title: Effects of muscle strength training and megestrol acetate on strength, muscle mass, and function in frail older people. Reducing frailty and falls in older persons: an investigation of Tai Chi and computerized balance training. Atlanta FICSIT Group. Frailty and Injuries: Cooperative Studies of Intervention Techniques. Exercise training for rehabilitation and secondary prevention of falls in geriatric patients with a history of injurious falls. Strength prior to endurance intra-session exercise sequence optimizes neuromuscular and cardiovascular gains in elderly men The prevalence of frailty syndrome in an older population from Spain. The Toledo study for healthy aging Community-based group exercise improves balance and reduces falls in at-risk older people: a randomised controlled trial. Effects of high-speed power training on functional capacity and muscle performance in older women Integration of balance and strength training into daily life activity to reduce rate of falls in older people (the LiFE study): randomised parallel trial Effectiveness of tai chi as a community-based falls prevention intervention: a randomized controlled trial. Attenuation of cardiovascular adaptations to exercise in frail octogenarians. Once weekly combined resistance and cardiovascular training in healthy older men. Community-based exercise program is cost-effective by preventing care and disability in Japanese frail older adults. Long-term effects of three multicomponent exercise interventions on physical performance and fall-related psychological outcomes in community-dwelling older adults: a randomized controlled trial. Two years later: a prospective long-term follow-up of a training intervention in geriatric patients with a history of severe falls. Effects of exercise training on frailty in community-dwelling older adults: results of a randomized, controlled trial. The Performance Enhancement Project: improving physical performance in older persons. Cardiovascular responses of 70- to 79-yr-old men and women to exercise training. Intense tai chi exercise training and fall occurrences in older, transitionally frail adults: a randomized, controlled trial. The effect of group exercise on physical functioning and falls in frail older people living in retirement villages: a randomized, controlled trial. 3 Different types of strength training in older women. Growth hormone administration and exercise effects on muscle fiber type and diameter in moderately frail older people. Dehydroepiandrosterone combined with exercise improves muscle strength and physical function in frail older women. A randomized, controlled trial of quadriceps resistance exercise and vitamin D in frail older people: the Frailty Interventions Trial in Elderly Subjects (FITNESS). Effects of exercise and amino acid supplementation on body composition and physical function in community-dwelling elderly Japanese sarcopenic women: a randomized controlled trial. Effects of traditional physical training and visual computer feedback training in frail elderly patients. A randomized intervention study. Short-term, light- to moderate-intensity exercise training improves leg muscle strength in the oldest old: a randomized controlled trial. Exercise training and nutritional supplementation for physical frailty in very elderly people.
abstract: OBJECTIVES To determine the independent and combined effects of progressive resistance muscle strength training ( PRMST ) and megestrol acetate ( MA ) on strength , muscle mass , and function in older recuperative care patients . DESIGN Double-blind , r and omized , controlled intervention using a two-by-two factorial design and conducted between 1999 and 2001 . SETTING University-affiliated Department of Veterans Affairs hospital . PARTICIPANTS Twenty-nine patients ( mean age 79.4 + /- 7.4 , 90 % white ) aged 65 and older and had recent functional decline . INTERVENTIONS After r and omization to one of four treatment groups ( low-resistance exercises plus 800 mg per day of MA or a placebo or high-intensity PRMST plus 800 mg/d of MA or placebo ) , subjects received training and the drug or placebo for 12 weeks . MEASUREMENTS Change in muscle strength , mid-thigh muscle area , and aggregate functional performance score as assessed using analysis of covariance . RESULTS Five subjects withdrew from the study before its completion . Based on intent-to-treat analyses , subjects who received high-intensity PRMST and placebo experienced the greatest strength gains . The addition of MA was associated with worse outcomes than with high-intensity exercise training alone , especially with regard to the leg exercises . Post hoc analysis demonstrated that subjects who received high-intensity PRMST and placebo experienced significantly greater percentage increases in leg strength than subjects in either of the MA treatment groups ( P<.05 for each comparison ) . There was also a significant negative effect of MA on physical function . In general , subjects who received MA experienced a deterioration in aggregate physical function scores , whereas the remaining subjects improved ( -0.80+/-0.40 vs 0.48+/-0.41 , P=.04 ) . There was not a significant interaction between exercise and MA for any outcome . CONCLUSION High-intensity PRMST is a safe and well-tolerated exercise regimen for frail elderly patients . The addition of MA appears to blunt the beneficial effects of PRMST , result ing in less muscle strength and functional performance gains OBJECTIVE To evaluate the effects of two exercise approaches , Tai Chi ( TC ) and computerized balance training ( BT ) , on specified primary outcomes ( biomedical , functional , and psychosocial indicators of frailty ) and secondary outcomes ( occurrence of falls ) . DESIGN The Atlanta FICSIT ( Frailty and Injuries : Cooperative Studies of Intervention Techniques ) , a prospect i ve , r and omized , controlled clinical trial with three arms ( TC , BT , and education [ ED ] . Intervention length was 15 weeks , with primary outcomes measured before and after intervention and at 4-month follow-up . Falls were monitored continuously throughout the study . SETTING Persons aged 70 and older living in the community . PARTICIPANTS A total of 200 participants , 162 women and 38 men ; mean age was 76.2 . MEASUREMENTS Biomedical ( strength , flexibility , cardiovascular endurance , body composition ) , functional ( IADL ) , and psychosocial well-being ( CES-D scale , fear of falling question naire , self-perception of present and future health , mastery index , perceived quality of sleep , and intrusiveness ) variables . RESULTS Grip strength declined in all groups , and lower extremity range of motion showed limited but statistically significant changes . Lowered blood pressure before and after a 12-minute walk was seen following TC participation . Fear of falling responses and intrusiveness responses were reduced after the TC intervention compared with the ED group ( P = .046 and P = .058 , respectively ) . After adjusting for fall risk factors , TC was found to reduce the risk of multiple falls by 47.5 % . CONCLUSIONS A moderate TC intervention can impact favorably on defined biomedical and psychosocial indices of frailty . This intervention can also have favorable effects upon the occurrence of falls .  Tai Chi warrants further study as an exercise treatment to improve the health of older people OBJECTIVE To determine the safety and efficacy of an exercise protocol design ed to improve strength , mobility , and balance and to reduce subsequent falls in geriatric patients with a history of injurious falls . DESIGN A r and omized controlled 3-month intervention trial , with an additional 3-month follow-up . SETTING Out-patient geriatric rehabilitation unit . PARTICIPANTS Fifty-seven female geriatric patients ( mean age 82 + /- 4.8 years ; range 75 - 90 ) admitted to acute care or inpatient rehabilitation with a history of recurrent or injurious falls including patients with acute fall-related fracture . INTERVENTION Ambulatory training of strength , functional performance , and balance 3 times per week for 3 months . Patients of the control group attended a placebo group 3 times a week for 3 months . Both groups received an identical physiotherapeutic treatment 2 times a week , in which strengthening and balance training were excluded . MEASUREMENTS Strength , functional ability , motor function , psychological parameters , and fall rates were assessed by st and ardized protocol s at the beginning ( T1 ) and the end ( T2 ) of intervention . Patients were followed up for 3 months after the intervention ( T3 ) . RESULTS No training-related medical problems occurred in the study group . Forty-five patients ( 79 % ) completed all assessment s after the intervention and follow-up period . Adherence was excellent in both groups ( intervention 85.4 + /- 27.8 % vs control 84.2 + /- 29.3 % ) . The patients in the intervention group increased strength , functional motor performance , and balance significantly . Fall-related behavioral and emotional restrictions were reduced significantly . Improvements persisted during the 3-month follow-up with only moderate losses . For patients of the control group , no change in strength , functional performance , or emotional status could be documented during intervention and follow-up . Fall incidence was reduced nonsignificantly by 25 % in the intervention group compared with the control group ( RR:0.753 CI:0.455 - 1.245 ) . CONCLUSIONS Progressive resistance training and progressive functional training are safe and effective methods of increasing strength and functional performance and reducing fall-related behavioral and emotional restrictions during ambulant rehabilitation in frail , high-risk geriatric patients with a history of injurious falls This study investigated the effects of different intra-session exercise sequences in the cardiovascular and neuromuscular adaptations induced by concurrent training  in elderly . Twenty-six healthy elderly men ( 64.7±4.1years ) , were r and omly placed into two concurrent training groups : strength training prior to ( SE , n=13 ) or after ( ES , n=13 ) endurance training . Subjects trained strength and endurance training 3 times per week performing both exercise types in the same training session .  The peak oxygen uptake ( VO(2peak ) ) , maximum aerobic workload ( W(máx ) ) , absolute ( VT(1 ) and VT(2 ) ) and relative ( VT(1)% and VT(2)% ) ventilatory thresholds , as well as workloads at VT(1 ) and VT(2 ) ( W(VT1 ) and W(VT2 ) ) were evaluated during a maximal incremental test on a cycle ergometer before and after the training . In addition , muscle quality ( MQ ) was evaluated by the quotient between maximal dynamic strength ( one repetition maximum test ) of the knee extensors and the quadriceps femoris muscle thickness determined by ultrasonography . There were no modifications after training in the VT(1 ) , VT(2 ) , VT(1)% , and VT(2)% . There was significant increase in the W(VT1 ) only in SE ( P<0.05 ) , as well as significant increase in the W(VT2 ) in both groups ( P<0.001 ) . There was significant increase in the VO(2peak ) , with both groups showing increases ( P<0.001 ) , with no difference between groups ; as well significant increase in the W(máx ) ( P<0.001 ) with no difference between SE and ES . The force per unit of muscle mass of knee extensors increased in both groups ( P<0.001 ) , but the increase was significantly higher in SE than in ES ( 27.5±12.7 vs. 15.2±10.3 % , P<0.02 ) . Hence , the intra-session exercise sequence had no influence in the maximal endurance power adaptations to concurrent training , but had influence in the magnitude of the muscle quality enhancements Objective To assess the prevalence of the frailty syndrome and its associated variables among the older adult population in the province of Toledo ( Spain ) . Methods Data were taken from the Toledo Study for Healthy Aging , a population -based study conducted on 2,488 individuals aged 65 years and older . Study participants were selected by a two-stage r and om sampling from the municipal census of Toledo , covering both institutionalized and community dwelling persons from rural and urban setting s. Data were collected from 2006 to 2009 , and included information on social support , activities of daily living , comorbidity , physical activity , quality of life , depressive symptoms , and cognitive function . In addition , a nurse collected  anthropometric data  , conducted tests of physical performance ( walk speed , upper and lower extremities strength , and the st and - and -sit from a chair test ) and obtained a blood sample . The diagnosis of the frailty syndrome was based on the Fried criteria ( weakness , low speed , low physical activity , exhaustion , and weight loss ) . Results In total , 41.8 % ( 95 % confidence interval [ CI ] 39.4–44.2 % ) of the study participants were prefrail , and 8.4 % ( 95 % CI 7.1–9.8 % ) were frail . There were no differences in the prevalence of frailty by sex , level of education , occupation , marital status , or place of residence . The frequency of the frailty syndrome increased with age , and was higher in those with disability , depression , hip fracture and other comorbidity , such as cardiovascular disease and disorders of the central nervous system . Conclusions The prevalence of the frailty syndrome in older Spanish adults is high and similar to that reported in other population s in the Mediterranean basin BACKGROUND recent studies have found that moderate intensity exercise is an effective intervention strategy for preventing falls  in older people . However , research is required to determine whether supervised group exercise programmes , conducted in community setting s with at-risk older people referred by their health care practitioner are also effective in improving physical functioning and preventing falls in this group . OBJECTIVES to determine whether participation in a weekly group exercise programme with ancillary home exercises over one year improves balance , muscle strength , reaction time , physical functioning , health status and prevents falls in at-risk community-dwelling older people . METHODS the sample comprised 163 people aged over 65 years identified as at risk of falling using a st and ardised assessment screen by their general practitioner or hospital-based physiotherapist , residing in South Western Sydney , Australia . Subjects were r and omised into either an exercise intervention group or a control group .  Physical performance and general health measures were assessed at baseline and repeated 6-months into the trial . Falls were measured over a 12-month follow-up period using monthly postal surveys . RESULTS at baseline both groups were well matched in their physical performance , health and activity levels . The intervention subjects attended a median of 23 exercise classes over the year , and most undertook the home exercise sessions at least weekly . At retest , the exercise group performed significantly better than the controls in three of six balance measures ; postural sway on the floor with eyes open and eyes closed and coordinated stability . The groups did not differ at retest in measures of strength , reaction time and walking speed or on Short-Form 36 , Physical Activity Scale for the Elderly or fear of falling scales . Within the 12-month trial period , the rate of falls in the intervention group was 40 % lower than that of the control group ( IRR=0.60 , 95 % CI 0.36 - 0.99 ) . CONCLUSIONS these findings indicate that participation in a weekly group exercise programme with ancillary home exercises can improve balance and reduce the rate of falling in at-risk community dwelling older people The purpose of the study was to examine the effects of 12 weeks high-speed power training on isometric contraction ( h and grip strength ) , maximal strength ( 1RM ) , muscle power ( walking velocity , counter movement jump and ball throwing ) and functional tasks of the arm and leg muscles ( sit-to-st and and get-up and go ) . Fifty-six older women were divided into an experimental group and a control group [ EG , n=28 , 62.5 ( 5.4 ) years ; CG : n=28 , 62.5 ( 4.3 ) years ] . The EG was su bmi tted to a high-speed power training that consisted of 40 % of one repetition maximum ( 1<RM ) to 75 % of 1RM ) ; 3 sets 4 - 12 reps , countermovement jump and medicine ball ( 1.5 kg ) throwing . Over the 12-week training period , the EG significantly increased dynamic and isometric strength performance ( 57 % to 61 % ) , muscle power ( range from 14 % to 40 % ) ( P<0.05 ) and function ( P<0.05 ) . No significant magnitudes of increase were observed in the CG . These data indicate that high-speed power training is an effective exercise approach leading to large gains in upper and lower extremity muscle performance and function capacity Objectives To determine whether a lifestyle integrated approach to balance and strength training is effective in reducing the rate of falls  in older , high risk people living at home . Design Three arm , r and omised parallel trial ; assessment s at baseline and after six and 12 months . R and omisation done by computer generated r and om blocks , stratified by sex and fall history and concealed by an independent secure website . Setting Residents in metropolitan Sydney , Australia . Participants Participants aged 70 years or older who had two or more falls or one injurious fall in past 12 months , recruited from Veteran ’s Affairs data bases and general practice data bases . Exclusion criteria were moderate to severe cognitive problems , inability to ambulate independently , neurological conditions that severely influenced gait and mobility , resident in a nursing home or hostel , or any unstable or terminal illness that would affect ability to do exercises . Interventions Three home based interventions : Lifestyle integrated Functional Exercise ( LiFE ) approach ( n=107 ; taught principles of balance and strength training and integrated selected activities into everyday routines ) , structured programme ( n=105 ; exercises for balance and lower limb strength , done three times a week ) , sham control programme ( n=105 ; gentle exercise ) . LiFE and structured groups received five sessions with two booster visits and two phone calls ; controls received three home visits and six phone calls . Assessment s made at baseline and after six and 12 months . Main outcome measures Primary measure : rate of falls over 12 months , collected by self report . Secondary measures : static and dynamic balance ; ankle , knee and hip strength ; balance self efficacy ; daily living activities ; participation ; habitual physical activity ; quality of life ; energy expenditure ; body mass index ; and fat free mass . Results After 12 months ’ follow-up , we recorded 172 , 193 , and 224 falls in the LiFE , structured exercise , and control groups , respectively . The overall incidence of falls in the LiFE programme was 1.66 per person years , compared with 1.90 in the structured programme and 2.28 in the control group . We saw a significant reduction of 31 % in the rate of falls for the LiFE programme compared with controls ( incidence rate ratio 0.69 ( 95 % confidence interval 0.48 to 0.99 ) ) ; the corresponding difference between the structured group and controls was non-significant ( 0.81 ( 0.56 to 1.17 ) ) . Static balance on an eight level hierarchy scale , ankle strength , function , and participation were significantly better in the LiFE group than in controls . LiFE and structured groups had a significant and moderate improvement in dynamic balance , compared with controls . Conclusions The LiFE programme provides an alternative to traditional exercise to consider for fall prevention . Functional based exercise should be a focus for interventions to protect older , high risk people from falling and to improve and maintain functional capacity . Trial registration Australia and New Zeal and Clinical Trials Registry 12606000025538 OBJECTIVES To compare the effectiveness of tai chi and low-level exercise in reducing  falls in older adults ; to determine whether mobility , balance , and lower limb strength improved and whether higher doses of tai chi result ed in greater effect . DESIGN R and omized controlled trial . SETTING Eleven sites throughout New Zeal and . PARTICIPANTS Six hundred eighty-four community-residing older adults ( mean age 74.5 ; 73 % female ) with at least one falls risk factor . INTERVENTION Tai chi once a week ( TC1 ) ( n = 233 ) ; tai chi twice a week ( TC2 ) ( n = 220 ) , or a low-level exercise program control group ( LLE ) ( n = 231 ) for 20 wks . MEASUREMENTS Number of falls was ascertained according to monthly falls calendars . Mobility ( Timed-Up- and -Go Test ) , balance ( step test ) , and lower limb strength ( chair st and test ) were assessed . RESULTS The adjusted incident rate ratio ( IRR ) for falls was not significantly different between the TC1 and LLE groups ( IRR = 1.05 , 95 % confidence interval ( CI ) = 0.83 - 1.33 , P = .70 ) or between the TC2 and LLE groups ( IRR = 0.88 , 95 % CI = 0.68 - 1.16 , P = .37 ) . Adjusted multilevel mixed-effects Poisson regression showed a significant reduction in logarithmic mean fall rate of -0.050 ( 95 % CI = -0.064 to -0.037 , P < .001 ) per month for all groups . Multilevel fixed-effects analyses indicated improvements in balance ( P < .001 right and left leg ) and lower limb strength ( P < .001 ) but not mobility ( P = .54 ) in all groups over time , with no differences between the groups ( P = .37 ( right leg ) , P = .66 ( left leg ) , P = .21 , and P = .44 , respectively ) . CONCLUSION There was no difference in falls rates between the groups , with falls reducing similarly ( mean falls rate reduction of 58 % ) over the 17-month follow-up period . Strength and balance improved similarly in all groups over time To determine the mechanisms underlying increased aerobic power in response to exercise training in octogenarians , we studied mildly frail elderly men and women r and omly assigned to an exercise group ( n = 22 ) who participated in a training program of 6 mo of physical therapy , strength training , and walking followed by 3 mo of more intense endurance exercise at 78 % of peak heart rate or a control sedentary group ( n = 24 ) . Peak O2 consumption ( V(O2 peak ) ) increased 14 % in the exercise group ( P < 0.0001 ) but decreased slightly in controls . Training induced 14 % increase ( P = 0.027 ) in peak exercise cardiac output ( Q ) , determined via acetylene re-breathing , and no change in arteriovenous O2 content difference . The increase in Q was mediated by increases in heart rate ( P = 0.009 ) and probably stroke volume ( P = 0.096 ) . Left ventricular stroke work also increased significantly . In the men , the increase in V(O2 peak ) was exclusively due to a large increase in peak Q ( 22 % ) . In the women , the gain in V(O2 peak ) was due to small increases in Q and O2 extraction from skeletal muscles . Pulse pressure normalized for stroke volume and arterial elastance during peak effort did not change with training . Controls showed no changes . The results suggest that , although frail octogenarians have a diminished capacity for improvement in aerobic power in response to exercise training , this adaptation is mediated mostly by an increase in Q during peak effort . Furthermore , Q likely plays a greater role in the adaptive increase in V(O2 peak ) in old men than old women PURPOSE To compare the effects of the 16-wk training period ( 2 d.wk(-1 ) ) of resistance training alone ( S ) , endurance training alone ( E ) , or combined resistance ( once weekly ) and endurance ( once weekly ) training ( SE ) on muscle mass , maximal strength and power of the leg and arm extensor muscles , and maximal workload ( Wmax ) by using a incremental cycling test in older men . METHODS Thirty-one healthy men ( 65 - 74 yr ) were divided into three treatment groups to train 2x wk(-1 ) for 16 wk : S ( N = 10 ) , E ( N = 11 ) , or SE ( N = 10 ; 1x wk(-1 ) S + 1x wk(-1 ) E ) . The subjects were tested at 8-wk intervals ( i.e. , weeks 8 and 16 ) . RESULTS There were no significant differences between  S- and SE-induced muscle hypertrophy ( 11 % and 11 % ) and maximal strength ( 41 % and 38 % ) gains of the legs as well as between E- and SE-induced Wmax ( 28 % and 23 % ) gains . The increase in arm strength in S ( 36 % ) was greater than that recorded in SE ( 22 % ) and greater than that recorded in E ( 0 % ) . CONCLUSIONS Prolonged combined resistance and endurance training in older men seemed to lead to similar gains in muscle mass , maximal strength , and power of the legs as resistance training alone and to similar gains in maximal peak power output measured in an incremental cycling test as endurance training alone . These findings may have an effect on how resistance exercise is prescribed to older adults BACKGROUND In Japan , older adults are assessed by frailty checklist for care prevention . However , the effect of care prevention programs in community-dwelling frail older adults is still unclear . OBJECTIVES The purpose of this study was to investigate whether the care prevention program would reduce care and disability and to measure its cost-effectiveness in frail older adults . DESIGN This is a prospect i ve study using propensity score matching . SETTING AND SUBJECTS A total of 610 community-dwelling older adults were recruited in 2 cities of Japan . INTERVENTION Subjects in the  exercise group ( n = 305 ) attended physical exercise sessions once a week for 16 consecutive weeks . The exercise sessions were in a st and ardized format consisting of moderate-intensity aerobic exercise , progressive strength training , flexibility and balance exercises , and cool-down activities . The control group ( n = 305 ) received only screening evaluation . MEASUREMENTS Primary outcome was long term care insurance requirement certification during the 1-year follow-up period . Secondary outcome measurements were changes of frailty checklist , and care and medical cost . RESULTS Twenty-five subjects ( 8.1 % ) in the exercise group and 55 ( 18 % ) in the control group were newly certified for long-term care insurance service requirement in 1 year after the intervention ( RR = 2.16 , 95 % CI = 1.46 - 3.20 ) . Consequently , the health care cost for the subjects in the exercise group was significantly lower than in the control group ( P < .001 ) . Moreover , subjects in the exercise group had significant improvements in total scores of the frailty checklist compared with the control group that worsened after 1 year ( exercise group : from 7.41 ± 3.98 to 7.11 ± 4.00 , control group : from 7.34 ± 4.27 to 8.02 ± 4.81 , F = 12.84 , P < .001 ) . CONCLUSION These results suggested that physical exercise is effective in preventing the progression of frailty and further disability in older adults living in the community . We could save heath care costs by our care prevention program OBJECTIVES To determine the long-term effects of three strength and balance exercise interventions on physical performance , fall-related psychological outcomes , and falls in older people . DESIGN A single-blinded , four-group , r and omized controlled trial . SETTING Community , Germany . PARTICIPANTS Community-dwelling adults aged 70 to 90 who had fallen in the past 6 months or reported fear of falling . INTERVENTION After baseline assessment , 280 participants were r and omly assigned to the control group ( CG ; no intervention ; n = 80 ) or one of three strength and balance exercise interventions ( the strength and balance group ( SBG ; strength and balance only ; n = 63 ) , the fitness group ( FG ; strength and balance plus endurance training ; n = 64 ) , or the multifaceted group ( MG ; strength and balance plus fall risk education ; n = 73 ) . The interventions consisted of 32 one-hour group sessions in 16 weeks . MEASUREMENTS Data on physical performance , fall-related psychological outcomes , and falls were collected for 24 months . RESULTS Mixed-effects regression analyses showed improved short- and long-term ( 12 and 24 months , respectively ) physical performance for the SBG and FG , particularly regarding mobility , balance , and walking speed ( P < .05 ) . The improvements in physical performance outcomes were most prominent in the FG . Fall-related psychological outcomes , number of falls , and injurious falls were not significantly different from in the control group . CONCLUSION Training focusing on strength , balance , and endurance can enhance physical performance for up to 24 months in community-dwelling older adults . These findings did not translate to improved fall-related psychological outcomes or reduced incidence of falls . This demonstrates the need for a different approach ( e.g. , regarding intervention dose and components ) to gain intervention benefits in the multiple domains that contribute to independence and well-being in older adults OBJECTIVE To study the long-term outcome of a physical training regimen of ambulant postward rehabilitation in community-dwelling geriatric patients with a history of injurious falls . DESIGN Prospect i ve 2-year follow-up of a r and omized placebo-controlled intervention trial . SETTING Postward rehabilitation in a geriatric hospital in Germany . PARTICIPANTS Fifty-seven geriatric patients ( mean age , 84.3+/-4.4 y ) with a history of severe falls . INTERVENTION Ambulatory training of strength , functional performance , and balance 3 times a week for 3 months for 31 patients versus placebo activities for 26 patients . MAIN OUTCOME MEASURES Strength , functional performance , fall-related psychologic parameters , and physical activity assessed by st and ardized protocol s 2 years after the training intervention , compared with baseline results . RESULTS Motor performance decreased substantially in both groups . As patients in the intervention group declined from significantly improved motor performance levels achieved in the initial training intervention , differences between the groups were still significant in most functional performances 2 years later . Functional decline was greater in persons who were institutionalized or being cared for by family members . Physical activity , which increased during the exercise intervention , returned to low baseline levels . CONCLUSIONS Improved functional performance in the training group did not lead to an increased level of physical activity after training , which might have preserved the functional improvements . In mobility-restricted , frail , geriatric patients such as our study population , training programs should continue to keep patients active and to prevent the decline in strength and functional performance that precedes loss of autonomy OBJECTIVES Although deficits in skeletal muscle strength , gait , balance , and oxygen uptake are potentially reversible causes of frailty , the efficacy of exercise in reversing frailty in community-dwelling older adults has not been proven . The aim of this study was to determine the effects of intensive exercise training ( ET ) on measures of physical frailty in older community-dwelling men and women . DESIGN R and omized controlled trial . SETTING Medical school research center . PARTICIPANTS One hundred fifteen sedentary men and women ( mean age + /- st and ard deviation = 83 + /- 4 ) with mild to moderate physical frailty , as defined by two of the following three criteria : Modified Physical Performance Test ( modified PPT ) score between 18 and 32 , peak oxygen uptake ( VO2 peak ) between 10 and 18 mL/kg/min , and self-report of difficulty or assistance with one basic activity of daily living ( ADL ) , or two instrumental ADLs . INTERVENTION Participants were r and omly assigned to a control group that performed a 9-month low-intensity home exercise program ( control ) or an exercise-training program ( ET ) . The control intervention primarily consisted of flexibility exercises . ET began with 3 months of flexibility , light-resistance , and balance training . During the next 3 months , resistance training was added , and , during the next 3 months , endurance training was added . MEASUREMENTS Modified PPT score , VO2 peak , performance of ADLs as measured by the Older Americans Re sources and Services instrument , and the Functional Status Question naire ( FSQ ) . RESULTS ET result ed in significantly greater improvements than home exercise in three of the four primary outcome measures . Adjusted 95 % confidence bounds on the magnitude of improvement in the ET group compared with the control group were 1.0 to 5.2 points for the modified PPT score , 0.9 to 3.6 mL/kg/min for VO2 peak , and 1.6 to 4.9 points for the FSQ score . CONCLUSIONS Our results show that intensive ET can improve measures of physical function and pre clinical disability in older adults who have impairments in physical performance and oxygen uptake and are not taking hormone replacement therapy better than a low-intensity home exercise program OBJECTIVE To determine the effects of center-based exercise on physical performance in older persons at risk for decline in physical functioning . DESIGN R and omized controlled trial . SETTING Senior centers . PARTICIPANTS A total of 155 community-dwelling persons , 78.7 % women , ages 70 years and older ( mean + /- st and ard deviation , 77.0+/-4.5y ) , with mobility impairments . INTERVENTION Intervention volunteers ( n=80 ) exercised at a center ( endurance , strength , balance , flexibility ) 3 times weekly , for months 1 to 6 ; once weekly , for months 7 to 12 with home exercise 2 sessions a week ; and at home only , for months 13 to 18 . Home control volunteers ( n=75 ) were instructed in home endurance exercise . MAIN OUTCOME MEASURES MacArthur battery , Physical Performance Test ( PPT-8 ) , and 6-Minute Walk Test ( 6MWT ) at baseline and 3 , 6 , 12 , and 18 months . RESULTS MacArthur battery scores improved in intervention compared with home control at 3 , 6 , and 12 months ( repeated- measures analysis of variance : group x time , P<.05 ) but not 18 months . PPT-8 and 6MWT did not improve . Intervention group assignment , younger age , and better baseline physical function and self-perceived health were independent predictors of long-term MacArthur battery score improvement . CONCLUSIONS Compared with home control , center-based exercise improved gait , chair rise time , and balance over 1 year . Improvements were not sustained with transition to home exercise for months 13 to 18 . Classes may be necessary to maintain improvements in older persons attending center-based exercise This study determined the effects of endurance or resistance exercise training on maximal O2 consumption ( VO2max ) and the cardiovascular responses to exercise of 70- to 79-yr-old men and women . Healthy untrained subjects were r and omly assigned to a control group ( n = 12 ) or to an endurance ( n = 16 ) or resistance training group ( n = 19 ) . Training consisted of three sessions per week for 26 wk . Resistance training consisted of one set of 8 - 12 repetitions on 10 Nautilus machines . Endurance training consisted of 40 min at 50 - 70 % VO2max and at 75 - 85 % VO2max for the first and last 13 wk of training , respectively . The endurance training group increased its VO2max by 16 % during the first 13 wk of training and by a total of 22 % after 26 wk of training ; this group also increased its maximal O2 pulse , systolic blood pressure , and ventilation , and decreased its heart rate and perceived exertion during submaximal exercise . The resistance training group did not elicit significant changes in VO2max or in other maximal or submaximal cardiovascular responses despite eliciting 9 and 18 % increases in lower and upper body strength , respectively . Thus healthy men and women in their 70s can respond to prolonged endurance exercise training with adaptations similar to those of younger individuals . Resistance training in older individuals has no effect on cardiovascular responses to submaximal or maximal treadmill exercise OBJECTIVES To determine whether an intense tai chi ( TC ) exercise program could reduce the risk of falls more than a wellness education ( WE ) program in older adults meeting criteria for transitioning to frailty . DESIGN R and omized , controlled trial of 48 weeks duration . SETTING Twenty congregate living facilities in the greater Atlanta area . PARTICIPANTS Sample of 291 women and 20 men aged 70 to 97 . MEASUREMENTS Demographics , time to first fall and all subsequent falls , functional measures , Sickness Impact Profile , Centers for Epidemiologic Studies -Depression Scale , Activities-specific Balance Confidence Scale , Falls Efficacy Scales , and adherence to interventions . RESULTS The risk ratio ( RR ) of falling was not statistically different in the TC group and the WE group ( RR=0.75 , 95 % confidence interval (CI)=0.52 - 1.08 ) , P=.13 ) . Over the 48 weeks of intervention , 46 % ( n=132 ) of the participants did not fall ; the percentage of participants that fell at least once was 47.6 % for the TC group and 60.3 % for the WE group . CONCLUSION TC did not reduce the RR of falling in transitionally frail , older adults , but the direction of effect observed in this study , together with positive findings seen previously in more-robust older adults , suggests that TC may be clinical ly important and should be evaluated further in this high-risk population OBJECTIVES To determine whether a 12-month program of group exercise can improve physical functioning and reduce the rate of falling in frail older people . DESIGN Cluster r and omized , controlled trial of 12 months duration . SETTING Retirement villages in Sydney and Wollongong , Australia . PARTICIPANTS Five hundred fifty-one people aged 62 to 95 ( mean+/-st and ard deviation=79.5+/-6.4 ) who were living in self- and intermediate-care retirement villages . MEASUREMENTS Accidental falls , choice stepping reaction time , 6-minute walk distance postural sway , leaning balance , simple reaction time , and lower-limb muscle strength . RESULTS Two hundred eighty subjects were r and omized to the weight-bearing group exercise ( GE ) intervention  that was design ed to improve the ability of subjects to undertake activities for daily living . Subjects r and omized to the control arm ( n=271 ) attended flexibility and relaxation ( FR ) classes ( n=90 ) or did not participate in a group activity ( n=181 ) . In spite of the reduced precision of cluster r and omization , there were few differences in the baseline characteristics of the GE and combined control ( CC ) subjects , although the mean age of the GE group was higher than that of the CC group , and there were fewer men in the GE group . The mean number of classes attended was 39.4+/-28.7 for the GE subjects and 31.5+/-25.2 for the FR subjects . After adjusting for age and sex , there were 22 % fewer falls during the trial in the GE group than in the CC group ( incident rate ratio=0.78 , 95 % confidence interval (CI)=0.62 - 0.99 ) , and 31 % fewer falls in the 173 subjects who had fallen in the past year ( incident rate ratio=0.69 , 95 % CI=0.48 - 0.99 ) . At 6-month retest , the GE group performed significantly better than the CC group in tests of choice stepping reaction time , 6-minute walking distance , and simple reaction time requiring a h and press . The groups did not differ at retest in tests of strength , sway , or leaning balance . CONCLUSION These findings show that group exercise can prevent falls and maintain physical functioning in frail older people The objective of the present study was to evaluate and compare the neuromuscular , morphological and functional adaptations of older women subjected to 3 different types of strength training . 58 , healthy women ( 67 ± 5 year ) were r and omized to experimental ( EG , n=41 ) and control groups ( CG , n=17 ) during the first 6 weeks when the EG group performed traditional resistance exercise for the lower extremity . Afterwards , EG was divided into three specific strength training groups ; a traditional group ( TG , n=14 ) , a power group ( PG , n=13 ) that performed the concentric phase of contraction at high speed and a rapid strength group ( RG , n=14 ) that performed a lateral box jump exercise emphasizing the stretch-shortening-cycle ( SSC ) . Subjects trained 2 days per week through the entire 12 weeks . Following 6 weeks of generalized strength training , significant improvements occurred in EG for knee extension one-repetition ( 1RM ) maximum strength ( + 19 % ) , knee extensor muscle thickness ( MT , + 15 % ) , maximal muscle activation ( + 44 % average ) and onset latency ( -31 % average ) for vastus lateralis ( VL ) , vastus medialis ( VM ) and rectus femoris ( RF ) compared to CG ( p<0.05 ) . Following 6 more weeks of specific strength training , the 1RM increased significantly and similarly between groups ( average of + 21 % ) , as did muscle thickness of the VL ( + 25 % ) , and activation of VL ( + 44 % ) and VM ( + 26 % ) . The onset latency of RF ( TG=285 ± 109 ms , PG=252 ± 76 ms , RG=203 ± 43 ms ) , reaction time ( TG=366 ± 99 ms , PG=274 ± 76 ms , RG=201 ± 41 ms ) , 30-s chair st and ( TG=18 ± 3 , PG=18 ± 1 , RG=21 ± 2 ) and counter movement jump ( TG=8 ± 2 cm , PG=10 ± 3 cm , RG=13 ± 2 cm ) was significantly improved only in RG ( p<0.05 ) . At the end of training , the rate of force development ( RFD ) over 150 ms ( TG=2.3 ± 9.8 N·s(-1 ) , PG=3.3 ± 3.2 N·s(-1 ) , RG=3.8 ± 6.8 N·s(-1 ) , CG=2.3 ± 7.0 N·s(-1 ) ) was significantly greater in RG and PG than in TG and CG ( p<0.05 ) . In conclusion , rapid strength training is more effective for the development of rapid force production of muscle than other specific types of strength training and by consequence , better develops the functional capabilities of older women 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 OBJECTIVES To investigate the effects of dehydroepi and rosterone ( DHEA ) combined with exercise on bone mass , strength , and physical function in older , frail women . DESIGN Double-blind , r and omized , placebo-controlled trial . SETTING A major medical institution . PARTICIPANTS Ninety-nine women ( mean age 76.6 ± 6.0 ) with low sulfated DHEA ( DHEAS ) levels , low bone mass , and frailty . INTERVENTION Participants received 50 mg/d DHEA or placebo for 6 months ; all received calcium and cholecalciferol . Women participated in 90-minute twice-weekly exercise regimens .  MEASUREMENTS Hormone levels , bone mineral density ( BMD ) , bone turnover markers , body composition , upper and lower extremity strength , physical performance . RESULTS Eighty-seven women ( 88 % ) completed 6 months . There were no significant changes in BMD or bone turnover markers  . DHEA supplementation result ed in gains in lower extremity strength ( from 459 ± 121 N to 484 ± 147 N ; P=.01 ) . There was also improvement in Short Physical Performance Battery score , a composite score that focuses on lower extremity function , in those taking DHEA ( from 10.1 ± 1.8 to 10.7 ± 1.9 ; P=.02 ) . There were significant changes in all hormone levels , including DHEAS , estradiol , estrone , and testosterone , and a decline in sex hormone-binding globulin levels in those taking DHEA . CONCLUSION DHEA supplementation improved lower extremity strength and function in older , frail women involved in a gentle exercise program of chair aerobics or yoga . No changes were found in BMD either due to small sample size , short duration of study or no effect . The physical function findings are promising and require further evaluation as frail women are at high risk for falls and fracture 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 OBJECTIVES To evaluate the effectiveness of exercise and amino acid supplementation in enhancing muscle mass and strength in community-dwelling elderly sarcopenic women . DESIGN R and omized controlled trial . SETTING Urban community in Tokyo , Japan . PARTICIPANTS One hundred fifty-five women aged 75 and older were defined as sarcopenic and r and omly assigned to one of four groups : exercise and amino acid supplementation ( exercise + AAS ; n = 38 ) , exercise ( n = 39 ) , amino acid supplementation ( AAS ; n = 39 ) , or health education ( HE ; n = 39 ) . INTERVENTION The exercise group attended a 60-minute comprehensive training program twice a week , and the AAS group ingested 3 g of a leucine-rich essential amino acid mixture twice a day for 3 months . MEASUREMENTS Body composition was determined using bioelectrical impedance analysis . Data from interviews and functional fitness parameters such as muscle strength and walking ability were collected at baseline and after the 3-month intervention . RESULTS A significant group × time interaction was seen in leg muscle mass ( P = .007 ) , usual walking speed ( P = .007 ) , and knee extension strength ( P = .017 ) . The within-group analysis showed that walking speed significantly increased in all three intervention groups , leg muscle mass in the exercise + AAS and exercise  groups , and knee extension strength only in the exercise + AAS group ( 9.3 % increase , P = .01 ) . The odds ratio for leg muscle mass and knee extension strength improvement was more than four times as great in the exercise + AAS group ( odds ratio = 4.89 , 95 % confidence interval = 1.89 - 11.27 ) as in the HE group . CONCLUSION The data suggest that exercise and AAS together may be effective in enhancing not only muscle strength , but also combined variables of muscle mass and walking speed and of muscle mass and strength in sarcopenic women BACKGROUND Physical training to increase muscle strength and balance is considered useful for prevention of falls in older people . AIM This study compares conventional balance training with visual computer feedback training . DESIGN This was a r and omized controlled 12-week intervention trial with pre- and post-training evaluations . SETTING Out- patients referred to a geriatric falls and balance clinic . POPULATION Thirty-five patients were r and omized into two training groups . METHODS Both groups received progressive resistance muscle strength training and physical fitness training . Additionally , one group received traditional balance training and the other group received computer feedback balance training .  Strength , physical endurance , balance and falls efficacy scale scoring were assessed before and after end of training . RESULTS Twenty-seven patients ( 77 % ) were available for the evaluation ; mean compliance was 71 % . In the combined group , significant mean improvement was observed in knee extension ( 19 % ) , ankle dorsiflexion ( 16 % ) , sitting to st and ing ( 16 % ) , and in the six-minute walk test ( 8 % ) . In the traditional balance training group , the static balance in the Modified Clinical Test of Sensory Interaction and Balance st and ing on a foam mat with closed eyes showed a significant increase ( 80 % ) . No increase occurred in the computer balance training group . However , the computer feed-back training group showed a marked improvement that was up to 400 % in the training specific performance . CONCLUSION Elderly frail patients were able to increase muscle strength and physical endurance . A limited improvement was seen in the static balance tests . The computer feedback group showed a remarkable increase in training specific performance . Clinical Rehabilitation Impact OBJECTIVES To assess the effects of an 8-week exercise training program with a special focus on light- to moderate-intensity resistance exercises ( 30 - 70 % of one repetition maximum , 1RM ) and a subsequent 4-week training cessation period ( detraining ) on muscle strength and functional capacity in participants aged 90 and older . DESIGN R and omized controlled trial performed during March to September 2009 . SETTING Geriatric nursing home . PARTICIPANTS Forty nonagenarians ( 90 - 97 ) were r and omly assigned to an intervention or control group ( 16 women and 4 men per group ) . INTERVENTION Eight-week muscle strength exercise intervention focused on lower limb strength exercises of light to moderate intensity . MEASUREMENTS PRIMARY OUTCOME 1RM leg press . SECONDARY OUTCOMES h and grip strength , 8-m walk test , 4-step stairs test , Timed Up and Go test , and number of falls . RESULTS A significant group by time interaction effect ( P=.02 ) was observed only for the 1RM leg press . In the intervention group , 1RM leg press increased significantly with training by 10.6 kg [ 95 % confidence interval (CI)=4.1 - 17.1 kg ; P=.01 ] . Except for the mean group number of falls , which were 1.2 falls fewer per participant in the intervention group ( 95 % CI=0.0 - 3.0 ; P=.03 ) , no significant training effect on the secondary outcome measures was found . CONCLUSION Exercise training , even of short duration and light to moderate intensity , can increase muscle strength while decreasing fall risk in nonagenarians 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
target: The multi-component exercise intervention composed by strength , endurance and balance training seems to be the best strategy to improve rate of falls , gait ability , balance , and strength performance in physically frail older adults
background: The aim of this review was to recommend training strategies that improve the functional capacity in physically frail older adults based on scientific literature , focusing specially in supervised exercise programs that improved muscle strength , fall risk , balance , and gait ability .