Physical Activity Guidelines Advisory Committee Report
Part G. Section 6: Functional Health
Table G6.A2. Summary Table of Studies Investigating Whether Regular
Physical Activity Improves or Maintains Functional Ability and Role Ability
With Aging In Older Adults Who Have Mild, Moderate, or Severe Functional or
Role Limitations
Article, Study Aims, Sample, Number in Study,
Duration |
Intervention |
Functional Outcomes |
Other Effects |
Comments |
Cress et al., 1999 (1)
- To evaluate exercise in independent older adults for
significant and meaningful improvements in physical function not detected by
commonly used measures of physical function.
- Men and women aged 70+ years, relatively good health, live in a
retirement community or an apartment
- n=56 (beginning sample)
- n=49 (analytic sample)
- 6 months
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- Intervention group: Aerobic, strength training (3/week, 60
minutes). Exercise intensity was graded by a specialized coach according to the
progression of each subject and based on the Borg scale. 60-minute resistance
exercises that consisted of a period of warming up, 3 levels of step-ups on a
stair and arm pull-ups using exercise bands plus respiratory muscle training.
Subjects also took part in 15-minute walking periods before and after
resistance training.
- Control group: Did not exercise
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- No significant differences were found between groups for
changes in the usual walking speed, or the 6 minutes walk. However, the CS-PFP
score improved significantly in the exercise group (14%, effect size
0.80).
- Functional reach distance changed significantly
(P=0.028) with the intervention effect size = 0.62.
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- No significant differences found between groups for changes in
time on balance beam, step reaction time, SIP, or SF-36 scales.
- Compared to the control group, the exercise group showed
significant increases in maximal oxygen consumption (11%) and muscle strength
(33%).
|
Mixed functional limitation at start |
King et al., 2000 (2)
- To evaluate the effects of two different community-based
physical activity regimens on measured and perceived physical functioning and
other health-related quality of life outcomes in older adults
- Men and women aged 65+ years, not exercising >2/week in
previous 6 months, free from CV disease and musculoskeletal problems that
would prevent participation in PA
- n=103 (baseline)
- n=103 (analytic)
- 12 months
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- Intervention group: Aerobic + strength (4/week, average 50
minutes), 2 days at class and 2 days at home. A combination of aerobic,
strength, and muscle-toning exercises conducted in a circuit-type format. Both
upper and lower body exercises. Participants were encouraged to reach a target
heart rate of 60-75% of heart rate reserve.
- Control group: Stretching (4/week, 40 minutes), 2 days in
class and 2 days at home, which included a total body stretching
routine.
- All subjects received individualized instruction before
beginning their exercise program and regular telephone counseling throughout
the intervention.
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- No significant between-group effects were observed for the
chair sit-to-stand task. Men had higher 12-month scores on this task than women
(P <0.015, one-tailed test).
- Intervention participants showed significantly greater 12-month
improvements in the lift and reach task compared to controls [flexibility]
(F[4,95]=3.93, P <0.025, one-tailed test).
- There was a significant main effect for group with respect to
self-efficacy related to strength. Intervention group reported greater
improvement in their confidence for lifting increasingly heavy objects relative
to controls (flexibility) (F[4,99]=3.66, P <0.03, one‑tailed
test).
- Intervention group reported a greater improvement in their
ability to walk than the control group [flexibility] according to the Colorado
Walking Impairment subscale (F[4,99] = 9.60, P <0.002,
one‑tailed test).
|
- Intervention group showed greater improvements in submax heart
rate than controls.
- No significant between group differences for VO2max.
- Men in the control group [flexibility] showed a greater
increase in the sit and reach than men in the intervention group; women
assigned to the intervention group showed a pattern of somewhat greater
increases, but not statistically significant.
- Intervention group reported greater improvement in their
confidence for lifting increasingly heavy objects relative to control
[flexibility] group.
- Intervention group reported greater improvement in their
self-efficacy for walking relative to control [flexibility] group.
- Both groups showed better adherence to home- versus class-based
portions of their exercise prescriptions, t‑test = 5.2, P
<0.0001
- Controls [flexibility] showed greater improvements in daily
pain levels relative to intervention group.
|
Mixed functional limitation at start |
Rubenstein et al., 2000 (3)
- To measure effects of an exercise intervention on muscle
strength, gait, balance, and endurance among elderly men with risk factors for
falls
- Men aged 70+years, ≥1 of the following: lower extremity
weakness, impaired gait, impaired balance, or >1 fall in previous 6 months
- n=59 (beginning sample)
- n=59 (analytic sample)
- 3 months
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- Intervention group: Strength, balance, mobility, endurance
(3/week, 90 minutes). Strength: subjects progressed from 1 to 3 sets of
12 repetitions over the first 4 weeks. Rate of progression was modified
for subjects with physical limitations. Balance training was performed
2/week, increasing in difficulty over the 12 weeks. Endurance training also
increased in intensity over the 12 weeks. Classes led by exercise physiology
grad student.
- Control: Continued usual activities
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- Exercise showed no significant effect on balance or
self-reported physical functioning.
- Exercisers had a 10% (P <0.05) increase in distance
walked in 6 minutes, and improved (P <0.05) scores on an
observational gait scale.
|
- Exercise showed no significant effect on hip or ankle strength,
or number of falls.
- Isokinetic endurance increased 21% for right knee flexion and
26% for extension.
|
– |
Bunout et al., 2001 (4)
- To assess the impact of an 18-month nutritional supplementation
and resistance training program on health functioning of elders.
- Men and women 70+ years, assigned to one of 3 outpatient
clinics, 2 that were providing nutritional supplements and 1 that was not
- n=149 (beginning sample)
- n=98 (analytic sample)
- 18 months
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- Intervention group: Strength, balance, respiratory muscle
training, walking (2/week, 90 minutes). Endurance intensity was 75-80% of
estimated 1RM.
- 10-minute warm-up, 40 minutes divided equally between aerobic
and strength. The kayak and single-stair stepper were used for aerobic
activity. Strength training included both upper and lower body exercises.
- Control group: Not supplemented, not trained
|
Walking capacity (12-minute walk) remained constant in trained
subjects whereas it declined significantly in non‑trained groups,
regardless of supplementation (P <0.01). |
Right quadriceps strength (P <0.01), right biceps
strength (P <0.01), and maximal inspiratory pressure
(P=0.03) improved more in trained than in non-trained subjects. No
effect of nutritional supplementation was observed. |
Mixed functional limitation at start |
Binder et al., 2002 (5)
- To determine the effects of intensive exercise training on
measures of physical frailty in older community-dwelling men and women
- Men and women aged 78+ years, at least 2 of the following:
score between 18 and 32 on the modified PPT, report of difficulty or need of
assistance with up to 2 IADLs or 1 ADL, or achievement of a VO2 peak
between 10 and 18 mL/kg/minute
- n=119 (beginning sample)
- n=115 (analytic sample)
- 9 months
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- Intervention group: Strength, balance, endurance (3/week,
progressive time). Program introduced in phases. Participants required to
complete 36 sessions of each phase before progressing to next phase. Phase
1 group format, included 22 exercises focused on flexibility, balance,
coordination, speed of reaction, and to a modest extent, strength. The
participants continued to perform a shortened version of the Phase 1 exercises
during Phase 2, which added progressive resistance training. Phase 3
endurance training introduced using treadmills, stationary bicycles, Aerodyne
bicycles, or rowing machines. Initially, participants exercised for 15
minutes. The duration was increased progressively to 20 minutes. The
training regimen was then supplemented with interval training interspersed with
2 to 3 minutes of rest. Shortened programs of Phase 1 and Phase 2 exercises
were continued during Phase 3.
- Control group: Performed a low-intensity exercise program
(2-3/week, of unknown duration), primarily flexibility, not expected to improve
primary outcome measures.
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- Modified PPT:
Intervention vs. Controls Improvement 95%
CI = 1.0 to 5.2 points
- FSQ:
Intervention vs. Controls Improvement 95% CI = 1.6
to 4.9 points
- OARS ADL scales:
No significant changes
- Responses on the Change in Health subscale of the self-reported
health status and quality of life (SF-36) improved more in the intervention
group than in the control.
|
- VO2 peak:
Intervention vs. Controls
Improvement 95% CI = 0.9 to 3.6 mL/kg/min
- Intervention group had significant improvements in maximum
voluntary knee extensor and knee flexor torque and one-leg stance time, and the
Berg Balance Test; these were significantly greater than the changes for
controls.
|
– |
King et al., 2002 (6)
- To determine the effects center-based exercise on physical
performance in older persons at risk for decline in physical functioning
- Men and women aged 70+ years, SPPB score of 9 or lower and
independence in at least 5 or 6 ADLs
- n=155 (beginning sample)
- n=155 (analytic sample)
- 18 months
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- Intervention group: Strength, endurance, balance, flexibility
(3/week, 75 minutes)
- Exercise at a center 3 times weekly, for months 1 to 6; once
weekly, for months 7 to 12 with home exercise 2 sessions/week; and at home
only, for months 13 to 18
- Control group: Instructed in home endurance exercise
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- 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 <0.05) but not 18 months. PPT-8 and 6-minute walk
test did not improve.
- Improvements were not sustained with transition to home
exercise for months 13 to 18.
- Better baseline physical function, intervention group
assignment, younger age, self-perceived health were independent predictors of
long‑term MacArthur battery score improvement.
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- At 6-month testing, the average intervention group ABC
score increased. Although the 2 groups did not differ at 6, 12, and
18 months, differences seen between baseline and 6‑month ABC scores in
the intervention group persisted.
- SF-36 improved in both groups from baseline to 6 months and
remained higher than baseline at 12 months. No group by time effect.
- The mental health subscale score did not change over time or
with the intervention.
|
– |
Miszko et al., 2003 (7)
- To determine whether power training is more efficacious than
strength training for improving whole-body physical function in older adults
and to examine the relationship between changes in anaerobic power and muscle
strength and changes in physical function
- Men and women aged 65-90 years, leg extensor power <140W for
women, <210W for men
- n=50 (beginning sample)
- n=39 (analytic sample)
- 4 months
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- Intervention group 1: Strength training, (3/week, N/R time), 3
upper and 3 lower body exercises performed for 3 sets of 6-8 repetitions. 5
minutes dynamic warm-up at the beginning of each session and
muscle‑specific stretches were performed after each set. Intensity
progressed from 50% to 70% of 1RM by week 8, then, remained at 80% 1RM for
weeks 9-16 (4‑second concentric, slow and controlled eccentric).
- Intervention group 2: Power training, (3/week, N/R time), first
8 weeks same as strength program; however, this group did jump squats instead
of squats. After 8 weeks, the program altered to 3 sets of 6-8 reps at 40% 1RM
as fast as possible (1 second concentric, 2 seconds eccentric)
- Control group: Maintained usual activity — no strength
training. Met for educational presentation 3 times during the 16 weeks.
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- CS-PFP total score was significantly greater for the Power
Training group compared to the Strength Training (P=0.033) and Control
groups (P=0.016).
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- Maximal strength was significantly greater for the strength
training group than for the control group (P=0.015).
- There was no significant difference between groups for peak
anaerobic power.
- Strength group had significantly more relative mean power than
the control group.
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– |
Jensen et al., 2004 (8)
- To determine whether exercise as part of a fall-prevention
program would have positive effects, both short- and long-term, on gait,
balance, and strength in older people with a high risk of falling and with
varying levels of cognition, residing in residential care facilities.
- Men and women aged 65+ years, screened as being at high risk of
falling
- n=402 (beginning sample)
- n=187 (analytic sample)
- 2.75 months, 9-month follow-up
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- Intervention group: Pattern, duration, and frequency not
reported. An individualized exercise program was designed for each resident
based on baseline assessment. Resident-specific programs included balance
exercises, resistance training focused on the lower extremities, and safe
movement behavior training.
- Control group: Usual care
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At 11 weeks:
- Positive intervention effects were found on independent
ambulation (FAC, P=0.026), maximum gait speed (P=0.002), and
step height (>10 cm, P <0.001), but not
significantly on the Berg Balance Scale.
At 9 months:
- Independent ambulation and maximum gait speed were maintained
in the intervention group, but deteriorated in the control group
(P=0.001).
- 3 intervention and 15 control residents had lost the ability to
walk (P=0.001).
- No association was found between improved mobility and reduced
risk of falling.
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– |
– |
Nelson et al., 2004 (9)
- To determine whether a home-based exercise program would
improve functional performance in elderly people.
- Men and women aged 70+ years, not currently exercising
>1 day/week, have at least 2 functional limitations, score 10 or less on
SPPB
- n=72 (beginning sample)
- n=70 (analytic sample)
- 6 months
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- Intervention group: Aerobic, strength, and balance (3/week,
varied time per day). Target exertion rate of 7-7-8 on the 10-point Borg scale
with the exception of the balance exercises. Participants received 2 home
visits during month 1, followed by 1 home visit each month thereafter. 2 sets
of 8 repetitions + balance + 120 minutes of PA per week.
- Attention control group: 6 months of nutrition education, 2
home visits with a dietician in first month of study, then 1 visit per month
thereafter.
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PPT:
Exercisers: ↑ 6.1 ± 13.4% Controls: ↓ by
2.8 ±13.6% (P=0.02)
SPPB:
Exercisers: ↑ 26.2 ± 37.5% Controls: ↓ 1.2
± 22.1% (P=0.001)
- There was a trend for exercise group to improve in maximal gait
speed (P=0.08)
- 6-minute walk test did not change
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- No differences between groups for SF‑36 or Geriatric
Depression Scale.
- Intervention group improved compared to the control in tandem
walk scores and one-legged stand (P=0.0002-0.007).
- No association was found between improved mobility and reduced
risk of falling.
- No significant group by time interaction on any measure of
strength.
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– |
Means et al., 2005 (10)
- To assess the short-term effect of an exercise-based
rehabilitation intervention on balance, mobility, falls, and injuries
- Men and women aged 65+ years, ability to walk at least 30 feet
with or without an assistive device and without physical assistance from
others
- n=338 (beginning sample)
- n=205 (analytic sample)
- 1.5, 6 months follow-up
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- Intervention group: Active stretching, postural control,
endurance walking, and repetitive muscle coordination exercises (3/week, 90
minutes). Progressive, guided by an RPE rating (13 — somewhat hard
— on the scale).
- Sessions were supervised by a physical therapist. Program
started at low-level intensity, and frequency, repetitions, and resistance of
the exercises were adjusted individually. Program included warm-up and
cool-down.
- Control group: Attended a series of seminars on various,
non-health-related topics of general interest to senior citizens.
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- The exercise group’s functional obstacle course quality
improved 2.3% post-intervention and 1.57% at follow-up compared with 0.3% for
the control group for each time period (P=0.001).
- Functional obstacle course completion time improved 7.69% at
post-intervention and 8.35% at follow-up for the exercise group compared with
4.0% and 3.4% for the control group.
- Of the baseline fallers in the intervention group, 87%
(compared with 34.5% for the controls) reported no falls in the subsequent 6
months.
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- The intervention group improved in muscle strength and declined
but remained above baseline level 6 months later, whereas the control
group remained relatively constant across all periods of the study.
- Significant group-by-time findings for range of motion.
|
Mixed functional limitation at start |
LIFE-P Study Investigators, 2006 (11)
- To assess the effect of a comprehensive physical activity
intervention on the SPPB and other physical performance measures.
- Men and women 70-89
- Sedentary, ambulatory, SPPB score ≤9
- n=424 (beginning sample)
- n=424 (analytic sample)
- Average 14 months
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- Intervention group: Aerobic (primary focus), strength training,
balance, flexibility (frequency varied, 40-60 minutes/strength, balance,
flexibility session). Walking goal of at least 150 minutes/week throughout
study. Program was divided into three phases: adoption (weeks 1-8), transition
(weeks 9‑24), maintenance (week 25 to end of trial). Adoption:
3 center-based sessions 40-60 minutes; Transition: 2 center-based sessions
and >3 home-based sessions; Maintenance: home-based exercise with optional
1-2/week center-based sessions. 5-minute warm-up, 45 minutes of 8-10
resistance exercises for upper and lower body, 5-minute cool‑down. Each
participant went through an individualized session before intervention started
to optimize safety and participation. They received behavioral counseling for
first 10 weeks.
- Active control group: Attended health education sessions.
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- Baseline SPPB score 7.5 (on a scale of 0-12, with 12
corresponding to the highest performance)
- At 6 and 12 months, the PA vs. control group adjusted SPPB
(± standard error) scores were 8.7 ± 0.1 vs. 8.0
± 0.1, and 8.5 ±0.1 vs. 7.9 ± 0.2, respectively
(P <0.001).
- There was a trend toward PA group having a lower incidence of
major mobility disability, defined as incapacity to complete a 400-meter walk
(hazard ratio = 0.71, 95% CI = 0.44-1.20). (Not significant)
|
– |
- Average frequency of PA at 6 months was 6.4/week; at 12
months, 5.1/week
- Average walking minutes/ week = 138
|
Luukinen et al., 2006 (12)
- To assess the effectiveness of an intervention planned and
implemented by regional geriatric care teams in order to prevent disability in
an elderly population
- Men and women aged 85+ years, recurrent falling, feelings of
loneliness, poor self-rated health, depression, low cognitive status, impaired
vision, hearing, and/or balance, slow walking speed, impaired ability to stand
up from a chair.
- n=486 (beginning sample)
- n=358 (analytic sample)
- 17 months
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- Intervention: One or more of the following: home, walking,
group, self-care exercises (varied x week, varied minutes/session).
Intervention conducted by geriatric home health care workers.
- Home: 5-15 reps/session, 3 sessions/day
- Walking: Not described
- Group: PA in small groups
- Self-care: Varies — planned by OT
- Control: Were asked to visit their physician without a written
intervention form
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- Mobility score improved more in interven-tion subjects than in
controls (P=0.013).
- No difference in ADL score between intervention and controls
(P=0.462).
- At the end of the intervention, severe mobility restrictions
and frequency of admissions into long-term institutional care existed similarly
in intervention and controls.
- Severe mobility restrictions:
Interventions: (48, 34%)
Controls: (46, 31%) (P=0.650)
- Long-term care admission:
Interventions: (15, 7%)
Controls: (13, 6%) (P=0.669)
- Impaired balance existed in fewer intervention subjects (64,
45%) than controls (89, 59%) (P=0.015).
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– |
↑, increases; ↓, decreases; ABC,
activities-specific balance confidence; ADL, activities of daily living; C,
control; CI, confidence interval; CS-PFP, Continuous Scale Physical Functional
Performance test; CV, cardiovascular; FAC, Functional Ambulation Categories
Scale; FSQ, functional status questionnaire; IADL, instrumental activities of
daily living; mL/kg/min, milliliters per kilogram per minute; N/R, not
reported; OARS, Older American Resources and Services; OT, occupational
therapist; PA, physical activity; PPT, Physical Performance Test; 1RM,
one-repetition maximum; RPE, rate of perceived exertion; SF-36, short form
health survey with 36 questions; SIP, Sickness Impact Profile; SPPB, Short
Physical Performance Battery; ST, strength training
Reference List
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deLateur BJ, Schwartz RS. Exercise: effects on physical functional performance
in independent older adults. J.Gerontol.A Biol.Sci.Med.Sci. 1999
May;54(5):M242-M248.
- King AC, Pruitt LA, Phillips W, Oka R, Rodenburg
A, Haskell WL. Comparative effects of two physical activity programs on
measured and perceived physical functioning and other health-related quality of
life outcomes in older adults. J.Gerontol.A Biol.Sci.Med.Sci. 2000
Feb;55(2):M74-M83.
- Rubenstein LZ, Josephson KR, Trueblood PR, Loy S,
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