vs 26 % ) . Fallers who were afraid of falling again had significantly ore balance ( 31.9 % vs 12.8 % ) and gait disorders ( 31.9 % vs 7.4 % ) at entry in the study in 1990 . Among sex , age , mental status , balance and gait abnormalities , economic re source and physical health , logistic regression analysis show gait abnormalities and poor self-perception of physical health , cognitive status and economic re sources to be significantly associated with fear of falling . Subjects who reported a fear of falling experienced a greater increase in balance ( P = 0.08 ) , gait ( P < 0.01 ) and cognitive disorders ( P = 0.09 ) over time , result ing in a decrease in mobility level . CONCLUSION The study indicated that about one-third of elderly people develop a fear of falling after an incident fall and this issue should be specifically addressed in any rehabilitation programme The terminal decline hypothesis states that in the proximity of death , an individual 's decline in cognitive abilities accelerates . We aim ed at estimating the onset of faster rate of decline in global cognition using  Mini Mental State Examination ( MMSE ) scores  from participants of the Cambridge City over 75 Cohort Study ( CC75C ) , a U.K. population -based longitudinal study of aging where almost all participants have died . The r and om change point model fitted to MMSE scores structured as a function of distance to death allowed us to identify a potentially different onset of change in rate of decline before death for each individual in the sample . Differences in rate of change before and after the onset of change in rate of decline by sociodemographic variables were investigated . On average , the onset of a faster rate of change occurred about 7.7 years before death and varied across individuals . Our results show that most individuals experience a period of slight decline followed by a much sharper decline . Education , age at death , and cognitive impairment at study entry were identified as modifiers of rate of change before and after change in rate of decline . Gender differences were found in rate of decline in the final stages of life . Our study suggests that terminal decline is a heterogeneous process , with its onset varying between individuals BACKGROUND Depression is common in later life . AIMS To determine whether exercise is effective as an adjunct to antidepressant therapy in reducing depressive symptoms in older people . METHOD Patients were r and omised to attend either exercise classes or health education talks for 10 weeks . Assessment s were made " blind " at baseline , and at 10 and 34 weeks . The primary outcome was seen with the 17-item Hamilton Rating Scale for Depression ( HRSD ) . Secondary outcomes were seen with the Geriatric Depression Scale , Clinical Global Impression and Patient Global Impression . RESULTS At 10 weeks a significantly higher proportion of the exercise group ( 55 % v. 33 % ) experienced a greater than 30 % decline in depression according to HRSD ( OR=2.51 , P=0.05 , 95 % CI 1.00 - 6.38 ) . CONCLUSIONS Because exercise was associated with a modest improvement in depressive symptoms at 10 weeks , older people with poorly responsive depressive disorder should be encouraged to attend group exercise activities BACKGROUND The role of walking , as compared with vigorous exercise , in the prevention of coronary heart disease remains controversial , and data for women on this topic are sparse . METHODS We prospect ively examined the associations between the score for total physical activity , walking , and vigorous exercise and the incidence of coronary events among 72,488 female nurses who were 40 to 65 years old in 1986 . Participants were free of diagnosed cardiovascular disease or cancer at the time of entry and completed serial detailed question naires about physical activity . During eight years of follow-up , we documented 645 incident coronary events ( nonfatal myocardial infa rct ion or death from coronary disease ) . RESULTS There was a strong , grade d inverse association between physical activity and the risk of coronary events . As compared with women in the lowest quintile group for energy expenditure ( expressed as the metabolic-equivalent [ MET ] score ) , women in increasing quintile groups had age-adjusted relative risks of 0.77 , 0.65 , 0.54 , and 0.46 for coronary events ( P for trend < 0.001 ) . In multivariate analyses , the inverse gradient remained strong ( relative risks , 0.88 , 0.81 , 0.74 , and 0.66 for women in increasing quintile groups as compared with those in the lowest quintile group ; P for trend=0.002 ) . Walking was inversely associated with the risk of coronary events ; women in the highest quintile group for walking , who walked the equivalent of three or more hours per week at a brisk pace , had a multivariate relative risk of 0.65 ( 95 percent confidence interval , 0.47 to 0.91 ) as compared with women who walked infrequently . Regular vigorous exercise ( > or = 6 MET ) was associated with similar risk reductions ( 30 to 40 percent ) . Sedentary women who became active in middle adulthood or later had a lower risk of coronary events than their counterparts who remained sedentary . CONCLUSIONS These prospect i ve data indicate that brisk walking and vigorous exercise are associated with substantial and similar reductions in the incidence of coronary events among women To study risk factors for falling , we conducted a one-year prospect i ve investigation , using a sample of 336 persons at least 75 years of age who were living in the community . All subjects underwent detailed clinical evaluation , including st and ardized measures of mental status , strength , reflexes , balance , and gait ; in addition , we inspected their homes for environmental hazards . Falls and their circumstances were identified during bimonthly telephone calls . During one year of follow-up , 108 subjects ( 32 percent ) fell at least once ; 24 percent of those who fell had serious injuries and 6 percent had fractures . Predisposing factors for falls were identified in linear-logistic models . The adjusted odds ratio for  sedative use was 28.3 ; for cognitive impairment , 5.0 ; for disability of the lower extremities , 3.8 ; for palmomental reflex , 3.0 ; for abnormalities of balance and gait , 1.9 ; and for foot problems , 1.8 ; the lower bounds of the 95 percent confidence intervals were 1 or more for all variables . The risk of falling increased linearly with the number of risk factors , from 8 percent with none to 78 percent with four or more risk factors ( P less than 0.0001 ) . About 10 percent of the falls occurred during acute illness , 5 percent during hazardous activity , and 44 percent in the presence of environmental hazards . We conclude that falls among older persons living in the community are common and that a simple clinical assessment can identify the elderly persons who are at the greatest risk of falling OBJECTIVE The role of exercise in the prevention of falls and fall-related injuries among elderly persons is unclear . The objective of this study was to assess the response to an exercise-based rehabilitation program intended to improve balance and mobility and reduce or prevent falls . DESIGN Pretest-posttest experimental design with repeated measures at baseline , immediately postintervention , and 6 months postintervention . To assess the effect of repeated exposure to our main outcome measure ( the obstacle course ) , half of the participants ( r and omly selected ) were allowed to practice on the obstacle course . SETTING A veterans affairs medical center . PARTICIPANTS Elderly , ambulatory , community-dwelling volunteers recruited from among local out patients at our medical center . INTERVENTION Sixty-five volunteers completed a 6-week supervised low to moderate intensity program of stretching , postural control , endurance walking , and coordination exercises design ed to improve balance and mobility . Participants were divided into 2 groups : 34 participants who did not practice on the obstacle course during their exercise program and 31 participants who practice d on the obstacle course in addition to their otherwise identical exercise program . MAIN OUTCOME MEASURES Performance on a functionally oriented obstacle course and self-reported falls and fall-related injuries . RESULTS No significant performance differences were found between the two groups . After intervention , mean qualitative obstacle course scores improved modestly ( 5 % ) and mean obstacle course completion time decreased by 15 % from baseline . These postintervention pairwise performance differences were clinical ly important but not statistically significant . Relative to baseline levels , postintervention falls and injuries did not change significantly . CONCLUSIONS Our exercise intervention may have the potential to improve functional performance . However , some modifications are necessary to enhance efficacy . The obstacle course may be a useful tool in the evaluation of elderly persons with balance and mobility impairment in the rehabilitation setting This study looked at the effect of a single session of mild exercise in a group of cognitively unimpaired institutionalized elderly patients , aged 70 + , on tests of cognitive performance . Results indicate that mild exercise , such as range-of-motion , does improve the ability to recall and that the effect lasts for at least half an hour . Mild exercise programmes appear to be a practical , low-cost nursing intervention that can enhance memory and independence . Programmes that are design ed to meet individual needs and that are incorporated into daily routine and activities without imposing extra effort or inconvenience are more appealing to elderly patients .  Exercise can be easily learned and implemented by nurses , personal care attendants or nurse aides . This is an extremely important consideration in a health care system that dem and s low-cost quality care OBJECTIVE Because of the rapid aging of the population and inconsistent findings of previous epidemiological studies in Hong Kong , a prevalence study of depression among older adults was timely . The authors assessed the prevalence of depression among older adults and identified factors associated with it . METHODS The authors interviewed a r and om representative sample of 917 community-dwelling Chinese adults age 60 and over . The 15-item Chinese Geriatric Depression Scale  with a cutoff of > or = 8 was used to identify clinical ly significant depression in the older adults . RESULTS The authors found that 11.0 % and 14.5 % of older Chinese men and women , respectively , scored above the cutoff , a prevalence rate similar to those found in other countries , including the United States , Engl and , and Finl and . Factors that were associated with an increased likelihood of depression among older adults included poor self-rated health , long-term pain , vision problems , higher level of impairment in activities of daily living , residing in Hong Kong less than 20 years , financial strain , and having less social support . CONCLUSIONS The prevalence rate of depression  among older Chinese adults in Hong Kong is more or less similar to rates found in Western countries . The data suggest that older adults who receive less social support are more likely to be depressed CONTEXT Five-year survival rates for early stage colorectal , breast , and prostate cancer currently exceed 90 % and are increasing . Cancer survivors are at greater risk for second malignancies , other comorbidities , and accelerated functional decline . Lifestyle interventions may provide benefit , but it is unknown whether long-term cancer survivors can modify their lifestyle behaviors sufficiently to improve functional status . OBJECTIVE To determine whether a telephone counseling and mailed print material -based diet and exercise intervention is effective in reorienting functional decline in older , overweight cancer survivors . DESIGN , SETTING , AND PARTICIPANTS R and omized controlled trial of 641 overweight ( body mass index > or = 25 and < 40 ) , long-term ( > or = 5 years ) survivors ( aged 65 - 91 years ) of colorectal , breast , and prostate cancer , who were r and omly assigned to an intervention group ( n = 319 ) or delayed intervention ( control ) group ( n = 322 ) in Canada , the United Kingdom , and 21 US states . Individuals were recruited for the Reach out to Enhance Wellness ( RENEW ) trial from July 1 , 2005 , through May 17 , 2007 . INTERVENTION A 12-month , home-based tailored program of telephone counseling and mailed material s promoting exercise , improved diet quality , and modest weight loss . The control group was wait-listed for 12 months . MAIN OUTCOME MEASURES Change in self-reported physical function on the Short-Form 36 physical function subscale ( score range , 0 - 100 ; a high score indicates better functioning ) from baseline to 12 months was the primary end point . Secondary outcomes included changes in function on the basic and advanced lower extremity function subscales of the Late Life Function and Disability Index ( score range , 0 - 100 ) , physical activity , body mass index , and overall health-related quality of life . RESULTS The mean baseline Short-Form 36 physical function score was 75.7 . At the 12-month follow-up , the mean function scores declined less rapidly in the intervention group ( -2.15 ; 95 % confidence interval [ CI ] , -0.36 to -3.93 ) compared with the control group ( -4.84 ; 95 % CI , -3.04 to -6.63 ) ( P = .03 ) . The mean baseline basic lower extremity function score was 78.2 . The mean changes in basic lower extremity function were 0.34 ( 95 % CI , -0.84 to 1.52 ) in the intervention group compared with -1.89 ( 95 % CI , -0.70 to -3.09 ) in the control group ( P = .005 ) . Physical activity , dietary behaviors , and overall quality of life increased significantly in the intervention group compared with the control group , and weight loss also was greater ( 2.06 kg [ 95 % CI , 1.69 to 2.43 kg ] vs 0.92 kg [ 95 % CI , 0.51 to 1.33 kg ] , respectively ; P < .001 ) . CONCLUSION Among older , long-term survivors of colorectal , breast , and prostate cancer , a diet and exercise intervention reduced the rate of self-reported functional decline compared with no intervention . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00303875 BACKGROUND Pharmacological treatment of depression in geriatric patients is often difficult . Although unsupervised exercise has been shown to benefit younger depressed patients , there is no evidence that unsupervised exercise can be used as a maintenance treatment for depression in elderly patients . Our aim was to test the feasibility and efficacy of unsupervised exercise as a long-term treatment for clinical depression in elderly patients . METHODS We studied 32 subjects ( 71.3 + /- 1.2 years of age , mean + /- SE ) in a 20-week , r and omized , controlled trial , with follow-up at 26 months . Subjects were community-dwelling patients with major or minor depression or dysthymia . Exercisers engaged in 10 weeks of supervised weight-lifting exercise followed by 10 weeks of unsupervised exercise . Controls attended lectures for 10 weeks . No contact was made with either group after 20 weeks until final follow-up . Blinded assessment was made with the Beck Depression Inventory ( BDI ) , the Philadelphia Geriatric Morale Scale , and Ewart 's Self Efficacy Scale at 20 weeks and with the BDI and physical activity question naire at 26 months . RESULTS Patients r and omized to the exercise condition completed 18 + /- 2 sessions of unsupervised exercise during Weeks 10 to 20 . The BDI was significantly reduced at both 20 weeks and 26 months of follow-up in exercisers compared with controls ( p < .05-.001 ) . At the 26-month follow-up , 33 % of the exercisers were still regularly weight lifting , versus 0 % of controls ( p < .05 ) . CONCLUSIONS Unsupervised weight-lifting exercise maintains its antidepressant effectiveness at 20 weeks in depressed elderly patients . Long-term changes in exercise behavior are possible in some patients even without supervision PURPOSE To compare the effects of functional home exercise of repeated sit-to-st and s with low-intensity progressive resistance training , on performance measures in mobility-limited adults over 80 years of age . SETTING Participants ' homes . DESIGN Community-dwelling older adults > or = 80 years of age were invited to participate in a r and omised controlled clinical trial . Baseline and outcome measures were : comfortable gait velocity , 30-s chair-st and test , 15-s step test , Berg Balance Scale , Modified Falls Efficacy Scale and the Late-Life Function and Disability Instrument-function component . Participants r and omised to the intervention group performed repeated sit-to-st and s using a Gr and St and System ; a biofeedback device that recorded and displayed the number of repetitions performed . Participants r and omised to the control group performed knee extensions using ankle cuff weights . Both groups performed the exercises daily for 6 weeks . RESULTS Sixty-six older adults took part . The intervention group had a statistically significant improvement in Berg Balance Scale mean score , 1.67 + /- 2.64 points , P = 0.001 ( control group 0.73 + /- 3.63 points , P = 0.258 ) , indicating an improvement in balance over the 6-week exercise period . There was no statistically significant effect of either intervention on the other outcome measures . CONCLUSIONS In a highly variable population of older adults with mobility limitations , low-intensity functional home exercise of repeated sit-to-st and s using the Gr and St and System improved Berg Balance Scale score while low-intensity progressive resistance training did not . While statistically significant , the improvement in Berg Balance Scale score was modest raising the issue of what extent of change in score is clinical ly significant in this population Background : Falls are among the leading causes of injuries and deaths . Results from a number of studies have suggested that a community-based exercise program may be effective in improving lower body strength , although some have shown only limited improvements . However , the impact of these programs on gait and balance are equivocal . Further , studies that have specifically targeted deconditioned elderly individuals , rather than individuals drawn from the general community , either showed limited or no improvements in gait and balance . Objective : This study examined the effectiveness of a community-based , short-term , low-intensity exercise intervention strategy on measures of mobility skills , gait and balance , and muscle strength for a clinical ly targeted group of elderly individuals at high risk of falls . Methods : 245 men and women aged 60 years or older were r and omized into either an intervention or control group and received a baseline ( T1 ) assessment . Subjects in the intervention group received up to 24 sessions ( 45 min long ) of low-intensity st and ard exercise modalities tailored to the individual patient over an 8- to 10-week period . At the conclusion of the program , the participants in the intervention group were instructed to continue performing the exercises at home until 1 year after T1 . Measures of physical function and performance were collected for all subjects at three different points of study enrollment . Results : Of the subjects assessed at baseline , 138 ( 56 % ) also had a postintervention assessment ( T2 ) , 128 ( 52 % ) had a 6-month follow-up assessment ( T3 ) , and 105 subjects had assessment s at all time points . Primary analyses were based on the 105 subjects who had assessment s at all time points . Intervention and control subjects did not differ in any of the physical function or performance measures at baseline . Between T1 and T2 , the intervention subjects showed significantly greater improvement than the control subjects on all outcomes , with improvements plateauing for most measures between T2 and T3 . Gait and balance scores continued to improve throughout the study period for both groups of subjects . Conclusions : This easily implemented , low-intensity exercise program may lead to improvements in physical functioning that are retained over the long term and effectively targets a clinical ly defined population of deconditioned elders at high risk of falling and sustaining serious injury OBJECTIVE To examine the effects of a 3-month low-intensity exercise program on physical frailty . DESIGN R and omized clinical trial . SETTING Regional tertiary-care hospital and academic medical center with an outpatient rehabilitation fitness center . PARTICIPANTS Eighty-four physically frail older adults ( mean age , 83 + /- 4 yrs ) . INTERVENTION Three-month low-intensity supervised exercise ( n = 48 ) versus unsupervised home-based flexibility activities ( n = 36 ) . MAIN OUTCOME MEASURES Physical performance test , measures of balance , strength , flexibility , coordination , speed of reaction , peripheral sensation . RESULTS Significant improvement was made by the exercise group on our primary indicator of frailty , a physical performance test ( PPT ) ( 29 + /- 4 vs 31 + /- 4 out of a possible 36 points ) , as well as many of the risk factors previously identified as contributors to frailty ; eg , reductions in flexibility , strength , gait speed , and poor balance . Although the home exercise control group showed increases in range of motion , the improvements in flexibility did not translate into improvements in physical performance capacity as assessed by the PPT . CONCLUSIONS Our results suggest that physical frailty is modifiable with a program of modest activities that can be performed by virtually all older adults . They also indicate that exercise programs consisting primarily of flexibility activities are not likely to reverse or attenuate physical frailty . Although results suggest that frailty is modifiable , it is not likely to be eliminated with exercise , and efforts should be directed toward preventing the condition INTRODUCTION An important mechanism by which physical activity reduces the risk of cardiovascular disease is through regulating plasma lipids . We investigated whether low-intensity exercise modulates lipid metabolism and the transcription factors peroxisome proliferator-activated receptor gamma ( PPARgamma ) and liver X receptor alpha ( LXRalpha ) responsible for controlling reverse cholesterol transport ( RCT ) . METHODS Thirty-four sedentary adults , mean age 45.6 + /- 11.1 yr , participated in an 8-wk low-intensity exercise program consisting of walking 10,000 steps , three times a week . Subjects were r and omly allocated to either an exercise group or a sedentary control group , and serum lipid or lipoprotein concentrations were determined . RESULTS Compared with controls , there was a significant decrease in total cholesterol ( preexercise , 5.73 + /- 1.39 mmol x L ; postexercise , 5.32 + /- 1.28 mmol x L ) and a significant increase in HDL ( preexercise , 1.46 + /- 0.47 mmol x L ; postexercise , 1.56 + /- 0.50 mmol x L ) after the exercise program . There was a significant increase in serum oxidized LDL ( oxLDL ) concentrations in the exercise group before and after exercise ( 0 wk , 554 + /- 107 ng x mL ; 4 wk , 698 + /- 134 ng x mL ; 8 wk , 588 + /- 145 ng x mL ) . A significant increase in leukocyte mRNA expression for PPARgamma ( 4 wk , 1.8 + /- 0.9-fold ; 8 wk , 4.3 + /- 1.9-fold ) was observed , which was reinforced by increased PPARgamma DNA-binding activity postexercise ( preexercise , 0.22 + /- 0.09 OD units ; postexercise , 1.13 + /- 0.29 OD units ) . A significant increase in gene expression was observed for the oxLDL scavenger receptor CD36 ( 4 wk , 3.8 + /- 0.6-fold ; 8 wk , 2.7 + /- 0.5-fold ) and LXRalpha ( 8 wk , 3.5 + /- 0.8-fold ) . Two LXRalpha-regulated genes involved in RCT , namely , ATP-binding cassette transporters A1 and GI ( ABCA1 and ABCG1 , respectively ) , were significantly up-regulated postexercise ( 8 wk : ABCA1 , 3.46 + /- 0.56-fold ; ABCG1 , 3.06 + /- 0.47-fold ) . CONCLUSION We propose that the net effect of these changes may be to increase oxLDL uptake , to stimulate RCT , and thus to promote clearance of proatherogenic lipids from the vasculature , ultimately contributing to the cardiovascular benefits of low-intensity aerobic exercise Thirty community-dwelling , moderately depressed elderly were r and omly assigned to 1 of 3 interventions : experimenter-accompanied exercise in the form of walking , a social contact control condition , and a wait-list control . Exercise and social contact both result ed in significant reductions in both the total and the psychological subscale of the Beck Depression Inventory ( BDI ) . The exercise condition , however , unlike the control conditions , result ed in decreased somatic symptoms of the BDI . These results indicate that , at least in the short term , exercise has a broader effect compared with control conditions in reducing depressive symptoms in the moderately depressed elderly BACKGROUND This study , conducted between 1998 and 2001 and analyzed in 2002 and 2003 , was design ed to test ( 1 ) whether exercise is an efficacious treatment for mild to moderate major depressive disorder ( MDD ) , and ( 2 ) the dose-response relation of exercise and reduction in depressive symptoms . DESIGN The study was a r and omized 2x2 factorial design , plus placebo control . SETTING / PARTICIPANTS All exercise was performed in a supervised laboratory setting with adults ( n = 80 ) aged 20 to 45 years diagnosed with mild to moderate MDD . INTERVENTION Participants were r and omized to one of four aerobic exercise treatment groups that varied total energy expenditure ( 7.0 kcal/kg/week or 17.5 kcal/kg/week ) and frequency ( 3 days/week or 5 days/week ) or to exercise placebo control ( 3 days/week flexibility exercise ) . The 17.5-kcal/kg/week dose is consistent with public health recommendations for physical activity and was termed " public health dose " ( PHD ) . The 7.0-kcal/kg/week dose was termed " low dose " ( LD ) . MAIN OUTCOME MEASURES The primary outcome was the score on the 17-item Hamilton Rating Scale for Depression ( HRSD(17 ) ) . RESULTS The main effect of energy expenditure in reducing HRSD(17 ) scores at 12 weeks was significant . Adjusted mean HRSD(17 ) scores at 12 weeks were reduced 47 % from baseline for PHD , compared with 30 % for LD and 29 % for control . There was no main effect of exercise frequency at 12 weeks . CONCLUSIONS Aerobic exercise at a dose consistent with public health recommendations is an effective treatment for MDD of mild to moderate severity . A lower dose is comparable to placebo effect
target: Conclusions The current literature suggests the effectiveness of low-intensity exercise on improved physical and cognitive health for older adults .
  It may be a desired intensity level in promoting health among older adults with better compliance , lower risk of injuries , and long-term sustainability
background: Background It is well known that physical exercise is important to promote physical and cognitive health in older population .
  However , inconsistent research findings were shown regarding exercise intensity , particularly on whether low-intensity exercise ( 1.5 metabolic equivalent tasks ( METs ) to 3.0 METs ) can improve physical and cognitive health of older adults .
  This systematic review aim ed to fill this research gap .
  The objective of this study is to conduct a systematic review of the effectiveness of low-intensity exercise interventions on physical and cognitive health of older adults .