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PubMed2004

Performance of valued life activities reflected asthma-specific quality of life more than general physical function.

OBJECTIVE: We examined the prevalence of disability in valued life activities (VLAs) among a group of adults with asthma and the impact of general physical function and performance of VLAs on asthma-specific quality of life (QOL). STUDY DESIGN AND SETTING: Interview data collected from two waves of a longitudinal cohort study were used to examine the prevalence of disability in VLAs, the cross-sectional association of general function and performance of VLAs with QOL, and the longitudinal association of changes in general function and changes in performance of VLAs with changes in QOL. General function was assessed with the SF-12; VLAs were assessed with a newly developed measure. RESULTS: A substantial portion of subjects reported disability in VLAs. VLA function was a stronger predictor of QOL than general physical function in cross-sectional and longitudinal analyses. CONCLUSION: Performance of VLAs is more closely tied to asthma-specific QOL than is general physical function.

Activities of Daily Living↗

PubMed1995

Measuring physical function in community-dwelling older persons: a comparison of self-administered, interviewer-administered, and performance-based measures.

PURPOSE: To compare two self-administered, one interviewer-administered, and one performance-based measure of physical function in community-based older persons. METHODS: Eighty-three subjects were recruited from meal sites, senior recreation centers, and senior housing units for a comprehensive geriatric assessment program. At the time of screening, study participants self-administered the Functional Status Questionnaire (FSQ) and were administered the Katz Activities of Daily Living (ADL) and the Older Americans Resources and Services Instrumental Activities of Daily Living (OARS-IADL) instruments by interview. Participants also completed the Physical Performance Test (PPT) and were given the Medical Outcomes Study SF-36 to self-administer on site or at home and return by mail. RESULTS: All 83 subjects completed FSQ, Katz ADL, OARS-IADL, and PPT; 72 returned SF-36 forms. Correlations between the two self-administered physical function measures (FSQ and SF-36) were higher than between self-administered and interviewer-assessed (ADL and OARS-IADL) or performance-based (PPT) measures. When assessed for construct validity, the self-administered, OARS, and PPT measures had comparable correlations with role limitations as a result of physical health problems, but relationships between physical functional status measures and other SF-36 measures of health were inconsistent. CONCLUSION: The relationships between commonly used self-administered, interviewer-administered, and performance-based measures of physical function were inconsistent and weak, suggesting that these instruments are not measuring the same construct.

Activities of Daily Living↗

PubMed2003

Sarcopenia, calf circumference, and physical function of elderly women: a cross-sectional study.

OBJECTIVES: To determine whether calf circumference (CC), related to appendicular skeletal muscle mass, can be used as a measure of sarcopenia and is related to physical function. DESIGN: Retrospective analysis of data from 1992 to 1994 of the European Patient Information and Documentation Systems Study. SETTING: Community setting in France. PARTICIPANTS: One thousand four hundred fifty-eight French women aged 70 and older without previous history of hip fracture were recruited from the electoral lists. MEASUREMENTS: Muscular mass was assessed using dual-energy x-ray absorptiometry (DEXA). CC was measured using a tape measure. Anthropometric measurements (height; weight; and waist, hip, and calf circumference), strength markers (grip strength), and self-reported physical function were also determined. Sarcopenia was defined (using DEXA) as appendicular skeletal muscle mass (weight (kg)/height (m2)) less than two standard deviations below the mean of a young female reference group. RESULTS: The prevalence of sarcopenia was 9.5%. CC was correlated with appendicular skeletal muscle mass (r = 0.63). CC under 31 cm was the best clinical indicator of sarcopenia (sensitivity = 44.3%, specificity = 91.4%). CC under 31 cm was associated with disability and self-reported physical function but not sarcopenia (defined using DEXA), independent of age, comorbidity, obesity, income, health behavior, and visual impairment. CONCLUSION: CC cannot be used to predict sarcopenia defined using DEXA but provides valuable information on muscle-related disability and physical function.

Absorptiometry, Photon↗

PubMed2003

Effects of tai chi exercise on pain, balance, muscle strength, and perceived difficulties in physical functioning in older women with osteoarthritis: a randomized clinical trial.

OBJECTIVE: Twelve forms of Sun-style tai chi exercise have been developed specifically to reduce the symptoms and improve the physical functioning of arthritic patients, and this randomized study examined the changes in symptoms and physical characteristics in older women with osteoarthritis (OA) at the completion of a 12-week tai chi exercise program. METHODS: Seventy-two patients with OA were randomly assigned into 2 groups. Due to a 41% overall dropout rate, 22 experimental subjects and 21 controls completed pre- and post-test measures over a 12 week interval. Outcome variables were physical symptoms and fitness, body mass index, cardiovascular functioning, and perceived difficulties in physical functioning. The independent t test was used to examine group differences. RESULTS: The homogeneity test confirmed that there were no significant group differences in demographic data and pretest measures. Mean comparisons of the change scores revealed that the experimental group perceived significantly less pain (t = -2.19, p = 0.034) and stiffness (t = -2.13, p = 0.039) in their joints, and reported fewer perceived difficulties in physical functioning (t = -2.81, p = 0.008), while the control group showed no change or even deterioration in physical functioning after 12 weeks. In the physical fitness test, there were significant improvements in balance (t = 3.34, p = 0.002) and abdominal muscle strength (t = 2.74, p = 0.009) for the tai chi exercise group. No significant group differences were found in flexibility and upper-body or knee muscle strength in the post-test scores. CONCLUSION: Older women with OA were able to safely perform the 12 forms of Sun-style tai chi exercise for 12 weeks, and this was effective in improving their arthritic symptoms, balance, and physical functioning. A longitudinal study with a larger sample size is now needed to confirm the potential use of tai chi exercise in arthritis management.

Accidental Falls↗

PubMed2004

Is serum leptin related to physical function and is it modifiable through weight loss and exercise in older adults with knee osteoarthritis?

OBJECTIVE: To determine the effect of weight loss and exercise interventions on serum leptin and to investigate the relationship of physical function and osteoarthritis (OA) severity with serum leptin in older overweight and obese adults with knee OA. In addition, the study examined if serum leptin predicts weight loss. DESIGN: Longitudinal, controlled clinical trial of weight loss and exercise interventions. SUBJECTS: Community dwelling, older, overweight and obese adults (n=316; >60 years of age; body mass index >/=28.0 kg m(-2)) with symptomatic knee OA and self-reported difficulty in performing selected physical activities were recruited. INTERVENTIONS: Participants were randomized into one of four groups for the 18-month study duration: Healthy Lifestyle Controls, Dietary Weight Loss (Diet), Exercise Training (Exercise), and a combination of Dietary Weight Loss and Exercise Training (Diet+Exercise). The weight loss goal for the two Diet groups was 5% from baseline at 18 months. Participants in the Exercise groups were trained for 3 days week(-1), 60 min day(-1). MEASUREMENTS: Body weight, body mass index, serum leptin, physical function, and OA severity were measured at baseline, 6 months, and 18 months. RESULTS: Diet and Diet+Exercise groups lost 5.3 and 6.1% of their weight, respectively, at 18 months with the Exercise group losing 2.9%. There was a significant main effect of weight loss on serum leptin with a decrease in serum leptin averaged across the 6- and 18-month time points for the Diet and Diet+Exercise groups compared to the other two groups (beta=0.245; P<0.01). No main effect for exercise training was observed. Serum leptin was related to self-reported physical function. In all participants, a mixed model analysis demonstrated that lower levels of baseline serum leptin predict larger weight loss (beta=-2.779; P=0.048). CONCLUSION: Decreases in serum leptin may be one mechanism by which weight loss improves physical function and symptoms in OA patients.

Aged↗

PubMed2003

The role of perceived control in the process of older peoples' recovery of physical functions after fall-related injuries: a prospective study.

This study examined the predictive role of perceived control in recovery of physical functions after fall-related injuries in a cohort of 165 older people who had completed preinjury baseline assessments including physical functioning and perceived control. Follow-up assessments of functioning were made at 8 weeks, 5 months, and 12 months. Indicators for perceived control were mastery and self-efficacy expectations. Physical functioning referred to self-reported difficulties with activities of daily living. Covariates included age, gender, level of education, preinjury health status, preinjury levels of social support and disability, and, additionally, the severity of the injury. Separate regression equations were estimated with disability as outcome at 8 weeks, 5 months, and 12 months post injury. Although significant at 8 weeks and borderline significant at 5 months post injury, the predictive role of perceived control appeared to be comparatively small. Preinjury levels of disability were highly predictive for disability at 8 weeks, 5 months, and 12 months post injury. The severity of the injury is the predominant contributor to disability in the short term but becomes insignificant over time, whereas the influence of age on recovery becomes important after 5 months.

Accidental Falls↗

PubMed2002

Anaerobic power and physical function in strength-trained and non-strength-trained older adults.

BACKGROUND: Challenging daily tasks, such as transferring heavy items or rising from the floor, may be dependent on the ability to generate short bursts of energy anaerobically. The purposes of this study were to determine if strength-trained (ST) older adults have higher anaerobic power output compared with non-strength-trained (NST) older adults and to determine the relationship between anaerobic power and performance-based physical function. METHODS: Thirty-five men and women (age 71.5 +/- 6.4 years, mean +/- SD; NST: n = 18, ST: n = 17) were grouped by training status. Outcome variables included relative anaerobic power (Wingate test), physical function measured with the Continuous Scale Physical Functional Performance Test (CS-PFP, scaled 0 to 100), and anthropometric lean thigh volume (LTV). Analysis of covariance (with age and sex as covariates) was used to determine group differences in the dependent variables listed above. Pearson's r was used to determine the relationship between anaerobic power, CS-PFP total score (TOT), and CS-PFP lower body strength domain score (LBS). RESULTS: The ST group had significantly higher mean anaerobic power (NST 58.9 +/- 16 W/l, ST 96.3 +/- 23 W/l), CS-PFP total (NST 61.2 +/- 13, ST 73.7 +/- 8), and LBS (NST 54.1 +/- 17, ST 70.9 +/- 8) compared with the NST group (p <.05). However, LTV was similar for both groups (NST 3.323 +/- 0.75; ST 3.179 +/- 0.79), which suggests that the ST group had higher muscle quality compared with the NST group. Anaerobic power was significantly related to TOT (r =.611, p =.001) and LBS (r =.650, p =.001). CONCLUSIONS: High levels of physical function in ST older adults may in part be explained by higher levels of anaerobic power associated with strength training.

Aged↗

PubMed2002

Limited effects of micronutrient supplementation on strength and physical function after abdominal aortic aneurysmectomy.

BACKGROUND: Tissue injury following ischemia-reperfusion is mediated in part by free oxygen radicals. We hypothesized that perioperative micronutrient supplementation would augment antioxidant defenses, minimize muscle injury, and minimize postoperative decreases in muscle strength and physical function following abdominal aortic aneurysmectomy. SETTING: A university-affiliated hospital and regional referral center. DESIGN: A randomized, double-blind, placebo-controlled trial of supplementation with beta-carotene, vitamins C and E, zinc, and selenium for a period of 2-3 weeks prior to surgery and 1 week thereafter. STUDY POPULATION: Patients undergoing elective abdominal aortic aneurysmectomy (n=18 per group). PRINCIPAL MEASUREMENTS: Handgrip and other measures of strength and physical function. RESULTS: Handgrip and quadriceps strength decreased following surgery, but not to a significantly different extent in the placebo and supplemented groups. Self-rated physical function decreased following surgery in the placebo group and was preserved in the supplemented group. CONCLUSIONS: Perioperative supplementation with micronutrients with antioxidant properties has limited effects on strength and physical function following major elective surgery.

Adult↗

PubMed2001

Disparate effects of socioeconomic status on physical function and emotional well-being in older adults.

We tested the hypothesis that among community living older adults with relatively low and high socioeconomic status (SES), low SES is associated with both poorer emotional well-being and physical function. Ambulatory, community living older men and women (70-89 years of age) were recruited from outpatient geriatric assessment clinics in relatively high socioeconomic areas of greater Boston (High SES, N=47), and from an urban senior center in the inner city (Low SES, N=66). We assessed health status, mental health, upper and lower extremity strength and physical function. We found that health status was not significantly different in the two groups. Quadriceps strength (Low SES: 199+/-57 N; High SES: 190+/-56 N; p=0.531) and Up and Go times (Low SES: 14.3+/-3.1 sec; High SES: 16.7+/-9.5 sec; p=0.068) were not significantly different in the two groups, while grip strength was slightly higher in the Low SES group (Low SES: 22.8+/-6.45 kg; High SES: 20.07+/-7.55 kg; p=0.049). In contrast, subjects with Low SES tended to have an increased tendency towards depression. Scores on the Geriatric Depression Scale were 3.8+/-3.0 in Low SES, and 1.8+/-2.8 in High SES (p<0.001). We conclude that while health status and physical function were not worse in subjects with low SES, emotional well-being was markedly less compared to seniors with high SES. SES may have disparate effects on physical function and mental health, perhaps due to different compensatory mechanisms.

Activities of Daily Living↗

PubMed1994

Physical function and social class among Swedish oldest old.

The relationship between physical ability and social class in later life was explored through an interview survey conducted on a nationally representative sample of persons aged 77-98 (N = 537). Physical ability was measured with activities of daily living, an index of mobility, and performance tests. Social class was measured according to previous occupation. Physical function was found to be correlated with social class, that is, former white-collar workers had better function than blue-collar workers. The differences were significant for all three measures of physical function.

Activities of Daily Living↗

PubMedDate not supplied

Quantification of lumbar function. Part 6: The use of psychological measures in guiding physical functional restoration.

The present article reviews the use of psychologic measures in guiding a functional restoration treatment program with chronic low-back pain patients. The results of the first 134 consecutive patients completing this program are reviewed. These results demonstrate that various psychologic measures paralleled improvement in physical function. Of particular interest is the finding that various Minnesota Multiphasic Personality Inventory (MMPI) scales that were initially clinically elevated showed a significant decrease to nonelevated levels after treatment. The clinical implications of these findings are discussed, along with the important observation that one should avoid assuming that a single psychologic test can reliably be used as the sole predictor variable in clinical cases.

Achievement↗

PubMed2002

Delineating the impact of Tai Chi training on physical function among the elderly.

BACKGROUND: Through a re-analysis of a Tai Chi intervention data set, the study objective was to determine which, if any, subgroups of the study sample evidenced differential benefits from the intervention. METHOD: Re-analysis of a Tai Chi intervention study, a randomized controlled trial in Eugene and Springfield, Oregon. Physically inactive participants aged > or =65 years were randomly assigned to one of two groups: Tai Chi (n=49) and a wait-list control (n=45). The main outcome measure was self-reported physical function. RESULTS: Initial latent curve analyses indicated significant Tai Chi training effects: Participants in the Tai Chi group reported significant improvements in perceived physical function compared to those in the control group. However, there was significant interindividual variability in response to Tai Chi. The overall intervention effect was further delineated by identifying two subgroups. This delineation showed that Tai Chi participants with lower levels of physical function at baseline benefited more from the Tai Chi training program than those with higher physical function scores. Inclusion of additional measures of individual characteristics at baseline, change in movement confidence, and class attendance further explained differences in treatment responses. CONCLUSIONS: Findings from this study suggest that although an intervention may show an overall effect (or no overall effect), it may be differentially effective for subgroups of participants that differ in their pre-intervention characteristics. Examination of variability in outcome measures can provide important information for refining and tailoring appropriate interventions targeted to specific subgroups.

Activities of Daily Living↗

PubMed2000

Declines in physical functioning attributable to hip fracture among older people: a follow-up study of case-control participants.

PURPOSE: To identify declines in physical functioning, directly attributable to the effects of hip fracture. METHODS: A follow-up study of participants in a case-control study was conducted in Auckland, New Zealand, between 1993 and 1996. Nine hundred and eleven randomly selected older people with a hip fracture at the time of the initial interview (cases) and 910 randomly selected older people, without hip fracture (controls), were invited to participate in the study. Two year changes in physical functioning, defined in terms of self-reported mobility, functional dependence and physical activity were examined. RESULTS: Data from the survivors (572 cases and 756 controls) showed that, after controlling for pre-existing chronic medical conditions and disabilities, cases were 4.2 times more likely than controls to be community immobile (95% confidence interval (CI) 2.8-6.2, p < 0.001) and 2.6 times more likely to be functionally dependent (95% CI 1.7-4.1, p < 0.001). Cases were also spending less hours per day on their feet (2.9) compared with controls (3.5) (F1,1211 = 55.7, p < 0.001). CONCLUSIONS: Hip fractures are associated with dramatic declines in physical functioning at two years, independent of the effects of increasing age, pre-existing medical conditions and disabilities.

Activities of Daily Living↗

PubMed1997

Effects of exercise on fatigue, physical functioning, and emotional distress during radiation therapy for breast cancer.

PURPOSES/OBJECTIVES: To test the hypothesis that women participating in a walking exercise program during radiation therapy treatment for breast cancer would demonstrate more adaptive responses as evidenced by higher levels of physical functioning and lower levels of symptom intensity than women who did not participate. DESIGN: Experimental, two-group pretest, post-test. SETTING: Two university teaching hospital outpatient radiation therapy departments. SAMPLE: 46 women beginning a six-week program of radiation therapy for early stage breast cancer. METHODS: Following random assignment, subjects in the exercise group maintained an individualized, self-paced, home-based walking exercise program throughout treatment. The control group received usual care. Dependent variables were measured prior to and at the end of radiation therapy. In addition, symptoms were assessed at the end of three weeks of treatment. MAIN RESEARCH VARIABLES: Participation in the walking exercise program, physical functioning fatigue, emotional distress, and difficulty sleeping. FINDINGS: Hypothesis testing by multivariate analysis of covariance, with pretest scores as covariates, indicated significant differences between groups on outcome measures (p < 0.001). The exercise group scored significantly higher than the usual care group on physical functioning (p = 0.003) and symptom intensity, particularly fatigue, anxiety, and difficulty sleeping. Fatigue was the most frequent and intense subjective symptom reported. CONCLUSIONS: A self-paced, home-based walking exercise program can help manage symptoms and improve physical functioning during radiation therapy. IMPLICATIONS FOR NURSING PRACTICE: Nurse-prescribed and -monitored exercise is an effective, convenient, and low-cost self-care activity that reduces symptoms and facilitates adaptation to breast cancer diagnosis and treatment.

Adult↗

PubMed2004

Leisure time physical activity and strenuousness of work as predictors of physical functioning: a 28 year follow up of a cohort of industrial employees.

AIMS: To examine associations of leisure time physical activity and physical strenuousness of work with physical functioning 28 years later. METHODS: A cohort (n = 902) of metal industry employees was studied for exercise and housework activity in 1973 and 1978, and for BMI, current smoking, strenuousness of work, grip strength, and chronic diseases in 1973. Of the 670 survivors in 2000, 529 (79%) responded to all studied items in a follow up questionnaire including the SF-36 Physical Functioning (PF) scale. Belonging to the lower quartile of the PF scale denoted poor functioning. RESULTS: Vigorous exercise and housework activity were inversely associated with poor PF 28 years later in both white-collar and blue-collar workers. Engaging in activities of any intensity was similarly associated among the blue-collar workers. In a multiple logistic regression model including as independent variables age, sex, occupational class, the number of chronic diseases, vigorous leisure time physical activity, BMI, physical work strenuousness, and smoking (all measured at baseline), the risk of poor PF at follow up was decreased by vigorous leisure time physical activity and increased by high physical strenuousness of work, high BMI, and smoking. The effect of work strenuousness was mainly due to that among the blue-collar group. Allowing for baseline grip strength did not materially alter the results. CONCLUSION: Vigorous leisure time physical activity decreased the risk of poor physical functioning as perceived considerably later in life, while high work strenuousness, smoking, and overweight increased it. Among blue-collar workers a beneficial association was observed with all leisure time activity, including that of lower intensity.

Adolescent↗

PubMedDate not supplied

Physical functional outcomes after cardiothoracic transplantation.

The study of patient healthcare outcomes after cardiothoracic transplantation has increased substantially over the last 2 decades. Physical function after heart, lung, and heart-lung transplantation has been studied using both subjective and objective measures. The majority of reports in the literature on physical function after cardiothoracic transplantation are descriptive and observational. The purposes of the article are to review and critique the existing literature on cardiothoracic recipients' subjective and objective physical function, including respiratory function for heart-lung and lung transplant recipients. In addition, the literature on sexual function in cardiothoracic recipients is examined, the gaps in the literature are identified, and recommendations are given for future research.

Activities of Daily Living↗

PubMedDate not supplied

Attendance at religious services and physical functioning after stroke among older Mexican Americans.

The purpose of this study was to examine the association of attendance at religious services and change in physical functioning among older Mexican Americans who report residual physical limitations due to stroke. Using data from the Hispanic Established Population for the Epidemiological Study of the Elderly (H-EPESE), generalized linear models were used to evaluate change in physical function over 3 years in persons with stroke aged 65 and older, controlling for demographics, medical conditions, health behaviors, and physical mobility. The results showed frequent attendees at religious services had significantly fewer declines in activities of daily living (ADLs) disability compared to infrequent attendees. The frequent attendance group also showed less decline in lower body function compared to the infrequent attendees. Findings are indicative that church attendance prestroke is associated with better physical function poststroke in older Mexican Americans.

Activities of Daily Living↗

PubMed2000

Assessment of physical function and exercise tolerance in older adults: reproducibility and comparability of five measures.

This study examined the reproducibility and comparability of five measures of function and exercise tolerance. The test battery and questionnaire on function and physical activity were administered twice, 7-10 days apart to 38 men and 12 women aged 54-80 years at the Baltimore Veterans Affairs Medical Center. Tests included fast pace 4 and 20-meter walks, 6-minute and graded treadmill walks, and a seated step test. All tests demonstrated good reproducibility with Pearson and intraclass correlation coefficients ranging from 0.84 to 0.98, and percent differences on retest ranging from 4 to 11%. Although correlations between different tests were all significant (range 0.34-0.89), comparison of performance ranks and linear regression analyses indicated that the short fast walks and seated step test may not be suitable substitutes for treadmill or long self-paced corridor walks. Only 28% had the same quintile performance ranking on the step test as on the treadmill walk, and 36% had rankings 2 or more points apart. The fast 20m walk shows the most promise as a low-level alternative to the 6-minute walk; performances had a correlation of 0.73, 82% of ranks were within one point, and 20m speed explained 42% of the variance in distance covered. More development is needed for comprehensive assessment of exercise tolerance in older adults; the 6-minute walk did not adequately discriminate fitness level in persons who walk regularly, and the treadmill posed problems for those with walking difficulty.

Aged↗