Exercise Helps Elderly Regain Physical Function and Avoid Major Disability

Regular structured exercise may allow previously sedentary elderly people to attain significant improvements in their physical functioning and reduce the likelihood of becoming disabled in the future, according to findings from a multicenter pilot study presented at the Gerontological Society of America's annual meeting in Dallas. The results of the study, known as the Lifestyle Interventions and Independence for Elders Pilot (LIFE-P) study, also appear in the November issue of the Journal of Gerontology: Medical Sciences.

The pilot study, which included senior researchers from the University of Pittsburgh Graduate School of Public Health (GSPH), the Cooper Institute in Dallas, Stanford University, Wake Forest University and the University of Florida, involved administering a structured physical activity consisting primarily of walking at a moderate intensity for at least 150 minutes a week, coupled with leg stretches, balance exercises and leg-strengthening exercises, to a group of sedentary elderly people ages 70 to 89. A second "control" group of elderly were given only instructions on "successful aging," which included information on good nutrition and the proper use of medications, foot care and preventive services. The physical functioning of both groups was tested before the interventions and twice during the one-year intervention.

Over the follow-up period, participants in the structured physical activity group increased their performance score on a test known as the Short Physical Performance Battery, or SPPB, from a baseline average of about 7.5 to about 8.5, whereas many participants in the "successful aging" intervention group actually saw a decline in their score. In addition, participants in the physical activity group improved their performance on a second assessment, a 400-meter walking test, and had a lower incidence of a major mobility disability, defined as an inability to walk a quarter mile, than did those in the control group.

Even a small improvement of a half point on the SPPB test score's scale of 0 to 12 may represent major improvement in an elder person's ability to perform activities of daily living, such as walking across a room, dressing, eating or bathing. A low score, between 0 and 4, is a strong risk factor for disability and death. The LIFE-P study looked at people with intermediate scores from 4 to 9 to see if exercise could improve or prevent a decline in their scores.

According to Anne B. Newman, M.D., M.P.H., professor of epidemiology and medicine and director of the Center for Aging and Population Health, GSPH, and the principal investigator for the University of Pittsburgh field center, these findings confirm that even sedentary elderly can be brought back from the precipice of disability by moderate, structured exercise.

"This pilot demonstrates the physical activity was extremely safe for the study participants, elderly people at a high risk of becoming disabled," Newman said.

Previous research has demonstrated that scores on the SPPB are highly predictive of future health problems. People with lower scores are more likely than others to die earlier, have health problems, be institutionalized and become unable to get around. Furthermore, in other studies, Dr. Newman's group has demonstrated that the inability to walk 400 meters is a significant predictor of future disability and premature death.

The LIFE-P study principal investigator, Marco Pahor, M.D., professor and chairman of the department of aging and geriatric research, University of Florida (UF) College of Medicine, and director of the UF Institute on Aging, emphasized that this is among the first studies to demonstrate that physical decline in the elderly is reversible. "Previously, we had no definitive empirical evidence that the score on the SPPB test could be modified," he said.

"This analysis showed that, compared with those who received health education, participants in the physical activity group had a 29 percent lower risk of being unable to walk 400 meters," said Pahor.

Jack M. Guralnik, M.D., Ph.D., co-principal investigator for the study and chief of the National Institute of Aging's (NIA) Laboratory of Epidemiology, Demography and Biometry, added that the study is very promising in regard to developing programs to keeping the elderly fit and mobile. "Lower-extremity functioning is a good reflection of overall functioning and disability in older adults. So, we are encouraged by these results, which demonstrate that a well-designed program combining aerobic, strength, balance and flexibility exercises can make a difference for those who are at high risk of losing mobility function," said Guralnik.

UF researchers are planning to conduct a full-scale study, testing 2,500 adults at 10 different sites over four years, the longest study to date to assess whether structured exercise can delay the inability to walk 400 meters, or a quarter mile.

"The results from this pilot study are very promising and indicate that a full-scale study is warranted," said Newman, whose center will be involved in the larger study.

This article originally appeared in the November 2006 issue of HME Business.

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