BACKGROUNDThis study tested the hypothesis that a home-based exercise program would improve functional performance in elderly people.METHODSWe conducted a 6-month, single-blinded, randomized controlled trial. 72 community dwelling men and women (aged >/=70 years) with self-reported and laboratory-based functional impairment were recruited for the study. Participants were randomly assigned to either a home-based progressive strength, balance, and general physical activity intervention or an attention-control group that received home-based nutrition education. Functional performance was measured in the laboratory using the Physical Performance Test (PPT) and the Established Populations for Epidemiologic Studies of the Elderly (EPESE) short physical performance battery. Physiologic capacity was measured by strength (one repetition maximum), dynamic balance (tandem walk), gait speed (2-meter walk), and cardiovascular endurance (6-minute walk).RESULTS70 participants (97%) completed the 6-month trial. Compliance with study interventions within each group ranged from 75% in controls to 82% in exercisers. PPT increased by 6.1 +/- 13.4% in exercisers and decreased by 2.8 +/- 13.6% in controls (p =.02). EPESE improved by 26.2 +/- 37.5% in exercisers and decreased by 1.2 +/- 22.1% in controls (p =.001). Dynamic balance improved by 33.8 +/- 14.4% in exercisers versus 11.5 +/- 23.7% in controls (p =.0002). There were no differences between groups in the change in strength, gait speed, or cardiovascular endurance.CONCLUSIONSMinimally supervised exercise is safe and can improve functional performance in elderly individuals. The improvements in functional performance occurred along with improvements in balance but without a significant change in muscle strength or endurance.

Resistance training (RT) increases strength in older adults, but there have been few studies of long-term RT or detraining in older adults. Postmenopausal participants (51–71 years of age) were randomized to RT or a control group for Year 1. For Year 2, participants chose whether to resistance train or not. Three groups emerged: train/train (n = 8: 60 ± 4 years), train/no train (n = 11: 62 ± 3 years), or controls (n = 17; 58 ± 6 years). Both training groups increased strength (p < .05) in Year 1. In Year 2, train/train maintained strength, whereas train/no train lost strength for knee extension (p < .001) but not for arm pulldown. Controls did not change. Reported physical activity levels were significantly increased in trainers in Year 1 and remained high regardless of RT in Year 2 (p < .05). Therefore, sustained changes in strength and physical activity behavior might be possible even if RT is discontinued.

Increased gait instability is common in older adults, even in the absence of overt disease. The goal of the present study was to quantitatively investigate the factors that contribute to gait instability and its potential reversibility in functionally impaired older adults. We studied 67 older men and women with functional impairment before and after they participated in a randomized placebo-controlled, 6-mo multimodal exercise trial. We found that 1) gait instability is multifactorial; 2) stride time variability is strongly associated with functional status and performance-based measures of function that have previously been shown to predict significant clinical outcomes such as morbidity and nursing home admission; 3) neuropsychological status and health-related quality of life play important, independent roles in gait instability; and 4) improvement in physiological capacity is associated with reduced gait instability. Although the etiology of gait instability in older persons with mild-moderate functional impairment is multifactorial, interventions designed to reduce gait instability may be effective in bringing about a more consistent and more stable walking pattern.

OBJECTIVE:To test the effects of a high intensity home-based progressive strength training program on the clinical signs and symptoms of osteoarthritis (OA) of the knee.METHODS:Forty-six community dwelling patients, aged 55 years or older with knee pain and radiographic evidence of knee OA, were randomized to a 4 month home based progressive strength training program or a nutrition education program (attention control). Thirty-eight patients completed the trial with an adherence of 84% to the intervention and 65% to the attention control. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index pain and physical function subscales. Secondary outcomes included clinical knee examination, muscle strength, physical performance measures, and questionnaires to measure quality of life variables.RESULTS:Patients in the strength training group who completed the trial had a 71% improvement in knee extension strength in the leg reported as most painful versus a 3% improvement in the control group (p < 0.01). In a modified intent to treat analysis, self-reported pain improved by 36% and physical function by 38% in the strength training group versus 11 and 21%, respectively, in the control group (p = 0.01 for between group comparison). In addition, those patients in the strength training group who completed the trial had a 43% mean reduction in pain (p = 0.01 vs controls), a 44% mean improvement in self-reported physical function (p < 0.01 vs controls), and improvements in physical performance, quality of life, and self-efficacy when compared to the control group.CONCLUSION:High intensity, home based strength training can produce substantial improvements in strength, pain, physical function and quality of life in patients with knee OA.

A self-sustaining network of strength and balance training programs for older adults has been created and evaluated for impact on functional status and health using an applied research model in the public health domain. The Strong Living Program (SLP) has three primary components: 1) a 12-wk research-based exercise prescription of 14 total body exercises using body weight and free weights; 2) an interactive training workshop for health care professionals and lay persons to provide detailed instruction and collateral materials and methods on how to implement, conduct and evaluate a SLP; and 3) program site visits and on-going administrative and exercise prescription support. Training workshop results showed that 91% of attendees (n = 81) were certified as SLP leaders and successfully implemented exercise programs at 27 community sites. Effectiveness of the exercise prescription was assessed using the Short Physical Performance Battery (SPPB) and the Medical Outcomes Survey SF-36 (MOS) data from a sample of healthy and diseased older women and men (n = 80, mean age = 70.9 ± 7.9 yr) from five sites. SPPB score increased significantly from 10.1 ± 2.3 at baseline to 11.2 ± 1.4 at 12 wk (p = 0.000), indicating clinical improvement in lower extremity functional status. MOS results for physical function and emotional health domains at both baseline and 12 wk were in the highest quartile. Despite this potential ceiling effect, a trend towards statistical significance was seen in emotional health after 12 wk of exercise. These longitudinal data suggest that a positive impact on public health can be achieved through the expansion of the SLP applied research model and increased access to these research-based exercise programs.

1929 The effect of a 24 week home-based program on functional performance was examined in 72 frail men and women (mean age 77±5; range 70-92). Subjects (57 women and 15 men) were randomly assigned to either a nutrition education attention control group (NUT: n=38) or a progressive strength and balance training program (EX; n=34). Subjects in EX group received progressive hand and ankle weights and limited supervision (11 home visits). They were expected to exercise 3 days per week on their own and were encouraged to increase their leisure time activities. Subjects in NUT received limited supervision (8 home visits) and were instructed to eat at least 5 fruits and vegetables and 3 calcium rich foods each day. There was an average of 83% compliance to both interventions. All assessments were performed by an investigator blinded to subject group assignment. A Short Physical Performance Battery test (including tandem stand, gait speed and chair stand time) improved by 26.2±37.5% in EX and decreased by 1.2±22.1% in NUT (P=0.001). Functional capacity as measured by the Physical Performance Test increased by 6.1±13.4% in EX and decreased by 2.8±13.6% in NUT (P=0.02). Dynamic balance (20 foot tandem walk in seconds) improved by 33.8±14.4% in EX and by only 11.5±23.7% in NUT (P=0.0002). There was no difference between groups in change in chair stand time, muscle strength (1 repetition max) or distance covered in six minute walk. There was no relationship between change in these variables or dynamic balance with functional performance. In conclusion: 1) functional performance can be improved by a moderate home-based exercise program with limited supervision; 2) it is possible that some non-physiologic effect of the exercise intervention was etiologic in the change in functional performance observed. Supported by: the Brookdale Foundation, National Institute of Aging, US Department of Agriculture, Tufts University and the Tufts Associated Health Plan

Osteoporosis is a major public health problem that is characterized by low bone mass and increased susceptibility to fractures, primarily of the hip, spine, and wrist. It is estimated to cause 1.5 million fractures annually in the United States in people aged 50 yr and older. Physical activity, particularly weight-bearing exercise, is thought to provide the mechanical stimuli or "loading" important for the maintenance and improvement of bone health, whereas physical inactivity has been implicated in bone loss and its associated health costs. Both aerobic and resistance training exercise can provide weight-bearing stimulus to bone, yet research indicates that resistance training may have a more profound site specific effect than aerobic exercise. Over the past 10 years, nearly two dozen cross-sectional and longitudinal studies have shown a direct and positive relationship between the effects of resistance training and bone density. Conversely, a handful of other studies have reported little or no effect on bone density. However, these results may be partially attributable to the study design, intensity and duration of the exercise protocol, and the bone density measurement techniques used. High-intensity resistance training, in contrast to traditional pharmacological and nutritional approaches for improving bone health in older adults, has the added benefit of influencing multiple risk factors for osteoporosis including improved strength and balance and increased muscle mass.

509 The effects of osteoporosis prevention workshops attended by 154 elder program providers from January 1996 through September 1997 were evaluated by survey to determine the subsequent initiation of new programs by the attendees in their respective communities. The workshops and accompanying materials included an exercise component with balance training and strength training with free weights and an education component presented in the format of a discussion. 105 responses to the survey were received: 47 attendees had implemented one or more prevention programs while 58 had not started programs. As a result, 866 older adults have participated in community-based osteoporosis prevention programs. Women (n=834) ranging in age from 45 - 98 years and men (n=32) ranging in age from 65 - 94 years had similar results for exercise and behavioral changes. The amount of weight used for strength training ranged from 1 to 16 pounds for ankle weights and from 1 to 5 pounds for dumbbells. 40 attendees (87%) reported that both the exercise and education/discussion components were included in the new programs while 7 attendees reported that they had eliminated the education/discussion component. Factors that prevented 58 survey respondents from initiating programs were personal circumstances (29%), lack of funding (25%), insufficient staff (21%), lack of equipment (13%), lack of interest (8%) and the need for more training (4%). This community-based training program has effectively linked research with public health and community programs in an outreach effort to train program providers in osteoporosis prevention strategies for the elders they serve.

The effects of a six month home-based exercise program on physical performance were examined in 29 frail men and women (mean age 75±3; range 70-84). Subjects (8 men and 21 women) were randomly assigned to either an attention control group (CON; n=13) or a progressive strength, balance and aerobic training program (EX; n=16). All baseline and final assessments were performed by an investigator blinded to subject group assignment. A Short Physical Performance Battery test (including tandem stand, gait speed and chair stand time) improved by 29±36% in EX and remained the same in CON(P<0.03). Functional status as measured by the Physical Performance Test increased by 8±13% in EX and decreased by 10±29% in CON(P<0.03). Dynamic balance (20 foot tandem walk in seconds) improved by 34±15% in EX and by 10±27% in CON (P=0.001). Muscle strength (1 repetition maximum) increased by 17±24% in EX and remained the same in CON (P<0.0001). Aerobic fitness (six minute walk, distance covered in meters) improved by 16±16% in EX and remained the same in CON(P<0.001). The results of this study indicate that it is feasible to implement a home-based exercise program in the frail elderly. Furthermore, a home-based balance, strength and aerobic training program improves physical performance in the frail elderly.

The purpose of this study was to compare the ability of various body-composition assessment techniques to detect changes in soft tissue in older, weight-stable women (50-70 y of age) completing a 1-y randomized, controlled trial of progressive resistance training. The intervention group (n = 20) performed high-intensity strength-training 2 d/wk with five different exercises; the control group (n = 19) was untreated. Hydrostatic weighing, 24-h urinary creatinine, computed tomography of thigh sections, total body potassium, and tritium dilution techniques were used to measure increases in total fat-free mass (FFM) and the muscle and water components of FFM. A decrease in fat mass (by hydrostatic weighing) was seen in the strength-trained women compared with the control subjects (P = 0.01-0.0001). Anthropometry, bioelectric impedance, dual-energy X-ray absorptiometry, and total body nitrogen and carbon did not measure any significant change in soft tissue. The choice of a body-composition technique is important when designing a study expected to affect soft tissue, because not all techniques available are precise enough to detect small changes.