Physical fitness, physical activity, and functional limitation in adults aged 40 and older

PURPOSE: A cohort of middle-aged and older men and women were followed for an average of 5.5 yr to examine the association between physical fitness, physical activity, and the prevalence of functional limitation. METHODS: The participants received medical assessments between 1980 and 1988 and responded to a mail-back survey regarding functional status in 1990. RESULTS: Among 3495 men and 1175 women over 40 yr of age at baseline, 350 (7.5%) reported at least one functional limitation in daily or household activities at follow-up. The prevalence of functional limitation was higher among women than men. Physically fit and physically active participants reported less functional limitation than unfit or sedentary participants. After controlling for age and other risk factors, the prevalence of functional limitation was lower for both moderately fit (odds ratio = 0.4, 95% CI = 0.2-0.6) and high fit men (odds ratio = 0.3, 95% CI = 0.2-0.4), compared with low fit men. Corresponding figures for women were 0.5 (0.3-0.7) and 0.3 (0.2-0.5) for moderately fit and high fit women. The association between physical activity and functional limitation was similar to the data for physical fitness. CONCLUSIONS: These data support a protective effect of physical fitness and physical activity on functional limitation among older adults and extend this protective effect to middle-aged men and women.     

A physical fitness model of older adults

Physical fitness for young people is viewed as a multidimensional construct, in that it consists of specific components such as strength, mobility, balance, flexibility, and stamina. This study examined whether this structure underlying physical fitness is also relevant to older adults. A 10-item performance test, which was assumed to assess six components of physical fitness, was administered to 69 healthy volunteers ranging in age from 61 to 83 years. A covariance structure model was applied to the test data: the second-order factor was Physical Fitness, and the first-order factors were Strength, Walking, Balance, Flexibility, Stamina, and Manual Speed which were assumed to be measured based on the ten observed variables. Goodness-of-fit index (GFI) of the model was acceptable (GFI = 0.93). While four factors relating to basic motor performances (Strength, Walking, Balance, and Manual Speed) had loadings more than 0.62 to Physical Fitness, Flexibility and Stamina had less than 0.35. It was suggested for elderly people that strength, mobility, balance, and speed components of physical fitness were highly correlated and explainable by a single factor, while flexibility and cardiorespiratory endurance were to be measured by use of specific measures.     

Physical fitness training and mental health.

Reviews theory and research that have attempted to relate fitness training to improvements on psychological variables among normals as well as selected clinical populations. Theoretical speculations in this area are critiqued, and research designs are evaluated as either experimental or quasi-experimental and therefore interpretable, or preexperimental and therefore largely uninterpretable. The research suggests that physical fitness training leads to improved mood, self-concept, and work behavior; the evidence is less clear as to its effects on cognitive functioning, although it does appear to bolster cognitive performance during and after physical stress. Except for self-concept, personality traits are not affected by improvements in physical fitness. Mentally retarded children demonstrate psychological improvement following physical fitness training, but no conclusion can be reached regarding the effects of physical fitness training with other clinical syndromes. (2? p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effect of resistance training on strength, postural control, and gait velocity among older adults

The purpose of this study was to examine the effects of a 14-week resistance training program on the ankle strength, training intensity, postural control, and gait velocity of older adults. Forty-two older adults (mean age = 72), 21 in the resistance and control groups, completed the 14-week project. The resistance training group participated in 14 weeks of resistance training three times per week using elastic bands (Theraband) for resistance. Isokinetic ankle strength, training intensity, postural stability, and gait velocity were measured prior to and following the 14-week intervention. Following the training, the resistance group exhibited improved ankle dorsiflexion, training resistances, and gait velocity, but showed no change in plantar flexion or postural control. The control group also exhibited improvements in dorsiflexion, but these gains were approximately one-half of the gains observed in the resistance training group. Finally, when adjusted for baseline differences, subjects in the resistance training group demonstrated no changes in the dependent measures over the control group.     

Effects of differing intensities and formats of 12 months of exercise training on psychological outcomes in older adults.

The 12-mo effects of exercise training on psychological outcomes in adults (aged 50–65 yrs) were evaluated. Ss (N?=?357) were randomly assigned to assessment-only control or to higher intensity group, higher intensity home, or lower intensity home exercise training. Exercisers showed reductions in perceived stress and anxiety in relation to controls. Reductions in stress were particularly notable in smokers. Regardless of program assignment, greater exercise participation was significantly related to less anxiety and fewer depressive symptoms, independent of changes in fitness or body weight. It is concluded that neither a group format nor vigorous activity was essential in attaining psychological benefits from exercise training in healthy adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evidence-based psychological treatments for insomnia in older adults.

The review describes evidence-based psychological treatments (EBTs) for insomnia in older adults. Following coding procedures developed by the American Psychological Association's Committee on Science and Practice of the Society for Clinical Psychology, two treatments were found to meet EBT criteria: sleep restriction-sleep compression therapy and multicomponent cognitive-behavioral therapy. One additional treatment (stimulus control therapy) partially met criteria, but further corroborating studies are needed. At the present time, there is insufficient evidence to consider other psychological treatments, including cognitive therapy, relaxation, and sleep hygiene education, as stand-alone interventions beneficial for treating insomnia in older adults. Additional research is also needed to examine the efficacy of alternative-complementary therapies, such as bright light therapy, exercise, and massage. This review highlights potential problems with using coding procedures proposed in the EBT coding manual when reviewing the existing insomnia literature. In particular, the classification of older adults as persons age 60 and older and the lack of rigorous consideration of medical comorbidities warrant discussion in the future. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Urinary incontinence and psychological distress among older adults.

We examined the relationship between urinary incontinence and psychological distress in a sample of community-dwelling older adults. The data are from a probability sample of Washtenaw County, Michigan residents ages 60 years and older, who were interviewed in 1983 and 1984. A total of 747 women and 431 men were included in the analyses. Experiencing urinary incontinence, particularly in a severe form, was weakly related to depression, negative affect, and low life satisfaction. These relationships are partly explained by the fact that incontinent respondents are less healthy than are continent respondents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Physical health impairment and depression among older adults

We studied the effect of tumor necrosis factor-alpha (TNF-alpha), interleukin-1 (IL-1), and interferon-gamma (IFN-gamma) on the function of thyroid cells and pituitary thyrotrophs. In FRTL-5 rat thyroid cells, both human and murine TNF-alpha inhibited basal and TSH-stimulated [125I]iodide transport. IL-1 shared this action with TNF-alpha, but was less potent. IL-1 and IFN-gamma did not cause a further reduction of TNF-alpha-induced inhibition of [125I]iodide transport. TNF-alpha, phorbol ester 12-myristate 13-acetate (PMA), and calcium ionophore (CI) A23817 all inhibited [125I]iodide transport, but high doses of PMA and CI also blocked the inhibitory action of TNF-alpha on [125I]iodide transport. Inhibition of protein kinase A and protein kinase C by H7 or HA inhibited TSH-stimulated iodide transport, but did not block the TNF-alpha action, suggesting that the mechanism of TNF-alpha action on thyroid cells is independent of protein kinase A and C. In pituitary cells, both human and murine TNF-alpha did not affect basal TSH secretion, but TNF-alpha reduced TRH-stimulated TSH secretion. This study provides further in vitro evidence that TNF-alpha inhibits the function of the hypothalamus-pituitary-thyroid axis acting directly on both the pituitary and thyroid glands.     

Association between aerobic fitness and visuospatial performance in healthy older adults.

Examined whether chronic physical exercise activity is associated with better neurocognitive performance in older adults. 105 men participated in 1 of 3 age groups (18–28, 35–45, and 60–73 yrs). For each age group, Ss were classified as high or low in fitness on the basis of self-reported activity levels and the results of a submaximal bicycle ergometer test. A comprehensive battery of neuropsychological tests was administered to each S, and older Ss scored significantly lower than the younger groups on most tests. Significant differences between high- and low-fit Ss were found only on tasks with heavy visuospatial demands, and these differences were most notable in the older adult group. These findings suggest that participation in aerobic exercise activity selectively preserves some cognitive functions that normally decline with age. The benefits of activity appear to be most evident on tasks that require visuospatial processing. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Physical fitness training: Beneficial for professional psychologists?

A survey was conducted to explore the degree to which practicing psychologists are involved in exercise programs, the patterns of exercise favored, and the degree of effect attributed to exercise on various dimensions of psychotherapy practice. Survey instruments were mailed to 262 psychologists listed in the National Register of Health Service Providers; 196 (74.81%) responded. Most of the respondents (71.43%) reported engaging in regular exercise. Chi-square analyses revealed that patterns of exercise were related to demographic factors. Dimensions of psychotherapy perceived as most positively affected by exercise were the physical stamina, mood, and mental stamina of the therapist. Analyses of variance revealed that demographic and exercise pattern variables were related to perceptions of exercise effect on some of the dimensions of psychotherapy. Most respondents reported that they would recommend regular exercise both to other therapists and to patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Commentary on evidence-based psychological treatments for older adults.

This article comments on the articles in the Special Section on Evidence-Based Psychological Treatments for Older Adults (see records 2007-03358-002, 2007-03358-003, 2007-03358-004, 2007-03358-005, and 2007-03358-006). The articles apply criteria developed by the Society of Clinical Psychology to evaluate treatments for late-life anxiety, insomnia, behavior disturbances in dementia, and caregiver distress. The articles document that there are evidence-based psychological treatments that can help older adults. However, there are 2 substantial hurdles: evidence and access. Gaps in the evidence, as mentioned by the authors of the articles in the special section, result from disproportionate research attention to some psychotherapies and some mental disorders, with corresponding lack of research about other treatments and disorders. The challenge for access is to ensure that older adults with treatable mental disorders will get connected to psychologists trained in these evidence-based therapies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effect of a 12-week dynamic resistance strength training program on gait velocity and balance of older adults

This study tested whether a 12-week dynamic resistance strength training program can change gait velocity and improve measures of balance among adults age 65 and older. Fifty-five community-dwelling adults (mean age = 71.1) were randomized into an exercise (n = 25) or control (n = 30) group. The exercisers were requested to complete three bouts of strength training per week for 12 weeks using elastic tubing. At posttest the exercisers demonstrated slower gait velocity, enhanced balance, and an improved ability to walk backward, although none of these posttest measures was significantly different from the control group.     

Cardiorespiratory fitness, hippocampal volume, and frequency of forgetting in older adults.

Objective: The purpose of this study was to extend our earlier work to determine the extent to which cardiorespiratory fitness is associated with the frequency of memory problems via its effects on the hippocampus and spatial working memory. We hypothesized that age, sex, education, body composition, and physical activity were direct determinants of fitness, which, in turn, influenced frequency of forgetting indirectly through hippocampal volume and spatial working memory. Method: We conducted assessments of demographic characteristics, Body Mass Index (BMI), physical activity, cardiorespiratory fitness, hippocampal volume, spatial working memory, and frequency of forgetting in 158 older adults (M age = 66.49). Path analyses within a covariance modeling framework were used to examine relationships among these constructs. Results: Sex, age, BMI, and education were all significant determinants of cardiorespiratory fitness. The hypothesized path models for testing the effects of fitness on frequency of forgetting through hippocampal volume and accuracy and speed of spatial working memory all fit the data well. Conclusions: Our findings suggest that older adults with higher levels of fitness show greater preservation of hippocampal volume, which, in turn, is associated with more accurate and faster spatial memory and fewer episodes of forgetting. Given the proportion of older adults reporting memory problems, it is necessary to determine whether improvements in fitness brought about by physical activity interventions can result in subsequent attenuation of memory problems or potentially in improvements in memory. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Physical fitness training and counseling as treatment for youthful offenders.

Two groups of 30 randomly selected males (15 yrs 5 mo to 18 yrs 6 mo) in a state industrial school for youthful offenders were administered pre- and posttreatment a battery of physiological and psychological measures by an exercise physiologist and a psychometrist. Measures included tests of cardiovascular fitness and muscle strength/endurance as well as the Self-Esteem Inventory, State-Trait Anxiety Inventory, and Beck Depression Inventory. The experimental group received a systematic physical fitness program delivered by counselors for 1.5 hrs/day, 3 days/wk, for 20 wks. Treatment included a counseling model previously used with delinquent adolescents. MANOVAs revealed significant differences between the groups on pretest measures in favor of controls. Significant differences on the posttest measures were found in favor of experimental Ss. Univariate analysis identified the areas of difference both physiologically and psychologically. (44 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Physical activity efficacy and effectiveness among older adults and minorities

The objective of this study was to consider efficacy and effectiveness of physical activity for the prevention and management of NIDDM among minorities and older adults of the U.S. Relevant population trends and projections are discussed, followed by a review of the efficacy of physical activity based on theoretical, prospective cohort, and intervention studies. With few empirical studies available, the assessment of effectiveness is largely theoretical and focuses on potentially important issues for future studies among older adults and minorities. Efficacy studies have shown that moderate-intensity physical activity is associated with a one- to two-thirds lower incidence of NIDDM over 4-14 years and 15-20% lower glycosylated hemoglobin over 3-4 months among people with NIDDM. With physical inactivity prevalence at 60-70%, much work remains to be done to improve physical activity effectiveness. In the most vulnerable populations, physician referral and community involvement structured around stage of change and self-efficacy theories are suggested as the most promising approaches to promoting physical activity adoption and maintenance. Effectiveness or demonstration studies that test and build on stage of change, self-efficacy, and other concepts of physical activity promotion and outcomes would likely prove to be highly valuable investments for public health.     

Balance and muscle strength as predictors of frailty among older adults

The term frailty is increasingly used in gerontological literature and in practice. However, indicators differentiating frail from nonfrail are not well delineated. Identifying factors discriminating between frail and nonfrail older community-residing adults may lead to more comprehensive clinical assessments and targeted interventions to minimize or prevent frailty. Eighty-four adults, ages 60 to 88 (mean = 74) living independently in the community completed a functional performance questionnaire and a perceived health questionnaire that were combined as measures of frailty. Predictor variables of frailty included four measures of balance and three measures of lower leg strength. Discriminant analysis revealed that one balance score and dorsiflexion correctly classified 65% of group membership, with better prediction of the nonfrail than frail group. This study clarifies that the predictors of frailty include the combination of dorsiflexion strength and balance, specifically the contribution of vision to balance when the support surface is compliant. Recommendations are proposed for conceptualizing and operationalizing frailty and adding variables to enhance discrimination between frailty and nonfrailty. Nursing implications include adding clinical assessments of specific components of balance and ankle strength to develop a more comprehensive evaluation of frailty.     

Supplemental group discussions in memory training for older adults.

Memory training was compared in adults aged 60–80. Groups 1 and 2 studied a self-instructional memory training manual; Group 2 also attended supplementary group discussions of typical problems of later life, related coping methods, and the techniques in the self-instructional manuals. Group 3 was a wait–list control group. Memory performance on 2 word lists significantly improved in the supplemental discussion group but not in the group that only studied the self-instructional manual. Enhanced performances were maintained at a 1-month follow-up. Bibliotherapy alone may be inferior to treatment involving a group component, although the mechanisms of such enhancement remain unexplored with respect to memory training. Neither treated group improved their digit span or recall of names and a brief prose passage; teaching older adults the strategies of chunking and use of imagery may not be beneficial. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evidence-based psychological treatments for distress in family caregivers of older adults.

This review identifies evidence-based psychological treatments (EBTs) for reducing distress, and improving well-being, of family members caring for an older relative with significant cognitive and/or physical impairment. Three categories of psychologically derived treatments met EBT criteria: psychoeducational programs (N = 14 studies), psychotherapy (N = 3 studies), and multicomponent interventions (N = 2 studies). Specifically, support within the psychoeducational category was found for skill-training programs focused on behavior management, depression management, and anger management and for the progressively lowered threshold model. Within the psychotherapy category, cognitive-behavioral therapy enjoys strong empirical support. Within the multicomponent category, programs using a combination of at least 2 distinct theoretical approaches (e.g., individual counseling and support group attendance) were also found to be effective. Suggestions for future research include the development of more well-integrated multicomponent approaches, greater inclusion of ethnically diverse family caregivers in research protocols, and greater incorporation of new technologies for treatment delivery. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reduction in intra-abdominal adipose tissue after strength training in older women

The purpose of this study was to examine the effects of a total body strength-training program on changes in total and regional body composition, in particular intra-abdominal adipose tissue (IAAT), in older women. Fourteen healthy older women (mean age 67 +/- 1 yr) exercised 3 times/wk for 16 wk. Strength was assessed by one-repetition maximum tests, with training intensity gradually increased to approximately 67% of one repetition maximum. Body composition was measured by hydrodensitometry and regional body composition was measured by computed tomography. Strength was significantly increased in the upper (51%) and lower body (65%). There was no significant change in body weight (64.4 +/- 2.7 vs. 64.2 +/- 2.7 kg), total body fat (38.7 +/- 1.4 vs. 38.0 +/- 1.6%) or fat-free mass (39.7 +/- 1.0 vs. 40.0 +/- 0.9 kg). However, after ST, there were significant reductions in IAAT (143.9 +/- 13.3 vs. 130.0 +/- 12.4 cm2), the IAAT-to-subcutaneous adipose tissue ratio (0.48 +/- 0.04 vs. 0.44 +/- 0.04), and midthigh subcutaneous adipose tissue (141.7 +/- 11.5 vs. 133.6 +/- 10.8 cm2) and an increase in midthigh muscle (52.9 +/- 2.6 vs. 58.0 +/- 2.0 cm2) (all P < 0.05). In conclusion, significant reductions in IAAT and an increase in strength and muscle area were observed after a strength-training program in healthy older women. These changes may be important in preventing the negative health outcomes associated with the age-related increase in intra-abdominal obesity.     

Public policy and the provision of psychological services to older adults.

Public policy shapes who delivers health care, how care is delivered, and how much providers are paid. The impact of public policy will become even more important to psychologists who serve older adults as 76 million members of the so called “baby boom” generation enter their later years. Armed with basic public policy facts, psychologists can better maneuver the systems created by public policy and even change policy. This article reviews how Medicare works since it is the primary payer of mental health services for older adults. The article then turns to the question of how many health care professionals (including psychologists) will be required to meet the needs of a rapidly growing older population and concurrent challenges of training and building that work force. Finally, different policy visions for a better mental health care system for older adults are summarized since they may be roadmaps to what the future of mental health care will look like. The article closes with practical recommendations on how psychologists can influence mental health and aging public policy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)