Strength training in the elderly

Effects on risk factors for age-related diseases  / by: Hurley BF, Roth SM.

Source:  Department of Kinesiology, College of Health & Human Performance, University of Maryland, College Park 20742, USA. bh24@umail.umd.edu

Abstract

Strength training (ST) is considered a promising intervention for reversing the loss of muscle function and the deterioration of muscle structure that is associated with advanced age.

This reversal is thought to result in improvements in functional abilities and health status in the elderly by increasing muscle mass, strength and power and by increasing bone mineral density (BMD).

In the past couple of decades, many studies have examined the effects of ST on risk factors for age-related diseases or disabilities.

Collectively, these studies indicate that ST in the elderly: (i) is an effective intervention against sarcopenia because it produces substantial increases in the strength, mass, power and quality of skeletal muscle; (ii) can increase endurance performance; (iii) normalises blood pressure in those with high normal values; (iv) reduces insulin resistance; (v) decreases both total and intra-abdominal fat; (vi) increases resting metabolic rate in older men; (vii) prevents the loss of BMD with age; (viii) reduces risk factors for falls; and (ix) may reduce pain and improve function in those with osteoarthritis in the knee region.

However, contrary to popular belief, ST does not increase maximal oxygen uptake beyond normal variations, improve lipoprotein or lipid profiles, or improve flexibility in the elderly.


Quelle:  http://www.ncbi.nlm.nih.gov/pubmed/11048773

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Exercise Training for Rehabilitation and Secondary Prevention of Falls

Exercise Training for Rehabilitation and Secondary Prevention of Falls in Geriatric Patients with a History of Injurious Falls

1. Klaus Hauer PhD¹,
2. Brenda Rost¹,
3. Kirstin Rütschle¹,
4. Hedda Opitz¹,
5. Norbert Specht MD¹,
6. Peter Bärtsch MD²,
7. Peter Oster MD¹,
8. Günter Schlierf MD¹

Abstract

Keywords:

• geriatric patients;
• injurious falls;
• physical training
•  

OBJECTIVE: To determine the safety and efficacy of an exercise protocol designed to improve strength, mobility, and balance and to reduce subsequent falls in geriatric patients with a history of injurious falls.

DESIGN: A randomized 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 standardized protocols 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 assessments 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.


Quelle:  http://onlinelibrary.wiley.com/doi/10.1046/j.1532-5415.2001.49004.x/abstract?deniedAccessCustomisedMessage=&userIsAuthenticated=true

Exercise Training for Rehabilitation and Secondary Prevention of Falls in Geriatric Patients with a History of Injurious Falls

Online im internet - Zugriff: 30.09.2012 . Full Text / pdf: 

http://knowledgetranslation.ca/sysrev/articles/project51/Hauer2001.pdf

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Effective Exercise for the Prevention of Falls

A Systematic Review and Meta-Analysis

1. Catherine Sherrington
2. Julie C. Whitney
3. Stephen R. Lord
4. Robert D. Herbert
5. Robert G. Cumming
6. Jacqueline C. T. Close

Keywords:

• falls;
• exercise;
• meta-analysis

Abstract

OBJECTIVES: To determine the effects of exercise on falls prevention in older people and establish whether particular trial characteristics or components of exercise programs are associated with larger reductions in falls.

DESIGN: Systematic review with meta-analysis. Randomized controlled trials that compared fall rates in older people who undertook exercise programs with fall rates in those who did not exercise were included.

SETTING: Older people.

PARTICIPANTS: General community and residential care.

MEASUREMENTS: Fall rates.

RESULTS: The pooled estimate of the effect of exercise was that it reduced the rate of falling by 17% (44 trials with 9,603 participants, rate ratio (RR)=0.83, 95% confidence interval (CI)=0.75–0.91, P<.001, I²=62%). The greatest relative effects of exercise on fall rates (RR=0.58, 95% CI=0.48–0.69, 68% of between-study variability explained) were seen in programs that included a combination of a higher total dose of exercise (>50 hours over the trial period) and challenging balance exercises (exercises conducted while standing in which people aimed to stand with their feet closer together or on one leg, minimize use of their hands to assist, and practice controlled movements of the center of mass) and did not include a walking program.

CONCLUSION: Exercise can prevent falls in older people. Greater relative effects are seen in programs that include exercises that challenge balance, use a higher dose of exercise, and do not include a walking program. Service providers can use these findings to design and implement exercise programs for falls prevention.


Quelle und Full Text - Zugriff 30.09.2012:

http://onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.2008.02014.x/full

 

Effective Exercise for the prevention of falls: A systematic review and meta-analysis

Full Text / pdf:

http://www.laterlifetraining.co.uk/wp-content/uploads/2011/12/Sherrington_Ex_Int_Review_2008_JAGS.pdf

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Exercise in the Prevention of Falls in Older People

A Systematic Literature Review Examining the Rationale and the Evidence

Authors: Carter N.D.; Kannus P; Khan K.M.
 
Source: Sports Medicine, Volume 31, Number 6, 1 June 2001 , pp. 427-438(12)

Abstract:

Falls are a major source of death and injury in elderly people. For example, they cause 90% of hip fractures and the current cost of hip fractures in the US is estimated to be about 10 billion dollars. Age-related changes in the physiological systems (somatosensory, vestibular and visual) which contribute to the maintenance of balance are well documented in older adults. 

 

These changes coupled with age-related changes in muscle and bone are likely to contribute to an increased risk of falls in this population. The integrated rehabilitation-based model of fall risk factors reveals multiple sites for interventions that may reverse fall risk factors. Regular exercise may be one way of preventing falls and fall-related fractures. 

 

The evidence for this contention comes from a variety of sources. On the basis of 9 randomised controlled studies conducted since 1996, exercise appears to be a useful tool in fall prevention in older adults, significantly reducing the incidence of falls compared with control groups. 

 

However, current limitations such as inconsistencies in the measurement of key dependent and independent variables do not, at present, permit a meta-analysis of intervention trials. Further investigation, using trials designed with the current limitations in mind, is necessary to establish the optimum exercise programme to maximise fall prevention in older adults. 

 

Keywords: Elderly; Exercise therapy
 
Document Type: Review article

Quelle:  http://www.ingentaconnect.com/content/adis/smd/2001/00000031/00000006/art00003


Exercise in the prevention of falls in oder people:  Full Text / pdf

http://resources.glos.ac.uk/shareddata/dms/0EEB551FBCD42A0394BE4E0235DC08D2.pdf

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Systematic Review of Progressive Resistance Strength Training in Older Adults

systematic review von:

1. Nancy K. Latham 
2. Derrick A. Bennett ,
3. Caroline M. Stretton  and
4. Craig S. Anderson

Abstract

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. 

Methods. Randomized controlled trials were identified from searches of relevant databases and study reference lists and contacts with researchers. Two reviewers independently screened the trials for eligibility, rated their quality, and extracted data. Only randomized controlled trials utilizing PRT as the primary intervention in participants, whose group mean age was 60 years or older, were included. Data were pooled using fixed or random effect models to produce weighted mean differences (WMD) and 95% confidence intervals (CI). Standardized mean differences (SMD) were calculated when different units of measurement were used for the outcome of interest. 

Results. 62 trials (n = 3674) compared PRT with a control group. 14 trials had data available to allow pooling of disability outcomes. Most trials were of poor quality. PRT showed a strong positive effect on strength, although there was significant heterogeneity (41 trials [n = 1955], SMD 0.68; 95% confidence interval [CI] 0.52, 0.84). A modest effect was found on some measures of functional limitations such as gait speed (14 trials [n = 798], WMD 0.07 meters per second; 95% CI 0.04, 0.09). No evidence of an effect was found for physical disability (10 trials [n = 722], SMD 0.01; 95% CI −0.14, 0.16). Adverse events were poorly investigated, but occurred in most studies where they were defined and prospectively monitored. 

Conclusions. 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.

Quelle:  http://biomedgerontology.oxfordjournals.org/content/59/1/M48.short

Download Full Text / Google Scholar / Ähnliche Artikel:   latham_et_al._2004_-_prt_in_older_adults-1.pdf

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Prevention of falls and consequent injuries in elderly people

Review / von:

• Prof Pekka Kannus, MD^{a, b, ,} ,
• Harri Sievänen, ScD^a,
• Mika Palvanen, MD^a,
• Teppo Järvinen, MD^b,
• Jari Parkkari, MD^c

• ^a Accident & Trauma Research Centre, UKK Institute for Health Promotion Research, Tampere, Finland
• ^b Department of Surgery, Tampere University Medical School and University Hospital, Tampere, Finland
• ^c Tampere Research Centre of Sports Medicine, UKK Institute for Health Promotion Research, Tampere, Finland

Abstract / Summary

Injuries resulting from falls in elderly people are a major public-health concern, representing one of the main causes of longstanding pain, functional impairment, disability, and death in this population.

The problem is going to worsen, since the rates of such injuries seem to be rising in many areas, as is the number of elderly people in both the developed and developing world.

Many methods and programmes to prevent such injuries already exist, including regular exercise, vitamin D and calcium supplementation, withdrawal of psychotropic medication, cataract surgery, professional environment hazard assessment and modification, hip protectors, and multifactorial preventive programmes for simultaneous assessment and reduction of many of the predisposing and situational risk factors.

To receive broader-scale effectiveness, these programmes will need systematic implementation. Care must be taken, however, to rigorously select the right actions for those people most likely to benefit, such as vitamin D and calcium supplementation and hip protectors for elderly people living in institutions.

Quelle:   http://www.sciencedirect.com/science/article/pii/S0140673605676040


Prevention of falls and consequent injuries in elderly people - Full Text / pdf:

http://www.grg-bs.it/usr_files/eventi/journal_club/programma/falls_lancet.pdf

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Control of rapid limb movements for balance recovery

age-related changes and implications for fall prevention

1. Brian E. Maki ¹ , ² and
2. William E. McIlroy ² , ³

1. ¹Department of Surgery and Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
2. ²Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
3. ³Graduate Department of Rehabilitation Science, University of Toronto, Toronto, Ontario, Canada

1. Address correspondence to: B. E. Maki, Centre for Studies in Aging, Sunnybrook Health Sciences, Centre, 2075 Bayview Avenue, Toronto, Ontario, Canada M4N 3M5. Tel: (+1) 416 480 6100x3513; Fax: (+1) 416 480 5856. Email: brian.maki@sri.utoronto.ca

Abstract

Background: balancing reactions that involve rapid stepping or reaching movements are critical for preventing falls. These compensatory reactions are much more rapid than volitional limb movements and can be very effective in decelerating the centre-of-mass motion induced by sudden unpredictable balance perturbation; however, age-related deterioration in the neural, sensory and/or musculoskeletal systems may impede the ability to execute these reactions effectively. 

Objective: this paper summarises recent research regarding age-related changes in compensatory stepping and reaching reactions and the practical implications of these findings for fall prevention programmes. 

Results: even healthy older adults experience pronounced difficulties. For stepping reactions, the main problems pertain to control of lateral stability—arresting the lateral body motion that occurs during forward and backward steps, and controlling lateral foot movement so as to avoid collision with the stance limb during lateral steps. Older adults appear to be more reliant on arm reactions than young adults but are less able to execute reach-to-grasp reactions rapidly. 

Conclusions: it is important for clinicians to assess compensatory stepping and reaching, in order to identify individuals who are at risk of falling and to pinpoint specific control problems to target for balance or strength training or other intervention. More effective use of stepping and reaching reactions can be promoted through improved design and appropriate use of sensory aids, mobility aids, footwear, handrails and grab-bars. It is particularly important to address the problems associated with the control of lateral stability because it is the lateral falls that are most likely to result in hip fracture. 

Key words

• ageing
• falls
• postural balance
• reachings
• tepping

Quelle:  http://ageing.oxfordjournals.org/content/35/suppl_2/ii12.short


Full Text / pdf:  http://ageing.oxfordjournals.org/content/35/suppl_2/ii12.full.pdf

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