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Biomedical subjects

James O Judge

Publications and source records attributed to James O Judge.

10 recordsLinked to original sources
PubMed2005

The effect of walking speed on lower-extremity joint powers among elderly adults who exhibit low physical performance.

OBJECTIVES: To compare peak joint powers and joint angles between comfortable and fast walking speeds among a group of elderly adults who exhibit low physical performance, and to test the primary hypothesis that peak ankle powers would not change when walking speed was increased, but that peak hip power output would increase significantly with speed. DESIGN: Three-dimensional analysis of joint kinematics and kinetics during comfortable and fast walking by both healthy and low-performing elderly adults (age, >70y). SETTING: Gait laboratory. PARTICIPANTS: Twenty-four healthy elderly adults and 27 elders who exhibited low performance on a standard battery of walking, standing balance, and chair-rise tasks that places them at risk of mobility-related disability. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Peak lower-extremity joint powers and joint angles. RESULTS: Low-performing elders increased both ankle and hip power outputs to increase walking speed. However, peak ankle power remained significantly below that of the healthy elderly adults even when the low-performing elders walked at a faster gait speed. Joint-power changes in the low-performing elderly were accompanied by a reduction in hip extension and ankle dorsiflexion, and an increase in transverse pelvic rotation. CONCLUSIONS: Compared with healthy elderly, the low-performing elderly adults showed speed-independent differences in ankle and hip mechanics that may reflect underlying neuromuscular impairments. In particular, an understanding of the interdependent contributions of hip flexibility and ankle power limitations seem important to inform interventions to maintain gait into advanced age.

Aged↗
PubMed2004

The effects of multidimensional home-based exercise on functional performance in elderly people.

BACKGROUND: This study tested the hypothesis that a home-based exercise program would improve functional performance in elderly people. METHODS: We 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). RESULTS: 70 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. CONCLUSIONS: Minimally 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.

Activities of Daily Living↗
PubMed2004

Medicare and Medicaid home health and Medicaid waiver services for dually eligible older adults: risk factors for use and correlates of expenditures.

PURPOSE: The purpose of this work was to, among frail dually eligible older adults, determine risk factors for the likelihood of using Medicare home health and Medicaid home health services and to, among service users, determine correlates of Medicare home health, Medicaid home health, and Medicaid waiver service expenditures. DESIGN AND METHODS: Dually eligible individuals enrolled in Connecticut's Medicaid home- and community-based services (HCBS) waiver program for the aged (N = 5,232) were identified from a statewide database containing person-level linked data from Medicare claims, Medicaid claims, and uniform clinical assessment forms. Expenditures, based on claims data, were observed from the month following clinical assessment over the period August 1995 to December 1997. RESULTS: In multivariate models controlling for medical conditions and sociodemographic variables, similar functional disability measures were strongly associated with the probability of the use of, and expenditures for, Medicare home health and Medicaid home health services; severe cognitive impairment was strongly associated with greater Medicaid waiver service expenditures. IMPLICATIONS: Given the similarity of factors associated with Medicare and Medicaid home health service use and expenditures, greater integration of Medicare and Medicaid financing, reimbursement, and delivery strategies for home health services may be feasible and warranted for dually eligible older adults enrolled in state Medicaid HCBS waiver programs.

Aged↗
PubMed2003

Prevalence of sarcopenia and predictors of skeletal muscle mass in nonobese women who are long-term users of estrogen-replacement therapy.

BACKGROUND: Sarcopenia refers to the loss of skeletal muscle mass with age. We have found a prevalence of sarcopenia of 22.6% in older postmenopausal women not receiving estrogen. The objective of this study was to determine the prevalence of sarcopenia in a population of older, nonobese, community-dwelling women who had been long-term users of estrogen replacement therapy (ERT). METHODS: We measured appendicular skeletal muscle mass by dual x-ray absorptiometry (DXA) in 189 women aged 59 to 78 years old who had been using ERT for at least 2 years (mean +/- SD duration, 12.7 +/- 8.2 years). We defined sarcopenia as an adjusted appendicular skeletal muscle mass (ASM) (mass divided by height squared) more than 2 SDs below the mean for a young healthy reference population. Health and menopause history were obtained. Body mass index (BMI) was calculated, and physical activity and performance were measured using the Physical Activity Scale in the Elderly, the chair rise time, the 6-minute walk, and measures of lower extremity strength and power. Serum estrone, estradiol, testosterone, and sex hormone binding globulin were measured. RESULTS: The prevalence of sarcopenia in nonobese, community-dwelling women who were long-term ERT users was 23.8%. Skeletal muscle mass correlated significantly with BMI, age at the time of starting ERT, hand grip strength, lower extremity strength and power, and testosterone level, but not with estradiol level. In linear regression analysis, BMI, leg press strength, and testosterone level contributed to adjusted ASM, accounting for 48.7% of the variance (p <.001). CONCLUSIONS: Sarcopenia is as common in nonobese women who are long-term ERT users as in community-dwelling women not using ERT, suggesting that ERT does not protect against the muscle loss of aging. BMI, strength, and testosterone level contributed to appendicular skeletal mass in women. These data suggest that interventions to target nutrition, strength training, and testosterone replacement should be further investigated for their role in preventing muscle loss with age.

Absorptiometry, Photon↗
PubMed2003

Exercise in older adults.

Physical activity and exercise are beneficial to overall health and delay disability, even in the oldest old. We present data on exercise in older adults and its various benefits. Furthermore, we describe exercise programs suitable for adults over 65 and identify resources available to both patient and physician.

Aged↗
PubMed2002

A home-based nutrition intervention to increase consumption of fruits, vegetables, and calcium-rich foods in community dwelling elders.

OBJECTIVE: To increase fruit, vegetable, and calcium-rich food consumption in community-dwelling, functionally impaired elderly. DESIGN: Six-month, home-based nutrition intervention study. SUBJECTS: Seventy men and women older than age 69 years were randomized to either a nutrition education intervention (n = 38) or a control group that received an exercise intervention (n = 32). INTERVENTION: Nutrition education was designed to increase fruit, vegetable, and calcium-rich food consumption. MAIN OUTCOME MEASURES: Food intake was assessed by a food frequency questionnaire. Fasting blood measures of nutrients and carotenoids were performed. Statistical Analysis Two-group randomized controlled trial with pre-test and post-test design and intention-to-treat analysis. Analysis of covariance to was used to assess differences between the two groups. Baseline and change partial correlation coefficients were performed between intake and blood nutrient levels. Paired t tests were conducted to test within-group changes. RESULTS: Compared with the exercise group, subjects in nutrition group increased their self-reported intake of fruits by 1.1 +/- 0.2 (mean +/- SEM) servings per day (2.8 to 3.9, P = .01), vegetables 1.1 +/- 0.2 servings per day (2.3 to 3.4, P = .001), and milk/dairy 0.9 +/- 0.2 servings per day (3.0 to 3.9, P = .001). There was an increase in the dietary intake of alpha-carotene and beta-carotene in the nutrition group and this correlated with the increase in blood concentrations of alpha-carotene and beta-carotene (P < or = .02; r = 0.33 and r = 0.33, respectively). CONCLUSION: The results of this study suggest that it is possible to improve the dietary intake of community dwelling elders to include more fruits, vegetables, and calcium-rich foods. Recommendations for increasing consumption of fruits, vegetables, and calcium-rich foods should be specific and individualized to meet the dietary pattern and lifestyle of the individual. Compliance should be encouraged with record keeping as well as through continuous monitoring and positive reinforcement.

Aged↗
PubMed2002

Initiation and maintenance of exercise behavior in older women: predictors from the social learning model.

The purpose of the present study was to determine the extent to which modifiable social learning constructs predicted long-term adherence to an exercise program in older individuals. Participants were 189 women aged 59 to 78 years and diagnosed with low bone density. Exercise behavior was assessed at 3-month intervals. Self-efficacy, readiness for change, orientation toward exercise, social support in general, and support specifically for exercise were measured at baseline and at 12-month follow-up. Analyses indicated that initial adoption of exercise behavior was best predicted by readiness to change. Maintenance was predicted by self-efficacy for exercise, and exercise behavior at 12 months was predicted by social support for exercise. The results were seen as supportive of the stages and processes of change model of health behavior change. Implications of the findings for interventions to enhance adoption and maintenance of exercise programs by older women are discussed.

Aged↗
PubMed2002

The Performance Enhancement Project: improving physical performance in older persons.

OBJECTIVE: To determine the effects of center-based exercise on physical performance in older persons at risk for decline in physical functioning. DESIGN: Randomized controlled trial. SETTING: Senior centers. PARTICIPANTS: A total of 155 community-dwelling persons, 78.7% women, ages 70 years and older (mean +/- standard deviation, 77.0+/-4.5y), with mobility impairments. INTERVENTION: Intervention volunteers (n=80) exercised at a center (endurance, strength, balance, flexibility) 3 times weekly, for months 1 to 6; once weekly, for months 7 to 12 with home exercise 2 sessions a week; and at home only, for months 13 to 18. Home control volunteers (n=75) were instructed in home endurance exercise. MAIN OUTCOME MEASURES: MacArthur battery, Physical Performance Test (PPT-8), and 6-Minute Walk Test (6MWT) at baseline and 3, 6, 12, and 18 months. RESULTS: MacArthur battery scores improved in intervention compared with home control at 3, 6, and 12 months (repeated-measures analysis of variance: group x time, P<.05) but not 18 months. PPT-8 and 6MWT did not improve. Intervention group assignment, younger age, and better baseline physical function and self-perceived health were independent predictors of long-term MacArthur battery score improvement. CONCLUSIONS: Compared with home control, center-based exercise improved gait, chair rise time, and balance over 1 year. Improvements were not sustained with transition to home exercise for months 13 to 18. Classes may be necessary to maintain improvements in older persons attending center-based exercise.

Activities of Daily Living↗
PubMedDate not supplied

Dance and movement program improves quality-of-life measures in breast cancer survivors.

A pilot research study was conducted at 2 cancer centers in Connecticut to determine the effect of a dance and movement program on quality of life and shoulder function in breast cancer survivors treated within the prior 5 years. Thirty-five women completed the trial that included a 12-week intervention, using The Lebed Method, Focus on Healing Through Movement and Dance. The study design was a randomized control trial with a wait list control group crossover to active treatment in weeks 13 to 25, with the treatment group receiving the program in weeks 1 to 12, and no program in weeks 13 to 25. Outcome measures were the Breast Cancer Quality of Life (FACT-B), Shoulder range of motion (ROM), and Body Image Scale. FACT-B significantly improved in the intervention group at 13 weeks from 102.0 +/- 15.8 to 116.7 +/- 16.9, compared to the wait list group 108.1 +/- 16.4 to 107.1 +/- 21.3 (time x group effect, P = .008). During the crossover phase, the FACT-B score increased in the wait list group and was stable in the treatment group. The overall effect of the training at 26 weeks was significant (time effect, P = .03), and the order of training was also significant (P = .015). Shoulder ROM increased in both groups at 13 weeks--15 degrees and 8 degrees in the intervention and wait list groups (Time effect, P = .03; time x group, P = .58). Body Image improved similarly in both groups at 13 weeks (time effect, P = .001; time x group, P = .25), and at 26 weeks. There was no significant effect of the order of training for these outcome measures. A dance movement program that addressed the physical and emotional needs of women following treatment for breast cancer substantially improved a breast cancer-specific quality-of-life measure. Larger studies are justified to determine the acceptability of this therapy as part of the continuum of care for breast cancer survivors.

Adult↗