title: Velocity training induces power-specific adaptations in highly functioning older adults. Effects of isometric strength training on quadriceps muscle properties in over 55 year olds A randomized trial of exercise programs among older individuals living in two long-term care facilities: the FallsFREE program. Once-weekly resistance exercise improves muscle strength and neuromuscular performance in older adults. Superiority of treadmill walking exercise versus strength training for patients with peripheral arterial disease. Implications for the mechanism of the training response. Effects of exercise on neurobehavioral function in community-dwelling older people more than 75 years of age. Effects of a group exercise program on strength, mobility, and falls among fall-prone elderly men. Effects of resistance training on strength, power, and selected functional abilities of women aged 75 and older. Resilience to exercise detraining in healthy older adults. Nursing rehabilitation and exercise strategies in the nursing home. Physical activity, self-esteem, and self-efficacy relationships in older adults: A randomized controlled trial Randomized controlled trial of exercise training for older people (Sendai Silver Center Trial; SSCT): study design and primary outcome. A randomized outcome evaluation of group exercise programs in long-term care institutions. Muscle strength and fiber adaptations to a year-long resistance training program in elderly men and women. Randomised controlled trial of weightlifting exercise in patients with chronic airflow limitation. Large energetic adaptations of elderly muscle to resistance and endurance training. Preventing falls on an elderly care rehabilitation ward Osteoarthritis of the knee: isokinetic quadriceps exercise versus an educational intervention. Injuries and adherence to walk/jog and resistance training programs in the elderly. Physical activity program for older persons: effect on balance, strength, neuromuscular control, and reaction time. Isokinetic strength training of the hemiparetic knee: effects on function and spasticity. High Intensity Resistance Training: Effects on Bone in Older Men and Women A randomized controlled trial of a home exercise programme for elderly people with poor mobility. The efficacy of home based progressive strength training in older adults with knee osteoarthritis: a randomized controlled trial. The effect of exercise on gait patterns in older women: a randomized controlled trial. Three-year controlled, randomized trial of the effect of dose-specified loading and strengthening exercises on bone mineral density of spine and femur in nonathletic, physically active women. Effects of group exercise on cognitive functioning and mood in older women Resistance exercise and bone turnover in elderly men and women. Progressive strength training in sedentary, older African American women. Progressive Resistance Muscle Strength Training of Hospitalized Frail Elderly Randomized trial of progressive resistance training to counteract the myopathy of chronic heart failure. Effects of resistance training on selected indexes of immune function in elderly women. Effect of intense strength training on standing balance, walking speed, and sit-to-stand performance in older adults. A randomized trial of physical rehabilitation for very frail nursing home residents. Effects of resistive and balance exercises on isokinetic strength in older persons. Effects of high-intensity strength training on multiple risk factors for osteoporotic fractures. A randomized controlled trial. Randomised controlled trial of a general practice programme of home based exercise to prevent falls in elderly women Effects of physical exercise for elderly patients with physical impairments. Home based exercise therapy for older patients with knee osteoarthritis: a randomized clinical trial. The effects of resistance training on well-being and memory in elderly volunteers. Exercise to improve gait velocity in older persons. Effects of 16 weeks of resistance training on left ventricular morphology and systolic function in healthy men >60 years of age. A controlled trial of exercise by residents of old people's homes. Aerobic and strength training in patients with chronic obstructive pulmonary disease. Heavy-resistance training in older Scandinavian men and women: short- and long-term effects on arm and leg muscles. Exercise and weight loss in obese older adults with knee osteoarthritis: a preliminary study. Resistance and aerobic training in older men: effects on VO2peak and the capillary supply to skeletal muscle. A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis. The Fitness Arthritis and Seniors Trial (FAST). The effect of a 12-month exercise trial on balance, strength, and falls in older women: a randomized controlled trial. A randomized controlled trial of progressive resistance training in depressed elders. Aerobic training involving a minor muscle mass shows greater efficiency than training involving a major muscle mass in chronic heart failure patients. Strength training can improve steadiness in persons with essential tremor. IGF-1 bioavailability is increased by resistance training in older women with low bone mineral density Effects of high-intensity strength training on quality-of-life parameters in cardiac rehabilitation patients. Systematic strength training as a model of therapeutic intervention. A controlled trial in postmenopausal women with osteopenia. A controlled trial of circuit weight training on aerobic capacity and myocardial oxygen demand in men after coronary artery bypass surgery. Comparative effects of two physical activity programs on measured and perceived physical functioning and other health-related quality of life outcomes in older adults. Muscle hypertrophy response to resistance training in older women. Light resistance and stretching exercise in elderly women: effect upon strength. Comprehensive local muscle training increases aerobic working capacity and quality of life and decreases neurohormonal activation in patients with chronic heart failure. A CLINICAL TRIAL OF STRENGTHENING AND AEROBIC EXERCISE TO IMPROVE GAIT AND BALANCE IN ELDERLY MALE NURSING HOME RESIDENTS Self-paced resistance training and walking exercise in community-dwelling older adults: effects on neuromotor performance. The effect of multidimensional exercises on balance, mobility, and fall risk in community-dwelling older adults. Dynamic strength training in patients with early rheumatoid arthritis increases muscle strength but not bone mineral density. Resistance Training To Counteract the Catabolism of a Low-Protein Diet in Patients with Chronic Renal Insufficiency Efficacy of low load resistive muscle training in patients with rheumatoid arthritis functional class II and III. Age effect on transcript levels and synthesis rate of muscle MHC and response to resistance exercise. Comparative effects of high- and low-intensity resistance training on thigh muscle strength, fiber area, and tissue composition in elderly women. Neuromuscular adaptations during bilateral versus unilateral strength training in middle-aged and elderly men and women. Effects of a short-term strength training programme on lymphocyte subsets at rest in elderly humans Strength and Aging: An Exploratory Study Body composition in elderly men: effect of dietary modification during strength training. Knee extension strength and walking speed in relation to quadriceps muscle composition and training in elderly women. Efficacy of heavy-resistance training for active women over sixty: muscular strength, body composition, and program adherence. Balance improvements in older women: effects of exercise training. Improvements in quadriceps strength with regular seated exercise in the institutionalized elderly. Exercise: effects on physical functional performance in independent older adults. Growth hormone administration and exercise effects on muscle fiber type and diameter in moderately frail older people. Resistance training in patients with peripheral arterial disease: effects on myosin isoforms, fiber type distribution, and capillary supply to skeletal muscle. Exercise training in the debilitated aged: strength and functional outcomes. Physical fitness and psychological benefits of strength training in community dwelling older adults. Resistance training over 2 years increases bone mass in calcium-replete postmenopausal women. Home program of physical therapy: effect on disabilities of patients with total hip arthroplasty. Effects of strength training on total and regional body composition in older men. A multifactorial intervention to reduce the risk of falling among elderly people living in the community. Effects of resistance training on regional and total bone mineral density in premenopausal women: a randomized prospective study. Fall risk index for elderly patients based on number of chronic disabilities. Effects of one year of resistance training on the relation between muscular strength and bone density in elderly women A randomized, controlled trial of quadriceps resistance exercise and vitamin D in frail older people: the Frailty Interventions Trial in Elderly Subjects (FITNESS). Exercise effects on bone mass in postmenopausal women are site-specific and load-dependent. Exercise--it's never too late: the strong-for-life program. Evaluation of a supervised exercise program in a geriatric population. High intensity knee extensor training, in patients with chronic heart failure. Major skeletal muscle improvement. A home-based exercise program for nondisabled older adults. Effects of a quantitative progressive rehabilitation program applied unilaterally to the osteoarthritic knee. Effects of progressive resistance training on immune response in aging and chronic inflammation. Strength training normalizes resting blood pressure in 65- to 73-year-old men and women with high normal blood pressure. A 10-week strength training program: effect on the motor performance of an unimpaired upper extremity. Sensori-motor function, gait patterns and falls in community-dwelling women. Exercise and balance in aged women: a pilot controlled clinical trial. Low-intensity exercise as a modifier of physical frailty in older adults. The effects of strength conditioning on older women's ability to perform daily tasks. High-intensity strength training of patients enrolled in an outpatient cardiac rehabilitation program. Group- vs home-based exercise training in healthy older men and women. A community-based clinical trial. Effect of Resistance Training on Strength, Postural Control, and Gait Velocity among Older Adults Effectiveness of home exercise on pain and disability from osteoarthritis of the knee: a randomised controlled trial Home exercise to improve strength and walking velocity after hip fracture: a randomized controlled trial. Is lower extremity strength gain associated with improvement in physical performance and disability in frail, community-dwelling elders? Dynamic muscle strength alterations to detraining and retraining in elderly men. Effect of exercise intensity on bone density, strength, and calcium turnover in older women. Site-specific effects of strength training on bone structure and geometry of ultradistal radius in postmenopausal women. Effects of muscle-strength training on the functional status of patients with osteoarthritis of the knee joint. Exercise training and nutritional supplementation for physical frailty in very elderly people. Long-term resistance training in the elderly: effects on dynamic strength, exercise capacity, muscle, and bone. Effects of a 16-week progressive high-intensity strength training (HIST) on indexes of bone turnover in men over 65 years: A randomized controlled study Concurrent cardiovascular and resistance training in healthy older adults. The effect of a 12-week dynamic resistance strength training program on gait velocity and balance of older adults. Effect of exercise on postural sway in the elderly. Effects of a whole-body resistive training regimen in the elderly. Effect of running versus isometric training programs on healthy elderly at rest.
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 Changes in strength , speed and size of the quadriceps muscle have been investigated in elderly men and women after 6 months of isometric strength training . We have also indirectly investigated the role of metabolites as a stimulus for muscle hypertrophy by study ing two training protocol s. One thigh was trained using short , intermittent contractions ( IC ) , while the other trained using long , continuous contractions ( CC ) . This meant that there should be a greater metabolite change in the muscle performing CC , as the blood flow is occluded for longer . Nine subjects [ eight women , mean ( SE ) age , 71.8 ( 2.9 ) years ] were measured for contractile properties and strength before and after training , and compared to nine age-matched controls [ 71.5 ( 2.1 ) years ] . The training group increased quadriceps strength by 48.7 (9.1)% ( P < 0.005 ) and 53.1 ( 11.3 ) % ( P < 0.005 ) following the IC and CC protocol s , respectively . There was no change in muscle strength in the controls . Both muscles showed significant slowing after training as measured by the relaxation times and the force-frequency ratio . There were non-significant decreases in muscle fatigability after training . The control group also showed some significant decreases in fatigability and muscle speed . The training group showed significant increases in muscle ( and bone ) cross-sectional area of 4.0 (1.7)% and 4.9 (1.3)% following the CC and IC protocol s , respectively . These increases were significantly different from the decrease observed in the control group . These findings suggest that people over the age of 55 still have the capacity to increase muscle strength and size , and that the training causes slowing of the muscle . Muscle hypertrophy does not seem to be strongly influenced by metabolite changes in this age group , as there were no differences in measurements observed between protocol OBJECTIVE To use two different exercise programs over a 2-year period to reduce falls and their sequelae among residents of two long-term care facilities . DESIGN R and omized , controlled trial . SETTING The study took place at two long-term care facilities with services ranging from independent living to skilled nursing . PARTICIPANTS One hundred and ten participants whose average age was 84 and who were capable of ambulating with or without assistive devices and could follow simple directions . INTERVENTION Participants were r and omized to one of two exercise groups ( resistance/endurance plus basic enhanced programming or tai chi plus basic enhanced programming ) or to a control group ( basic enhanced programming only ) . Exercise classes were held three times per week throughout the study . MEASUREMENTS Participants were evaluated for cognitive and physical functioning at baseline and 6 , 12 , and 24 months . Falls were determined from incident reports filed by the nursing staffs at the facilities . RESULTS Time to first fall , time to death , number of days hospitalized , and incidence of falls did not differ among the treatment and control groups ( P>.05 ) . Among all participants , those who fell had significantly lower baseline Folstein Mini-Mental State Examination and instrumental activities of daily living scores and experienced significantly greater declines in these measures over the 2-year program . CONCLUSION There were no significant differences in falls among the two exercise groups and the control group . Lack of treatment differences and low adherence rates suggest that residents of long-term care facilities may require individualized exercise interventions that can be adapted to their changing needs 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 In patients with intermittent claudication , a supervised walking exercise program increases peak exercise performance and community-based functional status .  Patients with peripheral arterial disease also have muscle weakness in the affected extremity that may contribute to the walking impairment . However , the potential benefits of training modalities other than walking exercise , such as strength training , have not been critically evaluated in this patient population . The present study tested the hypothesis that a strength training program would be as effective as treadmill walking exercise and that combinations of strengthening and walking exercise would be more effective than either alone in improving exercise performance . METHODS AND RESULTS Twenty-nine patients with disabling claudication were r and omized to 12 weeks of supervised walking exercise on a treadmill ( 3 h/wk at a work intensity sufficient to produce claudication ) , strength training ( 3 h/wk of resistive training of five muscle groups of each leg ) , or a nonexercising control group . Grade d treadmill testing was performed to maximally tolerated claudication pain to define changes in peak exercise performance . After 12 weeks , patients in the treadmill training program had a 74 + /- 58 % increase in peak walking time as well as improvements in peak oxygen consumption ( VO2 ) and the onset of claudication pain . Patients in the strength-trained group had a 36 + /- 48 % increase in peak walking time but no change in peak VO2 or claudication onset time . Control subjects had no changes in any of these measures over the 12-week period . After the first 12 weeks , patients in the initial walking exercise group continued for 12 more weeks of supervised treadmill training . This result ed in an additional 49 + /- 53 % increase in peak walking time ( total of 128 + /- 99 % increase over the 24 weeks ) . After the initial 12 weeks , patients in the strength-trained group began 12 weeks of supervised treadmill training , and patients in the control group participated in a 12-week combined program of strengthening and treadmill walking exercise . The combined strength and treadmill training program and treadmill training after 12 weeks of strength training result ed in increases in peak exercise performance similar to those observed with 12 weeks of treadmill training alone . CONCLUSIONS A supervised treadmill walking exercise program is an effective means to improve exercise performance in patients with intermittent claudication , with continued improvement over 24 weeks of training . In contrast , 12 weeks of strength training was less effective than 12 weeks of supervised treadmill walking exercise . Finally , strength training , whether sequential or concomitant , did not augment the response to a walking exercise program OBJECTIVE We evaluated the effects of exercise on neurobehavioral function in healthy older people more than 75 years of age . DESIGN A r and omized controlled trial with 6-month follow-up was conducted . SETTING The study was performed in the rural town of Kahoku , Japan , the population of which is considered representative of the older population of Japan . PARTICIPANTS We studied 42 healthy volunteers ( 18 men and 24 women ; mean age , 79 years ( range 75 to 87 years ) ) who were r and omly assigned to one of two groups , exercise or control . INTERVENTION Subjects assigned to the exercise group were instructed to exercise for 60 minutes twice a week for 6 months . Subjects in the control group were not instructed to engage in an specific exercise regimen . MEASUREMENTS The following measurements were recorded for both groups at baseline and at 6-month follow-up : ( 1 ) Neurobehavioral function as determined by the following tests : Mini-Mental State Exam ( MMSE ) , Hasegawa Dementia Scale Revised ( HDSR ) , Visuospatial Cognitive Performance Test ( VCP-test ) , Button score , Up & Go test , and Functional Reach ; and ( 2 ) Body mass index and blood pressure . RESULTS The effects of exercise were shown in the Up & Go test , and Functional Reach ( ANOVA with repeated measures ) . CONCLUSION This study demonstrates the acceptability and effectiveness of exercise on neurobehavioral function , even in older people more than 75 years of age 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 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 OBJECTIVE To determine the effects of stopping and restarting two types of exercise programs in older adults . DESIGN A controlled , longitudinal study that utilized r and om assignment of volunteers . Treatments were exercise programs design ed to improve cardiovascular or neuromuscular fitness . MEASUREMENTS Dependent variables measured before and after implementation of treatments were : maximum oxygen consumption , oxygen pulse , treadmill and cycle training workloads , quadriceps isokinetic peak torque , quadriceps isokinetic total work , and quadriceps training workload . MAIN RESULTS Exercise training was highly effective in improving cardiovascular endurance or muscular strength . Ten weeks of exercise detraining result ed in small losses in newly gained cardiovascular capacity but more noticeable losses in muscular strength . Exercise retraining was accomplished easily using cardiovascular or resistive exercises . The functional benefits of restarting a cardiovascular exercise program appeared additive despite a 10-week intervening period of exercise detraining . In this age group , cardiovascular exercise produced limited improvements in muscular strength , and resistive exercise training positively influenced cardiovascular exercise performance . CONCLUSIONS Older adults are fairly resilient to 10 weeks of cardiovascular detraining and retain newly gained muscular strength for at least 5 weeks , despite an interruption of formal exercise . An occasional missed exercise session or temporary cessation of habitual exercise should not be a cause for distress in exercising older adults . Instead , they should realize the case with which they may restart their exercise program and also appreciate the generalized fitness benefits that can be ascribed to becoming more active BACKGROUND The purpose of this study was to evaluate how weight training or nursing-based rehabilitative care programs in nursing homes impact on resident performance of Activities of Daily Living ( ADL ) and objectives tests of physical performance . METHODS This study involved a quasi-experimental control , longitudinal comparison of functional status over a 10-month period , where baseline status was adjusted through a weighting procedure based on functional status , cognitive status , and age . All residents from six residential care nursing home facilities were eligible except those with a terminal prognosis , a projected stay of less than 90 days , or with health complications that prohibited contact . Homes were placed into matched triplets based on patient characteristics : two members of each triplet were r and omly design ated to be experimental sites , the third became the control site . Baseline data were available for 468 subjects , follow-up for 392 .  ADL self-performance measures derived from the Minimum Data Set , including indicators of early loss ADL , locomotion , and late loss ADL ; a number of objective functional tests ( including measures of balance , power , and endurance ) ; and mood state as measured by the Geriatric Depression Scale . RESULTS Mean ADL values in the two experimental groups declined at a significantly lower rate than did rates for the controls . Functional decline was also lower in more specific measures : locomotion , early loss ADL , and late loss ADL . CONCLUSIONS With both interventions , facilities were able to implement a broad-based intervention that result ed in a significant reduction in ADL decline rates . A facility-wide nursing rehabilitation program can play a useful role in reversing functional decline , helping residents to maintain their involvement in a broad spectrum of ADL activities A r and omized controlled trial examined the growth and form of multidimensional self-esteem over a 12-month period ( 6-month exercise intervention and 6-month follow-up ) in 174 older adults engaged in either a walking or stretching/toning program .  The extent to which changes in physical fitness parameters and physical self-efficacy were related to changes in perceptions of attractive body , strength , physical conditioning , and physical self-worth was also determined . Latent growth curve analyses showed a curvilinear pattern of growth in esteem with significant increases at all levels of self-esteem upon completion of the intervention followed by significant declines at 6 months poistintervention in both groups . Frequency of activity and changes in physical fitness , body fat , and self-efficacy were related to improvements in esteem perceptions relative to attractive body , strength , and physical condition . Model fitting procedures suggested that the best fit of the data was to a model in which the influence of changes in efficacy and physical parameters on physical self-worth were mediated by perceptions of attractive body and physical conditions Physical exercise is expected to improve and maintain physical function in older people , thus promoting health and preventing or postponing the onset of disability in later life . The Sendai Silver Center Trial ( SSCT ) was a r and omized controlled trial design ed to evaluate the efficacy of exercise training among healthy free-living older people . Sixty-five eligible participants , aged from 60 to 81 years , were r and omly allocated to an exercise group or a control group . The subjects in the exercise group were asked to attend training classes at the Sendai Silver Center , a municipal health and welfare facility in the center of Sendai City , at least twice a week for 25 weeks . Each training class , lasting two hours , started with a warm-up session , followed by an endurance session with a bicycle ergometer , and a resistance exercise training session using rubber films , and ended with a cool-down session . The subjects in the control group were asked to attend recreational classes at the Center twice a month . There were no drop-outs or accidents during the intervention . Comparison of maximum oxygen consumption ( VO2max ) before and after the 25-week intervention revealed a significant increase in the exercise group ( 2.1 ml/kg/min ) but no significant change in the control group . Our result is equivalent to the participants becoming younger in aerobic capacity by five years after six months of exercise training BACKGROUND Physical activity programs in nursing homes typically consist of seated , range of motion ( ROM ) exercises , regardless of resident abilities . The Functional Fitness for Long-Term Care ( FFLTC ) Program was design ed not only to maintain ROM , but also to improve strength , balance , flexibility , mobility , and function . In addition , it was tailored to meet the needs of both high and low mobility residents . METHODS The feasibility and efficacy of the FFLTC Program were evaluated with 68 residents ( mean age 80 ) from five institutions . Persons were classified as low or high mobility and r and omized into either the FFLTC program or a seated ROM program . Classes were conducted in groups of 4 to 10 residents by trained facility staff for 45 minutes , three times per week . Assessment s at baseline and 4 months consisted of mobility , balance , gait , flexibility , functional capacity , and several upper and lower extremity strength measures . RESULTS Attendance averaged 86 % for the FFLTC and 79 % for the ROM classes . Four months of exercise led to significant improvements in mobility ( 16 % ) , balance ( 9 % ) , flexibility ( 36 % ) , knee ( 55 % ) , and hip ( 12 % ) strength for the FFLTC group . Shoulder strength was the only improvement found for the ROM group . The ROM group significantly deteriorated in some areas , particularly hip strength , mobility , and functional ability . CONCLUSIONS Institutionalized seniors , even those who are physically frail , incontinent and /or have mild dementia , can respond positively to a challenging exercise program . The FFLTC program demonstrated clear benefits over typical , seated ROM exercises . Moreover , with minimal training , the program can be safely delivered at low cost by institutional staff and volunteers BACKGROUND To study the effects of resistance training on muscle strength and size in older people , we enrolled 8 men and 17 women ( mean age 68.2 + /- 1 SEM ) into a one-year exercise trial . METHODS Subjects were r and omly assigned to exercise or control groups . Muscle biopsies were obtained from 11 subjects ( 8 exercisers/3 controls ) at baseline and after 15 weeks ; exercisers underwent another biopsy at 30 weeks . After testing maximum strength using the 1-RM method , the exercisers began a 12-exercise circuit ( 3 sets of 8 repetitions at 75 % of 1-RM ) , 3 times a week . The controls repeated the strength testing every 15 weeks . They were asked to continue usual activities and not to start any exercise program . RESULTS With exercise , muscle strength increased , average increases ranging from 30 % ( hip extensors ) to 97 % ( hip flexors ) . Strength increased rapidly over 3 months , then plateaued for the duration of the experiment . No strength changes were observed in sedentary controls . Cross-sectional area of type 1 muscle fibers increased in exercisers by 15 weeks ( 29.4 + /- 1 % , p < .02 ) and after 30 weeks ( 58.5 + /- 13.7 % , p < .002 ) compared to baseline . Type 2 fiber area did not change at 15 weeks , but increased by 30 weeks of training ( 66.6 + /- 9.5 % , p < .0002 ) . CONCLUSIONS These results suggest that prolonged moderate to high intensity resistance training may be carried out by healthy older adults with reasonable compliance , and that such training leads to sustained increases in muscle strength . These improvements are rapidly achieved and are accompanied by hypertrophy of both type 1 and type 2 muscle fibers BACKGROUND PATIENTS : with chronic airflow obstruction are often limited by muscle fatigue and weakness . As exercise rehabilitation programmes have produced modest improvements at best a study was design ed to determine whether specific muscle training techniques are helpful . METHODS : Thirty four patients with chronic airflow limitation ( forced expiratory volume in one second ( FEV1 ) 38 % of predicted values ) were stratified for FEV1 to vital capacity ( VC ) ratio less than 40 % and arterial oxygen desaturation during exercise and r and omised to a  control or weightlifting training group . In the experimental group training was prescribed for upper and lower limb muscles as a percentage of the maximum weight that could be lifted once only . It was carried out three times a week for eight weeks . RESULTS : Three subjects dropped out of each group ; results in the remaining 14 patients in each group were analysed . Adherence in the training group was 90 % . In the trained subjects muscle strength and endurance time during cycling at 80 % of maximum power output increased by 73 % from 518 ( SE69 ) to 898 ( 95 ) s , with control subjects showing no change ( 506 ( 86 ) s before training and 479 ( 89 ) s after training ) . No significant changes in maximum cycle ergometer exercise capacity or distance walked in six minutes were found in either group . Responses to a chronic respiratory question naire showed significant improvements in dyspnoea and mastery of daily living activities in the trained group . CONCLUSIONS : Weightlifting training may be successfully used in patients with chronic airflow limitation , with benefits in muscle strength , exercise endurance , and subjective responses to some of the dem and s of daily living This study determined the cellular energetic and structural adaptations of elderly muscle to exercise training .  Forty male and female subjects ( 69.2 + /- 0.6 yr ) were assigned to a control group or 6 mo of endurance ( ET ) or resistance training ( RT ) . We used magnetic resonance spectroscopy and imaging to characterize energetic properties and size of the quadriceps femoris muscle . The phosphocreatine and pH changes during exercise yielded the muscle oxidative properties , glycolytic ATP synthesis , and contractile ATP dem and . Muscle biopsies taken from the same site as the magnetic resonance measurements were used to determine myosin heavy chain isoforms , metabolite concentrations , and mitochondrial volume densities . The ET group showed changes in all energetic pathways : oxidative capacity ( + 31 % ) , contractile ATP dem and ( -21 % ) , and glycolytic ATP supply ( -56 % ) . The RT group had a large increase in oxidative capacity ( 57 % ) . Only the RT group exhibited change in structural properties : a rise in mitochondrial volume density ( 31 % ) and muscle size ( 10 % ) . These results demonstrate large energetic , but smaller structural , adaptations by elderly muscle with exercise training . The rise in oxidative properties with both ET and RT suggests that the aerobic pathway is particularly sensitive to exercise training in elderly muscle . Thus elderly muscle remains adaptable to chronic exercise , with large energetic changes accompanying both ET and RT Objective : Comparison of two flooring types – carpet and vinyl – in the bed areas , and two modes of physiotherapy – conventional therapy and additional leg strengthening exercises – in avoiding falls . Design : R and omized 2 × 2 controlled trial . Setting : Elderly care rehabilitation ward in a community hospital . Subjects : Fifty-four consecutive patients referred for rehabilitation . Outcome measures : The incidence of falls , and the change in strength . Results : There were 10 falls on carpet , and only a single fall on vinyl floor covering ( relative risk 8.3 , 95 % confidence interval 0.95–73 , p = 0.05 ) . There were four falls in those receiving  additional exercise  , and seven falls in those receiving only conventional physiotherapy ( relative risk 0.21 , 95 % confidence interval 0.04–1.2 , p = 0.12 ) . Fifty-nine per cent of patients were able to complete strength measurements on admission and discharge . In these , h and grip strength improved more in those given additional exercise than conventional physiotherapy ( 2.1 kg versus – 0.3 kg , p < 0.05 ) . Conclusion : There is no evidence to support either intervention in preventing falls on a rehabilitation ward , but within this low-powered study , there was a strong trend towards vinyl being superior OBJECTIVE To evaluate the effects of isokinetic exercise versus a program of patient education on pain and function in older persons with knee osteoarthritis . DESIGN A r and omized , comparative clinical trial , with interventions lasting 8 weeks and evaluations of 12 weeks . SETTING An outpatient Veterans Affairs Medical Center clinic and an affiliated university hospital . PATIENTS One hundred thirteen men and women between 50 and 80 years old with diagnosed osteoarthritis of the knee ; 98 completed the entire assigned treatment . INTERVENTION Patients received either a regimen of isokinetic exercise of the quadriceps muscle three times weekly over 8 weeks or a series of 4 discussion s and lectures led by health care professionals . MAIN OUTCOME MEASURES Variables studied for change were isokinetic and isometric quadriceps strength , pain and function determined by categorical and visual analog scales , and overall status using physician and patient global evaluations by the Arthritis Impact Scale , version 2 , Western Ontario McMaster 's Arthritis Index , and Medical Outcome Study Short Form 36 . RESULTS Both treatment groups showed significant strength gains ( p < .05 ) , which occurred over a wider velocity spectrum for the exercise group . Exercised patients also had improved pain scores for more of the variables measured than those receiving education . Both groups had positive functional outcomes and slightly improved measures of overall status . CONCLUSIONS Isokinetic exercise is an effective and well-tolerated treatment for knee osteoarthritis , but a much less costly education program also showed some benefits To evaluate the effects of 26 wk of aerobic and resistance training on the incidence of injury and program adherence in 70- to 79-yr-old men and women , 57 healthy volunteers ( 25 males , 32 females ) were r and omly assigned to a walk/jog ( W/J , N = 21 ) , strength ( STREN , N = 23 ) , or control ( CONT , N = 13 ) group . Walk/jog training was for 30 - 45 min , 3 d.wk-1 with intensity equal to 40 - 70 % heart rate max reserve ( HRmax reserve ) during the first 13 wk , and 75 - 85 % HRmax reserve for weeks 14 - 26 . STREN training consisted of one set ( 10 - 12 repetitions ) each of 10 variable resistance exercises performed to volitional fatigue . Forty-nine of the original participants completed the training program . Walk/jog training increased VO2max from 22.5 to 27.1 ml.kg-1.min-1 ( P less than or equal to 0.05 ) while STREN and CONT showed no change . STREN improved significantly in chest press and leg extension strength ( P less than or equal to 0.05 ) while W/J and CONT showed no change . Adherence to training was 20/23 ( 87 % ) and 17/21 ( 81 % ) in STREN and W/J , respectively . One repetition maximum ( 1-RM ) strength testing result ed in 11 injuries in the 57 subjects ( 19.3 % ) while STREN training result ed in only two injuries in 23 subjects ( 8.7 % ) . Walk training during weeks 1 - 13 result ed in one injury in 21 subjects ( 4.8 % ) . Eight of 14 subjects ( 57 % ) who began jogging intervals at week 14 incurred an injury : two of eight ( 25 % ) of the men and all of the women ( 6 of 6 ) . All W/J training injuries were to the lower extremity . ( ABSTRACT TRUNCATED AT 250 WORDS Regular exercise has been recommended to improve balance , strength , and coordination in older persons . In this study , 44 persons , aged 50 to 75 years ( mean 62.4 yrs ) underwent assessment s of quadriceps strength , reaction time , neuromuscular control , and body sway on two occasions before beginning a 10-week exercise program . The subjects were retested for the same measures at the end of the program . The mean number of classes attended for the 40 subjects who were retested was 16.2 ( range 11 to 19 ) . On completion of the program , the subjects showed improved performance in the tests of quadriceps strength , reaction time , body sway on a firm surface with the eyes closed , and a compliant surface with the eyes open and closed . In contrast , a group of nonexercisers showed no improvements in any of the test measures . These results suggest that exercise may play a role in improving a number of sensorimotor systems that contribute to stability in older persons PURPOSE To determine whether isokinetic training can improve the strength of the hemiparetic knee musculature , functional mobility , and physical activity and to evaluate its effect on spasticity in long-term stroke survivors . DESIGN Nonr and omized self-controlled trial . SUBJECTS A volunteer sample of 15 community-dwelling stroke survivors of at least 6 months . INTERVENTION A 6-week ( 3 days/week , 40 minutes/day ) program consisting of warm-up , stretches , reciprocal knee extension and flexion isokinetic strengthening , and cool-down for the paretic limb . MAIN OUTCOME MEASURES Peak isokinetic hamstring and quadriceps torque , quadriceps spasticity , gait velocity , timed Up and Go , timed stair climb , and the Human Activity Profile ( HAP ) scores were recorded at baseline , after training , and 4 weeks after training cessation ( follow-up ) . RESULTS Paretic muscle strength improved after training ( p < .05 ) while tone remained consistent ( p > .87 ) . Gait velocity increased after training ( p < .05 ) and at follow-up ( p < .05 ) . Changes in stair climbing and timed Up and Go were not significant ( p > .37 ; p > .91 ) , although subjects perceived gains in their physical abilities at follow-up ( p < .01 ) . CONCLUSIONS Gains in strength and gait velocity without concomitant increases in muscle tone are possible after a short-term strengthening program for stroke survivors . The psychological benefit associated with physical activity is significant Abstract . There is evidence that high intensity resistance training promotes bone maintenance in older women , however , the effect of high intensity free weight training has not been investigated in older men or women . Furthermore , little is known about the chronic effect of weight training on serum insulin growth factor-I ( IGF-I ) in this population . We compared the effects of a moderate intensity seated resistance-training program with a high intensity st and ing free weight exercise program on bone mass and serum levels of IGF-I and IGFBP3 in healthy older men and women . Twenty-eight men ( 54.6 ± 3.2 years ) and 26 nonestrogen-replaced women ( 52.8 ± 3.3 years ) served as their own controls for 12 weeks , then were r and omly assigned to a moderate or high intensity training group and trained three times/week for 24 weeks . Prior to and after the control period and at the end of training , bone mass and body composition were assessed by dual energy X-ray absorptiometry ( DXA ) , muscle strength by isokinetic dynamometry , muscular power by Wingate Anaerobic Power Test , and IGF-I by radioimmunoassay ( RIA ) . A repeated measures analysis of covariance ( ANCOVA ) revealed that high intensity training result ed in a gain in spine BMD in men ( 1.9 % ) , P < 0.05 , but not in women , whereas moderate intensity training produced no changes in either gender at this site . Increases were observed at the greater trochanter , P < 0.03 , in men regardless of training intensity , but not in women at any hip site . However , when compared with zero , both men and women in the high intensity group demonstrated significant increases in trochanteric BMD ( 1.3 % and 2.0 % , respectively ) and a decrease in femoral BMD ( −1.8 % ) . Neither circulating serum IGF-I nor IGFBP3 were altered by either training regimen , but both training programs result ed in improvements in total body strength ( 37.62 % ) and lean mass ( males 4.1 % , females 3.1 % ) . We conclude that although resistance training of moderate to high intensity produced similar muscle changes in older adults , a higher magnitude is necessary to stimulate osteogenesis at the spine . However , at the spine , intensity was not sufficient to offset low levels of estrogen in early postmenopausal women . Furthermore , bone changes were not accompanied by changes in circulating serum levels of IGF-I or IGFBP3 Eighty-six elderly people with limited mobility and dependence in at least one activity of daily living were recruited to a home exercise study . The subjects ( mean age 82 years ) were allocated at r and om to either a strength exercise group , a mobility exercise group or a health education group . Subjects were visited for 30 minutes every 3 - 4 weeks by a physiotherapist who gave both verbal and written instruction . Sixty-nine of the original 86 completed the 6-month study , with five drop-outs from the strength group , ten drop-outs from the mobility group , and two drop-outs from the health education group . By the end of the study , there were no significant differences between the groups with regard to changes in outcome variables . The results showed a trend towards improvement in both the exercise groups in both Sit to St and and Timed Get Up and Go tests , but this failed to attain statistical significance . Further work is required to identify the optimal exercise intervention for this subgroup of the elderly population OBJECTIVE To test the effects of a high intensity home-based progressive strength training program on the clinical signs and symptoms of osteoarthritis ( OA ) of the knee . METHODS Forty-six community dwelling patients , aged 55 years or older with knee pain and radiographic evidence of knee OA , were r and omized to a 4 month home based progressive strength training program or a nutrition education program ( attention control ) .  Thirty-eight patients completed the trial with an adherence of 84 % to the intervention and 65 % to the attention control . The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis ( WOMAC ) index pain and physical function subscales . Secondary outcomes included clinical knee examination , muscle strength , physical performance measures , and question naires to measure quality of life variables . RESULTS Patients in the strength training group who completed the trial had a 71 % improvement in knee extension strength in the leg reported as most painful versus a 3 % improvement in the control group ( p < 0.01 ) . In a modified intent to treat analysis , self-reported pain improved by 36 % and physical function by 38 % in the strength training group versus 11 and 21 % , respectively , in the control group ( p = 0.01 for between group comparison ) . In addition , those patients in the strength training group who completed the trial had a 43 % mean reduction in pain ( p = 0.01 vs controls ) , a 44 % mean improvement in self-reported physical function ( p < 0.01 vs controls ) , and improvements in physical performance , quality of life , and self-efficacy when compared to the control group . CONCLUSION High intensity , home based strength training can produce substantial improvements in strength , pain , physical function and quality of life in patients with knee OA BACKGROUND This study was undertaken to determine ( a ) whether a program of regular exercise can improve gait patterns in older women , and ( b ) whether any such improvement in gait is mediated by increased lower limb muscle strength . METHOD A 22-week r and omized controlled trial of exercise was conducted as part of the R and wick Falls and Fractures Study in Sydney , Australia . Subjects were 160 women aged 60 - 83 years ( Mean age 71.1 , SD = 5.2 ) who were r and omly recruited from the community .  Exercise and control subjects were tested prior to and at the end of the trial . At initial testing , exercisers and controls performed similarly in the strength and gait parameters . They were well matched in terms of age and a number of health and life-style characteristics . RESULTS At the end of the trial , the exercise subjects showed improved strength in five lower limb muscle groups , increased walking speed , cadence , stride length , and shorter stride times as indicated by both reduced swing and stance duration . There were no significant improvements in any of the strength or gait parameters in the controls . Within the exercise group , increased cadence was associated with improved ankle dorsiflexion strength , and increased stride length was associated with improved hip extension strength .  Exercise subjects with initial slow walking speed showed greater changes in velocity , stride length , cadence , and stance duration than those with initial fast walking speed . CONCLUSION These findings show that exercise can increase gait velocity and related parameters in older persons , and that part of this increase may be mediated by improved lower limb muscle strength The objectives of this study were to evaluate ( 1 ) the effect of spinal muscle strengthening by loading exercises on the bone mineral density ( BMD ) of the spine , and ( 2 ) the effect of upper extremity loading exercises on the BMD of the midradius and femur in healthy , premenopausal women . The study design was a r and omized , controlled trial of 3 years ' duration . Ninety-six healthy , premenopausal , white women aged 30 - 40 years participated ; 67 completed the study . All subjects were in good health ( normal menses ) and were active , but not athletic ( that is , not involved in a regular sport activity ) . Subjects were r and omized to an exercise or control group . The exercise group performed a supervised , non-strenuous , weight-lifting exercise program . Exercise performance was supervised once a week at the medical facility . In addition , the subjects performed the exercises twice a week on their own . Dietary calcium intake was to be maintained at 1,500 mg/day in both groups . Bone density was measured at the lumbar spine and hip with dual-energy X-ray absorptiometry at 0 , 1 , and 3 years . BMD of the midradius was measured with single photon absorptiometry . Measurements of muscle strength were obtained at baseline and every 3 months for 3 years . Maximal oxygen uptake was measured , and the level of physical activity was recorded . Compliance with the exercise program was excellent during the first year of the study , but decreased thereafter . At the end of 3 years , subject withdrawal was about 34 % from the exercise group and about 22 % from the control group ( total subject withdrawal was about 30 % ) . Muscle strength in the exercise group increased significantly at all involved skeletal sites ( p values all < 0.001 ) . There was a modest positive correlation between the BMD of Ward 's triangle with spinal flexor strength ( r = 0.32 , p = 0.008 ) and with grip strength ( r = 0.38 , p = 0.001 ) . Comparing study groups , we found no significant effect of the loading and nonstrenuous strengthening exercises in the exercise group or free physical activity group ( our control group ) on BMD at the spine , hip , or midradius measurement sites . In active , but not athletic premenopausal women , additional moderate weight-lifting exercises showed no significant effect on BMD 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 This investigation examined the effect of 6 months of high- or low-intensity resistance exercise ( REX ) on bone mineral density ( BMD ) and biochemical markers of bone turnover in adults aged 60 - 83 yr . METHODS Sixty-two men and women ( 68.4 + /- 6 yr ) were stratified for strength and r and omly assigned to a control ( CON , N = 16 ) , low-intensity ( LEX , N = 24 ) , or high-intensity ( HEX , N = 22 ) group . Subjects participated in 6 months of progressive REX training . Subjects trained at either 50 % of their one repetition maximum ( 1-RM ) for 13 repetitions ( LEX ) or 80 % of 1-RM for 8 repetitions ( HEX ) 3 times x wk(-1 ) for 24 wk . One set each of 12 exercises was performed . 1-RM was measured for eight exercises . BMD was measured for total body , femoral neck , and lumbar spine by dual energy x-ray absorptiometry ( DXA ) . Serum levels of bone-specific alkaline phosphatase ( BAP ) , osteocalcin ( OC ) , and pyridinoline cross-links ( PYD ) were measured . RESULTS 1-RM significantly increased for all exercises tested for both the HEX and LEX groups ( P < and = 0.050 ) . The percent increases in total strength ( sum of all eight 1-RMs ) were 17.2 % and 17.8 % for the LEX and HEX groups , respectively . Bone mineral density ( BMD ) of the femoral neck significantly ( P < 0.05 ) increased by 1.96 % for the HEX group . No other significant changes for BMD were found . OC increased by 25.1 % and 39.0 % for the LEX and HEX groups , respectively ( P < 0.05 ) . BAP significantly ( P < 0.05 ) increased 7.1 % for the HEX group . CONCLUSION These data indicate high-intensity REX training was successful for improving BMD of the femoral neck in healthy elderly subjects . Also , these data suggest REX increased bone turnover , which over time may lead to further changes in BMD PURPOSE This study investigated effects of an 8-wk , low-frequency and low-volume , supervised , progressive strength training program emphasizing free weight , multijoint movements on the muscular power , strength , endurance , and flexibility of African American women 44 to 68 yr of age . METHODS Nineteen sedentary African American women were r and omly assigned to a  strength training ( ST ) only group ( N = 12 ; mean age , 51 yr ) or a  nonexercise control ( C ) group ( N = 7 ; mean age , 52 yr ) . Maximal power , strength , absolute endurance , and flexibility were assessed before and after training . Subjects trained 2 d x wk(-1 ) using free weight ( barbells and dumbbells ) and machine ( plate loaded ) exercises for two to three sets of 8 to 10 repetitions on both primary and assistance exercises . RESULTS Upper body power ( medicine ball put distance ) significantly increased statistically ( P = 0.002 ) , but gains possibly lacked practical significance because of measurement variation . Lower body power ( peak watts on bicycle ) experienced a small , nonsignificant increase in the ST group . Significant increases ( P = 0.000 ) in 1RM muscle strength occurred in the ST group ( leg press , + 99.8 % ; bench press , + 34.4 % ) . Absolute endurance significantly increased ( P = 0.000 ) in the ST group ( leg press repetitions to failure at 70 % pretest 1RM , + 221 % ; bench press repetitions to failure at 50 % pretest 1RM , + 112 % ) . Significant flexibility gains occurred in the ST group ( sit- and -reach test , + 8.2 % ; P = 0.017 ) . No significant changes occurred in power , strength , absolute endurance , or flexibility in the C group . CONCLUSION This study demonstrates that 8 wk of low-frequency , supervised , progressive strength training emphasizing free weight , multijoint movements can safely cause significant gains in muscle strength , absolute endurance , and flexibility in older African American women Sullivan DH , Wall PT , Bariola JR , Bopp MM , Frost YM : Progressive resistance muscle strength training of hospitalized frail elderly . Am J Phys Med Rehabil 2001;80:503–509 . Objective To determine whether frail elderly patients recuperating from acute illnesses could safely participate in and gain appreciable improvement in muscle strength from progressive resistance muscle strength training . Design Muscle strength ( one repetition maximum ) , functional abilities ( sit-to-st and maneuver and 20-sec maximal safe gait speed ) , and body composition were measured before and at the conclusion of a 10-wk program of lower limb progressive resistance muscle strength training . The nonr and omized study was conducted in a 30-bed geriatric rehabilitation unit of a university-affiliated Veterans Affairs hospital and a 28-bed transitional care unit of a community nursing home . Participants included 19 recuperating elderly subjects ( 14 male , 5 female ; 13 ambulatory , 6 nonambulatory ) > 64 yr ( mean age , 82.8 ± 7.9 yr ) . Results The one repetition maximum increased an average of 74 % ± 49 % ( median , 70 % ; interquartile range , 38%–95 % , and an average of 20 ± 13 kg ( P = 0.0001 ) . Sit-to-st and maneuver times improved in 15 of 19 cases ( 79 % ) . Maximum safe gait speeds improved in 10 of 19 cases ( 53 % ) . Four of the six nonambulatory subjects progressed to ambulatory status . No subject experienced a complication . Conclusions A carefully monitored program of progressive resistance muscle strength training to regain muscle strength is a safe and possibly effective method for frail elderly recuperating from acute illnesses . A r and omized control study is needed to examine the degree to which progressive resistance muscle strength training offers advantages , if any , over routine posthospital care that includes traditional low-intensity physical therapy Chronic heart failure ( CHF ) is characterized by a skeletal muscle myopathy not optimally addressed by current treatment paradigms or aerobic exercise . Sixteen older women with CHF were compared with 80 age-matched peers without CHF and r and omized to progressive resistance training or control stretching exercises for 10 wk . Women with CHF had significantly lower muscle strength ( P < 0.0001 ) but comparable aerobic capacity to women without CHF . Exercise training was well tolerated and result ed in no changes in resting cardiac indexes in CHF patients . Strength improved by an average of 43.4 + /- 8.8 % in resistance trainers vs. -1.7 + /- 2.8 % in controls ( P = 0.001 ) , muscle endurance by 299 + /- 66 % vs. 1 + /- 3 % ( P = 0.001 ) , and 6-min walk distance by 49 + /- 14 m ( 13 % ) vs. -3 + /- 19 m ( -3 % ) ( P = 0.03 ) . Increases in type I fiber area ( 9.5 + /- 16 % ) and citrate synthase activity ( 35 + /- 21 % ) in skeletal muscle were independently predictive of improved 6-min walk distance ( r2 = 0.78 ; P = 0.0024 ) . High-intensity progressive resistance training improves impaired skeletal muscle characteristics and overall exercise performance in older women with CHF . These gains are largely explained by skeletal muscle and not resting cardiac adaptations Women aged 67 - 84 yr were r and omly assigned to either resistance exercise ( RE , n = 15 ) or control group ( C , n = 14 ) . RE group completed 10 wk of resistance training , whereas C group maintained normal activity . Blood sample s were obtained from the RE group ( at the same time points as for resting C ) at rest , immediately after resistance exercise , and 2 h after exercise before ( week 0 ) and after ( week 10 ) training . Mononuclear cell ( CD3 + , CD3+CD4 + , CD3+CD8 + , CD19 + , and CD3-CD16+CD56 + ) number , lymphocyte proliferative ( LP ) response to mitogen , natural cell-mediated cytotoxicity ( NCMC ) , and serum cortisol levels were determined . Strength increased significantly in RE subjects ( % change 8-repetition maximum = 148 % ) . No significant group , exercise time , or training effects were found for CD3 + , CD3+CD4 + , or CD3+CD8 + cells , but there was a significant exercise time effect for CD3-CD16+CD56 + cells . LP response was not different between groups , across exercise time , or after training . NCMC was increased immediately after exercise for RE subjects at week 0 and for RE and C groups at week 10 . The week 0 and week 10 NCMC values were above baseline for both RE and C groups 2 h after exercise . In conclusion , acute resistance exercise did not result in postexercise suppression of NCMC or LP , and 10 wk of resistance training did not influence resting immune measures in women aged 67 - 84 yr BACKGROUND Muscle size and strength decrease with aging , and the result ant muscle weakness has been implicated in increased risk of falls in older adults . These falls have large economic and functional costs . METHODS The purpose of this r and omized , controlled study was to determine if an 8-week , 3-day per week intense ( 77.8 + /- 3.4 % of 1-repetition maximum [ 1RM ] ) strength training program could improve functional ability related to the risk of falling in subjects aged 61 - -87 years ( mean 72 , SD 6.3 ) . Twelve strength-training-naive subjects performed two sets of 10 repetitions for six lower body exercises while 12 subjects served as nonintervention controls . Subjects were tested pre- , mid- , and postintervention for strength gain and on three tests of functional ability . RESULTS Postintervention strength was significantly better ( p < .017 ) in all training subjects across all exercises , and no injuries were reported as a result of either training or 1RM testing . After controlling for preintervention differences , repeated measure analysis of covariance ( ANCOVA ) found a significant difference between experimental and nonintervention control subjects for postintervention maximal walking speed [ F(1,19 ) = 5.03 , p < .05 ] . There were no significant between-group differences for 1-leg blind balance time or 5-repetition sit-to-st and performance [ F(1,19 ) = .082 ; F(1,19 ) = .068 , respectively , p > .05 ] . CONCLUSIONS These findings suggest that strength training alone does not appear to enhance st and ing balance or sit-to-st and performance in active , community-dwelling older adults but that it may improve maximal walking speed . The relationship between strength gain and risk of falls remains unclear . The data do reinforce the notion that intense strength training is a safe and effective way to increase muscle strength in this population BACKGROUND Past studies suggest multidisciplinary interventions that include physical therapy ( PT ) can improve function of nursing home residents . This trial specifically evaluates effects of PT for frail long-stay nursing home residents . DESIGN R and omized , controlled trial . SETTING One academic nursing home and eight community nursing homes . PATIENTS A total of 194 elderly nursing home residents dependent in at least two activities of daily living residing in the nursing home for at least 3 months . INTERVENTIONS Patients were r and omized to individually tailored one-on-one PT sessions or friendly visits ( FVs ) three times a week for 4 months . Physical therapy included range-of-motion , strength , balance , transfer , and mobility exercises . MAIN OUTCOME MEASURES Performance-based physical function assessed by the Physical Disability Index ; self-perceived health status assessed with the Sickness Impact Profile ; observer-reported activities of daily living ; and falls . RESULTS Eighty-nine percent and 92 % of PT and FV sessions , respectively , were attended ; 5 % and 9 % of subjects dropped out in the PT group and FV group , respectively . Compared with the FV group , the PT group experienced no significant improvements in overall Physical Disability Index , Sickness Impact Profile , or activities of daily living scores . A 15.5 % improvement in the mobility subscale of the Physical Disability Index was seen ( 95 % confidence interval [ CI ] , 6.4 % to 24.7 % ) ; no benefits in range-of-motion , strength , or balance subscales were found . Compared with the FV group , the PT group used assistive devices for bed mobility tasks less often ( P = .06 ) and were less likely to use assistive devices and wheelchairs for locomotion ( P < .005 ) . There were 79 falls in the PT group vs 60 falls in the FV group ( P = .11 ) . Charge for the 4-month PT program was $ 1220 per subject ( 95 % CI , $ 412 to $ 1832 ) . CONCLUSION This st and ardized physical therapy program provided modest mobility benefits for very frail long-stay nursing home residents with physical disability due to multiple comorbid conditions OBJECTIVE To determine the safety and efficacy of 3 months of resistive training of multiple lower extremity muscle groups compared with balance training in persons over 75 years . DESIGN R and omized 3-month clinical trial . Subjects ( n = 110 , mean age 80 ) were r and omized to 4 groups in a 2 x 2 design ( control , resistive , balance , combined resistive/balance ) . INTERVENTIONS Resistive training involved knee extension and flexion , hip abduction and extension , and plantar and dorsiflexion using simple resistive machines and s and bags . Balance training consisted of exercises to improve postural control . The control group attended 5 health-related discussion sessions . MEASUREMENTS Summed isokinetic moments ( N m ) of 8 leg movements : hip , knee and ankle flexion/extension , and hip abduction/adduction . Secondary outcomes were gait velocity and chair rise time . MAIN RESULTS Summed peak moment increased in both resistive exercise-trained groups ( 13 % increase in the resistive group and 21 % in the combined training group , P < 0.001 ) . The effect of resistance training was significant ( MANOVA F = 21.1 , P < 0.001 ) , but balance training did not improve strength , and there was no interaction ( positive or negative ) between balance and resistive training . Maximal gait velocity and chair rise time did not improve . Eleven subjects ( 20 % ) had musculoskeletal complaints related to resistive training , but all were able to complete the program with modifications . CONCLUSION Resistive training using simple equipment is an effective and acceptable method to increase overall leg strength in older persons .  Resistive or balance training did not improve maximal gait velocity or chair rise time in this sample of relatively healthy older persons OBJECTIVE To determine how multiple risk factors for osteoporotic fractures could be modified by high-intensity strength training exercises in postmenopausal women . DESIGN R and omized controlled trial of 1-year duration . SETTING Exercise laboratory at Tufts University , Boston , Mass. POPULATION Forty postmenopausal white women , 50 to 70 years of age , participated in the study ; 39 women completed the study . The subjects were sedentary and estrogen-deplete . INTERVENTIONS High-intensity strength training exercises 2 days per week using five different exercises ( n = 20 ) vs untreated controls ( n = 19 ) . MAIN OUTCOME MEASURES Dual energy x-ray absorptiometry for bone status , one repetition maximum for muscle strength , 24-hour urinary creatinine for muscle mass , and backward t and em walk for dynamic balance . RESULTS Femoral neck bone mineral density and lumbar spine bone mineral density increased by 0.005 + /- 0.039 g/cm2 ( 0.9 % + /- 4.5 % ) ( mean + /- SD ) and 0.009 + /- 0.033 g/cm2 ( 1.0 % + /- 3.6 % ) , respectively , in the strength-trained women and decreased by -0.022 + /- 0.035 g/cm2 ( -2.5 % + /- 3.8 % ) and -0.019 + /- 0.035 g/cm2 ( -1.8 % + /- 3.5 % ) , respectively , in the controls ( P = .02 and .04 ) . Total body bone mineral content was preserved in the strength-trained women ( + 2.0 + /- 68 g ; 0.0 % + /- 3.0 % ) and tended to decrease in the controls ( -33 + 77 g ; -1.2 % + /- 3.4 % , P = .12 ) . Muscle mass , muscle strength , and dynamic balance increased in the strength-trained women and decreased in the controls ( P = .03 to < .001 ) . CONCLUSIONS High-intensity strength training exercises are an effective and feasible means to preserve bone density while improving muscle mass , strength , and balance in postmenopausal women Abstract Objective : To assess the effectiveness of a home exercise programme of strength and balance retraining exercises in reducing  falls and injuries in elderly women . Design : R and omised controlled trial of an individually tailored programme of physical therapy in the home ( exercise group , n=116 ) compared with the usual care and an equal number of social visits ( control group , n=117 ) . Setting : 17 general practice s in Dunedin , New Zeal and . Subjects : Women aged 80 years and older living in the community and registered with a general practice in Dunedin . Main outcome measures : Number of falls and injuries related to falls and time between falls during one year of follow up ; changes in muscle strength and balance measures after six months . Results : After one year there were 152 falls in the control group and 88 falls in the exercise group . The mean ( SD ) rate of falls was lower in the exercise than the control group ( 0.87 ( 1.29 ) v 1.34 ( 1.93 ) falls per year respectively ; difference 0.47 ; 95 % confidence interval 0.04 to 0.90 ) . The relative hazard for the first four falls in the exercise group compared with the control group was 0.68 ( 0.52 to 0.90 ) . The relative hazard for a first fall with injury in the exercise group compared with the control group was 0.61 ( 0.39 to 0.97 ) . After six months , balance had improved in the exercise group ( difference between groups in change in balance score 0.43 ( 0.21 to 0.65 ) . Conclusions : An individual programme of strength and balance retraining exercises improved physical function and was effective in reducing  falls and injuries in women 80 years and older . Key messages Modifiable risk factors for falls in elderly people have been well defined ; they include loss of muscle strength and impaired balance A programme to improve strength and balance in women aged 80 years and older can be set up safely with four home visits from a physiotherapist This programme reduced falls and moderate injuries appreciably over the subsequent year in Dunedin , New Zeal and The benefit was most noticeable in elderly people who fell Exercise is known to preserve many physiological responses in the healthy elderly , yet those with physical impairments are often discouraged from exercising . The authors studied the effects of a closely supervised exercise program design ed specifically for elders with health problems and functional limitations . Tests , selected for their relevance to clinical patient management , included the Self Evaluation of Life Function question naire , treadmill performance , and tests of autonomic nervous system and neuromotor functions .  Ambulatory volunteers , aged 64 to 83 years , with noncardiac health problems , were r and omly assigned to a control group ( CG ; n = 17 ) or a 16-week exercise group ( EG ; 3 hr/wk , n = 18 ) . Nine of the control and 13 of the exercise subjects completed the study . All EG dropouts were due to illness . EG attendance averaged 87 % , and subjects trained at a heart rate ( HR ) of 103 + /- 5 beats/min ( SD ) ( 98 % of prescription HR ) . Though EG test responses showed a tendency to improve , none reached statistical significance . This result was affected by the small number completing the study and the variability inherent in such a sample . Though these impaired elderly subjects enthusiastically and safely participated with high attendance and at an exercise intensity adequate to expect benefit , measurable training effects were not demonstrated OBJECTIVE This 8 week r and omized , double blind clinical trial compared the effect of a combined home based progressive exercise program and treatment with the nonsteroidal medication oxaprozin to treatment with oxaprozin alone on pain and physical functioning in older community dwelling patients with unilateral knee osteoarthritis ( OA ) . METHODS Efficacy variables measured before and after 8 weeks included ( 1 ) pain using the Western Ontario McMaster ( WOMAC ) pain , physical disability , and stiffness subscales and a 10 point visual analog scale ( VAS ) before and after self-paced walking ( SPW ) and stepping ( SPS ) functional tasks ; ( 2 ) physical function using the time to complete a self-paced 40 m walk ( SPW ) and 20 cycles of 2 steps ( SPS ) : ( 3 ) physical activity level using the Physical Activity Scale for Elderly ( PASE ) ; ( 4 ) clinical measures of knee functioning ( range of motion ) .  One hundred seventy-nine men and women ( mean age 74 + /- 6 yrs ) with radiographic evidence of mild/moderate medial compartment OA were r and omized to either a progressive home based knee exercise program ( n = 88 ) or a control program ( n = 89 ) . All patients were given oxaprozin 1,200 mg per os daily . RESULTS We observed significant reduction from baseline in activity related pain ( VAS ) ; and improvement in SPW and SPS test time , passive range of motion , and PASE after 8 weeks in both groups . These changes were significantly greater ( p < 0.05 ) in the exercise versus sham group . CONCLUSION Addition of a progressive exercise program to nonsteroidal antiinflammatory therapy in patients with knee OA can improve measures of activity and activity related pain more than medication alone OBJECTIVE To determine the short- and long-term effects of resistance training on muscle strength , psychological well-being , control-beliefs , cognitive speed and memory in normally active elderly people . METHODS 46 elderly people ( mean age 73.2 years ; 18 women and 28 men ) , were r and omly assigned to training and control groups ( n=23 each ) . Pre- and post-tests were administered 1 week before and 1 week after the 8-week training intervention . The training sessions , performed once a week , consisted of a 10 min warm-up phase and eight resistance exercises on machines . RESULTS There was a significant increase in maximum dynamic strength in the training group . This training effect was associated with a significant decrease in self-attentiveness , which is known to enhance psychological well-being . No significant changes could be observed in control-beliefs . Modest effects on cognitive functioning occurred with the training procedure : although there were no changes in cognitive speed , significant pre/post-changes could be shown in free recall and recognition in the experimental group . A post-test comparison between the experimental group and control group showed a weak effect for recognition but no significant differences in free recall . Significant long-term effects were found in the training group for muscular strength and memory performance ( free recall ) 1 year later . CONCLUSION An 8-week programme of resistance training lessens anxiety and self-attentiveness and improves muscle strength The effect of 12 weeks of resistance and balance training on strength and gait measures in older persons was tested in a r and omized control trial . Thirty-one residents of two life-care communities volunteered ( mean age , 82.1 years ) . The exercise group ( E ) trained three times per week , performing resistance training to fatigue for knee extension , hip abduction , ankle dorsiflexion , hip extension , and knee flexion , and postural control exercises . The control group ( C ) met weekly for flexibility exercises performed sitting in a chair . The exercise group achieved significant improvements in muscle strength and gait velocity ( p < .05 ) . Knee extension one maximum repetition increased 32 % ( 24 % to 40 % , 95 % confidence interval [ CI ] ) , from 55 + /- to 72 + /- 4N.m . Isokinetic knee extension torque increased 25 % ( 3 % to 47 % ) from 40 + /- 5 to 50 + /- 5N.m at 120 degrees s-1 . Usual gait velocity increased 8 % ( 3 % to 13 % ) in E from 1.04 + /- .07 to 1.12 + /- .06 m/s . There was a trend of improvement in maximal gait speed 4 % ( 0 to 8 % ) from 1.43 + /- 0.1 to 1.49 + /- 0.1 m/s , p = 0.054 . Gait and strength measures in C were unchanged . A short-term exercise program that trained strength and balance achieved a clinical ly significant improvement in gait velocity Resistance training ( RT ) has gained popularity as an effective form of exercise for older adults . However , the effects of RT on left ventricular ( LV ) morphology and systolic function in older persons is not well known . The purpose of this study was to assess the effects of 16 weeks of RT on LV morphology and systolic function in healthy older men . Subjects were r and omly assigned into a  RT group ( n = 10 ; mean+/- SD age , 68 + /- 3 years ) or a nonexercise control group ( n = 10 ; age 68 + /- 4 years ) .  RT was performed 3 times per week for 16 weeks at a mean intensity between 60 % and 80 % of 1 repetition maximum .  Leg and bench press 1 repetition maximum and 2-dimensional echocardiography  were performed at baseline and after 4 , 8 , 12 , and 16 weeks of training in the RT group . Sixteen weeks of RT was associated with an increase in leg press maximal strength ( baseline , 285 + /- 48 kg ; after 16 weeks , 367 + /- 47 kg ; p < 0.05 ) and bench press maximal strength ( baseline , 59 + /- 11 kg ; after 16 weeks , 69 + /- 11 kg ; p < 0.05 ) . No change in leg press maximal strength ( baseline , 291 + /- 59 kg ; after 16 weeks , 290 + /- 53 kg ; p > 0.05 ) or bench press maximal strength ( baseline , 60 + /- 9 kg ; after 16 weeks , 61 + /- 13 kg ; p > .05 ) was found in control subjects during the same time . RT was not associated with changes in LV cavity size , wall thickness , mass , or systolic function after 4 , 8 , 12 , and 16 weeks of exercise . Thus , 16 weeks of RT was sufficient to increase leg press and bench press maximal strength but did not alter the size or systolic function of the senescent left ventricle Regular exercise is widely advocated for the young and middle-aged , but less is heard about its relevance to elderly people . This study reports the findings of a controlled trial of seated exercise in residents of local authority homes for the elderly . Forty-nine residents aged 64 - 91 years volunteered for the 7-month project , and participated in either twice-weekly exercise or reminiscence sessions . Primary outcome measures were postural sway , flexibility of the spine and knees , h and -grip strength and functional capacity . The average ( range of ) attendance at the exercise sessions was 91 % ( 64 - 100 % ) , and at the reminiscence sessions was 86 % ( 46 - 100 % ) . By the end of the project , the change observed in the exercise group was significantly different from that of the reminiscence group in terms of grip strength ( p < 0.02 ) , spinal flexion ( p < 0.001 ) , chair-to-st and time ( p < 0.001 ) , activities of daily living ( p < 0.05 ) , and self-rating of depression ( p < 0.01 ) . Even very elderly residents of old peoples homes can benefit from participation in regular seated exercise and improve their functional capacity The purpose of this study was to evaluate whether strength training is a useful addition to aerobic training in patients with chronic obstructive pulmonary disease ( COPD ) . Forty-five patients with moderate to severe COPD were r and omized to 12 wk of aerobic training alone ( AERO ) or combined with strength training ( AERO + ST ) . The AERO regimen consisted of three weekly 30-min exercise sessions on a calibrated ergocycle , and the ST regimen included three series of eight to 10 repetitions of four weight lifting exercises .  Measurements of peripheral muscle strength , thigh muscle cross-sectional area ( MCSA ) by computed tomographic scanning , maximal exercise capacity , 6-min walking distance ( 6MWD ) , and quality of life with the chronic respiratory question naire were obtained at baseline and after training . Thirty-six patients completed the program and constituted the study group . The strength of the quadriceps femoris increased significantly in both groups ( p < 0.05 ) , but the improvement was greater in the AERO + ST group ( 20 + /- 12 % versus 8 + /- 10 % [ mean + /- SD ] in the AERO group , p < 0.005 ) . The thigh MCSA and strength of the pectoralis major muscle increased in the AERO + ST group by 8 + /- 13 % and 15 + /- 9 % , respectively ( p < 0.001 ) , but not in the AERO group ( 3 + /- 6 % and 2 + /- 10 % , respectively , p > 0.05 ) . These changes were significantly different in the two study groups ( p < 0.01 ) . The increase in strength of the latissimus dorsi muscle after training was modest and of similar magnitude for both groups . The changes in peak exercise work rate , 6MWD , and quality of life were comparable in the two groups . In conclusion , the addition of strength training to aerobic training in patients with COPD is associated with significantly greater increases in muscle strength and mass , but does not provide additional improvement in exercise capacity or quality of life The short- and long-term effects of heavy-resistance training ( 85 % of one-repetition maximum ( RM ) ) on elbow flexion and knee extension dynamic and isokinetic strength and on morphology in the biceps brachii and vastus lateralis muscles were evaluated during 1 year in 35 Sc and inavian men and women , aged 70 - 77 years , 12 of whom formed a control group . After the first 11 weeks of training ( n = 23 ; 3 times/week )  elbow flexion and knee extension dynamic strength ( 1 RM ) had increased [ mean + /- SD ] 49 % + /- 16 and 163 % + /- 75 , respectively , with no significant difference between men and women . For the following 27 weeks , strength was maintained with one training session per week ( n = 12 ) but dropped without training ( n = 11 ) . After the final 11 weeks of training ( n = 11 ; 3 times/week ) , strength had further increased 32 % + /- 16 in both the arm and the leg . Isokinetic strength measurements ( Cybex II ; 30 degrees/s ) revealed similar but smaller gains than for dynamic strength . Muscle biopsies ( n = 20 ) taken at the start and after the first 11 weeks of training showed a significant increase in the area of both type 1 and type 2 fibers in the biceps brachii muscle and a positive significant correlation between the percentage increase in the proportional area of type 2 fibers in the vastus lateralis muscle and the percentage increase in knee extension dynamic muscle strength . In conclusion , older Sc and inavian men and women have a high capacity both to improve and to maintain muscle strength , some of which is mediated through an adaptation in the muscle fiber type population OBJECTIVE The purpose s of this pilot study were to determine if a combined dietary and exercise intervention would result in significant weight loss in older obese adults with knee osteoarthritis , and to compare the effects of exercise plus dietary therapy with exercise alone on gait , strength , knee pain , biomarkers of cartilage degradation , and physical function . DESIGN Single-blind , two-arm , r and omized clinical trial conducted for 24 weeks . SETTING A university health and exercise science center . PARTICIPANTS Twenty-four community-dwelling obese older adults aged > or = 60 years , body mass index > or = 28 , knee pain , radiographic evidence of knee osteoarthritis , and self-reported physical disability . INTERVENTION R and omization into two groups : exercise and diet ( E&D ) and exercise alone ( E ) . Exercise consisted of a combined weight training and walking program for 1 hour three times per week . The dietary intervention included weekly sessions with a nutritionist utilizing cognitive-behavior modification to change dietary habits to reach a group goal of an average weight loss of 15 lb ( 6.8 kg ) over 6 months . MEASUREMENTS All measurements were conducted at baseline and 3 and 6 months , except for synovial fluid analysis , which was obtained only at baseline and 6 months . In addition , weight was measured weekly in the E&D group . Physical disability and knee pain were measured by self-report and physical performance was measured using the 6-minute walk and stair climb tasks . Biomechanical testing included kinetic and kinematic analysis of gait and isokinetic strength testing . Synovial fluid was analyzed for levels of total proteoglycan , keratan sulfate , and interleukin-1 beta . RESULTS Twenty-one of the 24 participants completed the study , with one dropout in the E&D group and two in the E group . The E&D group lost a mean of 18.8 lb ( 8.5 kg ) at 6 months compared with 4.0 lb ( 1.8 kg ) in the E group ( P = .01 ) . Significant improvements were noted in both groups in self-reported disability and knee pain intensity and frequency as well as in physical performance measures . However , no statistical differences were found between the two groups at 6 months in knee pain scores or self-reported performance measures of physical function . There was no difference in knee strength between the groups , with both groups showing modest improvements from baseline to 6 months . At 6 months , the E&D group had a significantly greater loading rate ( P = .03 ) and maximum braking force ( P = .01 ) during gait . There were no significant between-group differences in the other biomechanical measures . Synovial fluid sample s were obtainable at both baseline and 6 months in eight participants ( four per group ) . The level of keratan sulfate decreased similarly in both groups from an average baseline of 96.8 + /- 37.1 to 71.5 + /- 23 ng/microg total proteoglycan . The level of IL-1 decreased from 25.3 + /- 9.8 at baseline to 8.3 + /- 6.1 pg/mL. The decrease in IL-1 correlated with the change in pain frequency ( r = -0.77 , P = .043 ) . CONCLUSIONS Weight loss can be achieved and sustained over a 6-month period in a cohort of older obese persons with osteoarthritis of the knee through a dietary and exercise intervention . Both exercise and combined weight loss and exercise regimens lead to improvements in pain , disability , and performance . Moreover , the trends in the biomechanical data suggest that exercise combined with diet may have an additional benefit in improved gait compared with exercise alone . A larger study is indicated to determine if weight loss provides additional benefits to exercise alone in this patient population Both aerobic training ( AT ) and resistance training ( RT ) may increase aerobic power ( VO2peak ) in the older population ; however , the role of changes in the capillary supply in this response has not been evaluated . Twenty healthy men ( age 65 - 74 yr ) engaged in either 9 wk of lower body RT followed by 9 wk of AT on a cycle ergometer ( RT-->AT group ) or 18 wk of AT on a cycle ergometer ( AT-->AT group ) . RT was performed three times per week and consisted of three sets of four exercises at 6 - 12 repetitions maximum . AT was performed three times per week for 30 min at 60 - 70 % heart rate reserve . VO2peak was increased after both RT and AT ( P < 0.05 ) . Biopsies ( vastus lateralis ) revealed that the number of capillaries per fiber perimeter length was increased after both AT and RT ( P < 0.05 ) , paralleling the changes in VO2peak , whereas capillary density was increased only after AT ( P < 0.01 ) . These results , and the finding of a significant correlation between the change in capillary supply and VO2peak ( r = 0.52 ) , suggest the possibility that similar mechanisms may be involved in the increase of VO2peak after high-intensity RT and AT in the older population OBJECTIVE To determine the effects of structured exercise programs on  self-reported disability in older adults with knee osteoarthritis . SETTING AND DESIGN A r and omized , single-blind clinical trial lasting 18 months conducted at 2 academic medical centers . PARTICIPANTS A total of 439 community-dwelling adults , aged 60 years or older , with radiographically evident knee osteoarthritis , pain , and self-reported physical disability .  INTERVENTIONS An aerobic exercise program , a resistance exercise program , and a health education program . MAIN OUTCOME MEASURES The primary outcome was self-reported disability score ( range , 1 - 5 ) . The secondary outcomes were knee pain score ( range , 1 - 6 ) , performance measures of physical function , x-ray score , aerobic capacity , and knee muscle strength . RESULTS A total of 365 ( 83 % ) participants completed the trial . Overall compliance with the exercise prescription was 68 % in the aerobic training group and 70 % in the resistance training group . Postr and omization , participants in the aerobic exercise group had a 10 % lower adjusted mean ( + /- SE ) score on the physical disability question naire ( 1.71 + /- 0.03 vs 1.90 + /- 0.04 units ; P<.001 ) , a 12 % lower score on the knee pain question naire ( 2.1 + /- 0.05 vs 2.4 + /- 0.05 units ; P=.001 ) , and performed better ( mean [ + /- SE ] ) on the 6-minute walk test ( 1507 + /- 16 vs 1349 + /- 16 ft ; P<.001 ) , mean ( + /-SE ) time to climb and descend stairs ( 12.7 + /- 0.4 vs 13.9 + /- 0.4 seconds ; P=.05 ) , time to lift and carry 10 pounds ( 9.1 + /- 0.2 vs 10.0 + /- 0.1 seconds ; P<.001 ) , and mean ( + /-SE ) time to get in and out of a car ( 8.7 + /- 0.3 vs 10.6 + /- 0.3 seconds ; P<.001 ) than the health education group . The resistance exercise group had an 8 % lower score on the physical disability question naire ( 1.74 + /- 0.04 vs 1.90 + /- 0.03 units ; P=.003 ) , 8 % lower pain score ( 2.2 + /- 0.06 vs 2.4 + /- 0.05 units ; P=.02 ) , greater distance on the 6-minute walk ( 1406 + /- 17 vs 1349 + /- 16 ft ; P=.02 ) , faster times on the lifting and carrying task ( 9.3 + /- 0.1 vs 10.0 + /- 0.16 seconds ; P=.001 ) , and the car task ( 9.0 + /- 0.3 vs 10.6 + /- 0.3 seconds ; P=.003 ) than the health education group . There were no differences in x-ray scores between either exercise group and the health education group . CONCLUSIONS Older disabled persons with osteoarthritis of the knee had modest improvements in measures of disability , physical performance , and pain from participating in either an aerobic or a resistance exercise program . These data suggest that exercise should be prescribed as part of the treatment for knee osteoarthritis OBJECTIVE To determine whether a 12-month program of regular exercise can improve balance , reaction time , neuromuscular control , and muscle strength and reduce the rate of falling in older women . DESIGN A r and omized , controlled trial of 12 months duration . SETTING Conducted as part of the R and wick Falls and Fractures Study in Sydney , Australia . PARTICIPANTS One hundred ninety-seven women aged 60 to 85 years ( mean age 71.6 , SD = 5.4 ) who were r and omly recruited from the community . OUTCOME MEASURES Accidental falls , postural sway , reaction time , neuromuscular control , and lower limb muscle strength . MAIN RESULTS Exercise and control subjects were tested before , midway through , and at the end of the trial . At initial testing , exercisers and controls performed similarly in all tests and were well matched in relevant health and lifestyle factors . The mean number of classes attended for the 75 exercise subjects who completed the program was 60.0 ( range 26 - 82 ) . At the end of the trial , the exercise subjects showed improved performance in all five strength measures , in reaction time , neuromuscular control , body sway on a firm surface with the eyes open , and body sway on a compliant surface with the eyes open and closed . In contrast , there were no significant improvements in any of the test measures in the controls . In one test measure , hip flexion strength , the exercisers showed continued improvement throughout the study year . There was no significant difference in the proportion of fallers between the exercise and control subjects . Interesting trends were evident , however , between falls frequency and adherence to the exercise program . CONCLUSIONS These findings show that exercise can produce long-term benefits with regard to improving sensorimotor function in older persons . The findings also suggest that high compliance to an exercise program may reduce falls frequency , although further studies are required to conclusively demonstrate that exercise offers an effective means of preventing falls BACKGROUND Depression in elderly people may be contributed to by the multiple losses of aging . Exercise has the potential to positively impact many of these losses simultaneously . We tested the hypothesis that progressive resistance training ( PRT ) would reduce depression while improving physiologic capacity , quality of life , morale , function and self-efficacy without adverse events in an older , significantly depressed population . METHODS We conducted a 10-week r and omized controlled trial of volunteers aged 60 and above with major or minor depression or dysthymia . Subjects were r and omized for 10 weeks to either a supervised PRT program three times a week or an attention-control group . RESULTS A total of 32 subjects aged 60 - 84 , mean age 71.3 + /- 1.2 yr , were r and omized and completed the study . No significant adverse events occurred . Median compliance was 95 % . PRT significantly reduced all depression measures ( Beck Depression Inventory in exercisers 21.3 + /- 1.8 to 9.8 + /- 2.4 versus controls 18.4 + /- 1.7 to 13.8 + /- 2 , p = .002 ; Hamilton Rating Scale of Depression in exercisers 12.3 + /- 0.9 to 5.3 + /- 1.3 versus controls 11.4 + /- 1.0 to 8.9 + /- 1.3 , p = .008 ) . Quality of life subscales of bodily pain ( p = .001 ) , vitality ( p = .002 ) , social functioning ( p = .008 ) , and role emotional ( p = .02 ) were all significantly improved by exercise compared to controls . Strength increased a mean of 33 % + /- 4 % in exercisers and decreased 2 % + /- 2 % in controls ( p < .0001 ) . In a multiple stepwise regression model , intensity of training was a significant independent predictor of decrease in depression scores ( r2 = .617 , p = .0002 ) . CONCLUSIONS PRT is an effective antidepressant in depressed elders , while also improving strength , morale , and quality of life BACKGROUND Beneficial training outcomes have been reported in sedentary patients with chronic heart failure ( CHF ) after exercise training .  However , data on training effects in previously trained patients , as well as comparisons of different exercise modes , are lacking . The aim of this study is to compare exercise training on a cycle ergometer ( major muscle mass ) and aerobic knee-extensor training ( minor muscle mass ) in previously trained patients with CHF . METHODS AND RESULTS Twenty-four men and women ( age , 63 + /- 10 years [ mean + /- SD ] ) with stable , moderate CHF ( left ventricular ejection fraction , 30 % + /- 11 % ) who had completed their first exercise training period more than 1 year ago were allocated to either the exercise or control group . After stratification for sex , age , ejection fraction , and cardiac output response , the training group was further r and omized to either cycle ergometer or knee-extensor training for 8 weeks . The control and training patients did not differ at baseline , and the measured variables did not change in the control group during the 8 weeks . Citrate synthase activity in skeletal muscle increased after cycle training ( 23 % ; P < .02 ) and knee-extensor training ( 45 % ; P < .008 ) , and blood lactate concentration at submaximal intensities decreased ( P < .04 ) in both groups . However , only after knee-extensor training did the peak oxygen uptake increase ( 19 % ; P < .01 ) and sympathetic nervous system activity , measured as plasma norepinephrine concentration at rest ( P < .05 ) and during exercise ( P < .008 ) , decrease . Minnesota Living with Heart Failure question naire scores also showed improvement in the health-related quality of life ( P < .05 ) only after knee-extensor training . CONCLUSION Physical training is beneficial in previously trained patients with CHF . Aerobic training involving a minor muscle mass shows greater efficiency than training involving a major muscle mass We evaluated the effect of a strength-training program on the ability of persons with essential tremor  to exert steady forces with the index finger . Thirteen subjects with a diagnosis of essential tremor were assigned to three different groups : one group trained with heavy loads , one with light loads , and one did not perform any training . Subjects attempted to generate steady contractions during both postural and constant-force tasks . Steadiness was quantified by the root mean square amplitude of acceleration during postural tasks and the st and ard deviation and coefficient of variation of force during the constant-force tasks . Subjects who performed the training program with heavy loads experienced an increase in steadiness around the target force during the constant-force tasks . Subjects in the other two groups did not exhibit any changes . These findings suggest that strength training can decrease the magnitude of tremor . However , we did not observe any associated improvements in functional abilities We investigated if long-term resistance training would increase insulin-like growth factor-1 ( IGF-1 ) bioavailabilty at rest in older women ( 68+/-1 years ) with low bone mineral density .  IGF-1 levels were significantly lower ( P<0.05 ) , and insulin-like growth factor binding proteins -1 and -3 ( IGFBP-1 and IGFBP-3 ) significantly higher than an age-matched healthy normal group . Resistance training result ed in significant ( P<0.05 ) increases in repetition maximums across all exercises ( range 41 - 78 % ) . Resting IGF-1 levels were significantly ( P<0.05 ) elevated ( 70 % ) by the resistance training whereas no significant changes occurred in IGFBP-1 and IGFBP-3 levels . IGFBP-1/IGF-1 and IGFBP-3/IGF-1 ratios were significantly decreased ( approximately - 50 % ) as a result of resistance training ( P<0.05 ) . Thus , IGF-1 bioavailability was increased as a result of resistance training induced increases in IGF-1 levels in older women with low bone mineral density . These alterations in the IGF-1 system may be contributing to the significant strength gain observed with the resistance training in this population Cardiac rehabilitation programs have not consistently been shown to improve the psychological well being of their patients . In our study of 38 cardiac patients ( 29 men and 9 women ) , a variety of quality -of-life parameters were assessed before and after they completed either 12 weeks of high-intensity strength training or flexibility training added to their outpatient cardiac rehabilitation  aerobic exercise program . The strength-trained patients increased their self-efficacy scores for lifting ( 29 % vs 4 % , p < 0.05 ) , push-ups ( 65 % vs. 17 % , p < 0.01 ) , climbing ( 36 % vs 0 % , p < 0.001 ) , and jogging ( 100 % vs -9 % , p < 0.001 ) , when compared with the flexibility-trained patients . The strength group also had greater improvements in Profile of Mood States dimensions : total mood disturbance ( 123 % vs 18 % , p < 0.05 ) , depression/dejection ( 73 % vs 15 % , p < 0.05 ) , and fatigue/inertia ( 42 % vs 3 % p < 0.05 ) , than did the flexibility group . The Medical Outcome Survey Short Form 36 role emotional health domain scores were significantly improved in the strength group when compared with the flexibility group ( 64 % vs 0 % , p < 0.05 ) , and the role limitation scores improved in both groups . Increases in strength were associated with enhanced self efficacy and improved mood and well-being scores ( n = 34 , r = 0.30 to 0.53 , p < 0.05 ) . High-intensity strength training added to a cardiac rehabilitation program of selected patients leads to improvements in quality -of-life parameters . These data , in conjunction with improvements in strength , strongly support the value of adding high-intensity strength training to cardiac rehabilitation programs Physical exercise is often recommended as a therapeutic tool to combat pre- and postmenopausal loss of bone density . However , the relationship between training dosage ( intensity , duration , frequency ) and the effect on bone density still is undergoing discussion . Furthermore , the exercise quantification programs are often described so inadequately that they are neither quantitatively nor qualitatively reproducible . The aim of this investigation was to determine whether a clearly defined training of muscle strength , under defined safety aspects , performed only twice weekly , can counteract bone density loss in women with postmenopausal osteopenia . Data from 16 women in the training group ( age , 63.6 + /- 6.2 yr ) and 15 women in the control group ( age , 67.4 + /-9.7 yr ) , of comparable height and weight , were evaluated .  Strength training was performed for 6 mo as continually adapted strength training , providing an intensity of about 70 % of each test person 's one repetition maximum . Bone mineral density of lumbar vertebrae 2 to 4 and the femoral neck was measured by dual-energy x-ray absorptiometry . Maximum performance in watts and parameters of hemodynamics were controlled with a bicycle ergometer test to maximal effort . In addition , metabolic data were assessed . In the lumbar spine and femoral neck , the training group showed no significant changes , whereas the control group demonstrated a significant loss of bone mineral density , especially in the femoral neck ( P<0.05 ) . The strength increase was highly significant in all exercised muscle groups , rising to about 70 % above the pretraining status ( P<0.001 ) . Heart rate and blood pressure data indicated a slight economization , metabolism was not significantly influenced . Based on these findings , we conclude that continually adapted strength training is an effective , safe , reproducible , and adaptable method of therapeutic strength training , following only two exercise sessions per week BACKGROUND Cardiovascular benefits of resistance training in cardiac patients have been suggested but not studied in a r and omized , controlled trial of circuit weight training ( CWT ) without an aerobic exercise component . The purpose of the current study was to examine the effects of 10 weeks of CWT on muscular strength , peak oxygen consumption ( peak VO2 ) , and myocardial oxygen dem and ( mVO2 ) in men after coronary artery bypass surgery . METHODS Twenty-six , post-coronary bypass male subjects ( mean 19 months after bypass ) , aged 60 + /- 8.5 years , were r and omly allocated to 10 weeks of CWT at 40 to 60 % of maximum voluntary contraction ( n = 12 ) or to a control group ( n = 14 ) . Muscular strength was assessed using a modified one repetition maximum technique .  Peak VO2 was recorded during symptom-limited treadmill exercise . Rate pressure product , as an indirect measure of mVO2 , was measured during isometric , isodynamic , and dynamic exercise . RESULTS No ischemic symptoms nor electrocardiographic changes were recorded during testing or training . Strength increased by 18 % ( P < 0.005 ) in five out of seven exercises in the training group , but was unchanged in the control group . Training did not improve peak VO2 . Rate pressure product during isometric and isodynamic exercise decreased from pre- to post-testing ( P < 0.05 ) but was equivalent to that seen in the control group . CONCLUSIONS Moderate intensity CWT is safe and can improve strength in selected low-risk patients after coronary artery bypass surgery . However , it does not significantly increase peak VO2 nor reduce mVO2 during isometric , isodynamic , and dynamic exercise BACKGROUND Although inactivity is an important contributor to impaired functioning and disability with age , little is known concerning how improvements in physical functioning and well-being in older adults vary with the type of physical activity undertaken . METHODS One hundred three adults age 65 years and older , recruited via population -based methods , were r and omized to 12 months of community-based , moderate-intensity endurance and strengthening exercises ( Fit & Firm ) or stretching and flexibility exercises ( Stretch & Flex ) . A combination of class- and home-based exercise formats was used . Measured and self-rated physical performance along with perceived functioning and well-being were assessed pre- and postintervention . RESULTS Fit & Firm subjects showed greater 12-month improvements in both measured and self-rated endurance and strength compared to Stretch & Flex subjects . Stretch & Flex subjects reported greater improvements in bodily pain , and Stretch & Flex men evidence d greater improvements in flexibility relative to Fit & Firm subjects . Although overall exercise adherence was high in both exercise conditions ( approximately 80 % ) , subjects in both conditions showed better adherence to the home- versus class-based portions of their exercise prescriptions . CONCLUSIONS Community-based programs focusing on moderate-intensity endurance and strengthening exercises or flexibility exercises can be delivered through a combination of formats that result in improvement in important functional and well-being outcomes . This represents one of the first studies to report significant improvements in an important quality of life outcome -bodily pain-with a regular regimen of stretching and flexibility exercises in a community-based sample of older adults We conducted a 12-wk resistance training program in elderly women [ mean age 69 + /- 1.0 ( SE ) yr ] to determine whether increases in muscle strength are associated with changes in cross-sectional fiber area of the vastus lateralis muscle . Twenty-seven healthy women were r and omly assigned to either a control or exercise group . The program was satisfactorily completed and adequate biopsy material obtained from 6 controls and 13 exercisers . After initial testing of baseline maximal strength , exercisers began a training regimen consisting of seven exercises that stressed primary muscle groups of the lower extremities . No active intervention was prescribed for the controls . Increases in muscle strength of the exercising subjects were significant compared with baseline values ( 28 - 115 % ) in all muscle groups . No significant strength changes were observed in the controls . Cross-sectional area of type II muscle fibers significantly increased in the exercisers ( 20.1 + /- 6.8 % , P = 0.02 ) compared with baseline . In contrast , no significant change in type II fiber area was observed in the controls . No significant changes in type I fiber area were found in either group . We conclude that a program of resistance exercise can be safely carried out by elderly women , such a program significantly increases muscle strength , and such gains are due , at least in part , to muscle hypertrophy Forty-seven elderly women ( 63 to 88 years of age , mean = 71 years ) were studied to determine the effect of a 25-week light resistance and aerobic exercise program upon arm and leg strength . Three groups were formed :  nonexercising controls  ( C , n = 12 ) , exercise ( EN , n = 18 ) and exercise with light weights on on the wrists and ankles ( EW , n = 17 ) . Exercise was performed for one hour , three times/week . Subjects were pretested and posttested for maximal isokinetic muscle strength ( angular velocity 60 degrees/sec ) for elbow flexion and extension , shoulder internal and external rotation , and knee flexion and extension . Dunn planned contrasts were used to compare C vs exercise groups combined ( EN + EW ) and EN vs EW . No significant differences were found among groups at baseline . EN + EW improved significantly ( p less than 0.05 ) more than C in elbow extension ( 17 % ) , shoulder internal rotation ( 14 % ) , shoulder external rotation ( 9 % ) , and knee flexion ( 20 % ) . No significant differences were found between EN and EW . These data indicate that elderly women can achieve substantial gains in the strength of arm and leg musculature as a result of regular light resistance and aerobic exercise , but that the use of light weights on the wrists and ankles for added resistance did not enhance this effect BACKGROUND Beneficial training outcomes have been reported in patients with chronic heart failure ( CHF ) following leg exercise training .  However , data from more comprehensive training programs are limited . The aim of this study was to test the hypothesis that exercise training applying the concept of comprehensive local muscle training can improve aerobic and functional working capacity as well as quality of life in patients with CHF . METHODS Twenty-four men and women [ age 63+/-9 years ( mean+/-S.D. ) ] with stable , moderate chronic heart failure ( left ventricular ejection fraction 30+/-10 % ) , were investigated in a r and omized controlled study with a training group of 16 patients and a  control group of 8 patients . The training was performed as an aerobic resistance training by activating all the main muscle groups , one at a time . The patients exercised for 1 h , three times per week for 8 weeks . RESULTS Patient groups did not differ at baseline . Peak oxygen uptake ( 8 % , P<0.03 ) , the distance walked in a 6-min walking test ( 11 % , P<0.002 ) , the health-related quality of life ( P<0.001 ) and plasma norepinephrine levels at rest ( 32 % , P<0.003 ) and at submaximal intensities ( P<0.03 ) improved after training . No changes were found in the control group , except for decreased peak oxygen uptake ( P<0.02 ) and quality of life scores ( P<0.03 ) . CONCLUSIONS Since comprehensive physical training activating a minor muscle mass at a time markedly improves exercise capacity and quality of life and reduces catecholamine levels , it can be recommended for the rehabilitation of patients with CHF under supervision of a physical therapist The purpose of this study was to determine whether a moderate to high intensity strengthening and aerobic exercise program can improve the strength , exercise capacity , gait and balance of deconditioned male nursing home residents . Ambulatory subjects who scored 30 or less on the modified Tinetti gait and balance assessment scale , who demonstrated less than 80 % of age-matched lower extremity strength on isokinetic muscle testing and who gave informed consent were enrolled . Subjects were r and omized to either an  exercise ( n = 8) or a  control ( n = 6 ) group . All participants underwent an exercise test to determine maximal oxygen uptake ( Vo2max ) and received quantitative gait and balance measurements . The subjects assigned to the exercise group then completed a 12-wk program of weight training for the lower extremities and stationary cycling . Both the exercise and control groups were then retested . Ten outcome variables were assessed : Tinetti mobility scores , Vo2max , isokinetic-tested lower extremity strength and endurance , stride length , gait velocity , stance time , gait duration , cadence and balance . The exercise group , after completion of the program , demonstrated significant improvements in Tinetti mobility scores ( P < 0.05 ) , combined right and left quadricep muscle strength ( P < 0.01 ) , right and left lower extremity muscular endurance ( P < 0.01 ) , left stride length and gait velocity ( P < 0.05 ) , although other outcome variables changed insignificantly . The control group revealed no changes of significance with the exception of improvement of the combined right and left hamstring muscle strength ( P < 0.05 ) . Nevertheless , for those outcome variables that had improved significantly in the exercise group , the changes amounted to only a 5 to 10 % increase over the baseline measurements . These findings showed that an appropriately design ed high intensity exercise program can result in significant although limited improvements for clinical mobility scores , strength , muscular endurance and certain gait parameters BACKGROUND Resistance-training intervention studies have demonstrated meaningful health benefits in older adults ; however , most have used exercises performed at specific intensities on expensive equipment , which limit their widespread applicability . We tested whether two self-paced , less expensive exercise protocol s could be effective and safe for modifying neuromotor performance and functional capacity in community-dwelling adults 65 - 95 years of age . METHODS One hundred and thirty-one subjects were r and omized to a  novel resistance training , walking , or control group .  Subjects determined their level of resistance or walking intensity ( self-paced ) on a session-by-session basis . Muscle strength , balance , reaction time , stair climbing speed , and a timed pen pickup task were measured before and after the intervention period . Exercisers met three times per week for 10 months . RESULTS Significant improvements in t and em stance and single-legged stance with eyes open times and stair climbing speed were seen in both exercise groups . In addition , resistance trainers improved their muscle strength and ability to pick up an object from the floor and reduced the number of missteps taken during t and em walking , and walkers reduced t and em walking time . Controls showed no significant improvement in any variable . CONCLUSIONS The two self-paced exercise protocol s were effective at improving neuromotor performance and functional capacity in the study sample and show promise as a safe , effective , cost-efficient , acceptable exercise model for primary and secondary prevention in the general population of community-dwelling older adults BACKGROUND AND PURPOSE This prospect i ve clinical investigation examined the effects of a multidimensional exercise program on balance , mobility , and risk for falls in community-dwelling older adults with a history of falling . Factors used to predict adherence and a successful response to exercise were identified . SUBJECTS A total of 105 community-dwelling older adults ( > or = 65 years of age ) with a history of two or more falls in the previous 6 months ( no neurologic diagnosis ) participated . They were classified into ( 1 ) a control group of fallers ( n = 21 ) , ( 2 ) a fully adherent exercise group ( n = 52 ) , and ( 3 ) a partially adherent exercise group ( n = 32 ) . METHODS Following evaluation , each patient received an individualized exercise program addressing the impairments and functional disabilities identified during the assessment . The control group received no intervention . Changes in performance on five clinical tests of balance and mobility and fall risk were compared among groups . RESULTS Both exercise groups scored better than the control group on all measures of balance and mobility . Although both exercise groups showed a reduction in fall risk compared with the control group , the greatest reduction was found in the fully adherent exercise group . Factors associated with successful response to exercise included degree of adherence to exercise program and pretest score on the Tinetti Mobility Assessment . CONCLUSION AND DISCUSSION Exercise can improve balance and mobility function and reduce the likelihood for falls among community-dwelling older adults with a history of falling . The amount of exercise needed to achieve these results , however , could not be determined from this study OBJECTIVE To assess the effects of 12 months ' dynamic strength training on muscle strength and bone mineral density ( BMD ) at the lumbar spine and femoral neck in patients with early rheumatoid arthritis ( RA ) . METHODS Thirty-two subjects in the training group ( EG ) and 33 in the control group ( CG ) completed the study . EG carried out strength training 2 times a week with moderate loads of 50 - 70 % of repetition maximum . They were also encouraged to do recreational physical activities . CG performed recreational physical activities and range of motion exercises .  Maximal strength of the knee extensors , trunk extensors and flexors , and grip strength were recorded with dynamometers . BMD was measured using dual x-ray absorptiometry . Modified Disease Activity Score , erythrocyte sedimentation rate , and pain were used for the estimation of disease activity , and Stanford Health Assessment Question naire to measure functional disability . RESULTS The 12 month resistance training in EG led to statistically significant mean increases of 22 - 35 % in all muscle groups examined . CG patients were also able to increase their strength to some degree ( 3 - 24 % ) , but at the end of the study strengths in CG were significantly lower than in EG . By the end of the study lumbar spine BMD had changed by + 0.19 % ( 4.24 ) in EG and by -1.14 % ( 4.36 ) in CG . The corresponding changes of femoral BMD were + 1.10 % ( 3.71 ) and -0.03 % ( 3.58 ) . The changes in BMD were minor and statistically not significant in both groups . However , femoral BMD was found to be decreased among those patients treated periodically with oral glucocorticoids ( n = 15 , 3 subjects from EG and 12 from CG ) compared with changes in BMD among those not treated with systemic glucocorticoids ( n = 50 ) . CONCLUSION Minimally supervised strength training result ed in significant improvements in muscle strength without detrimental effects on disease activity . The detected annual changes in central BMD were minor and statistically insignificant in both groups . Special attention should be focused on those patients with RA with high disease activity and concomitant glucocorticoid treatment Chronic renal insufficiency , regardless of cause , generally progresses to end-stage renal disease ( 1 ) . Malnutrition and muscle wasting in chronic uremia often parallel the progression of renal failure ( 2 ) . They also contribute to excess morbidity and mortality in patients with renal disease ( 3 ) . Protein-restricted diets delay the progression of renal disease ( 4 , 5 ) and alleviate uremic symptoms ( 6 ) . Although nutritional status , as assessed by biochemical and anthropometric indicators , may be maintained during protein restriction ( 6 , 7 ) , studies have shown that deterioration of nutritional status is associated with low energy and protein intake in patients with chronic renal insufficiency ( 8) . Resistance training increases nitrogen retention ( 9 ) , protein synthesis ( 10 ) , and expression of insulin-like growth factor I in skeletal muscle ( 11 ) ; ameliorates losses of muscle mass and function ; and enhances quality of life ( 12 ) in both healthy and unwell persons . The anabolic potential of resistance training counteracts the catabolism of HIV infection ( 13 ) and myopathy secondary to corticosteroid use in cardiac transplantation ( 14 ) , the loss of lean tissue during energy restriction for obesity ( 15 ) , and the interleukin-mediated myopathy of chronic heart failure ( 16 ) . However , its utility as an adjunctive treatment off setting the catabolism of a low-protein diet in uremic patients is not known ( 17 ) . We conducted a r and omized , controlled trial to determine whether resistance training would preserve lean body mass , nutritional status , and muscle function through alterations in protein turnover ( synthesis and oxidation ) in patients with moderate chronic renal insufficiency who were consuming a low-protein diet to slow the progression of renal failure . Methods Study Design Patients older than 50 years of age with chronic renal insufficiency were r and omly assigned to a low-protein diet plus resistance training or a low-protein diet plus sham exercises ( referred to as low-protein diet alone ) . Patients were asked to follow a low-protein diet ( 0.6 g/kg of body weight per day ) for 2 to 8 weeks ( run-in period ) before r and omization . They continued the low-protein diet for an additional 12 weeks after r and omization ( intervention period ) ( Figure 1 ) . The Human Investigation Review Committee at Tufts University , Boston , Massachusetts , and collaborating hospitals approved the study , and written informed consent was obtained from all patients . Figure 1 . Flow of patients through the study . * The post office returned letters because addresses were incorrect or persons had relocated . No patients withdrew , experienced ineffective interventions , or were lost to follow-up . One patient in each group had incomplete postintervention measures because of health-related reasons . HNRCA = Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging . Study Sample Patients were recruited from the nephrology clinic at New Engl and Medical Center , Saint Elizabeth 's and Newton Wellesley Hospitals , and the Lahey Hitchcock Clinic , all in Boston , Massachusetts .  Screening procedures took place at the Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging ( HNRCA ) at Tufts University . These procedures included sociodemographic and health history question naires ; physical examination ; electrocardiography ; blood hematology , chemistry , and urine analyses ; and a treadmill stress test .  Eligibility criteria included serum creatinine concentrations between 133 and 442 mol/L ( 1.5 and 5.0 mg/dL ) and physician approval to follow a low-protein diet .  A nephrologist confirmed renal diagnosis by review ing renal biochemistry results and clinical records . Exclusion criteria were myocardial infa rct ion ( within the past 6 months ) , any unstable chronic condition , dementia , alcoholism , dialysis or previous renal transplantation , current resistance training , recent involuntary weight change ( 2 kg ) , albumin level less than 30 g/L , proteinuria greater than 10 g/d , or abnormal stress test results at screening ( 18 ) . Reasons for early withdrawal from the study included loss of more than 25 % of initial body weight ; need for dialysis or transplantation ; development of any serious condition requiring hospitalization or precluding exercise ; and signs of malnutrition , such as a decrease in serum transferrin levels to less than 1.5 g/L or a 15 % decrease in hemoglobin or leukocyte count to below baseline levels . Diet Dietary intake of macronutrients and micronutrients and adherence to the low-protein diet were monitored twice per week during the run-in period and weekly during the intervention period by 3-day assisted dietary records ( including week and weekend days ) and regular meetings with the study dietitian , who was not blinded to group assignment . Dietary data were coded and analyzed by using Nutritionist-IV software ( N-Squared Computing , San Bruno , California ) . Patients collected one 24-hour urine specimen for every 3-day dietary record . Protein intake was also estimated by urea nitrogen levels ( 19 ) calculated from urine collection s and was used to assess adherence , which was defined as intake within 15 % of the prescribed low-protein intake ( 0.6 g/kg per day ) . Patients were counseled to reduce their habitual protein intake by eating food sources with less protein or by reducing portion sizes of higher-protein foods . Behavior modification strategies , including tips , recipes , food models , and self-monitoring tools for protein counts , were provided . These strategies were adapted from the Modification of Diet in Renal Disease Study ( 20 ) . Exercise Muscle strength was determined twice before r and omization and once after 12 weeks by measuring one repetition maximum ( 1 RM ) ( 21 ) using Keiser resistance training equipment ( Keiser Sports Health Equipment , Inc. , Fresno , California ) . One repetition maximum is the heaviest load that can be lifted once in good form through the full range of motion . Five machines ( chest and leg press , latissimus pull-down , knee extension , and knee flexion ) were used to include functionally large muscle groups . The better of the two baseline measurements of 1 RM was used in analyses and to set initial training loads for patients r and omly assigned to resistance training . All exercise sessions were performed at the HNRCA three times per week under the supervision of an exercise physiologist . Vital signs and body weight were recorded before each session . Patients who performed  resistance training  had monthly 1 RM testing on each machine . Workload during training was adjusted to reflect 80 % of the most recent 1 RM . In addition , patients ' workloads were progressively increased as appropriate according to the trainer 's objective perception of patients ' difficulty with workloads at each session . Patients performed three sets of eight repetitions on each machine per session , which lasted about 45 minutes ( 21 ) . Patients assigned to the  low-protein diet alone performed five to eight sham exercises ( gentle movements while st and ing , sitting , and bending ) for the upper and lower body . These were design ed not to have a physiologic impact but to provide trainer contact time similar to that of the resistance training group . Study Measures All measures were taken before ( week 0 ) and 12 weeks after r and omization . Observers were blinded to study group assignment at all times , except during assessment s of postintervention muscle strength . Main Outcome Measures Total body potassium is the best single measure of body cell mass closely linked to functional status ( 22 ) , prognosis , and survival ( 23 ) . Body cell mass ( muscle and viscera ) comprises the metabolically active tissues where protein is targeted ( 24 ) . Potassium-40 represents approximately 0.0118 % of total body potassium . Loss of total body potassium occurs in patients following low-protein diets ( 25 ) and in patients with renal disease ( 26 ) , as well as in patients with many other wasting syndromes .  Total body potassium  was determined in the body composition laboratory at HNRCA , with a coefficient of variation of 5 % ( 24 ) . Regional body composition of the area involving the mid-thigh muscle was determined by computerized tomography of the nondominant thigh . A Siemens DR3 CT Scanner ( Somatom-Siemens , Erlangen , Germany ) was used to obtain an 8-mm scan at the midpoint between the inguinal crease and the proximal pole of the patella . Images were digitized and analyzed to the nearest 0.01 cm2 , as described elsewhere ( coefficient of variation , 0.5 % to 1.5 % ) ( 21 ) . Type I and type II muscle-fiber cross-sectional areas were determined from vastus lateralis muscle biopsies of the nondominant thigh , performed with a 5-mm Bergstrom needle ( 27 ) . Sections were stained with adenosine triphosphatase ( pH , 4.3 ) to visualize type I and type II fibers . A slide preparation was made for each biopsy specimen , and 50 to 150 fibers per patient were analyzed by light microscopy ( coefficient of variation , 3 % ) ( 11 , 27 ) . Anthropometry Body weights were measured to the nearest 0.1 kg on a Toledo Weight-Plate ( Bay State Scale & Systems , Inc. , Burlington , Massachusetts ) . Height was measured once to the nearest 0.25 cm , without shoes , by using a wall-mounted stadiometer . Body mass index was determined from body weight and height as kg/m2 . Biochemical Measures All measurements were collected in the fasting state in a blinded fashion at the nutrition evaluation laboratory at HNRCA ( coefficient of variation , 5 % to 10 % ) . Urea nitrogen and creatinine concentrations in serum and urine and levels of plasma insulin-like growth factor I were determined , as described elsewhere ( 25 , 27 ) . In addition , blood cell count ; hematocrit ; and levels of serum albumin , transferrin , and prealbumin were measured monthly to evaluate nutritional status . Glomerular Filtration Rate Glomerular filtration rate was measured as the renal clearance of 125I-iothalamate ( Glofil , Cypros Pharmaceutical Corp. , Carlsbad , California ) , with a coefficient of OBJECTIVE To determine the effect of a low load resistance exercise training program on muscle strength , functional outcome , and cardiovascular endurance . METHODS Forty-nine patients , 37 women and 12 men between the ages of 35 - 76 yrs ( mean 60.5 yrs ) , with definite rheumatoid arthritis ( RA ) functional class II and III ( mean disease duration of 10.5 yrs ) were r and omly assigned to exercise and control groups for a 12 wk resistive muscle training program . A circuit weight bearing form of training was incorporated using light loads with high repetitions . A video tape demonstrating the exercises was given to all exercising participants to enable them to continue the program at home at least 3 times per wk with a biweekly self-report evaluation . Baseline and post-intervention evaluations included joint activity , muscle strength , endurance , functional outcome , and self-report . Cardiovascular fitness measured by treadmill time , anaerobic threshold and peak oxygen consumption ( VO2 ) in this group were assessed at baseline and 12 wks . RESULTS A significant improvement at 12 wks was noted in the exercise group for self-reported joint count ( p = 0.02 ) , number of painful joints ( p = 0.004 ) , HAQ ( p = 0.012 ) , sit-to-st and time ( p = 0.02 ) , grip strength ( p = 0.05 ) knee extension 60 degrees ( p = 0.03 ) , Arthritis Impact Measurement Scales dexterity ( p = 0.02 ) , and time to anaerobic threshold ( p = 0.03 ) . Significant improvement in the exercise group compared to the control group was noted for self-reported joint count ( p = 0.02 ) , night time pain ( p = 0.05 ) , and sit-to-st and time ( p = 0.02 ) . Increase in treadmill time was not statistically significant nor was a change in peak oxygen consumption ( VO2 ) noted . Abnormalities on initial treadmill screening were detected in 2 of 49 asymptomatic patients . They were excluded from the study and subsequent workup revealed significant coronary artery disease . CONCLUSION Low load resistive muscle training increased functional capacity as reported by patients and is a clinical ly safe form of exercise in functional class II and III RA . Screening this population for dormant coronary artery disease is recommended Experimental evidence indicates that a lower synthesis rate of muscle contractile protein myosin heavy chain ( MHC ) occurs in age-related muscle wasting and weakness . To determine the molecular mechanism of this lower synthesis of MHC , we measured transcript levels of isoforms of MHC ( MHCI , MHCIIa , and MHCIIx ) in muscle biopsy sample s of 7 young ( 20 - 27 yr ) , 12 middle-aged ( 47 - 60 yr ) , and 14 older ( > 65 yr ) people . We further determined the effect of 3 mo of resistance exercise training ( exercise ) vs. nonintervention ( control ) on transcript levels of MHC isoforms on these subjects and the fractional synthesis rate ( FSR ) of MHC in 39 people aged 46 - 79 yr .  MHCI mRNA levels did not significantly change with age , but MHCIIa decreased 38 % ( P < 0.05 ) from young to middle age and further decreased 50 % ( P < 0.05 ) from middle to old age . MHCIIx decreased 84 % ( P < 0.05 ) from young to middle age and 48 % from middle to old age ( P < 0.05 ) . Exercise increased FSR of MHC by 47 % ( P < 0.01 ) and mixed muscle protein by 56 % ( P < 0.05 ) . Exercise training results in an increase ( 85 % ) in transcript levels of MHCI and a decrease in the transcript levels of MHCIIa and MHCIIx . In conclusion , an age-related lowering of the transcript levels of MHCIIa and MHCIIx is not reversed by exercise , whereas exercise results in a higher synthesis rate of MHC in association with an increase in MHCI isoform transcript levels The effects of 52 weeks resistance training at one of two exercise intensities on thigh muscle strength , fiber cross-sectional area ( CSA ) , and tissue composition were studied in healthy 65 - 79-year-old women . Subjects were assigned to either a control ( CO ) , high-intensity ( HI ) or low-intensity ( LO ) training group . Exercise regimens consisted of three sets of leg press , knee extension , and knee flexion exercises , 3 days/week , at either 80 % of one-repetition maximum ( 1-RM ) for seven repetitions ( HI ) or 40 % of 1-RM for 14 repetitions ( LO ) . Dynamic muscle strength was evaluated by 1-RM , thigh lean tissue mass ( LTM ) , fat mass , and bone mineral density ( BMD , g/cm2 ) by dual energy X-ray absorptiometry , and fiber CSA of vastus lateralis m. by histomorphometry . Muscle strength increased , on average ( + /- SEM ) , by 59.4 + /- 7.9 % and 41.5 + /- 7.9 % for HI and LO , respectively , compared to 1.3 + /- 4.8 % in CO ( P = 0.0001 ) . Type I fiber CSA increased over time ( P < 0.05 ) in both exercise groups , with a trend for increased type II area ( HI , P = 0.06 ; LO , P = 0.11 ) . There was no significant effect of either exercise program on thigh tissue composition , except for BMD at the 1/3 site ( middle third of the femur ) , where LO and CO groups experienced a decline ( P < 0.05 ) of -2.2 + /- 0.5 % and -1.8 + /- 0.6 % , respectively , while HI maintained BMD ( + 1.0 + /- 1.0 % ) . Both training programs produced significant gains in thigh muscle strength , which were associated with fiber hypertrophy , although these did not translate into appreciable alterations in thigh tissue composition Twelve middle-aged men and 12 middle-aged women in the 50-year-old age group ( M50 ; range 44 - 57 years ; W50 ; 43 - 57 ) , and 12 elderly men and 12 elderly women in the 70-year-old age group ( M70 ; 59 - 75 ; W70 ; 62 - 75 ) volunteered as subjects in order to examine effects of 12-week progressive heavy resistance strength training on electromyographic activity ( EMG ) , muscle cross-sectional area ( CSA ) of the quadriceps femoris and maximal concentric force in a one repetition maximum ( 1 RM ) test of the knee extensor muscles . One half of the subjects in each group performed the knee extension ( and flexion ) exercises only bilaterally ( BIL ) , while another half performed the exercises only unilaterally ( UNIL ) . None of the subject groups demonstrated statistically significant changes in any of the 1 RM values during the 2 week control period with no training ( between week -2 and 0 ) preceding the actual experimental training . However , the 12-week training result ed in increases ( P < 0.05 - 0.001 ) in 1 RM values in each group so that the average relative increase of 19 + /- 12 % ( P < 0.001 ) in bilateral 1 RM in all BIL trained subjects was greater ( P < 0.05 ) than that of 13 + /- 8 % ( P < 0.001 ) recorded for all UNIL trained subjects . The average relative increases of 17 + /- 11 % ( P < 0.001 ) and 14 + /- 14 % ( P < 0.001 ) in unilateral 1 RM values of the right and left leg in all UNIL trained subjects were greater ( P < 0.05 ) than those of 10 + /- 18 % ( P < 0.001 ) and 11 + /- 11 % ( P < 0.001 ) recorded for all BIL trained subjects , respectively . The relative average increase of 19 + /- 19 % ( P < 0.001 ) observed in the maximum averaged IEMG of both legs during the bilateral actions in all BIL trained subjects was greater ( P < 0.05 ) than that of 10 + /- 17 % ( P < 0.05 ) recorded for all UNIL trained subjects . The relative increases of 14 + /- 12 % ( P < 0.001 ) and 11 + /- 6 % ( P < 0.001 ) recorded for the CSA in all BIL and UNIL trained subjects did not differ significantly from each others . The present findings suggest that progressive heavy resistance strength training leads to great increases in maximal dynamic strength of the trained subjects accompanied by both considerable neural adaptations and muscular hypertrophy not only in middle-aged but also in elderly men and women . Both bilateral and unilateral exercises are effective to produce functional and structural adaptations in the neuromuscular system , although the magnitude of functional strength increase seems to be specific to the type of exercise used , further supporting the principle of specificity in the design of strength programmes Abstract The effects of a short-term strength training programme on resting lymphocyte subsets and stress hormone concentrations were analysed in 32 elderly sedentary subjects . Out of these 32 subjects , 8 women and 8 men [ mean age 70.1 ( SEM 1.0 ) years ] were r and omly assigned to a 8-week strength training programme which consisted of three sets of eight repetitions at 80 % of one repetition maximum , for leg press , bilateral leg extension and seated chest press , 3 days a week . The remaining 8 women and 8 men [ mean age 70.5 ( SEM 0.9 ) years ] served as controls  . Absolute counts of lymphocyte subsets ( CD20 + , CD3 + , CD3+CD4 + , CD3+CD8 + , CD3−CD56+CD16 + ) were measured with a new technique combining fluorescent microspheres and flow cytometry . In the trained subjects , substantial increases in strength took place in one repetition maximum during the 8-week training period for leg press [ from means of 20.7 ( SEM 1.0 ) to 23.6 ( SEM 1.0 ) N · kg−1LBM ( lean body mass ) ] , chest press [ from means of 5.4 ( SEM 0.3 ) to 6.2 ( SEM 0.3 ) N · kg−1LBM ] and bilateral leg extension [ from means of 6.3 ( SEM 0.2 ) to 7.4 ( SEM 0.3 ) N · kg−1LBM ] movements . Baseline cortisol concentration ( P < 0.01 ) , CD20 + cell count ( P < 0.05 ) , CD3 + cell count ( P < 0.05 ) , and CD4 + cell count ( P < 0.01 ) decreased in both groups secondary to circannual variations between winter and summer . No significant effect of strength training on resting adrenaline , noradrenaline and cortisol concentrations or distributions of lymphocyte subsets at rest was observed . The main finding of this study was to demonstrate that 8-week is too short a duration for a strength training programme to modify counts of lymphocyte subsets at rest in elderly sedentary adults Strength measurements were administered to 52 men ranging in age from 42 to 83 years , who were then r and omly assigned within their respective age group to either the  Isometric-training Group ( ITG ) or to the  Control-exercise Group ( CEG )  . At the conclusion of a six-week training program all initial measurements were again administered . No significant differences were found in ( 1 ) strength trainability by age group , and ( 2 ) in strength trainability by muscle group when the upper-extremity-strength ratios were compared with the lower-extremity-strength ratios . When the initial and final strength scores of the ITG were subjected to a t test for correlated sample s , the findings included : ( 1 ) the four age groups of the ITG experienced statistically significant gains in strength for six of the eight strength measurements , and ( 2 ) as age increased , strength trainability appeared to decrease OBJECTIVE To assess how dietary change affects gain in strength and muscle mass during heavy resistance training of elderly men . DESIGN R and omized controlled trial . INTERVENTION During 12 weeks of resistance training of knee extensors and flexors , a daily supplement of 560 + /- 16 kcal/day ( 17 % energy from protein , 43 % from carbohydrate , 40 % from fat ) was r and omly assigned to six men ( S ) while five men ( U ) received no supplement .  Food intake , strength , whole body composition , and midthigh composition by CT scan were assessed before training and at 6 and 12 weeks . SETTING The men were out patients but lived in a Metabolic Research Unit during the three assessment s. PARTICIPANTS Eleven healthy men aged 61 to 72 years . RESULTS Densitometry showed no change over time in fat or fat-free mass . However , the S men increased ( P less than 0.05 ) weight , skinfold thickness at six sites , subcutaneous midthigh fat , and creatinine excretion ; in all men , changes in these values and in midthigh muscle were proportional to changes in reported energy intake ( P less than 0.05 ) . There was midthigh muscle hypertrophy in both groups , but it was greater in S than U ( P less than 0.01 ) . Both groups gained strength ( P less than 0.001 ) with no effect of diet . CONCLUSIONS During physical rehabilitation of the elderly , dietary intake may influence the increase in lean as well as adipose tissue without altering strength gain . These preliminary findings should be confirmed by a larger study with sedentary controls Knee extension strength , walking speed , quadriceps muscle mass and composition of the muscle compartment were studied in 66 to 85-year-old female athletes and controls .  Maximal voluntary knee extension force , force/body mass , extension torque , torque/body mass and walking speed were higher for the athletes than the controls . A muscle index indicating intramuscular fat and connective tissue measured using ultrasonography was lower for the athletes than the controls . There were no differences between the study groups in knee extension force related either to cross-sectional area ( CSA ) or lean tissue area ( CSAL ) of the quadriceps . Within the subgroups , there was no significant correlation between knee extension torque and CSA or CSAL of the same muscle . In the athletes high knee extension torque/body mass was related to a low muscle index and high walking speed to a low relative proportion of fat in the muscle . The muscle index was lower the more kilometers trained during the preceding year . In the controls high knee extension torque/body mass and high walking speed were related to a low relative proportion of fat . Knee extension torque and walking speed were higher the more kilometers walked during the preceding year . The results indicate that elderly female athletes have superior muscle performance compared to their age-peers . Performance in a maximal isometric strength test in elderly women is not clearly related to muscle mass . However , to some extent it is related to the composition of the same muscle , especially the degree to which fat is infiltrated into the muscle OBJECTIVE To determine the effects of resistance training on muscular strength , body composition ( percent fat and lean tissue mass ) , and program adherence in active women over 60 years of age . DESIGN This study was design ed as a stratified , r and omized , non-blinded trial . Subjects were stratified into rank-ordered pairs by level of physical activity according to the Blair Seven-Day Recall , then r and omly assigned into either a weight-training ( WT , n = 18 ) or control ( CON , n = 18 ) group . PARTICIPANTS AND SETTING Thirty-six women over the age of 60 ( 67.1 + /- 1.5 , chi + /- SE ) were recruited from the San Diego community . All subjects had to be engaging in some form of aerobic exercise  at least 3 days each week for a minimum of 6 months . MEASUREMENTS AND INTERVENTION : Subjects engaged in isotonic training 3 days/week on Polaris machines at a target intensity of 80 % of the 1 repetition maximum ( 1 RM ) for three sets of seven exercises selected to train major muscle groups of the trunk and upper and lower body . The 1 RM was re-tested every 6 weeks in WT and the workload adjusted to maintain target intensity . The 1 RM was tested at 0 , 12 , and 24 weeks in CON . Body fatness and lean tissue mass , excluding skeletal mass , were assessed at 0 and 24 weeks by dual energy radiography using a total body scan . RESULTS Increases in muscle strength of the weight trainers were significant for all seven exercises ( 5%-65 % ) , with the greatest gains in the shoulder and trunk muscles . Percent body fat of weight trainers decreased significantly ( from 38.8 % to 37.9 % , P < 0.05 ) , while lean tissue mass increased by 1.5 kg ( P < 0.01 ) . No changes in body composition were observed in control subjects . Overall program adherence was 83 % ( 15 weight trainers and 15 control women completed the study ) . Monthly attendance averaged 86.8 + /- 3.3 % , with no incidence of injury during the training sessions . CONCLUSIONS These data indicate that heavy-resistance weight training is safe and enjoyable for older women and that meaningful gains in muscular strength and body composition can be made even in women who are already highly active BACKGROUND AND PURPOSE Loss of lower-extremity strength increases the risk of falls in older persons . The purpose of this study was to test the hypothesis that a vigorous program of lower-extremity strengthening , walking , and postural control exercises would improve the single-stance balance of healthy older women and lower their risk of falls and fall-associated injuries . SUBJECTS From a total of 38 respondents , 21 women were r and omly assigned to either a treatment group ( combined training , n = 12 ) or a control group ( flexibility training , n = 9 ) . The subjects ranged in age from 62 to 75 years ( mean = 68 , SD = 3.5 ) . METHODS A r and omized control trial compared the effects of two exercise programs on static balance . The combined training group exercised three times per week on knee extension and sitting leg press machines , walked briskly for 20 minutes , and performed postural control exercises , which included simple tai chi movements . The flexibility training group performed postural control exercises weekly . Measurements of balance were obtained on a force platform in double and single stance , at baseline and following 6 months of exercise training . RESULTS Double-stance measurements were unchanged after training . The mean displacement of the center of pressure in single stance improved 17 % in the combined training group and did not change in the flexibility training group . A repeated- measures analysis of variance revealed that the difference in improvement between the combined training and flexibility training groups was not significant . DISCUSSION AND CONCLUSION This is the first intervention trial to demonstrate improvements in single-stance postural sway in older women with exercise training . Additional studies with more subjects will be needed to determine whether a combined training program of resistance training , walking , and postural exercises can improve balance more than a program of postural control exercises alone The quadriceps strength of a group of residents homes for the elderly ( mean age 83 years ) was assessed in a r and omized controlled trial of seated group exercise versus group reminiscence therapy .  Fifty-five of 65 volunteers completed the 6-month study , with 4 dropouts from the exercise group , and 6 dropouts from the reminiscence group . There were no adverse effects . Average of attendance at the exercise sessions was 72 % ( range , 18 % to 98 % ) and 62 % ( range , 29 % to 100 % ) at the reminiscence sessions . The reminiscence sessions comprised group interaction and discussion prompted by the use of reminiscence aids . By the end of the study , the change observed in the exercise group was significantly different from the reminiscence group in terms of quadriceps strength ( p < 0.01 , Mann-Whitney U test ) . Both groups improved equally in their ability to climb up steps , but neither cognitive function ( Mini-Mental State Examination ) nor reaction time altered significantly 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 OBJECTIVE Reduced muscle mass and strength are characteristic findings of growth hormone deficiency ( GHD ) and aging . We evaluated measures of muscle strength , muscle fiber type , and cross sectional area in response to treatment with recombinant human growth hormone ( rhGH ) with or without a structured resistance exercise program in frail older subjects . DESIGN Placebo-controlled , r and omized , double blind trial . SETTING Outpatient clinical research center at an urban university-affiliated teaching hospital . PARTICIPANTS Thirty-one consenting older subjects ( mean age 71.3 + /- 4.5 years ) recruited as a subset of a larger project evaluating rhGH and exercise in older people , who underwent 62 quadricep-muscle biopsies . INTERVENTION R and om assignment to a 6-month course of one of four protocol s : rhGH administered subcutaneously daily at bedtime , rhGH and a structured resistance exercise program , structured resistance exercise with placebo injections , or placebo injections only . MEASUREMENTS Muscle biopsy specimens were obtained from the vastus lateralis muscle . Isokinetic dynamometry strength tests were used to monitor individual progress and to adjust the weights used in the exercise program . Serum insulin-like growth factor-I ( IGF-I ) was measured and body composition was measured using a Hologic QDR 1000W dual X-ray densitometer . RESULTS The administration of rhGH result ed in significant increase in circulating IGF-I levels in the individuals receiving rhGH treatment . Muscle strength increased significantly in both the rhGH/exercise ( + 55.6 % , P = .0004 ) as well as the exercise alone ( + 47.8 % , P = .0005 ) groups . There was a significant increase in the proportion of type 2 fibers between baseline and six months in the combined rhGH treated subjects versus those not receiving rhGH ( P = .027 ) . CONCLUSIONS Our results are encouraging in that they suggest an effect of growth hormone on a specific aging-correlated deficit . IGF-I was increased by administrating rhGH and muscle strength was increased by exercise . The administration of rhGH to frail older individuals in this study result ed in significant changes in the proportions of fiber types . Whether changes in fiber cross-sectional area or absolute number occur with long-term growth hormone administration requires further study The purpose of this study was to investigate the effects of a progressive resistance training program on myosin heavy chain isoform expression , fiber type , and capillarization in patients with symptomatic peripheral arterial disease . Patients were r and omized to either a training group ( n = 11 , mean + /- SD , 70 + /- 6 years , 4 men , 7 women ) or a control group ( n = 9 , 66 + /- 6 years , 5 men , 4 women ) . The training sessions were completed 3 times/week , using 2 sets of various exercises , each performed for 8 - 15 repetitions . Muscle biopsies were obtained before and after 24 weeks from the medial gastrocnemius . Following the 24-week training program , the training group had significantly decreased the percentage of myosin heavy chain type IIB . The proportion of type IIB/AB fibers as measured by using myosin adenosine triphosphatase histochemistry decreased significantly in the training group . There were significant increases in type I and type II fiber areas , and capillary density also increased significantly in the training group . There were significant increases in 10 repetition maximum leg press and calf press strengths in the trained subjects . There were no significant changes in any of the measurements in the control group . It is concluded that progressive resistance training results in significant increases in muscle strength and alters skeletal muscle composition of subjects with peripheral arterial disease OBJECTIVE Resistance and endurance training result in gains in fitness in the aged . It is unclear whether the debilitated elderly can perform moderate-intensity training and whether such training results in short-term improvements in strength , endurance , and function in this population . DESIGN R and omized , controlled trial . SETTING S AND PATIENTS Subjects were from a Veterans Affairs nursing home and rehabilitation unit and a community nursing home . They were older than 60 yrs with impairment in at least one physical activity of daily living . Seventy-eight subjects volunteered and 58 ( mean age , 75 yrs ; 9 women , 49 men ) completed the intervention and initial posttest . Only one subject withdrew because of injury or disinterest . INTERVENTION Thrice-weekly resistance training ( using an isokinetic dynamometer ) and twice-weekly endurance training for 4 to 8 weeks . MAIN OUTCOMES Isometric strength in dominant arm and leg , heart rate response to timed endurance test , and activities of daily living score . RESULTS The mean change in isometric strength across the muscle movements tested was 32.8 % in the training group and 10.2 % in the control group ( difference , 22.6 % ; 95 % confidence interval , 6.2 % to 39.0 % ) . No change in heart rate during exercise was seen in the training group . Trained subjects tended to have a greater improvement in functional activity than control subjects , which was statistically significant ( p = .04 ) for those subjects who at enrollment were most dysfunctional ( i.e. , activities of daily living score less than 13 [ maximum score 26 ] ) . CONCLUSION This group of debilitated elderly patients effectively performed resistance training and increased their strength , with the most impaired gaining the most function . Few in the group could effectively perform endurance training Previous studies concerning psychological benefits of exercise among the elderly has focused predominantly on the effects of aerobic exercise . In the present study , psychological and behavioral adaptations in response to 12-weeks of strength training were examined in medically healthy but sedentary 42 older adults ( mean age = 68 years ) . The purpose of this study was to evaluate the effects of high and low intensity resistance training intensity on a ) muscular fitness , b ) psychological affect , and c ) neurocognitive functioning . Subjects were r and omly assigned to high intensity/low volume ( EXH : 2 sets of 8 to 10 repetitions for 75 to 85 % of 1 RM ) , low intensity/high volume ( EXL : 2 sets of 14 to 16 repetitions for 55 to 65 % of 1 RM ) , or no exercise control programs . Prior to and following the 12-week program , subjects underwent comprehensive physiological and psychological evaluations . Physiological assessment included measurements of blood pressure , heart rate , arm and leg muscle strength , body composition , and oxygen consumption ( VO2max ) . Psychological measures included evaluations of mood , anxiety , and physical self-efficacy as well as cognitive functioning . The results of this study indicated that both high and low intensity strength programs were associated with marked improvements in physiological fitness and psychological functioning . Specifically , subjects in the strength training programs increased overall muscle strength by 38.6 % and reduced percent body fat by 3.0 % . Favorable psychological changes in the strength-trained subjects included improvements in positive and negative mood , trait anxiety , and perceived confidence for physical capability . The treatment effects of neurocognitive functioning were not significant . In summary , this study demonstrated that participation in 12-weeks of high or low intensity strength training can improve overall physical fitness , mood , and physical self-efficacy in older adults while cognitive functioning remains constant Underst and ing the stress/strain relationship between exercise and bone is critical to underst and ing the potential benefit of exercise in preventing postmenopausal bone loss . This study examined the effect of a 2-year exercise intervention and calcium supplementation ( 600 mg ) on bone mineral density ( BMD ) in 126 postmenopausal women ( mean age , 60 + /- 5 years ) . Assignment was by block r and omization to one of three groups : strength ( S ) , fitness ( F ) , or nonexercise control ( C ) . The two exercise groups completed three sets of the same nine exercises , three times a week . The S group increased the loading , while the F group had additional stationary bicycle riding with minimal increase in loading .  Retention at 2 years was 71 % ( 59 % in the S group , 69 % in the F group , and 83 % in the C group ) , while the exercise compliance did not differ between the exercise groups ( S group , 74 + /- 13 % ; F group , 77 + /- 14 % ) . BMD was measured at the hip , lumbar spine , and forearm sites every 6 months using a Hologic 4500 . Whole body BMD also was measured every 6 months on a Hologic 2000 . There was no difference between the groups at the forearm , lumbar spine , or whole body sites . There was a significant effect of the  strength program  at the total ( 0.9 + /- 2.6 % ; p < 0.05 ) and intertrochanter hip site ( 1.1 + /- 3.0 % ; p < 0.01 ) . There was a significant time and group interaction ( p < 0.05 ) at the intertrochanter site by repeated measures . This study shows the effectiveness of a progressive strength program in increasing bone density at the clinical ly important hip site . We concluded that a strength program could be recommended as an adjunct lifestyle approach to osteoporosis treatment or used in combination with other therapies OBJECTIVE To study the effect of a home program of physical therapy . DESIGN Nonr and omized control trial . SETTING Home based . PATIENTS Subjects had total hip arthroplasty ( THA ) for hip osteoarthritis ( hip-OA ) without THA failure , or cardiopulmonary , neurological , or cognitive problems . Twenty-three subjects ( mean age 63.4 years ; mean post-THA period 793 days , 6 to 48 months ) were divided into 3 groups matching with age , gender , and postoperative periods . INTERVENTION The 6-week home program included range of motion ( ROM ) exercises , and low resistance isometric and eccentric exercises of hip abductors . Physical therapists prescribed ROM and isometric exercises for group A , all programs for group B , and no programs for the control group . The programs were modified every 2 weeks as necessary . MAIN OUTCOME MEASURE Hip ROM , maximum isometric hip abduction torque measured by Cybex II , gait speed , and cadence were evaluated . RESULTS The practice ratio of the program was about 70 % for both groups . Maximum isometric torque improved in the THA side of group A ( p < .01 ) and the control group ( p < .05 ) , and on both sides in group B ( p < .01 ) . Gait speed and cadence also improved significantly . No correlation coefficient existed between practice days and the improvement ratio of the maximum torque . CONCLUSION The home program was effective in long-term post-THA The effects of a 16-wk strength-training program on total and regional body composition were assessed by dual-energy X-ray absorptiometry ( DEXA ) , magnetic resonance imaging ( MRI ) , and hydrodensitometry in 13 untrained healthy men [ 60 + /- 4 ( SD ) yr ] . Nine additional men ( 62 + /- 6 yr ) served as inactive controls . The strength-training program result ed in substantial increases in both upper ( 39 + /- 8 % ; P < 0.001 ) and lower ( 42 + /- 14 % ; P < 0.001 ) body strength . Total fat-free mass ( FFM ) increased by 2 kg ( 62.0 + /- 7.1 to 64.0 + /- 7.2 kg ; P < 0.001 ) , and total fat mass decreased by the same amount ( 23.8 + /- 6.7 to 21.8 + /- 6.0 kg ; P < 0.001 ) when measured by DEXA . When measured by hydrodensitometry , similar increases in FFM ( 61.3 + /- 7.8 to 63.0 + /- 7.6 kg ; P < 0.01 ) and decreases in fat mass ( 23.8 + /- 7.9 to 22.1 + /- 7.7 kg ; P < 0.001 ) were observed . When measured by DEXA , FFM was increased in the arms ( 6.045 + /- 0.860 to 6.418 + /- 0.803 kg ; P < 0.01 ) , legs ( 19.416 + /- 2.228 to 20.131 + /- 2.303 kg ; P < 0.001 ) , and trunk ( 29.229 + /- 4.108 to 30.134 + /- 4.184 kg ; P < 0.01 ) , whereas fat mass was reduced in the arms ( 2.383 + /- 0.830 to 2.128 + /- 0.714 kg ; P < 0.01 ) , legs ( 7.583 + /- 1.675 to 6.945 + /- 1.551 kg ; P < 0.001 ) , and trunk ( 12.216 + /- 4.143 to 11.281 + /- 3.653 kg ; P < 0.01 ) as a result of training . ( ABSTRACT TRUNCATED AT 250 WORDS BACKGROUND Since falling is associated with serious morbidity among elderly people , we investigated whether the risk of falling could be reduced by modifying known risk factors . METHODS We studied 301 men and women living in the community who were at least 70 years of age and who had at least one of the following risk factors for falling : postural hypotension ; use of sedatives ; use of at least four prescription medications ; and impairment in arm or leg strength or range of motion , balance , ability to move safely from bed to chair or to the bathtub or toilet ( transfer skills ) , or gait . These subjects were given either a combination of adjustment in their medications , behavioral instructions , and exercise programs aim ed at modifying their risk factors ( intervention group , 153 subjects ) or usual health care plus social visits ( control group , 148 subjects ) . RESULTS During one year of follow-up , 35 percent of the intervention group fell , as compared with 47 percent of the control group ( P = 0.04 ) . The adjusted incidence-rate ratio for falling in the intervention group as compared with the control group was 0.69 ( 95 percent confidence interval , 0.52 to 0.90 ) . Among the subjects who had a particular risk factor at base line , a smaller percentage of those in the intervention group than of those in the control group still had the risk factor at the time of re assessment , as follows : at least four prescription medications , 63 percent versus 86 percent , P = 0.009 ; balance impairment , 21 percent versus 46 percent , P = 0.001 ; impairment in toilet-transfer skills , 49 percent versus 65 percent , P = 0.05 ; and gait impairment , 45 percent versus 62 percent , P = 0.07 . CONCLUSIONS The multiple-risk-factor intervention strategy result ed in a significant reduction in the risk of falling  among elderly persons in the community . In addition , the proportion of persons who had the targeted risk factors for falling was reduced in the intervention group , as compared with the control group . Thus , risk-factor modification may partially explain the reduction in the risk of falling This study was design ed to assess the effects of 18 months of resistance exercise on regional and total bone mineral density ( BMD ) and soft tissue lean mass ( STL ) in premenopausal women aged 28 - 39 r and omly assigned to an exercise or control group .  Twenty-two exercise and 34 control subjects completed the 18-month training study . All subjects were previously inactive and untrained women . Initial , 5- , 12- and 18-month assessment s were made of total and regional BMD and total and regional STL using dual energy X-ray absorptiometry . All subjects consumed a 500 mg/day elemental calcium supplement throughout the study . Initial Ca intake without supplement averaged 1,023 mg/day in total sample . Serum levels of bone osteocalcin and dietary assessment s using 12 r and omly assigned days of diet records were also completed . Muscular strength was assessed from both 1 repetition maximum ( RM ) testing of 10 weightlifting exercises and by peak torque for hip abduction/adduction and knee extension/flexion . Training increased strength by 58.1 % based on 1 RM testing and by 33.8 % based on isokinetic testing at 18 months versus baseline . BMD increased significantly above baseline at the lumbar spine for the exercise group at 5 months ( 2.8 % ) , 12 months ( 2.3 % ) , and 18 months ( 1.9 % ) as compared with controls . Femur trochanter BMD increased significantly ( p < 0.05 ) in the exercise group at 12 months ( 1.8 % ) and 18 months ( 2.0 % ) but not at 5 months ( 0.7 % ) as compared with controls . No changes in total BMD , arm BMD , or leg BMD were found . There was a 20 % increase in BGP in the exercise group as compared with controls at 5 months and this difference was maintained throughout the study . For STL , significant increases for total , arm , and leg were found at 5 , 12 , and 18 months for the exercise group versus control ranging from 1 - 6 % over baseline . These results support the use of strength training for increasing STL and muscular strength with smaller but significant regional increases in BMD in the premenopausal population The present study was design ed to identify prospect ively the individual chronic characteristics associated with falling among elderly persons and to test the hypothesis that risk of falling increases as the number of chronic disabilities increases . Seventy-nine consecutive admissions to three intermediate care facilities were evaluated . Twenty-five of the subjects became recurrent fallers . The nine risk factors included in the fall risk index were mobility score , morale score , mental status score , distant vision , hearing , postural blood pressure , results of back examination , postadmission medications , and admission activities of daily living score . A subject 's fall risk score was the number of index factors present . The proportions of recurrent fallers increased from 0 percent ( 0 of 30 ) in those with 0 to three risk factors , to 31 percent ( 11 of 35 ) in those with four to six factors , to 100 percent ( 14 of 14 ) in those with seven or more factors . Falling , at least among some elderly persons , appears to result from the accumulated effect of multiple specific disabilities . Some of these disabilities may be remediable . The  mobility test  , the best single predictor of recurrent falling , may be useful clinical ly because it is simple , recreates fall situations , and provides a dynamic , integrated assessment of mobility Objectives —There is a paucity of long term studies on exercise training in elderly women . The purpose of this study was to investigate the effects of one year of progressive resistance exercise ( PRE ) on dynamic muscular strength and the relations to bone mineral density ( BMD ) in elderly women . Methods —Forty four healthy sedentary women ( mean age 68.8 years ) volunteered for this study and were r and omly assigned to either an exercise group or a control group . The exercise group were involved in three one hour sessions a week for 52 weeks of supervised PRE to strengthen the large muscle groups of the body , while the control group were instructed to continue their normal lifestyle . The exercise circuit included three sets of eight repetitions at 75 % of one repetition maximum focused on the large muscle groups .  BMD was measured by dual energy x ray absoptiometry ( Lunar DPX ) at the lumbar spine and at three sites in the proximal femur . Other selected parameters of physical fitness were also measured . Results —Statistical analyses ( analysis of covariance ) showed significant strength gains ( p<0.01 ) in bilateral bench press ( > 29 % ) , bilateral leg press ( > 19 % ) , and unilateral biceps curl ( > 20 % ) . No significant difference between groups was evident in body weight , grip strength , flexibility , waist to hip ratio , or the sum of eight skinfolds . Significant relations ( p<0.05 ) were recorded between dynamic leg strength and the BMD of the femoral neck , Ward 's triangle , and the lumbar spine . Conclusions —Significant strength changes , after one year of PRE , were evident in elderly women , and the muscle increases may parallel changes in BMD ; however , correlation coefficients were moderate OBJECTIVES To determine the effectiveness of vitamin D and home-based quadriceps resistance exercise on reducing falls and improving the physical health of frail older people after hospital discharge . DESIGN Multicenter , r and omized , controlled trial with a factorial design . SETTING Five hospitals in Auckl and , New Zeal and , and Sydney , Australia . PARTICIPANTS Two hundred forty-three frail older people . INTERVENTIONS Patients were r and omized to receive a single dose of vitamin D ( calciferol , 300,000 IU ) or placebo tablets and 10 weeks of high-intensity home-based quadriceps resistance exercise or frequency-matched visits . MEASUREMENTS The primary endpoints were physical health according to the short-form health survey at 3 months and falls over 6 months . Physical performance and self-rated function were secondary endpoints . Assessment s took place in the participants ' homes at 3 and 6 months after r and omization and were performed by blinded assessors . RESULTS There was no effect of either intervention on physical health or falls , but patients in the exercise group were at increased risk of musculoskeletal injury ( risk ratio = 3.6 , 95 % confidence interval = 1.5 - 8.0 ) . Vitamin D supplementation did not improve physical performance , even in those who were vitamin D deficient ( < 12 ng/mL ) at baseline . CONCLUSION Neither vitamin D supplementation nor a home-based program of high-intensity quadriceps resistance exercise improved rehabilitation outcomes in frail older people after hospitalization . There was no effect of vitamin D on physical performance , and the exercises increased the risk of musculoskeletal injury . These findings do not support the routine use of these interventions at these dosages in the rehabilitation of frail older people It is considered that skeletal mass in humans may respond to loading or the number of loading cycles . The aim of this study was to examine the effect of a 1 year progressive resistance training program on the bone mass of 56 postmenopausal women . Assignment was by block r and omization to one of two resistance training groups : a strength trained group ( 3 x 8 repetition maximum ) or an endurance group ( 3 x 20 repetition maximum ) . The resistance exercises were selected to stress the ipsilateral forearm and hip region . The exercising side was r and omly assigned with one side exercised while the alternate side acted as the nonexercise control .  Bone mineral density ( BMD ) was measured every 3 months at the radial forearm and four hip sites using the Hologic QDR 2000 bone densitometer . A linear regression function was fitted for each individual 's bone density results , and the slope was compared for the exercise and control side using paired t-tests . The bone mass increase with the strength regimen was significantly greater at the trochanteric hip site ( control -0.6 + /- 2.2 % , exercise 1.7 + /- 4.1 % , p < 0.01 ) , at the intertrochanteric hip site ( control -0.1 + /- 2.1 % , exercise 1.5 + /- 3.0 % , p < 0.05 ) , Ward 's triangle ( control 0.8 + /- 5.2 % , exercise 2.3 + /- 4.0 % , p < 0.05 ) , and at the ultradistal radial site ( control -1.4 + /- 2.3 % , exercise 2.4 + /- 4.3 % , p < 0.01 ) . There was no significant increase in BMD with the endurance regimen except at the radius midsite ( control -1.0 + /- 2.3 % , exercise 0.1 + /- 1.4 % , p < 0.01 ) . In both the endurance and the strength group , muscle strength , tested by a one-repetition maximum ( 1RM ) test , increased significantly for all 10 exercises ( p < 0.01 ) and to a similar degree in the two groups . In the strength group but not the endurance group there were significant correlations between the slope of the change in BMD and the percentage increase in strength as follows : trochanter with leg press ; intertrochanter with leg press ( p < 0.05 ) ; and Ward 's triangle with hip extension and hip adduction ( p < 0.05 ) . Thus these results support the notion of a site-specific response of bone to maximal loading from resistance exercise in that although the trochanter and intertrochanter bone density was elevated by the resistance exercises undertaken , there was no effect on the femoral neck value . Postmenopausal bone mass can be significantly increased by a strength regimen that uses high-load low repetitions but not by an endurance regimen that uses low-load high repetitions . We conclude that the peak load is more important than the number of loading cycles in increasing bone mass in early postmenopausal women OBJECTIVES This investigation determined whether an in-home resistance training program achieved health benefits in older adults with disabilities . METHODS A r and omized controlled trial compared the effects of assigning 215 older persons to either a home-based resistance exercise training group or a waiting list control group . Assessment s were conducted at baseline and at 3 and 6 months following r and omization . The program consisted of videotaped exercise routines performed with elastic b and s of varying thickness . RESULTS High rates of exercise adherence were achieved , with 89 % of the recommended exercise sessions performed over 6 months . Relative to controls , subjects who participated in the program achieved statistically significant lower extremity strength improvements of 6 % to 12 % , a 20 % improvement in t and em gait , and a 15 % to 18 % reduction in physical and overall disability at the 6-month follow-up . No adverse health effects were encountered . CONCLUSIONS These findings provide important evidence that home-based resistance exercise programs design ed for older persons with disabilities hold promise as an effective public health strategy Most studies that assess the effects of exercise in the elderly involve subjects who are in good health . The objective of this prospect i ve longitudinal study was to examine the impact of exercise on cardiovascular fitness , flexibility , and strength in an elderly population that included chronically ill individuals . Patients were recruited initially from a population of veterans over 64 years of age who use a VA outpatient clinic as their regular source of care . The exercise intervention consisted of 90 minutes of exercise 3 days per week at 70 % of the patient 's maximal capacity . Activities included stationary cycling , stretching , weight training , and walking .  Of 69 patients who began the program , 49 ( 71 % ) reached 4-month follow-up . Most patients completing follow-up ( 76 % ) had at least one chronic disease , such as arthritis , hypertension , or heart disease . Patients who dropped out were more likely to have multiple chronic illnesses than those who remained in the program . Average weekly attendance was 65 % and was stable over time . Improvements in cardiovascular fitness at 4-month follow-up were significant : Metabolic equivalents increased from 7.1 + /- 2.3 to 8.3 + /- 2.6 ( P less than .001 ) , treadmill time increased from 8.5 + /- 3.8 to 11.2 + /- 4.2 minutes ( P less than .001 ) , submaximal heart rate decreased from 123.7 + /- 18.8 to 118.8 + /- 19.4 beats per minute ( P less than .001 ) and resting heart rate decreased from 68.1 + /- 10.6 to 63.3 + /- 11.6 beats per minute ( P = .005 ) . ( ABSTRACT TRUNCATED AT 250 WORDS Skeletal muscle adaptations to high intensity knee extensor strength and /or endurance training in patients with chronic heart failure were investigated . Eleven patients with chronic heart failure were r and omized into two groups and exercised the m. quadriceps femoris 3 days/week for 8 weeks . After training , the maximal exercise intensity tolerated on the ergometer cycle was raised from 99 ( 32 ) to 114 ( 40 ) watts ( W , P < 0.05 ) for all 11 patients . Peak dynamic knee extensor work rate showed the greatest increase after endurance training ( 40 % , P < 0.01 ) . Maximal dynamic and isometric strength were elevated by 40 - 45 % ( P < 0.05 ) after strength training . The cross-sectional area of m. quadriceps femoris was increased in the strength-trained legs ( 9 % , P < 0.05 ) , and the capillary per fibre ratio of m. vastus lateralis was raised by 47 and 58 % in the endurance-trained legs ( P < 0.05 ) . The oxidative enzyme activity in m. vastus lateralis was significantly raised above 50 % after endurance training , whereas glycolytic enzyme activity was unaltered . The peripheral skeletal musculature in patients with chronic heart failure adapts fairly quickly to high intensity knee extensor training . This results in a marked rise in local , and a small rise in total work capacity , indicating maintained plasticity of skeletal muscle in chronic heart failure patients OBJECTIVES This paper describes a videotaped , home-based , strength training program , titled Strong-for-Life and reports on its effectiveness in improving muscle strength , psychological well-being , and health status in a sample of older persons . DESIGN AND SETTING We enrolled 102 nondisabled , community-dwelling older people aged 66 to 87 , identified from the Medicare beneficiary list , into a r and omized , controlled trial . MEASUREMENTS Effectiveness was based on change in isokinetic upper and lower extremity muscle strength , psychologic well-being , and health status . RESULTS Results revealed several statistically significant short-term benefits after 12 to 15 weeks of exercise , especially for men . Younger older adults demonstrated a 10 % improvement in knee extensor strength relative to control subjects . Older male exercisers achieved significant differences relative to controls in perceived anger , tension , and overall social functioning . Male exercisers , in general , achieved significant improvement in perceived vigor . Women did not report psychological benefits following participation in the program . CONCLUSION Study results reveal that the Strong for Life program , design ed to be widely disseminated to the nondisabled older population , has many short-term positive benefits Decreases in muscular strength , endurance , and angular velocity have previously been demonstrated in the elderly . Osteoarthritis ( OA ) , especially of the knee , may cause further reductions in these parameters and lead to functional limitations . This study measured the effects of a quantitative progressive exercise muscle rehabilitation program ( QPE ) that was added to a physical therapy ( PT ) program .  Forty subjects ( 20 men and 20 women ) with OA of the knees were r and omly selected from a group of volunteers ( N = 437 ) for the 3-month program . Measurements of strength , endurance , angular velocity , and the Jette Functional Status Index were determined before and after 1 , 2 , and 3 months of the program . The QPE program was composed of isometric , isotonic , isotonic with resistance , endurance , and speed contractions prescribed in a progressive sequence . Muscle strength ( 14 % and 29 % ) and endurance ( 38 % and 43 % ) increased significantly ( p < 0.05 , ANOVA for repeated measures ) for both the quadriceps and hamstrings , respectively , after rehabilitation . There were marked decreases in walking time and the difficulty and pain experienced during functional activities The effects of 12 wk of progressive resistance strength training on in vivo and in vitro immune parameters were evaluated in a controlled study of eight subjects with rheumatoid arthritis ( RA ) , eight healthy young ( 22 - 30 yr ) , and eight healthy elderly ( 65 - 80 yr ) individuals . Six healthy elderly ( 65 - 80 yr ) nontraining control subjects were also evaluated to account for seasonal and psychosocial effects . Training subjects exercised at 80 % of their one-repetition maximum and performed eight repetitions per set , three sets per session on a twice weekly basis . Peripheral blood mononuclear cell ( P BMC ) sub population s , cytokine and prostagl and in ( PG ) E2 production , proliferative response , and delayed type hypersensitivity ( DTH ) skin response were measured before and after 12 wk of training . Training did not induce changes in P BMC subsets , interleukin (IL)-1 beta , tumor necrosis factor-alpha ( TNF ) , IL-6 , IL-2 , or PGE2 production , lymphocyte proliferation , or DTH response in any of the training groups , compared with control subjects . These data suggest that 12 wk of high-intensity progressive resistance strength training does not affect immune function in young or elderly healthy individuals or subjects with RA OBJECTIVE To determine the effects of heavy resistance strength training ( ST ) on resting blood pressure ( BP ) in older men and women . DESIGN Prospect i ve intervention study . SETTING University of Maryl and Exercise Science Laboratory . PARTICIPANTS Twenty-one sedentary , healthy older men ( 69 + /- 1 year , n = 11 ) and women ( 68 + /- 1 year , n = 10 ) served as subjects for the study . INTERVENTION Six months of progressive whole body ST performed 3 days per week using Keiser K-300 air-powered resistance machines . MEASUREMENTS One-repetition maximum ( 1 RM ) strength was measured for seven different exercises before and after the ST program .  Resting BP was measured on six separate occasions before and after ST for each subject . RESULTS Substantial increases in 1 RM strength were observed for upper body ( UB ) and lower body ( LB ) muscle groups for men ( UB : 215 vs 265 kg ; LB : 694 vs 838 kg ; P < .001 ) and women ( UB : 128 vs 154 kg ; LB : 441 vs 563 kg ; P < .001 ) . The ST program led to reductions in both systolic ( 131 + /- 2 vs 126 + /- 2 mm Hg , P < .010 ) and diastolic ( 79 + /- 2 vs 75 + /- 1 mm Hg , P < .010 ) BP . Systolic BP was reduced significantly in men ( 134 + /- 3 vs 127 + /- 2 mm Hg , P < .01 ) but not in women ( 128 + /- 3 vs 125 + /- 3 mm Hg , P < .01 ) , whereas diastolic BP was reduced following training in both men ( 81 + /- 3 vs 77 + /- 1 , mm Hg , P = .054 ) and women ( 78 + /- 2 vs 74 + /- 2 mm Hg , P = .055 ) . CONCLUSIONS Six months of heavy resistance ST may reduce resting BP  in older persons . According to the latest guidelines from the Joint National Committee for the Detection , Evaluation , and Treatment of Hypertension , the changes in resting BP noted in the present study represent a shift from the high normal to the normal category OBJECTIVE Muscle strength training is one of the most common therapy methods in physical therapy programs , and the usual goal of this treatment is to improve muscle strength . Little attention has been paid , however , to the effects of strength training on the other components of motor performance . This study examined the effects of a 10-week strength training program on the motor performance of the h and , including reaction time , speed of movement , tapping speed , and coordination in normal healthy volunteers . DESIGN Before-after trial . SUBJECTS AND SETTING Sixteen healthy women volunteers aged 25 to 45 years participated . INTERVENTION Subjects accomplished a 10-week muscle strength training program of the upper extremities . MAIN OUTCOME MEASURES Reaction time , speed of movement , tapping speed , and coordination were measured three times on consecutive days , and muscle strength and electromyographic values of the right upper extremity were recorded once before the training period . After the training period , the same measurements were made as before the training . RESULTS The 10-week strength training decreased choice reaction time by 6 % ( p < .01 ) and increased tapping speed by 3 % ( p < .01 ) and coordination by 5 % ( p < .05 ) . Speed of movement increased , but this change was not statistically significant . All the measured isometric muscle strengths and electromyographic activations upon maximum isometric contraction increased . CONCLUSIONS A 10-week strength training of the upper extremities increased muscle strength and some motor performance functions of the h and , including choice reaction time , tapping speed , and coordination Tests of vision , vestibular function , peripheral sensation , strength , reaction time , balance and gait were administered to 183 community-dwelling women aged 22 - 99 years .  Walking speed , stride length and cadence declined with age with corresponding increases in stance duration and percentage of the stride in the stance phase . Visual acuity and contrast sensitivity , tactile and vibration sense in the lower limb , vestibular function ( as assessed by the vestibular X Writing Test ) , quadriceps and ankle dorsiflexion strength and reaction time were significantly associated with all five gait parameters . Postural sway measures were associated with walking speed , stride length and percentage of the stride in the stance phase . Multiple regression analyses revealed seven sensori-motor measures as significant predictors for one or more of the gait parameters : low contrast visual acuity , tactile sensitivity , vibration sense , vestibular X-test writing performance , quadriceps strength , reaction time and sway . Quadriceps strength was included as a predictor variable for every gait parameter and in each case had the strongest beta weight . Women who fell on two or more occasions in a one-year prospect i ve period had significantly reduced and more variable cadence and significantly increased stance duration ( measured in absolute terms and as a percentage of stride ) than those who did not fall or fell on one occasion only . The study findings eluci date the relative importance of specific physiological systems in the maintenance of normal gait and identify temporal gait measures that are associated with falling in older people A pilot controlled trial was conducted to determine the feasibility of testing an exercise program as a means of improving balance in aged women . A r and om sample of 50 women more than 65 years old was recruited from two apartment buildings . The buildings were r and omized to serve as exercise and control sites . The 24 exercisers did not differ significantly from the 26 controls except that they were better educated and had better vision . The median compliance was 85 % of requested sessions attended by the exercisers . Follow-up measures were obtained in 92 % and 81 % of the exercise and control groups , respectively . The outcome variables studied were changes in sway ( areas and velocity of the center of force as measured using a biomechanics platform ) in four stances with eyes open or closed , on two feet , or on one foot . After 16 weeks , in stances on one foot , exercisers had smaller areas compared to controls with eyes open , but larger areas with eyes closed . Subgroup analysis indicated that compliance with the exercise program was a determinant of degree of change in the area measures . The inconsistent effect of exercise on area measures of sway in this study may be due to ( a ) lack of statistical power to detect between-group differences , ( b ) inadequate compliance with the exercise program , ( c ) baseline differences between the two groups at r and omization , and ( d ) ineffective or inadequate duration of the exercise program . We conclude that controlled clinical trials to study the effect of exercise on balance measures in community-dwelling elderly women are feasible . ( ABSTRACT TRUNCATED AT 250 WORDS 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 OBJECTIVES The objectives of this study were to determine the effects of a strength-training program on walking speed and relative muscular stress , as measured by normalized integrated electromyographic ( nIEMG ) activity , while carrying a box of groceries and st and ing from a chair . DESIGN Prospect i ve intervention study . SETTING Volunteer subjects from the community of Birmingham , Alabama . PARTICIPANTS Fourteen healthy women aged 60 to 77 years . INTERVENTION Sixteen weeks of total body strength conditioning . MEASUREMENTS Before and after 16 weeks of strength conditioning , the following variables were evaluated for all subjects : ( 1 ) strength , six isotonic tests and two isometric tests ; ( 2 ) walking velocity ; ( 3 )  nIEMG of the biceps while carrying a box of groceries ;  and ( 4 )  nIEMG of the rectus femoris while st and ing from a chair .  MAIN RESULTS After the strength training program , subjects ' isotonic strength increased significantly , an average of 52 % on the isotonic tests and 31 % on the isometric tests . Walking velocity also increased significantly ( 18 % ) . nIEMG of the biceps decreased 36 % while carrying a box of groceries . Rectus femoris nIEMG decreased 40 % while st and ing and 47 % while sitting . CONCLUSIONS After strength conditioning , healthy older women showed not only substantially increased strength but also improvements in walking velocity and the ability to carry out daily tasks such as rising from a chair and carrying a box of groceries PURPOSE This r and omized controlled study assessed whether adding a program of high-intensity strength training ( 80 % of maximum ) to an outpatient cardiac rehabilitation program would be a safe and effective means of improving muscle strength and body composition . METHODS Thirty-eight cardiac patient volunteers ( 29 men and 9 women ) were r and omized  to either high-intensity strength training or flexibility training added concurrently to a 12-week outpatient cardiac rehabilitation aerobic exercise program .  Muscle strength , local muscle endurance , joint flexibility , maximum treadmill tolerance time , and body composition were measured before and after completion of the training . RESULTS The strength-trained patients ( n = 18 ) had greater increases in mean strength ( 90 + /- 19 % versus 9 + /- 4 % , P < 0.0001 ) and local muscle endurance ( 20 versus 6 times , P < 0.0001 ) , and decreases in mean perceived exertion for lifting the initial one repetition maximum load ( 11 + /- 1 versus 15 + /- 1 , P < 0.0001 ) when compared with flexibility-trained patients ( n = 16 ) . The strength group lost more body fat ( 2.8 + /- 2.0 versus 1.3 + /- 2.0 kg , P < 0.01 ) , tended to gain more lean tissue ( 1.5 + /- 2.3 versus 0.5 + /- 1.2 kg , P < 0.10 ) , and had greater improvements in treadmill time ( 2.3 + /- 1.3 versus 1.2 + /- 1.0 minute , P < 0.02 ) than did the flexibility group . Improvements in joint flexibility were similar for each group . None of the subjects had evidence of cardiac ischemia or arrhythmia during the training sessions . CONCLUSIONS Medically supervised high-intensity strength training is well tolerated when added to the aerobic training of cardiac rehabilitation programs and allows patients to aggressively gain the strength and endurance they will need to complete daily living tasks at lower perceived efforts . Strength training also reduces cardiac risk factors by improving body composition and maximum treadmill exercise time OBJECTIVE --To determine the effectiveness of group- vs home-based exercise training of higher and lower intensities among healthy , sedentary older adults . DESIGN --Year-long r and omized , controlled trial comparing ( 1 ) higher-intensity group-based exercise training ; ( 2 ) higher-intensity home-based exercise training ; ( 3 ) lower-intensity home-based exercise training ; or ( 4 ) assessment -only control . SETTING --General community located in northern California . PARTICIPANTS --One hundred sixty women and 197 men 50 to 65 years of age who were sedentary and free of cardiovascular disease . One out of nine persons contacted through a community r and om-digit-dial telephone survey and citywide promotion were r and omized . INTERVENTIONS --For higher-intensity exercise training , three 40-minute endurance training sessions per week were prescribed at 73 % to 88 % of peak treadmill heart rate . For lower-intensity exercise training , five 30-minute endurance training sessions per week were prescribed at 60 % to 73 % of peak treadmill heart rate . MAIN OUTCOME MEASURES --Treadmill exercise test performance , exercise participation rates , and heart disease risk factors . RESULTS --Compared with controls , subjects in all three exercise training conditions showed significant improvements in treadmill exercise test performance at 6 and 12 months ( P less than .03 ) . Lower-intensity exercise training achieved changes comparable with those of higher-intensity exercise training . Twelve-month exercise adherence rates were better for the two home-based exercise training conditions relative to the group-based exercise training condition ( P less than .0005 ) . There were no significant training-induced changes in lipid levels , weight , or blood pressure . CONCLUSIONS --We conclude that ( 1 ) this community-based exercise training program improved fitness but not heart disease risk factors among sedentary , healthy older adults ; ( 2 ) home-based exercise was as effective as group exercise in producing these changes ; ( 3 ) lower-intensity exercise training was as effective as higher-intensity exercise training in the home setting ; and ( 4 ) the exercise programs were relatively safe The purpose of this study was to examine the effects of a 14-week resistance training program on the anile strength training intensity , postural control , and gait velocity of older adults . Forty-two older adults ( mean age = 72 ) , 21 in the resistance and control groups , completed the 14-week project . The resistance training group participated in 14 weeks of resistance training three times per week using elastic b and s ( Therab and ) for resistance .  Isokinetic ankle strength , training intensity , postural stability , and gait velocity were measured prior to and following the 14-week intervention . Following the training , the resistance group exhibited improved ankle dorsiflexion , training resistances , and gait velocity , but showed no change in plantar flexion or postural control . The control group also exhibited improvements in dorsiflexion , but these gains were approximately one-half of the gains observed in the resistance training group . Finally , when adjusted for baseline differences , subjects in the resistance training group demonstrated no changes in the dependent measures over the control group OBJECTIVE To assess the effect of a home based exercise programme , design ed to improve quadriceps strength , on knee pain and disability . Methods —191 men and women with knee pain aged 40–80 were recruited from the community and r and omised to exercise ( n=113 ) or no intervention ( n=78 ) . The exercise group performed strengthening exercises daily for six months . The primary outcome measure was change in knee pain ( Western Ontario McMaster Osteoarthritis index ( WOMAC ) ) . Secondary measures included visual analogue scales ( VAS ) for pain on stairs and walking and WOMAC physical function scores . Results —WOMAC pain score reduced by 22.5 % in the exercise group and by 6.2 % in the control group ( between group difference p<0.05 , unpairedt test).VAS scores for pain also reduced in the exercise group compared with the control group ( p<0.05 ) . Physical function scores reduced by 17.4 % in the exercise group and were unchanged in controls ( p<0.05 ) . Conclusion —A simple programme of home quadriceps exercises can significantly improve self reported knee pain and function OBJECTIVE To determine the effect of a home exercise program on strength , postural control , and mobility following hip fracture . DESIGN R and omized controlled trial of 1 month 's duration . SETTING Daily exercise carried out within the subjects ' home environments . PARTICIPANTS Forty-two people 64 to 94 years of age , 35 of whom were living independently in the community and 7 of whom were residing in institutional care . Subjects were recruited on average 7 months after a fall-related hip fracture and r and omly allocated to either the intervention or the control group ( n = 21 each ) . The groups were well matched in terms of medical conditions , medication use , disability , and activity levels . INTERVENTION A " home-based " program of weight-bearing exercise established at a visit by a physiotherapist . MAIN OUTCOME MEASURES Quadriceps strength , postural sway , functional reach , weight-bearing ability , walking velocity , and self-rated fall risk . The subjects undertook these assessment s at the beginning and end of the trial . RESULTS At pretest , exercisers and controls performed similarly in all tests . At the end of the trial , the intervention group showed significantly greater quadriceps strength in the affected ( hip-fractured ) leg and increased walking velocity . The intervention subjects also improved their weight-bearing ability and reported reduced subjective falls risk . In contrast , there were no significant improvements in any of the test measures in the controls . Within the intervention group , improvements in quadriceps strength were significantly associated with improved performances in the weight-bearing test measures and with increased walking velocity . CONCLUSIONS This exercise program improved strength and mobility following hip fracture . Further research is needed to ascertain whether the extent of this improvement in these fall risk factors is sufficient to prevent falls BACKGROUND Strength loss is strongly associated with functional decline and is reversible with exercise . The effect of increased strength on function has not been clearly established . The purpose of this study was to determine whether strength gain is associated with improvement in physical performance and disability . METHODS One hundred functionally impaired community-dwelling men and women ( 77.6 + /- 7.6 yrs ) were tested at baseline and outcome for lower extremity strength , physical performance , and disability . After r and om group assignment , exercise participants received strengthening exercises in their homes three times a week for 10 weeks while control subjects continued their normal activities . Using multiple regression techniques , the relationship between strength gain and improvement in physical performance and disability was assessed , controlling for age , depression , and baseline strength . RESULTS A significant impact of strength gain on mobility skills ( p = .0009 ) was found . The impact of strength gain on chair rise performance was significant in participants who were more impaired ( p = .04 ) . Strength gain was associated with gain in gait speed ( p = .02 ) and in falls efficacy ( p = .05 ) , but not with other balance , endurance , or disability measures . CONCLUSIONS Lower extremity strength gain is associated with gains in chair rise performance , gait speed , and in mobility tasks such as gait , transfers , stooping , and stair climbing , but not with improved endurance , balance , or disability . Strength gain is also associated with improvement in confidence in mobility . Factors that may influence the ability of strength gain to affect function are initial level of frailty and specificity of exercise . These results support the idea that strength training is an intervention that can potentially improve physical health status in many frail elders To investigate the effects of cessation and subsequent resumption of training on muscle strength in elderly men , 11 men ( aged 65 - 77 years ) , just completing a 24-week r and omized controlled trial of recombinant human growth hormone ( rhGH ) and resistance exercise ( rhGH  , n = 6 ; placebo , n = 5 ) , detrained for 12 weeks and subsequently retrained for 8 weeks . During the detraining and retraining phase , subjects did not receive rhGH . The resistance programme included three sets of eight repetitions at 75 % of one-repetition maximum ( 1-RM ) , three times per week , for 10 upper and lower body exercises .  Dynamic muscle strength was assessed by the 1-RM method every 2 weeks for 44 weeks . Needle biopsies of vastus lateralis muscle were obtained from seven men . Muscle strength increased during initial training by 40.4 + /- 5.5 % ( mean + /- SEM ) , ranging from 26.0 + /- 5.0 to 83.9 + /- 15.6 % , depending on muscle group . Increased strength was accompanied by hypertrophy ( P < 0.05 ) of type I ( 17.4 + /- 4.1 % ) and II ( 25.8 + /- 12.4 % ) muscle fibres . Of initial strength gains , only 29.9 + /- 5.2 % was lost with detraining . However , type I and II fibre cross-sectional area reverted to pretraining values . After 8 weeks of retraining , muscle strength returned to trained values , but without a significant change in fibre morphology . The results indicate that elderly men lose some muscle strength following short-term detraining , but that only a brief period of retraining suffices to regain maximal strength . Reversal of fibre cross-sectional area with detraining , and only modest improvement with retraining , suggests that much of the retention in strength with detraining and reacquisition of lost strength with retraining reflects neural adaptation PURPOSE This study examined the effects of 24 wk of high intensity strength training or low intensity walking on lumbar bone mineral density ( BMD ) , muscular strength , and calcium turnover in Australian women either taking hormone replacement therapy ( HRT ) or not taking HRT .  METHODS A subject pool of 64 women between 45 - 65 yr and r and omly allocated into weights ( N = 21 ) , walking ( N = 20 ) , weightsHRT ( N = 14 ) , and walkingHRT ( N = 9 ) groups completed this study . All subjects trained twice weekly in either a 50-min walking or weight-training program ( 60 - 90 % IRM ) . Measurements included maximal isometric knee strength , IRM bench press , IRM squat , isokinetic back strength , lumbar ( L2-L4 ) BMD , serum osteocalcin , and urinary deoxypyridinoline crosslinks ( Dpd ) . RESULTS No significant group differences in BMD were evident at the completion of training . However , a significant ( P < 0.05 ) within group change was apparent for the walking group since BMD decreased 1.3 % below baseline testing . Osteocalcin levels increased significantly ( P < 0.05 ) in the walking ( 22 % ) group . Maximal bench press and squat strength improved significantly ( P < 0.05 ) in the weights ( 25.8 % and 37.7 % ) and weightsHRT ( 25.4 % and 35.7 % ) groups . The weights group also increased significantly ( P < 0.05 ) in isokinetic back strength ( 22.2 % ) . CONCLUSION It was concluded that short-term high intensity resistance training provides an effective means for increasing muscular strength in women between 45 and 65 yr . The training effects on lumbar BMD were not apparent in the present study Knowledge of the effects of exercise on bone mass in postmenopausal women is limited and controversial . Animal studies have shown that the response of bone to bending strain is an alteration of bone geometry . We studied 250 postmenopausal women , aged 52 - 72 years , willing to participate in a 6-month exercise program .  The first 125 started the program immediately and the remaining 125 served as controls . The training program included exercises design ed to maximize the stress on the wrist . One hundred and eighteen of the active group and 116 of the control group completed the study and were reassessed 6 months later . Bone mineral density ( BMD ) of the femoral neck , lumbar spine , ultradistal and proximal radius was measured by dual-energy X-ray absorptiometry ( DXA ) both before and at the end of the exercise program . The forearm was also evaluated by peripheral quantitative computed tomography , which measures the area , bone mineral content ( BMC ) , and volumetric density for both the cortical and the trabecular component . The results showed that the DXA measurements at the femoral neck , lumbar spine , ultradistal and proximal radius were similar between the two groups . No significant difference was detected after the exercise program at the proximal radius . At the ultradistal radius , the cross-sectional area of cortical bone rose by 2.8 + /- 15.0 % ( SD , p < 0.05 ) , apparently for both periosteal apposition and corticalization of the trabecular tissue . The volumetric density of cortical bone rose by 2 . 2 + /- 15.8 % ( p < 0.1 ) , and that of trabecular bone decreased by 2.6 + /- 10.7 % ( p < 0.01 ) . The combined changes in both bone volume and density in the exercise group were associated with marked increase in cortical BMC ( 3.1 + /- 10.7 % , p < 0.01 ) and decrease in trabecular BMC ( -3.4 + /- 14.2 % , p < 0.05 ) , which were statistically different from those observed in the control group ( p < 0.05 ) . In conclusion , these results confirm that site-specific moderate physical exercises have very little effect on bone mass . However , it appears that some exercises may reshape the bone segment under stress by increasing both the cross-sectional area and the density of the cortical component . These structural changes are theoretically associated with increases in the bending strength This study was design ed to determine whether an 8-week isokinetic muscle-strength-training program improved the functional health status of patients with osteoarthritis of the knee joint . Twenty volunteers with osteoarthritis of the knee joint were r and omly assigned to either an experimental ( n=10 ) or control ( n=10 ) group . The experimental group completed six sets of five maximal contractions three times per week for 8 weeks on a Cybex II dynamometer at 90 degrees per second . Both groups were pre- and posttest for extension and flexion strength of the right and left legs , the 50-foot walk time , range of motion at the knee joint , the Osteoarthritis Screening Index ( OASI ) , and the Arthritis Impact Measurement Scale ( AIMS ) . There was a significant decrease in pain and stiffness , and a significant increase in mobility . There was also a significant decline in arthritis activity in the experimental group as measured by the OASI and AIMS . The experimental group significantly increased in all strength measures , while the control group increased in only right leg flexion and left leg extension across the training period BACKGROUND Although disuse of skeletal muscle and undernutrition are often cited as potentially reversible causes of frailty in elderly people , the efficacy of interventions targeted specifically at these deficits has not been carefully studied . METHODS We conducted a r and omized , placebo-controlled trial comparing progressive resistance exercise training , multinutrient supplementation , both interventions , and neither in 100 frail nursing home residents over a 10-week period . RESULTS The mean ( + /- SE ) age of the 63 women and 37 men enrolled in the study was 87.1 + /- 0.6 years ( range , 72 to 98 ) ; 94 percent of the subjects completed the study .  Muscle strength increased by 113 + /- 8 percent in the subjects who underwent exercise training , as compared with 3 + /- 9 percent in the nonexercising subjects ( P < 0.001 ) . Gait velocity increased by 11.8 + /- 3.8 percent in the exercisers but declined by 1.0 + /- 3.8 percent in the nonexercisers ( P = 0.02 ) . Stair-climbing power also improved in the exercisers as compared with the nonexercisers ( by 28.4 + /- 6.6 percent vs. 3.6 + /- 6.7 percent , P = 0.01 ) , as did the level of spontaneous physical activity . Cross-sectional thigh-muscle area increased by 2.7 + /- 1.8 percent in the exercisers but declined by 1.8 + /- 2.0 percent in the nonexercisers ( P = 0.11 ) . The nutritional supplement had no effect on any primary outcome measure . Total energy intake was significantly increased only in the exercising subjects who also received nutritional supplementation . CONCLUSIONS High-intensity resistance exercise training is a feasible and effective means of counteracting muscle weakness and physical frailty in very elderly people . In contrast , multi-nutrient supplementation without concomitant exercise does not reduce muscle weakness or physical frailty We examined the effects of 42 weeks of progressive weight-lifting training on dynamic muscle strength , peak power output in cycle ergometry , symptom limited endurance during progressive treadmill walking and stair climbing , knee extensor cross-sectional areas , and bone mineral density and content in healthy males and females aged 60 - 80 years , currently enrolled in a 2-year resistance training program . Subjects were r and omized into either exercise ( EX ) or control ( CON ) groups ( 60 - 70 years : 38 males and 36 females ; 70 - 80 years : 25 males and 43 females ) . EX trained several muscle groups twice per week for 42 weeks at intensities ranging from 50 - 80 % of the load that they could lift once only ( 1 RM ) ; CON did usual daily activities . After the 10 months there was no change in 1 RM strength in CON , but significant gains ( mean increases up to 65 % ) in EX ( no independent age or gender effects ) ; 30 % and 47 % of the increase in 1 RM had occurred by 6 and 12 weeks , respectively . In EX , the 7.1 % increase in peak cycling power output was significantly greater than in CON ( + 1.1 % ) . The 17.8 % improvement in symptom limited treadmill walking endurance was also greater than in CON ( + 3.4 % ) , but the difference between groups during stair climbing was not significant ( EX + 57 % , CON + 33 % ) . The cross-sectional areas of the knee extensors increased significantly by 5.5 % in EX but were unchanged in CON . There were no changes in bone mineral density or content in either group . We conclude that long-term resistance training in older people is feasible and results in increases in dynamic muscle strength , muscle size , and functional capacity The aim of the present study was to evaluate the effects of a 16-week progressive high-intensity strength training ( HIST ) program on peripheral markers of bone turnover ( bone Gla protein , BGP ; bone alkaline phosphatase , B-AP ; N-terminal propeptide of type I procollagen , PINP ; C-terminal cross-linked telopeptide of type I collagen , ICTP ) in healthy , elderly men over 65 yr of age . Thirty healthy men ( aged 65–81 yr ) , performing light to moderate daily physical activity , were r and omly divided into two groups . Group 1 ( no.=16 ) followed a supervised 16-week progressive HIST program , while subjects of group 2 ( no.=14 ) , used as controls , were requested to maintain their habitual level of physical activity for 16 weeks . HIST program consisted of 6 different sets of exercise ( 2 involving the major muscle groups of the lower limb and 4 involving those of the upper limb ) . Three sessions/week , during which 10 repetitions of each exercise set were completed , were performed . Lower limb exercises shifted from 50 to 80 % of the one maximal repetition ( 1MR ) during the first month of the protocol and were thereafter maintained at an intensity of 80 % 1MR throughout the training . Upper limb exercises shifted from 40 to 65 % of 1MR with a similar pattern . All sessions were preceded by 15 min of cycloergometer exercise at 50 % of maximal oxygen uptake and by a warm-up of 15 repetitions at 20 % of 1MR of each exercise set . The HIST program did not significantly change BGP ( mean±SE , before : 15.6±1.2 μg/l vs after : 16.0±1.2 μg/l , NS ) and PINP levels ( before : 44.6±6.7 μg/l vs after : 43.1±6.0 μg/l , NS ) . On the contrary , serum B-AP significantly increased ( before : 50.2±6.1 IU/l vs after : 62.3±7.0 IU/l , p<0.001 ) and serum ICTP slightly reduced ( before : 4.0±0.3 μg/l vs after : 3.8±0.3 μg/l , p<0.05 ) . When bone turnover was expressed as the ratio between bone formation to bone resorption ( B-AP/ICTP ratio ) , a significant improvement in this ratio was found in all subjects of group 1 ( before : 12.9±1.3 IU/μg vs after : 17.3±1.5 IU/μg , p<0.0001 ) , while no significant changes were observed in Group 2 . No significant changes of IGF-I levels were observed after the HIST program ( before : 94.9±9.4 μg/l vs after : 89.9±9.7 μg/l ) . No significant changes of BGP , PINP , B-AP , ICTP , B-APICTP ratio and IGF-I levels were observed in controls ( group 2 ) during the 16 weeks of observation . Although the positive effects of a progressive HIST program  on B-AP levels and B-AP-ICTP ratio seem promising , the support of bone mass measurement and the determination of other bone markers are requested to better identify exercise protocol ( duration , intensity ) for elderly people PURPOSE The recommendations for exercise training and physical activity for older adults include cardiovascular and resistance training components ( CVT and RT , respectively ) . The purpose of the present investigation was to compare the fitness benefits of concurrent CVT and RT with those attained through an equivalent duration of CVT or RT alone . METHODS Thirty-six participants ( ages 60 - 84 ) were assigned to a control group or to one of three exercise treatment groups . The treatment groups exercised three times per week for 12 wk using RT ( N = 11 ) , CVT ( N = 10 ) , or CVT and RT ( BOTH , N = 9 ) . Pre- and post-training , participants performed a submaximal exercise test ( GXT ) , five repetition-maximum strength tests ( 5RM ) , and the AAHPERD functional fitness test for older adults . RESULTS All exercise treatment groups revealed lower resting heart rate and rate-pressure product ; lower exercise diastolic blood pressure and rating of perceived exertion ; increased GXT duration ; increased leg , back , and shoulder 5RM scores ; and improved AAHPERD flexibility , coordination , and cardiovascular endurance scores . The exercise treatment groups responded differently on the following : RT and BOTH enhanced arm and chest strength more than CVT ; and BOTH enhanced AAHPERD strength and agility scores more than CVT or RT . CONCLUSIONS Concurrent CVT and RT is as effective in eliciting improvements in cardiovascular fitness and 5RM performance as CVT or RT , respectively . Moreover , incorporating both CVT and RT in exercise programs for older adults may be more effective in optimizing aspects of functional fitness than programs that involve only one component This study tested whether a 12-week dynamic resistance strength training program can change gait velocity and improve measures of balance among adults age 65 and older . Fifty-five community-dwelling adults ( mean age = 71.1 ) were r and omized into an exercise ( n = 25 ) or control ( n = 30 ) group . The exercisers were requested to complete three bouts of strength training per week for 12 weeks using elastic tubing . At posttest the exercisers demonstrated slower gait velocity , enhanced balance , and an improved ability to walk backward , although none of these posttest measures was significantly different from the control group Fifty female subjects , aged 72 - 92 ( mean 82 ) years , were enrolled in a 12-week ( 36 classes ) exercise program aim ed at increasing postural stability . Subjects were residents of sheltered apartments , rest homes or nursing homes , well enough and mobile enough to participate in the classes . The subjects were r and omized into an exercise or a control group . Their postural sway , st and ing at rest on a force platform , was measured with eyes open and eyes closed . The groups were well matched in all respects . The results showed no improvement in the postural sway as a result of the exercise program . We hypothesize that increasing postural sway in the elderly represents a deterioration in , for the most part , the nervous system and may at this extreme of life indicate an irreversible loss of function . For this reason no improvement in postural sway may be possible Twenty active elderly subjects ( mean age = 66.4 years , range 51 - 81 ) participated in a 12-week weight-training program to determine the possibility of increasing muscular strength and lean body weight . The training utilized variable resistance weight machines which trained the major muscle groups . The male subjects ( n = 11 ) experienced an average increase of 66.1 % ( SD = 19.39 , p < 0.00001 ) in total maximum weight lifted while the females ( n = 9 ) showed an average increase of 72.2 % ( SD = 33.44 , p < 0.001 ) . Lean body weight , which was calculated by skinfold measurements for each group did increase , but was not statistically significant ( males p < 0.11 , females p < 0.18 ) . The study demonstrated the positive effects a weight-training regimen can have on an elderly population Left ventricular function and hemodynamic alterations at rest were measured echocardiographically following running or isometric training in 40 healthy elderly . They were r and omly assigned into two groups . Twenty ( 67 + /- 4 years ) were engaged in running and 20 ( 67.8 + /- 3.8 years ) in isometric training programs . All subjects underwent a 12-week program , 3 times a week 30 min each session . The running exercise ( REX ) group had an aerobic exercise conditioning program at 70 % of their VO2max . The program for the isometric exercise ( IEX ) group included weight lifting utilizing large muscle mass at 30 % of their maximal voluntary contraction . After training , the REX group increased significantly ( p less than 0.05 ) their VO2max from 2.08 + /- 0.37 to 2.36 + /- 0.41 liter/min and ejection fraction 56 + /- 5.9 to 62 + /- 6.1 % . They decreased significantly their heart rate , from 73 + /- 7 to 65 + /- 7 beats/min . No change occurred in the IEX group in left ventricular function and hemodynamic parameters . These data suggest that left ventricular responses at rest differ between the two groups following a short-term training with a favorable response after REX training . In addition , this study demonstrated that a controlled aerobic training program is a better way to improve physical capacity than is a weight lifting program for trained healthy elderly
target: PRT results in improvements to muscle strength and some aspects of functional limitation , such as gait speed , in older adults .
  However , based on current data , the effect of PRT on physical disability remains unclear .
  Further , due to the poor reporting of adverse events in trials , it is difficult to evaluate the risks associated with PRT
background: BACKGROUND The aim of this systematic review was to quantify the effectiveness of progressive resistance strength training ( PRT ) to reduce  physical disability in older people .