A Novel Exercise for Enhancing Visuospatial Ability in Older Adults with Frailty: Development, Feasibility, and Effectiveness.

We aimed to develop a novel exercise to improve visuospatial ability and evaluate its feasibility and effectiveness in older adults with frailty. A non-randomized preliminary trial was conducted between June 2014 and March 2015. We recruited 35 adults with frailty (24 women), aged 66-92 years. Participants were assigned to either locomotive- or visuospatial-exercise groups. All participants exercised under the supervision of physiotherapists for 90 min/week for 12 weeks. The visuospatial exercise participants used cubes with six colored patterns and were instructed to "reproduce the same colored pattern as shown in the photo", using the cubes. In the locomotive exercise group, lower extremity functional training was provided. Rates of retention and attendance measured feasibility. Most participants completed the intervention (77.3%, locomotive; 84.6%, visuospatial) and had good attendance (83.8%, locomotive; 90.7%, visuospatial). Mini-mental state examination (MMSE), clock drawing test (CDT), and seven physical performance tests were conducted before and after interventions. The improvement in the MMSE score, qualitative analysis of CDT, grip strength, and sit and reach assessments were significantly greater in the visuospatial exercise group than in the locomotive exercise group. The cube exercise might be a feasible exercise program to potentially improve visuospatial ability and global cognition in older adults with frailty.

Longitudinal association between habitual walking and fall occurrences among community-dwelling older adults: analyzing the different risks of falling.

The purpose of this longitudinal study was to examine the association between habitual walking and multiple or injurious falls (falls) among community-dwelling older adults, by considering the relative risk of falling. A cohort of Japanese community-dwelling older adults (n=535) aged 60-91 years (73.1±6.6 year, 157 men and 378 women) who underwent community-based health check-ups from 2008 to 2012 were followed until 2013. Incidence rate of falls between walkers and non-walkers was compared separately by the number of risk factors (Groups R0, R1, R2, R3 and R4+). The Cox proportional hazard model was used to assess the association between habitual walking and falls separately by lower- (R<2) and higher- (R≥2) risk groups. In Groups R0 and R1, the incidence of falls was lower in walkers than non-walkers; however, in Groups R2, R3, and R4+, the incidence of falls was higher in walkers. The Cox proportional hazard model showed that habitual walking was not significantly associated with falls (hazard ratio (HR): 0.88, 95% confidence interval (CI): 0.48-1.62) among the lower risk group but that it was significantly associated with increased falls (HR: 1.89, 95% CI: 1.04-3.43) among the higher risk group. The significant interaction between habitual walking and higher risk of falling was found (P<0.05). When individuals have two or more risk factors for falling, caution is needed when recommending walking because walking can actually increase their risk of experiencing multiple or injurious falls.

Association between habitual light-intensity physical activity and lower-extremity performance: a cross-sectional study of community-dwelling older Japanese adults.

AIM: Habitual moderate vigorous-intensity physical activity (MVPA) positively affects lower-extremity performance. It is unclear whether habitual light-intensity physical activity (LPA), such as leisurely walking, has similar effects on lower-extremity performance. The aim of the present study was to identify the associations between habitual LPA and lower-extremity performance in older adults. METHODS: This cross-sectional study included 802 community-dwelling Japanese older adults, 187 men and 615 women, aged 60-96 years. A uniaxial accelerometer measured physical activity intensity for over 10 h/day continuously for 7 days. Lower-extremity performance was assessed by repeated chair stands (RCS), single-leg stance (SLS) and Timed Up & Go (TUG). Multiple regression analysis was used to identify whether LPA was associated with lower-extremity performance, independent of potential confounders. RESULTS: The multiple regression analysis showed that longer LPA was significantly associated with better performance of RCS and TUG. In the results of stratified analyses, LPA was significantly associated with RCS in participants aged ≥75 years and in those with at least one medical condition or joint pain. LPA was also associated with TUG in participants aged ≥75 years, in those with at least one medical condition or joint pain and in those with low MVPA (<13.9 min/day). CONCLUSIONS: These results suggest that habitual LPA is a useful lifestyle indicator of better performance in lower-extremity strength and gait with dynamic balance. Maintaining a higher level of LPA could be a recommended approach for preserving lower-extremity performance, especially among physically frail older adults.

[Evaluation of the association between cognitive impairment and the vitamin D levels among community-dwelling Japanese pre-frail elderly individuals].

AIM: Cognitive impairment is the second leading cause of long-term care, and the number of cognitively impaired elderly individuals is increasing. Cognitive impairment has been reported to be associated with a low vitamin D level. However, many elderly individuals are deficient in vitamin D due to undernutrition and a house-bound status. It is unknown whether cognitive impairment is independently associated with the vitamin D level. The aim of this study was to examine the association between cognitive impairment and the levels of vitamin D among community-dwelling Japanese pre-frail elderly individuals. METHODS: A cross-sectional survey was conducted in two towns (latitude: 36 degrees north) from June 2006 to January 2011. The subjects included 316 community-dwelling pre-frail elderly individuals 65 years of age or older (mean±SD: 77.0±5.7 yr) who attended a program for nursing care prevention. A questionnaire-based interview was conducted regarding activities of daily living. The serum levels of intact parathyroid hormone (iPTH), 25-hydroxyvitamin D (25(OH)D) and 1,25-dihydroxyvitamin D (1,25(OH)2D) were measured. Age and gender were recorded, as well as the presence of cognitive impairment determined according to the Mini Mental State Examination (MMSE). The factors associated with an MMSE score of ≤23 were examined using a multiple logistic regression analysis. RESULTS: Of the subjects, 21.2% were men and 30.6% had an MMSE score of ≤23. The mean MMSE score was 25.3±3.7. The prevalence of severe deficiency of 25(OH)D was 1.7%, and only 14.0% of the participants had a sufficient vitamin D level. The multiple logistic regression analysis suggested that an MMSE score of less than 23 was significantly associated with the levels of iPTH and 25(OH)D among the pre-frail men, but not the women. CONCLUSIONS: Our data suggest that the vitamin D level is significantly associated with cognitive impairment in pre-frail elderly men.

Physical performance measures as a useful indicator of multiple geriatric syndromes in women aged 75 years and older.

AIM: To identify whether individual physical performance measures or a combination of measures is a better indicator of multiple geriatric syndromes (MGS) defined as the concomitant presence of more than one geriatric syndrome in an individual. METHODS: We carried out cross-sectional analyses on data from 340 community-dwelling women aged 75 years and older (mean 80.0 years). We examined the following geriatric syndromes: urinary incontinence, falls, underweight, depression and functional decline. Trained testers measured usual gait speed (UGS), hand-grip strength and lower extremity performance (LEP) score derived from four LEP measures: tandem stance, chair stand test, alternate step and timed up-and-go (TUG). We categorized UGS to distinguish high- and low-performing participants using the established 1.0 m/s cut-off point. Applying the same population percentile (35.8%), we determined cut-off points for all individual measures and the LEP score. RESULTS: The UGS, TUG and LEP score had similar discriminating powers for MGS (each with area under receiver-operator curves [AUC] of 0.80), which were more significant than the discriminating powers of other individual measures (AUC = 0.69-0.76) when considered as continuous variables. A slow UGS, especially less than 1.0 m/s, was more strongly associated with MGS (odds ratio [OR] = 7.6, 95% confidence interval [CI] = 3.6-15.9) than the same percentiles for TUG (OR = 3.9, 95% CI = 1.9-7.8) and LEP score (OR = 5.2, 95% CI = 2.5-10.6). CONCLUSION: The UGS test alone might be sufficient in detecting MGS in women aged 75 years and older compared with a more comprehensive test battery.

Comparison of a combination of upper extremity performance measures and usual gait speed alone for discriminating upper extremity functional limitation and disability in older women.

Although usual gait speed (UGS) is considered an indicator of overall well-being, it is unclear whether upper extremity performance (UEP) measures provide a similar, additive contribution to functional status. We aimed to identify whether combining UEP measures can more accurately discriminate upper extremity functional limitation (UE limitation) and disability compared to UGS. We conducted a cross-sectional analysis on data from 322 community-dwelling older women, aged 65-96 years. Trained testers assessed UGS, and hand-grip strength (GRIP), functional reach (FR), back scratch, manipulating pegs (PEG), and moving beans with chopsticks as UEP measures. We assessed three functional statuses: UE limitation, activities of daily living (ADLs) and instrumental ADLs (IADLs) disabilities using self-reported questionnaires. Areas under the receiver operating characteristic curves (AUCs) were used to compare the discriminating power of UGS, with the individual and combined UEP measures for each status. Among UEP measures, only GRIP (AUC=0.68 for UE limitation, 0.81 for IADLs disability, and 0.84 for ADLs disability) could accurately discriminate each status as well as UGS (AUC=0.65, 0.83, and 0.91, respectively). Furthermore, UGS alone could discriminate UE limitation almost as well as the combination of GRIP, PEG, and FR (AUC=0.70). Combining other UEP measures did not help discriminate further. There were few advantages to combining UEP measures, and UGS or GRIP alone may suffice for assessing UE limitation and disability. However, the UGS should be the test of first choice, certainly more than GRIP, in routine assessment of functional limitation and disability, including UE limitation.

Assessment of vulnerable older adults' physical function according to the Japanese Long-Term Care Insurance (LTCI) system and Fried's criteria for frailty syndrome.

This study aimed to evaluate the physical frailty status of vulnerable older adults as classified in the Japanese LTCI system and to compare this with Fried's definition. A total of 444 older adults were classified based on the LTCI system as independent, vulnerable, or dependent, and 400 of these participants also fit Fried's criteria for not frail, pre-frail or frail. We evaluated their physical function with a 12 item physical function test. We derived a physical function score (PFS) from these 12 items and a principal component analysis was used to make comparisons. The receiver operating characteristic (ROC) curve analysis was performed to identify the sensitivity and specificity of the PFS cut-off points to distinguish the dependent category from the other categories. We found significant differences and a hierarchical order for the PFSs among the three groups of the LTCI system (the independent, 0.41 ± 0.54; the vulnerable, -0.40 ± 0.76; and the dependent, -1.49 ± 0.73) and of Fried's definition (not frail, 0.50 ± 0.51; pre frail, -0.11 ± 0.63; and frail, -1.25 ± 0.98). The optimal cut-off value (OCV) was -0.593. This study showed that the range of physical function of people considered frail category (pre-frail, vulnerable, and frail) is wide and overlapping. That is, the physical function of vulnerable older adults is worse than the pre-frail, but better than the frail. To better recognize older adults in need of greater support, the vulnerable should also receive assessment of their frailty status according to Fried's definition.

Exploring effective items of physical function in slow walking speed and self-reported mobility limitation in community-dwelling older adults.

AIM: To examine gender differences in regards to the disagreement between walking speed and self-reported mobility limitations, and, furthermore, to explore the items that affect each physical function task by comparing slow walking speed and self-reported mobility limitation in community-dwelling older adults. METHODS: The subjects consisted of 1381 community-dwelling men and women aged 65-84 years who were classified into four categories according to a combination of mobility status measured by a slow walking speed (usual gait speed < 1.0 m/s) and self-reported mobility limitation (difficulty walking 1 km). The physical function tests comprised one-legged stance, tandem stance, functional reach, tandem walk, alternate step and five chair sit-to-stand. RESULTS: The prevalence of limitations increased more rapidly with age in women than in men for five mobility tasks (P < 0.001). The percent difference between slow walking speed and self-reported mobility limitation was higher in women (24%) than men (19%). The multivariate logistic regression model showed that after adjusting for all covariates, the tandem walk, alternate step and five chair sit-to-stand were identified as effective physical function tests in regards to mobility status as measured by the difference between slow walking speed and self-reported mobility limitation (P < 0.01). CONCLUSION: Tandem walk, alternate step and five chair sit-to-stand are important effective items of physical function and permit good comparisons between slow walking speed and self-reported mobility limitation in community-dwelling older adults.

Is a composite score of physical performance measures more useful than usual gait speed alone in assessing functional status?

Overall physical performance can be represented by a composite score that is derived from upper and lower extremity performance measures. We aimed to identify whether composite scores of performance measures, particularly the lower extremity performance (LEP) score, upper extremity performance (UEP) score, and an overall score, are more accurate than usual gait speed (UGS) for assessing a wide range of functional status. We conducted a cross-sectional analysis on data from 701 community-dwelling older women (mean age 74.3 years). Trained testers measured UGS and the seven tests included in the composite scores. Using self-reported questionnaires, we assessed multiphasic functional status: physical function, higher-level functional capacity, mobility limitation, activities of daily living (ADLs), and falls. We compared the areas under the receiver operating characteristic curves (AUCs) of UGS with LEP, UEP, and overall scores for each status. We found no significant differences between the AUCs of UGS and LEP score for each status. The UEP score had significantly smaller AUCs for low physical function (0.73) and mobility limitation (0.78) than UGS alone (0.81 and 0.85, respectively), and the differences were substantial. Although the overall score had significantly greater AUCs for low higher-level functional capacity (0.83) and ADLs disability (0.83) than UGS alone (0.78 and 0.80, respectively), the differences were only 3-5%. The UGS should not be regarded solely as a measure of lower extremity function; this single test may represent overall physical performance. The UGS alone, which can be measured quickly and easily, suffice for assessing a wide range of functional status in older women.

[Intervention effects of inclusive support in an "exercise and a nutritional community-based prevention program" for pre-frail elderly individuals].

OBJECTIVES: The purpose of this study was to examine intervention effects of a community-based prevention program for pre-frail elderly individuals by comparing an intervention group (exercise with nutritional care) with a control group (exercise without nutritional care). METHODS: The study was conducted in Y town and S city in Ibaraki Prefecture in Japan. The subjects comprised 161 pre-frail elderly individuals in the community-based prevention program, who were divided into two groups, the intervention group (N = 81, Y town, mean age : 76.2 +/- 5.7 years), and the control group (N = 81, S city, mean age 76.2 +/- 4.7 years). The items surveyed included age, gender, activities of daily living, functional capacity, and dietary variety score (DVS). Functional fitness measurement items (grip strength, alternate step, 5-repetition sit-to-stand, one-leg balance with eyes open, tandem stance, functional reach (FR), sit and reach, 5-m habitual walk, and timed up and go (TUG)) and blood data were assessed at the beginning and end of the intervention. RESULTS: The DVS of the intervention group was significantly improved compared to that of the control group (P < 0.01). In particular, the food frequencies of fish and shellfish, meat, eggs, milk, fruits, and fat and oil (P < 0.01) were significantly increased in the intervention group, as were those of soybean products, seaweed, and potatoes (P < 0.05). On the other hand, significant increases were seen only in the frequencies of fish and shellfish, meat, and milk in the control group. The intervention group showed significant improvement in five-repetition sit-to-stand, tandem stance, FR, sit and reach, and TUG by the end of the intervention. In addition, the intervention group's performance on one-leg balance with eyes open (P < 0.05) was significantly improved even after adjusting for age, gender, and the functional fitness measurement items which were different at the beginning of the study. CONCLUSION: This study suggests that a combined exercise and nutrition program for pre-frail elderly individuals improves their food intake and functional fitness.

Alternative items for identifying hierarchical levels of physical disability by using physical performance tests in women aged 75 years and older.

AIM: To identify individuals at hierarchical levels of physical disability by using physical performance tests and to determine threshold values for the discriminating of levels of physical disability in women aged 75 years or older. METHODS: A cross-sectional observational study was conducted on 306 community-dwelling women aged 75 years or order (range, 75-99 years). Physical disability was categorized into no disability, mobility disability and activities of daily living (ADL) disability, by evaluating selected ADL and mobility-related functional tasks. Physical function tests comprised nine items (such as strength, balance, mobility and walking ability). To assess the observed threshold values, receiver-operator curves were prepared for all the scales. RESULTS: The results revealed significant differences among all the pairwise group comparisons in all the performance tests, except in the one-legged stance, tandem stance and tandem walk tests. The individuals with ADL disability were unable to perform the one-legged stance (28.9%), tandem stance (32.5%), functional reach (19.3%), tandem walk (61.4%), alternate step (53.0%) and 5-chair sit-to-stand (31.3%) tests. The observed thresholds for discriminating between the no disability and mobility disability groups and between the mobility disability and ADL disability groups were as follows: timed Up & Go test, 8.5 s and 12.7 s; usual gait speed, 1.05 m/s and 0.79 m/s; and grip strength, 19.5 kg and 16.3 kg, respectively. CONCLUSION: Tests for balance and lower extremity strength can be used together to identify or monitor the characteristics of the hierarchical levels of physical disability in women aged 75 years or older.

Mobility performance tests for discriminating high risk of frailty in community-dwelling older women.

We aimed to compare and identify high and low risk of frailty in community-dwelling older women by using five mobility performance tests. The participants were 166 older women at high risk and 171 age-matched controls at low risk of frailty according to the long-term care insurance (LTCI) system (age: 65-90 years). The mobility performance tests included 5-chair sit-to-stand (STS), alternate step, timed up-and-go (TUG), timed rapid gait (TRG), and usual gait speed (UGS). Data analysis showed that high-risk individuals (81.9%) were more likely to be pre-frail than low-risk individuals (55.0%) by Fried's frailty phenotype. The four mobility performance tests, except the 5-chair STS, had the largest areas under the curve (AUC) for discriminating older women at high and low risk (AUC>0.80, p<0.001). The optimal cutpoint (6 s) for the TRG test had the highest sensitivity (78%) and specificity (83%) in identifying high risk of frailty. Our results suggest that walking ability tests are clinically useful in screening older individuals at high risk of frailty. In particular, the TRG test is more likely than other tests to discriminate older women at high risk of frailty based on the LTCI system.

Effects of serum 25-hydroxyvitamin D(3) levels on physical fitness in community-dwelling frail women.

The aim of this study was to evaluate the effects of a combination of serum 25-hydroxyvitamin D(3) (25(OH)D(3)) levels and exercise on physical fitness in community-dwelling frail elderly in Japan. A longitudinal survey was conducted in a town (latitude 36 degrees north). Eighty women aged 65 years and over attended a 3-month exercise class. A face-to-face interview was conducted based on a questionnaire. The serum levels of 25(OH)D(3), intact parathyroid hormone (iPTH), were measured. Nine physical fitness tests were performed at baseline and at the end of a 3-month follow-up period. Among 80 subjects, 56.3% experienced falls, and 71.3% experienced stumbling more than once during the past year. The prevalence of 25(OH)D(3)<50 nmol/l or 25(OH)D(3)<75 nmol/l was 27.5% and 88.8%, respectively. Significantly greater improvements in alternate step, functional reach (FR), "timed up & go" (TUG), and 5-m walk, and superior functional capacity for the subjects with 25(OH)D(3) levels greater than 67.5 nmol/l (highest quartile) was observed at the end of the class. In contrast, the subjects with 25(OH)D(3) levels <47.5 nmol/l (lowest quartile) did not improve their physical fitness. A serum 25(OH)D(3) level of greater than 47.5 nmol/l may therefore be necessary to maintain walking ability and balance. Greater than 67.5 nmol/l appears to be preferable for lower extremity strength in Japanese frail elderly women.

[A functional fitness test battery for pre-frail older adults (so-called "specified elderly individuals")].

BACKGROUND: In Japan, an exercise program for pre-frail older adults (so-called "specified elderly individuals") (SEIs) has been prescribed under the newly developed long-term care insurance system. Three functional fitness measures (grip strength, one-leg balance with eyes open, and 5-m habitual walk) are used in the system; however, it has yet to be determined if applying these measures to SEIs is appropriate. PURPOSE: The purpose of this study was to develop a new test battery assessing functional fitness for SEIs, and to determine cross-validity and responsiveness of these measures. METHODS: One hundred and twenty seven SEIs (76.6 +/- 5.9 yr) and 315 healthy older adults (HOAs) (72.2 +/- 5.8 yr) completed twelve functional fitness tests related to activities of daily living (ADL) and mobility. The SEI was defined by the Japanese Ministry of Health, Labour and Welfare in 2005. The test battery items were selected by logistic regression analysis. A functional fitness score (FFS) equation was developed by principal component analysis. The cross-validity of the FFS equation was then tested using a different set of 28 SEIs (77.5 +/- 6.5 yr) and 143 HOAs (71.5 +/- 4.7 yr). Responsiveness of the FFS was also assessed in 62 SEIs (76.7 +/- 5.9 yr) after a 3-month exercise program. RESULTS: The following 4 test items were selected for assessment of functional fitness in SEIs: tandem stance, 5-repetition sit-to-stand, alternate step, and timed up and go. Applying principal component analysis to the 4 selected functional fitness items, the first principal component was interpreted as total functional fitness. The following equation was developed to estimate FFS based on the first principal component coefficient of each variable: FFS = 0.031X1-0.106X2-0.192X3-0.096X4 + 1.672, X1 = tandem stance(s), X2 = 5-repetition sit-to-stand (s), X3 = alternate step(s), X4 = timed up and go(s). The cut-off value to distinguish SEIs from HOAs using receiver operating characteristic ROC) curve was 0.065 (sensitivity 82.2%, specificity 81.9%). The cross-validity and responsiveness of the FFS equation was considered acceptable. CONCLUSION This newly developed test battery should be a useful tool for comprehensively evaluating functional fitness in SEIs.

Validation of lower extremity performance tests for determining the mobility limitation levels in community-dwelling older women.

BACKGROUND AND AIMS: Assessment of mobility status among community-dwelling older people is important for preventing further deterioration of mobility and identifying changes in mobility as early as possible. We attempted to identify the optimal cut-off values for eight lower extremity performance (LEP) tests in community-dwelling older women with mobility limitation (ML) levels. METHODS: The ML levels of 433 community-dwelling older women, mean age 73.2 years (SD 5.7, range 65-93) were classified according to selfreports. ML levels were identified by face-to-face interviews and according to self-reported difficulty in walking one-quarter of a mile or climbing 10 steps without resting. The LEP tests comprised one-legged stance, tandem stance, functional reach, tandem walk, alternate step, five chair sit-to-stands, timed up-and-go (TUG) and usual gait speed. Receiver-operating characteristic curves were obtained for all scales to assess optimal cut-off values. RESULTS: The optimal cut-off value of 6.52 (s) for the TUG test was shown by the highest sensitivity (74%) and specificity (71%) in the discrimination of no ML from moderate ML, whereas the optimal cut-off value of 1.05 (m/s) in the usual gait speed test showed the highest sensitivity (73%) and specificity (67%) in the discrimination of moderate ML from severe ML. CONCLUSIONS: Among community-dwelling older women, TUG and usual gait speed had the highest sensitivity and specificity in discriminating ML levels.

Effects of exercise frequency on functional fitness in older adult women.

This study evaluated the effects of exercise frequency on functional fitness in older women participating in a 12-week exercise program. Participants (67.8+/-4.6 years) were divided into three different exercise groups (I, II, and III; n=34) and a control group (Group C; n=11). Group I participated in a 90-min exercise program once a week, for 12 weeks, while Group II attended it twice a week, and Group III attended three times a week. The exercise program consisted of a 10-min warm-up, 20 min of walking, 30 min of recreational activities, 20 min of resistance training, and a 10-min cool-down. The following items were measured before and after the program: muscular strength, muscular endurance, dynamic balance, coordination, and cardiorespiratory fitness (6-min walking distance). Comparisons of baseline and post-intervention measures showed significantly greater improvements in body weight, coordination, and cardiorespiratory fitness for Group III compared to the other groups (p<0.05). In addition, the greatest improvements in body fat, muscular endurance, and dynamic balance were also observed in Group III (p<0.05). However, no significant differences were found in muscular strength. Older women who participate in an exercise program three times a week gain greater functional fitness benefits than those who exercise less frequently. In order to improve functional fitness in older women, an exercise frequency of at least three times each week should be recommended.

The influence of physical activity-induced energy expenditure on the variance in body weight change among individuals during a diet intervention.

OBJECTIVE: We investigated the relationship between the variability in body weight change among individuals and diet restriction or physical activity during a 14-week intervention. DESIGN: A prospective clinical trial with a 14-week weight reduction intervention design. In total, 90 middle aged, Japanese, obese women enrolled as subjects. MEASUREMENTS: The outcome variable was the change in body weight during the intervention period. Other primary variables were total energy intake, carbohydrate intake, fat intake, protein intake, total energy expenditure (TEE), and activity energy expenditure (AEE). Diet intake was assessed by 3 days, weighed dietary records and dietary recall interviews. Physical activity was assessed by a uniaxial accelerometry sensor and a diary of exercise. RESULTS: Significant reductions were observed in body weight (-8.5 kg) as a result of intervention. When the subjects were assigned to three categories depending on AEE during intervention, the loss of body weight was significantly greater for subjects within the upper (-9.6 kg) AEE category than for those in the middle (-8.5 kg) or lower AEE (-7.5 kg) categories. In addition, a significant correlation (r = 0.57, p < 0.0001) was observed between a subject's AEE before and during the intervention. On the other hand, no significant correlation was observed between body weight reduction and energy intake, indicating that strict diet restriction does not always result in a large weight loss. CONCLUSION: Activity energy expenditure, not only through voluntary exercise but also through spontaneous, daily, physical activities can have a positive effect on reducing body weight.

Dance-based aerobic exercise may improve indices of falling risk in older women.

OBJECTIVE: to determine the effect of dance-based aerobic exercise on indices of falling in older women. DESIGN: an exercise intervention trial with participants assigned either to an exercise group or to a control group. SETTING: an exercise hall at a community centre for senior citizens. PARTICIPANTS: thirty-eight healthy women aged 72-87 years, living independently in the community. INTERVENTION: twenty women performed dance-based aerobic exercise for 60 minutes, 3 days a week, for 12 weeks. The exercise included single-leg standing, squatting, marching, and heel touching; and targeted balance, strength, locomotion/agility, and motor processing. MAIN OUTCOME MEASURES: single-leg balance with eyes open/closed and functional reach as balance, hand-grip strength and keeping a half-squat position as strength, walking time around two cones and 3-minute walking distance as locomotion/agility, and hand-reaction time and foot tapping as motor processing. RESULTS: at the pre-test, both exercise and control groups performed similarly in all tests. At the end of the intervention, the exercise group showed significantly greater single-leg balance with eyes closed, functional reach, and walking time around two cones. In contrast, there were no significant improvements in any of the test measures in the control group. CONCLUSIONS: dance-based aerobic exercise specifically designed for older women may improve selected components of balance and locomotion/agility, thereby attenuating risks of falling.