Mind over bladder: Women, aging, and bladder health.

The purpose of this study was to explore the efficacy and acceptability of an innovative, electronically delivered self-management intervention for urinary incontinence (UI) that included daily mindfulness practice, completion of sequential bladder diaries, and bladder health education to improve UI in older women living independently in a retirement community. A mixed methods pilot study was conducted over ten weeks using a custom website or CD. Ten women were recruited and 8 completed the study; 5 of those (71%) experienced fewer daily UI episodes post intervention (p = 0.055). The women also reported a statistically significant decrease in the impact UI had on their everyday life (p = 0.04). Seventy-one percent (N = 5) reported subjective improvement in UI, and high acceptability scores also were achieved. The intervention was both effective in helping older women self-manage UI and acceptable to the population group. Further research is needed with a larger and diverse population of older women.

Gait speed response to aerobic versus resistance exercise training in older adults.

BACKGROUND: Little is known about the comparative effect of aerobic training (AT) versus resistance training (RT) on gait speed, a strong predictor of disability. AIMS: To compare the effect of AT versus RT on gait speed and other functional measures. METHODS: Overweight and obese [body mass index (BMI) ≥27.0 kg/m2] sedentary men and women aged 65-79 years engaged in 5 months of either 4 days/weeks moderate-intensity treadmill walking, AT, (n = 44) or 3 days/weeks moderate-intensity RT (n = 56). Usual-pace gait speed, fast-pace gait speed and short physical performance battery (SPPB) were evaluated in all participants before and after training. Peak oxygen consumption (VO2peak) was assessed in AT participants only, and knee extensor strength was assessed in RT participants. RESULTS: Both AT and RT resulted in clinically significant improvements in usual-pace gait speed (0.08 ± 0.14 and 0.08 ± 0.17 m/s, respectively, both p < 0.05) and SPPB (0.53 ± 1.40 and 0.53 ± 1.20 points, both p < 0.05) and chair rise time (-1.2 ± 3.2 and -1.7 ± 3.0 s, p < 0.05). Only AT improved fast-pace gait speed (0.11 ± 0.10 m/s, p < 0.05). In the RT participants, lower baseline knee strength was associated with less improvement in usual-pace gait speed. In AT participants, lower baseline VO2peak was associated with less improvement in chair rise time and self-reported disability. DISCUSSION: While both AT and RT improved usual-pace gait speed, only AT improved fast-pace gait speed. Lower baseline fitness was associated with less improvement with training. CONCLUSION: Research to directly compare which mode of training elicits the maximum improvement in older individuals with specific functional deficits could lead to better intervention targeting.

Standardized Rehabilitation and Hospital Length of Stay Among Patients With Acute Respiratory Failure: A Randomized Clinical Trial.

IMPORTANCE: Physical rehabilitation in the intensive care unit (ICU) may improve the outcomes of patients with acute respiratory failure. OBJECTIVE: To compare standardized rehabilitation therapy (SRT) to usual ICU care in acute respiratory failure. DESIGN, SETTING, AND PARTICIPANTS: Single-center, randomized clinical trial at Wake Forest Baptist Medical Center, North Carolina. Adult patients (mean age, 58 years; women, 55%) admitted to the ICU with acute respiratory failure requiring mechanical ventilation were randomized to SRT (n=150) or usual care (n=150) from October 2009 through May 2014 with 6-month follow-up. INTERVENTIONS: Patients in the SRT group received daily therapy until hospital discharge, consisting of passive range of motion, physical therapy, and progressive resistance exercise. The usual care group received weekday physical therapy when ordered by the clinical team. For the SRT group, the median (interquartile range [IQR]) days of delivery of therapy were 8.0 (5.0-14.0) for passive range of motion, 5.0 (3.0-8.0) for physical therapy, and 3.0 (1.0-5.0) for progressive resistance exercise. The median days of delivery of physical therapy for the usual care group was 1.0 (IQR, 0.0-8.0). MAIN OUTCOMES AND MEASURES: Both groups underwent assessor-blinded testing at ICU and hospital discharge and at 2, 4, and 6 months. The primary outcome was hospital length of stay (LOS). Secondary outcomes were ventilator days, ICU days, Short Physical Performance Battery (SPPB) score, 36-item Short-Form Health Surveys (SF-36) for physical and mental health and physical function scale score, Functional Performance Inventory (FPI) score, Mini-Mental State Examination (MMSE) score, and handgrip and handheld dynamometer strength. RESULTS: Among 300 randomized patients, the median hospital LOS was 10 days (IQR, 6 to 17) for the SRT group and 10 days (IQR, 7 to 16) for the usual care group (median difference, 0 [95% CI, -1.5 to 3], P = .41). There was no difference in duration of ventilation or ICU care. There was no effect at 6 months for handgrip (difference, 2.0 kg [95% CI, -1.3 to 5.4], P = .23) and handheld dynamometer strength (difference, 0.4 lb [95% CI, -2.9 to 3.7], P = .82), SF-36 physical health score (difference, 3.4 [95% CI, -0.02 to 7.0], P = .05), SF-36 mental health score (difference, 2.4 [95% CI, -1.2 to 6.0], P = .19), or MMSE score (difference, 0.6 [95% CI, -0.2 to 1.4], P = .17). There were higher scores at 6 months in the SRT group for the SPPB score (difference, 1.1 [95% CI, 0.04 to 2.1, P = .04), SF-36 physical function scale score (difference, 12.2 [95% CI, 3.8 to 20.7], P = .001), and the FPI score (difference, 0.2 [95% CI, 0.04 to 0.4], P = .02). CONCLUSIONS AND RELEVANCE: Among patients hospitalized with acute respiratory failure, SRT compared with usual care did not decrease hospital LOS. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00976833.

The influence of muscle action on heart rate, RPE, and affective responses after upper-body resistance exercise.

Ratings of perceived exertion (RPE) are routinely used to monitor, assess, and prescribe aerobic exercise. Heart rate (HR) is another measure used to evaluate exercise intensity. Additionally, affective responses to aerobic exercise have been studied and seem to be influenced by the intensity of the exercise. The perceptual, HR, and affective responses to resistance exercise have not been effectively established. The purpose of this study was to examine whether differences in affect, RPE, and HR exist among college-aged women (n = 31) performing three different modes of resistance training: concentric (CE), eccentric (EE), and traditional concentric/eccentric (TE) performed at varying resistances. The women were asked to complete four sessions of resistance training on variable resistance machines: chest press, seated row, overhead press, and biceps curl. The first session was used to establish the 10-repetition maximum (RM) load for each station. Subsequent sessions involved the execution of training in one of the three test conditions: CE, EE, or TE. The participants performed three sets of each lift at 80% 10-RM, 100% 10-RM, and 120% 10-RM. The data revealed lower RPE during EE than the other test conditions. Similarly, EE elicited more mild HR response than either CE or TE. This finding is potentially important for the establishment of training programs, especially for those individuals recovering from an illness, who had been previously sedentary, and who are involved in rehabilitation of an injury.

Effect of Resistance Training and Caloric Restriction on the Metabolic Syndrome.

PURPOSE: The prevalence of metabolic syndrome (MetS) is greatest in older obese adults, and effective evidence-based treatment strategies are lacking. This study determined the efficacy of adding caloric restriction (CR) for weight loss to resistance training (RT) on MetS and its individual components in older overweight and obese adults. METHODS: We performed a 5-month randomized controlled trial in 126 older (65-79 yr) overweight and obese (body mass index = 27-35 kg·m) men and women who were assigned to a progressive 3-d·wk moderate-intensity RT with (RT + CR) or without caloric restriction (RT). MetS components, according to the National Cholesterol Education Program Adult Treatment Panel III, were determined before and immediately after the interventions. RESULTS: Body mass decreased in RT + CR (-5.67% loss of initial mass) but was unchanged in RT (-0.15%). Compared with RT, RT + CR resulted in reduced VLDL cholesterol, triglycerides, and systolic and diastolic blood pressures (P between 0.000 and 0.013). The RT group showed no significant within-group changes in MetS criteria. Abdominal obesity, hypertension, the number of metabolic abnormalities and the presence of MetS significantly decreased with RT + CR. There were significant group differences for abdominal obesity, hypertension, and number of metabolic abnormalities. CONCLUSION: RT + CR is an effective strategy for improving some of the metabolic abnormalities associated with MetS among older overweight and obese adults.

Effects of Resistance Training With and Without Caloric Restriction on Arterial Stiffness in Overweight and Obese Older Adults.

BACKGROUND: Arterial stiffness is an important marker of vascular aging that is increased in sedentary, obese older adults. Weight loss induced by caloric restriction (CR) can improve arterial stiffness in this population; however, the effects of resistance training (RT) are not clear. This pilot study determined the effects of RT with and without CR on arterial stiffness in overweight and obese older adults. METHODS: Participants (mean age = 68±3 years, mean body mass index = 31.1±2.7 kg/m(2), 56% female, 13% Black) were randomly assigned to 3 days/week of supervised moderate-intensity RT (n = 16) or RT+CR (n = 16) for 5 months. Three indices of arterial stiffness were measured: brachial-ankle pulse wave velocity, large artery elasticity, and small artery elasticity. RESULTS: Body mass was significantly reduced in the RT+CR group compared to the RT group (-6.2±4.8 vs. 0.2±1.2 kg, P = 0.0006). Within-group analyses showed that none of the arterial stiffness measures changed with RT or RT+CR. There were also no significant between-group differences, though median changes in large artery elasticity were slightly greater with RT+CR: 0.7 (-2.5, 5.1) vs. 0.3 (-2.6, 0.9) ml/mm Hg × 10, P = 0.07. Changes in large artery elasticity were negatively correlated with changes in waist circumference (r = -0.36, P < 0.05), systolic blood pressure (r = -0.38, P = 0.03), and diastolic blood pressure (r = -0.41, P = 0.02). CONCLUSIONS: The combination of RT and CR, leading to a modest amount of weight loss (7%), tended to increase large artery elasticity more than RT alone. Our data suggest that reductions in waist circumference and blood pressure may promote improvements in elasticity. CLINICAL TRIALS REGISTRATION: Trial Number NCT01049698.

Effects of resistance training with and without caloric restriction on physical function and mobility in overweight and obese older adults: a randomized controlled trial.

BACKGROUND: Resistance training (RT) improves muscle strength and overall physical function in older adults. RT may be particularly important in the obese elderly who have compromised muscle function. Whether caloric restriction (CR) acts synergistically with RT to enhance function is unknown. OBJECTIVE: As the primary goal of the Improving Muscle for Functional Independence Trial (I'M FIT), we determined the effects of adding CR for weight loss on muscle and physical function responses to RT in older overweight and obese adults. DESIGN: I'M FIT was a 5-mo trial in 126 older (65-79 y) overweight and obese men and women who were randomly assigned to a progressive, 3-d/wk, moderate-intensity RT intervention with a weight-loss intervention (RT+CR) or without a weight-loss intervention (RT). The primary outcome was maximal knee extensor strength; secondary outcomes were muscle power and quality, overall physical function, and total body and thigh compositions. RESULTS: Body mass decreased in the RT+CR group but not in the RT group. Fat mass, percentage of fat, and all thigh fat volumes decreased in both groups, but only the RT+CR group lost lean mass. Adjusted postintervention body- and thigh-composition measures were all lower with RT+CR except intermuscular adipose tissue (IMAT). Knee strength, power, and quality and the 4-m gait speed increased similarly in both groups. Adjusted postintervention means for a 400-m walk time and self-reported disability were better with RT+CR with no group differences in other functional measures, including knee strength. Participants with a lower percentage of fat and IMAT at baseline exhibited a greater improvement in the 400-m walk and knee strength and power. CONCLUSIONS: RT improved body composition (including reducing IMAT) and muscle strength and physical function in obese elderly, but those with higher initial adiposity experienced less improvement. The addition of CR during RT improves mobility and does not compromise other functional adaptations to RT. These findings support the incorporation of RT into obesity treatments for this population regardless of whether CR is part of the treatment. This trial was registered at clinicaltrials.gov as NCT01049698.

Heterogeneity of physical function responses to exercise training in older adults.

OBJECTIVES: To describe the interindividual variability in physical function responses to supervised resistance and aerobic exercise training interventions in older adults. DESIGN: Data analysis of two randomized, controlled exercise trials. SETTING: Community-based research centers. PARTICIPANTS: Overweight and obese (body mass index (BMI)≥27.0 kg/m2) sedentary men and women aged 65 to 79 (N=95). INTERVENTION: Five months of 4 d/wk of aerobic training (AT, n=40) or 3 d/wk of resistance training (RT, n=55). MEASUREMENTS: Physical function assessments: global measure of lower extremity function (Short Physical Performance Battery (SPPB)), 400-m walk, peak aerobic capacity (VO2 peak), and knee extensor strength. RESULTS: On average, both exercise interventions significantly improved physical function. For AT, there was a 7.9% increase in VO2 peak; individual absolute increases varied from 0.4 to 4.3 mL/kg per minute, and four participants (13%) showed no change or a decrease in VO2 peak. For RT, knee extensor strength improved an average of 8.1%; individual increases varied from 1.2 to 63.7 Nm, and 16 participants (30%) showed no change or a decrease in strength. Usual gait speed, 400-m walk time, chair rise time, and SPPB improved for the majority of AT participants and usual gait speed, chair rise time, and SPPB improved for the majority of RT participants, but there was wide variation in the magnitude of improvement. Only change in 400-m walk time with RT was related to exercise adherence (correlation coefficient=-0.31, P=.004). CONCLUSION: Despite sufficient levels of adherence to both exercise interventions, some participants did not improve function, and the magnitude of improvement varied widely. Additional research is needed to identify factors that optimize responsiveness to exercise to maximize its functional benefits in older adults.

The Virtual Short Physical Performance Battery.

BACKGROUND: Performance-based and self-report instruments of physical function are frequently used and provide complementary information. Identifying older adults with a mismatch between actual and perceived function has utility in clinical settings and in the design of interventions. Using novel, video-animated technology, the objective of this study was to develop a self-report measure that parallels the domains of objective physical function assessed by the Short Physical Performance Battery (SPPB)-the virtual SPPB (vSPPB). METHODS: The SPPB, vSPPB, the self-report Pepper Assessment Tool for Disability, the Mobility Assessment Tool-short form, and a 400-m walk test were administered to 110 older adults (mean age = 80.6±5.2 years). One-week test-retest reliability of the vSPPB was examined in 30 participants. RESULTS: The total SPPB (mean [±SD] = 7.7±2.8) and vSPPB (7.7±3.2) scores were virtually identical, yet moderately correlated (r = .601, p < .05). The component scores of the SPPB and vSPPB were also moderately correlated (all p values <.01). The vSPPB (intraclass correlation = .963, p < .05) was reliable; however, individuals with the lowest function overestimated their overall lower extremity function while participants of all functional levels overestimated their ability on chair stands, but accurately perceived their usual gait speed. CONCLUSION: In spite of the similarity between the SPPB and vSPPB, the moderate strength of the association between the two suggests that they offer unique perspectives on an older adult's physical function.

Physical activity and physical function in older adults with knee osteoarthritis.

PURPOSE: To assess correlates of physical activity, and to examine the relationship between physical activity and physical functioning, in 160 older (66 ± 6 years old), overweight/obese (mean body mass index = 33.5 ± 3.8 kg/m2), sedentary (less than 30 mins of activity, 3 days a week) individuals with knee osteoarthritis. METHODS: Physical activity was measured with accelerometers and by self-report. Physical function was assessed by 6-min walk distance, knee strength, and the Short Physical Performance Battery. Pain and perceived function were measured by questionnaires. Pearson correlations and general linear models were used to analyze the relationships. RESULTS: The mean number of steps taken per day was 6209 and the average PAEE was 237 ± 124 kcal/day. Participants engaged in 131 ± 39 minutes of light physical activity (LPA) and 10.6 ± 8.9 minutes of moderate-vigorous physical activity (MPA/VPA). Total steps/day, PAEE, and minutes of MPA/VPA were all negatively correlated with age. The 6-min walk distance and lower extremity function were better in those who had higher total steps/day, higher PAEE, higher minutes of MPA/VPA, and a higher PASE score. CONCLUSIONS: This study demonstrates that a population who has higher levels of spontaneous activity have better overall physical function than those who engage in less activity.

Mirrors and resistance exercise, do they influence affective responses?

The purpose of this study was to examine affective responses during and following resistance exercise in a mirrored environment. Thirty-two females completed three sessions. During session one, exercise intensity was determined for the subsequent two sessions. During the next two sessions participants performed eight exercises either with or without mirrors. Affect was measured prior to, during, immediately following and 15 minutes post-exercise. Affect was more pleasant and activated during and following exercise, but did not differ by condition. The inability to find a difference in mirrored condition may be a result of participants using the mirrors for technique as opposed to self-evaluation purposes.

Should physical activity programs be tailored when older adults have compromised function?

The purpose of this study was to determine whether a walking program supplemented by tasks designed to challenge balance and mobility (WALK+) could improve physical function more than a traditional walking program (WALK) in older adults at risk for mobility disability. 31 community-dwelling older adults (M +/- SD age = 76 +/- 5 yr; Short Physical Performance Battery [SPPB] score = 8.4 +/- 1.7) were randomized to treatment. Both interventions were 18 sessions (1 hr, 3x/wk) and progressive in intensity and duration. Physical function was assessed using the SPPB and the 400-m-walk time. A subset of participants in the WALK group who had relatively lower baseline function showed only small improvement in their SPPB scores after the intervention (0.3 +/- 0.5), whereas a subset of participants in the WALK+ group with low baseline function showed substantial improvement in their SPPB scores (2.2 +/- 0.7). These preliminary data underscore the potential importance of tailoring interventions for older adults based on baseline levels of physical function.

The Lifestyle Interventions and Independence for Elders Pilot (LIFE-P): 2-year follow-up.

BACKGROUND: It is well recognized that physical activity (PA) is important for older adults; yet, clinicians remain pessimistic about the ability of older adults with compromised function to adhere to long-term treatment and to maintain behavior change once treatment has been terminated. METHODS: We examined the functional status of older adults at a field center (Wake Forest University) 2 years after completing 12 months of treatment in the Lifestyle Interventions and Independence for Elders Pilot study. At baseline, participants were randomized to either a PA or a successful aging (SA) control group. Outcome measures included an interview assessment of PA, the Short Physical Performance Battery (SPPB), and performance on a 400-m self-paced walking test. RESULTS: Two years after the formal intervention had ended, participants who were originally in the PA group continued to engage in more minutes of moderate PA and tended to have better SPPB and walking speed than those in the SA group (effect sizes [ES]: SPPB = 0.40, walking speed = 0.37). Seven (12.7%) participants in the PA group failed the 400-m walk at the 36-month follow-up assessment, whereas this number was 11 (21.6%) in the SA group. CONCLUSION: Older adults who have compromised physical function are able to sustain some of the benefits derived from participating in structured PA 2 years after supervised treatment has been terminated.