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PubMedDate not supplied

[Metabolic and cardiorespiratory responses to maximal and submaximal exercise in eutrophic and stunted girls].

OBJECTIVE: The metabolic and cardiovascular responses of eutrophic girls and girls who underwent early undernutrition, were examined during physical exercise, in order to verify whether previous undernutrition could, in addition to cause a deficit in the children's height, and limit their functional capability to perform a maximal and submaximal exercise in an ergometric bicycle. SUBJECTS: Our sample was composed of 24 girls, of which 12 were eutrophic, with 9.13 +/- 0.79 years (mean +/- s.d.), 27.64 +/- 3.64 kg of body weight, and 131.31 +/- 6.04 cm in height. The 12 early undernourished girls were 9.75 +/- 1.1 years old, 25.16 +/- 2.33 kg, and 125.06 +/- 3.9 cm high. MEASUREMENTS: The method included clinical evaluation and ergo-spirometric test on an ergometric bicycle, from which all the metabolic and cardiac-respiratory variables were obtained and analyzed. The test protocol was an initial two minutes period with 25 watts, followed by increments of 15 watts every two minutes, until exhaustion. RESULTS: Analysis of the results of the test of maximal effort did not reveal significant differences between eutrophic (E) and early undernourished (UN) girls in any of the variables: VO2max expressed in l/min (E = 1.11 +/- 0.25; UN = 1.02 +/- 0.19); VO2max expressed in ml/min/kg (E = 40.23 +/- 6.98; UN = 40.53 +/- 6.32), VEmax (E = 40.61 +/- 8.79; UN = 38.25 +/- 8.95), R (E = 1.13 +/- 0.07; UN = 1.13 +/- 0.05), HRmax (E = 195.33 +/- 9.13; UN = 193.85 +/- 11.18), previous % HRmax (E = 92.87 +/- 4.33; UN = 92.80 +/- 4.87), and maximum watts (E = 90.00 +/- 20.56; UN = 91.25 +/- 11.33). Analysis of the results obtained in test of submaximal effort, reflected by the intensity of effort in the anaerobic threshold (AT), showed differences between the groups in the following variables: VO2max expressed in l/min. (E = 0.77 +/- 0.14; UN = 0.62 +/- 0.13), % of VO2max (E = 70.07 +/- 7.52; UN = 61.21 +/- 9.83), HR (E = 166.58 +/- 14.25; UN = 146.33 +/- 17.40), % HRmax (E = 85.31 +/-6.41; UN = 75.50 +/- 7.73), VE (E = 24.18 +/- 5.81; UN = 17.69 +/- 4.30), % VEmax (E = 59.64 +/- 8.45; UN = 46.95 +/- 10.59). No differences were found for VO2max, expressed in l/min/kg (E = 28.06 +/- 4.87; UN = 24.81 +/- 5.31) and watts (E = 51.25 +/- 17.47; UN = 45.00 +/- 9.77). CONCLUSION: The reestablishment of the ratio weight/height in early undernourished girls is also useful to indicate lack of limitation of functional capability to perform physical exercises.

Body Height↗

PubMed2004

Using compensations to assess physical performance for ambulatory outpatients.

OBJECTIVE: To construct a physical performance scale for community-dwelling ambulatory outpatients that is linear, includes high functioning tasks, and uses common compensations to assess difficulty levels. DESIGN: Calibrated subject performances on 19 tasks were rated by an examiner, timed, and had compensations recorded. SETTING: Ambulatory outpatient physical therapy (PT) department of a tertiary care center. PARTICIPANTS: Convenience sample of 50 community-dwelling patients with difficulties in mobility referred for PT. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The Community Ambulatory Physical Performance Scale (CAPPS) constructed by using Rasch analysis, the Lower Extremity Functional Scale (LEFS), and the six-minute walk test (6MWT). RESULTS: The CAPPS showed construct validity after removal of 3 items. Two additional items were removed for improved clinical utility. The person reliability was .89 and item reliability was .98. Subjects' performance on the CAPPS correlated with the 6MWT (r=.79; 95% confidence interval [CI], .65-.87) and with the LEFS (r=.62; 95% CI, .40-.78). CONCLUSIONS: The CAPPS showed good psychometric properties and has utility for assessments of higher-level physical functioning. This standardized approach to performance testing for ambulatory outpatients appears to be a promising method for articulating the compensations persons use to accomplish common tasks. Use of compensatory strategies to assess difficulties in physical performance may assist in delineating interventions directed toward improving task performance.

Activities of Daily Living↗

PubMed1996

The influence of diabetes, hypertension, and stroke on ethnic differences in physical and cognitive functioning in an ethnically diverse older population.

Prevention of decline in cognitive and physical functioning in the elderly has become an important focus in geriatric medicine. Hispanics are among the fastest-growing group of elderly in the United States, yet few data are available on functional impairments in this group. We examined the association between ethnicity (non-Hispanic whites [NHW], English-speaking Hispanics [EH], and Spanish-speaking Hispanics [SH]) and cognitive status, self-assessed functional status, and physical performance in a community-dwelling sample of 589 people aged > or = 60 years. The purpose of this study was to examine the association between ethnicity and these measures of functional status and to evaluate the influence of comorbid stroke, diabetes, and hypertension on this association. We found that EH and SH had significantly lower scores on the MiniMental State Exam than NHW, but that this difference was almost entirely due to educational level. When SH whose educational attainment was grade 8 or higher were compared to NHWs, there were no differences in cognitive functioning. Those with diabetes and stroke had poorer cognitive functioning. Among those with stroke, EH and SH women had more self-assessed functional limitations (IADLs and ADLs) than NHW. Male SH and EH with diabetes also had more self-assessed functional limitations than NHW. SH with two or three of these conditions had more IADL limitations. Our results suggest that elderly community-dwelling Hispanics experience greater levels of disability and that this is due, in part, to lower socioeconomic status and higher prevalence of disabling conditions.

Activities of Daily Living↗

PubMed2004

Weight loss intervention for obese older women: improvements in performance and function.

OBJECTIVES: To determine the feasibility of a 3-month weight loss program for obese older women with short-term laboratory, performance, functional, and life quality outcomes. RESEARCH METHODS AND PROCEDURES: This was a pre- and postintervention design. Community-dwelling women (n = 26) > or =60 years old with BMI > or =30 were enrolled in a 3-month weight loss program promoting prudent diet, behavior modification, and physical activity. The primary emphasis of the program was on health, function, and quality of life. The approach was specifically tailored to older subjects through use of large-font instructional materials, supplementation of calcium and vitamin D, and moderate weight loss and physical activity goals. An initial assessment by a bariatric physician was followed by eight visits with a dietitian and a follow-up physician visit. Measurements included anthropometrics, body composition, laboratories, pedometer, physical performance, Short-Form 36 Health Status Survey (SF-36), Life Space Assessment, and dietary assessment. RESULTS: Eighteen participants completed the program. There was a significant decrease in mean body weight (100 +/- 15 vs. 96 +/- 18 kg, p = 0.006), with a mean weight loss of 4.3 +/- 5.5 kg (range -15.5 to +7.20 kg). Significant improvements were observed for diastolic blood pressure, total cholesterol, triglycerides, physical performance, pedometer-measured step counts, and step climb and descent. Self-rated physical functioning (SF-36 subscore) and vitality (SF-36 subscore) were also significantly improved. DISCUSSION: It is feasible for self-selected obese older women to achieve a moderate weight loss and increase in physical activity resulting in short-term improvements in laboratory, physical performance, self-reported function, vitality, and life quality outcomes.

Aged↗

PubMed2006

Measuring change in activities of daily living in nursing home residents with moderate to severe cognitive impairment.

BACKGROUND: The objective of this study was to assess the responsiveness of the Minimum Data Set Activities of Daily Living (MDS-ADL) Scale to change over time by examining the change in physical function in adults with moderate to severe dementia with no comorbid illness who had been resident in a nursing home for over 90 days. METHODS: Longitudinal data were collected on nursing home residents with moderate (n = 7001) or severe (n = 4616) dementia in one US state from the US national Minimum Data Set (MDS). Severity of dementia was determined by the MDS Cognitive Performance Scale (CPS). Physical function was assessed by summing the seven items (bed mobility, transfer, locomotion, dressing, eating, toilet use, personal hygiene) on the MDS activities of daily living (ADL) Long Form scale. Mean change over time of MDS-ADL scores were estimated at three and six months for residents with moderate (CPS score of 3) and severe (CPS score of 4 or 5) dementia. RESULTS: Physical function in residents with moderate cognitive impairment deteriorated over six months by an average of 1.78 points on the MDS-ADL Long Form scale, while those with severe cognitive impairment declined by an average of 1.70 points. Approximately one quarter of residents in both groups showed some improvement in physical function over the six month period. Residents with moderate cognitive impairment experienced the greatest deterioration in early-loss and mid-loss ADL items (personal hygiene, dressing, toilet use) and residents with severe cognitive impairment showed the greatest deterioration in activities related to eating, a late loss ADL. CONCLUSION: The MDS-ADL Long Form scale detected clinically meaningful change in physical function in a large cohort of long-stay nursing home residents with moderate to severe dementia, supporting its use as a research tool in future studies.

Activities of Daily Living↗

PubMed2002

Resistance training for health and performance.

Resistance training is recommended by national health organizations for incorporation into a comprehensive fitness program that includes aerobic and flexibility exercise. Its potential benefits on health and performance are numerous; it has been shown to reduce body fat, increase basal metabolic rate, decrease blood pressure and the cardiovascular demands to exercise, improve blood lipid profiles, glucose tolerance, and insulin sensitivity, increase muscle and connective tissue cross-sectional area, improve functional capacity, and relieve low back pain. Many improvements in physical function and athletic performance are associated with the increases in muscle strength, power, endurance, and hypertrophy observed during resistance training. The key element to effective resistance training is supervision by a qualified professional and the proper prescription of the program variables. Proper program design, ie, that which uses progressive overload, variation, and specificity, is essential to maximize the benefits associated with resistance training.

Exercise↗

PubMed1999

The impact of severe asthma on schoolchildren.

Episodic airway obstruction and hypoxia are potentially life-threatening to children with asthma and may account for neuropsychological impairment. Moreover, living with this chronic disease may severely disrupt children's emotional functioning. The general functioning of 25 children with severe asthma aged 10-13 years was tested by a comparison with 25 matched normal controls. Testing included variables with relevance to normal daily functioning: memory, concentration, school performance, physical condition, subjective symptoms after exercise, and negative emotions. The results showed that children with asthma did not significantly deviate from controls. They reported more dyspnea after physical exercise, which could not be attributed to lung function. Differences in school performance were not significant. It was concluded that children may generally adapt well to living with asthma.

Activities of Daily Living↗

PubMedDate not supplied

Implications of expiratory muscle strength training for rehabilitation of the elderly: Tutorial.

With age, physical functions decline, which influences respiratory performance. One of the physical changes associated with aging is sarcopenia, a reduction in muscle strength and power. Sarcopenia has been extensively studied in the elderly with regard to limb function but less with regard to respiratory function. Elderly individuals experience reduced muscle mass and strength in respiratory musculature, which may hinder the ability to generate adequate expiratory driving force for both ventilatory and nonventilatory activities. Increasing expiratory muscle strength may enhance an elderly individual's ability to generate and maintain the expiratory driving force critical to cough, speak, and swallow. Previous studies demonstrate that expiratory muscle strength training (EMST) improves ventilatory and nonventilatory functions. This paper discusses the potential impact that EMST can have on the rehabilitation of respiratory muscle decline, particularly in the elderly. This tutorial reviews an EMST paradigm, its physiological underpinnings, and its potential outcomes.

Aged↗

PubMed2002

Older adults in cardiac rehabilitation: a new strategy for enhancing physical function.

PURPOSE: This study contrasted the effect of a group-mediated cognitive-behavioral intervention (GMCB) versus traditional cardiac rehabilitation (CRP) upon changes in objective and self-reported physical function of older adults [mean (SD) age of 64.7 (7.5) yr] after 3 months of exercise therapy. METHODS: This randomized clinical trial enrolled 147 participants who were eligible for inclusion into cardiac rehabilitation. Baseline to 3-month changes in self-reported and performance related measures of physical function were assessed using a physical functioning questionnaire, a 6-min walk test, and measured MET levels. RESULTS: Paired t-tests revealed that participants made improvements in all measures across the first 3 months of the study, irrespective of group treatment (P < 0.001). General linear models including effects for baseline levels of physical function, treatment, and gender revealed that lower functioning men in the GMCB treatment made greater improvements than any other subgroup on the two performance outcomes: 6-min walk and measured MET levels (P < 0.01). Gender did not moderate change in self-reported level of physical function (P > 0.05); however, the lower functioning participants in the GMCB intervention experienced greater improvements in self-reported physical function than those in CRP (P < 0.05). CONCLUSIONS: Exercise therapy is a valuable intervention for improving physical function of older adults with cardiovascular disease (CVD) and those at increased risk for CVD. Baseline level of physical function and gender are important variables to consider when studying the relationship between exercise therapy and improvements in physical function.

Activities of Daily Living↗

PubMedDate not supplied

Health status of heart transplant recipients versus patients awaiting heart transplantation: a preliminary evaluation of the SF-36 questionnaire.

Measures of the effects of health care on patients' lives are being requested to evaluate heart transplantation programs. A relatively short, 36-item, questionnaire (SF-36) designed to measure health status is being evaluated as an outcome measure for a variety of conditions. The SF-36 was sent to all adults awaiting heart transplantation (n = 48) and heart transplant recipients (n = 177) at the University of Minnesota as a pilot study of the SF-36 applied to heart transplantation. Response rates were 88% and 81%, respectively. Heart transplant recipients had significantly (p < 0.0001) better scores for general health perceptions (70 +/- 21 versus 33 +/- 21), vitality (62 +/- 19 versus 39 +/- 2), physical function (71 +/- 22 versus 36 +/- 24), ability to perform roles without physical limitations (62 +/- 41 versus 27 +/- 35), and social function (85 +/- 18 versus 63 +/- 31) compared with patients awaiting heart transplantation. Mental function and ability to perform roles without emotional problems were good in both groups and not significantly different. Mean SF-36 scores for the heart transplant recipients were uniformly not as high as scores for a historical group with only minor medical problems. These preliminary data suggest that the SF-36 is sensitive to the effects of heart transplantation. Additional studies of the SF-36 as an outcome measure for heart transplantation are warranted and should include methods to control for extraneous variability and to provide unbiased data collection.

Female↗

PubMed2004

Psychometric evaluation of two scales assessing functional status and peripheral neuropathy associated with chemotherapy for ovarian cancer: a gynecologic oncology group study.

PURPOSE/OBJECTIVES: To evaluate the psychometric properties of two adapted scales, one for functional status and one for peripheral neuropathy secondary to neurotoxic chemotherapy. DESIGN: Repeated measures methodologic design conducted within a Gynecologic Oncology Group (GOG) phase III clinical trial that randomly assigned patients with advanced epithelial ovarian cancer to cisplatin and cyclophosphamide or cisplatin and paclitaxel. SETTING: 8 GOG institutions participating in the GOG clinical trial. SAMPLE: 88 evaluable outpatients enrolled in the GOG clinical trial. Sample size at time 1 (T1) was 88 patients and at time 2 (T2) was 67 patients. METHODS: All scales were administered at T1 (prior to initiation of chemotherapy) and T2 (after six cycles of chemotherapy but prior to second-look laparotomy). Internal consistency reliability, criterion validity, and construct validity were evaluated, and clinical application was explored. MAIN RESEARCH VARIABLES: Self-reported peripheral neuropathy and functional status (comprised of physical function and role function subscales), the GOG performance status scale, and the GOG toxicity criteria. FINDINGS: Reliability coefficients at T1 were physical function = 0.83, role function = 0.96, and peripheral neuropathy = 0.91; at T2, they were physical function = 0.83, role function = 0.92, and peripheral neuropathy = 0.89. At T1, physical function and role function correlated positively with performance status. Peripheral neuropathy correlated positively with GOG toxicity criteria used at T2. Principal component factor analysis suggested that the functional status scale had a two-factor structure with factors representing general and specific mobility and that the peripheral neuropathy scale also had a two-factor structure with factors representing foot and hand neuropathy. CONCLUSIONS: The physical function, role function, and peripheral neuropathy scales have internal consistency, reliability, criterion validity, and construct validity. However, revision of the scales should address modification of specific questions and consider increasing the Likert scale from a four-point to a five- or seven-point scale to enhance clinical sensitivity and application. IMPLICATIONS FOR NURSING: With minor modifications, these scales should be useful in assessing physical function, role function, and peripheral neuropathy in patients who receive agents that may cause peripheral neuropathy.

Adult↗

PubMed2002

Effects of hyaluronate sodium on pain and physical functioning in osteoarthritis of the knee: a randomized, double-blind, placebo-controlled clinical trial.

BACKGROUND: Intra-articular hyaluronate sodium is a relatively new therapy for the treatment of osteoarthritis of the knee. This randomized, double-blind clinical trial was conducted at a large primary care medical center to determine the impact of hyaluronate sodium vs conventional therapy on measures of pain, stiffness, and disability at rest and following functionally relevant walking and stepping activities. METHODS: A total of 120 patients (mean age, 67 years) with unilateral grades 1 to 3 medial compartment knee osteoarthritis were randomized to 1 of 4 treatment groups: group 1, 2 mL of hyaluronate sodium at a concentration of 10 mg/mL and placebo (100 mg of lactose); group 2, nonsteroidal anti-inflammatory drugs (NSAIDs) (75 mg of diclofenac and 200 microg of misoprostol) and hyaluronate sodium; group 3, NSAIDs and placebo (2 mL of isotonic sodium chloride solution [saline]); and group 4, placebo (lactose and saline). Intra-articular hyaluronate sodium or saline (2 mL) was administered once weekly over 3 weeks while NSAIDs or lactose were administered twice daily over 12 weeks. MAIN OUTCOME MEASURES: (1) Western Ontario McMaster Universities Index (WOMAC) global measure of pain, stiffness, and disability; (2) visual analog scale (VAS) scores for pain at rest and following functional walking and stepping activities (self-paced walking and stepping); and (3) functional performance (exercise time, heart rate, and predicted maximum oxygen uptake) at baseline and weeks 4 and 12. RESULTS: At week 4, significant improvement in WOMAC scores for pain and disability and VAS score for resting pain was observed in groups 1 to 3 compared with baseline measures. Groups 1 and 2 showed significantly lower self-paced stepping pain, while no change was observed in group 4. At week 12, groups 1 to 3 showed significantly greater improvement in WOMAC pain subscale score and VAS score for resting pain; however, these differences did not vary from week 4. Following self-paced walking and stepping, groups 1 and 2 reported significantly less activity pain, while group 1 showed significantly faster self-paced walking and stepping test results. Groups 1 to 3 improved self-paced walking and stepping time at week 12 compared with baseline measures, while predicted maximum oxygen uptake was significantly higher in the hyaluronate sodium groups 1 and 2 at weeks 4 and 12 compared with baseline measures. CONCLUSIONS: For resting pain relief, hyaluronate sodium seems to be as effective as NSAIDs. Further, for pain with physical activity and functional performance, hyaluronate sodium may be superior to placebo alone or NSAIDs alone.

Aged↗

PubMed2004

Evidence of exercise-induced arterial hypoxemia in prepubescent trained children.

Exercise-induced arterial hypoxemia (EIAH) is a recognized phenomenon in highly trained adults. Like adult athletes, prepubescent trained children may develop high-level metabolic demand but with a limited lung capacity in comparison with adults. The purpose of this investigation was to search for evidence of EIAH in prepubescent trained children. Twenty-four prepubescent (age: 10.3 +/- 0.2 y) trained children (10.0 +/- 0.7 h of weekly physical activity) performed pulmonary function tests and a graded maximal exercise test on a cycle ergometer. EIAH was defined as a drop of at least 4% from resting level arterial oxygen saturation (Sao(2)) measured by pulse oximetry. EIAH was observed in seven children. Forced vital capacity (FVC), ventilatory response to exercise (Delta(E)/Deltaco(2)), and breathing reserve at maximal exercise were significantly lower, whereas tidal volume relative to FVC was higher in hypoxemic children than in nonhypoxemic children; weekly physical activity and maximal oxygen uptake were similar. Moreover, positive relationships were found between Sao(2) at maximal exercise and breathing reserve (r = 0.56; p < 0.05) or volume relative to FVC (r = 0.70; p < 0.01). EIAH may occur in prepubescent trained children with a relatively low maximal oxygen uptake (42 mL. min(-1). kg(-1)); however, the mechanisms remain unclear and need to be investigated more accurately.

Adult↗

PubMed1997

A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis. The Fitness Arthritis and Seniors Trial (FAST).

OBJECTIVE: To determine the effects of structured exercise programs on self-reported disability in older adults with knee osteoarthritis. SETTING AND DESIGN: A randomized, single-blind clinical trial lasting 18 months conducted at 2 academic medical centers. PARTICIPANTS: A total of 439 community-dwelling adults, aged 60 years or older, with radiographically evident knee osteoarthritis, pain, and self-reported physical disability. INTERVENTIONS: An aerobic exercise program, a resistance exercise program, and a health education program. MAIN OUTCOME MEASURES: The primary outcome was self-reported disability score (range, 1-5). The secondary outcomes were knee pain score (range, 1-6), performance measures of physical function, x-ray score, aerobic capacity, and knee muscle strength. RESULTS: A total of 365 (83%) participants completed the trial. Overall compliance with the exercise prescription was 68% in the aerobic training group and 70% in the resistance training group. Postrandomization, participants in the aerobic exercise group had a 10% lower adjusted mean (+/- SE) score on the physical disability questionnaire (1.71 +/- 0.03 vs 1.90 +/- 0.04 units; P<.001), a 12% lower score on the knee pain questionnaire (2.1 +/- 0.05 vs 2.4 +/- 0.05 units; P=.001), and performed better (mean [+/- SE]) on the 6-minute walk test (1507 +/- 16 vs 1349 +/- 16 ft; P<.001), mean (+/-SE) time to climb and descend stairs (12.7 +/- 0.4 vs 13.9 +/- 0.4 seconds; P=.05), time to lift and carry 10 pounds (9.1 +/- 0.2 vs 10.0 +/- 0.1 seconds; P<.001), and mean (+/-SE) time to get in and out of a car (8.7 +/- 0.3 vs 10.6 +/- 0.3 seconds; P<.001) than the health education group. The resistance exercise group had an 8% lower score on the physical disability questionnaire (1.74 +/- 0.04 vs 1.90 +/- 0.03 units; P=.003), 8% lower pain score (2.2 +/- 0.06 vs 2.4 +/- 0.05 units; P=.02), greater distance on the 6-minute walk (1406 +/- 17 vs 1349 +/- 16 ft; P=.02), faster times on the lifting and carrying task (9.3 +/- 0.1 vs 10.0 +/- 0.16 seconds; P=.001), and the car task (9.0 +/- 0.3 vs 10.6 +/- 0.3 seconds; P=.003) than the health education group. There were no differences in x-ray scores between either exercise group and the health education group. CONCLUSIONS: Older disabled persons with osteoarthritis of the knee had modest improvements in measures of disability, physical performance, and pain from participating in either an aerobic or a resistance exercise program. These data suggest that exercise should be prescribed as part of the treatment for knee osteoarthritis.

Activities of Daily Living↗

PubMed2000

Exercise and weight loss in obese older adults with knee osteoarthritis: a preliminary study.

OBJECTIVE: The purposes of this pilot study were to determine if a combined dietary and exercise intervention would result in significant weight loss in older obese adults with knee osteoarthritis, and to compare the effects of exercise plus dietary therapy with exercise alone on gait, strength, knee pain, biomarkers of cartilage degradation, and physical function. DESIGN: Single-blind, two-arm, randomized clinical trial conducted for 24 weeks. SETTING: A university health and exercise science center. PARTICIPANTS: Twenty-four community-dwelling obese older adults aged > or = 60 years, body mass index > or = 28, knee pain, radiographic evidence of knee osteoarthritis, and self-reported physical disability. INTERVENTION: Randomization into two groups: exercise and diet (E&D) and exercise alone (E). Exercise consisted of a combined weight training and walking program for 1 hour three times per week. The dietary intervention included weekly sessions with a nutritionist utilizing cognitive-behavior modification to change dietary habits to reach a group goal of an average weight loss of 15 lb (6.8 kg) over 6 months. MEASUREMENTS: All measurements were conducted at baseline and 3 and 6 months, except for synovial fluid analysis, which was obtained only at baseline and 6 months. In addition, weight was measured weekly in the E&D group. Physical disability and knee pain were measured by self-report and physical performance was measured using the 6-minute walk and stair climb tasks. Biomechanical testing included kinetic and kinematic analysis of gait and isokinetic strength testing. Synovial fluid was analyzed for levels of total proteoglycan, keratan sulfate, and interleukin-1 beta. RESULTS: Twenty-one of the 24 participants completed the study, with one dropout in the E&D group and two in the E group. The E&D group lost a mean of 18.8 lb (8.5 kg) at 6 months compared with 4.0 lb (1.8 kg) in the E group (P = .01). Significant improvements were noted in both groups in self-reported disability and knee pain intensity and frequency as well as in physical performance measures. However, no statistical differences were found between the two groups at 6 months in knee pain scores or self-reported performance measures of physical function. There was no difference in knee strength between the groups, with both groups showing modest improvements from baseline to 6 months. At 6 months, the E&D group had a significantly greater loading rate (P = .03) and maximum braking force (P = .01) during gait. There were no significant between-group differences in the other biomechanical measures. Synovial fluid samples were obtainable at both baseline and 6 months in eight participants (four per group). The level of keratan sulfate decreased similarly in both groups from an average baseline of 96.8 +/- 37.1 to 71.5 +/- 23 ng/microg total proteoglycan. The level of IL-1 decreased from 25.3 +/- 9.8 at baseline to 8.3 +/- 6.1 pg/mL. The decrease in IL-1 correlated with the change in pain frequency (r = -0.77, P = .043). CONCLUSIONS: Weight loss can be achieved and sustained over a 6-month period in a cohort of older obese persons with osteoarthritis of the knee through a dietary and exercise intervention. Both exercise and combined weight loss and exercise regimens lead to improvements in pain, disability, and performance. Moreover, the trends in the biomechanical data suggest that exercise combined with diet may have an additional benefit in improved gait compared with exercise alone. A larger study is indicated to determine if weight loss provides additional benefits to exercise alone in this patient population.

Activities of Daily Living↗

PubMed2001

The Edmonton Functional Assessment Tool: further development and validation for use in palliative care.

The objective of this study was to examine the validity of the revised version of the Edmonton Functional Assessment Tool (EFAT-2), which was designed to measure physical impairment and functional performance of patients in palliative care. The EFAT-2 was administered to 275 patients on admission to an acute palliative care unit. Principal-components factor analysis was performed on the 10 items of the scale, and Cronbach's alpha was calculated to measure internal consistency. A one-way analysis of variance (ANOVA) was carried out to compare the admission EFAT-2 scores of three groups of patients: (a) deceased on the unit, (b) transferred to a continuing care palliative unit, (c) discharged home. Two main factors were revealed: physical and non-physical (cognitive/affective). Pain was identified as an independent item and did not correlate with any other item. Cronbach's alpha was 0.86. The ANOVA was significant (F [2,267] 29.063, p < 0.001). The results suggest that the EFAT-2 measures one construct. They also suggest that the EFAT-2 is able to discriminate between palliative care patients based on discharge location.

Activities of Daily Living↗

PubMed2003

Two years later: a prospective long-term follow-up of a training intervention in geriatric patients with a history of severe falls.

OBJECTIVE: To study the long-term outcome of a physical training regimen of ambulant postward rehabilitation in community-dwelling geriatric patients with a history of injurious falls. DESIGN: Prospective 2-year follow-up of a randomized placebo-controlled intervention trial. SETTING: Postward rehabilitation in a geriatric hospital in Germany. PARTICIPANTS: Fifty-seven geriatric patients (mean age, 84.3+/-4.4 y) with a history of severe falls. INTERVENTION: Ambulatory training of strength, functional performance, and balance 3 times a week for 3 months for 31 patients versus placebo activities for 26 patients. MAIN OUTCOME MEASURES: Strength, functional performance, fall-related psychologic parameters, and physical activity assessed by standardized protocols 2 years after the training intervention, compared with baseline results. RESULTS: Motor performance decreased substantially in both groups. As patients in the intervention group declined from significantly improved motor performance levels achieved in the initial training intervention, differences between the groups were still significant in most functional performances 2 years later. Functional decline was greater in persons who were institutionalized or being cared for by family members. Physical activity, which increased during the exercise intervention, returned to low baseline levels. CONCLUSIONS: Improved functional performance in the training group did not lead to an increased level of physical activity after training, which might have preserved the functional improvements. In mobility-restricted, frail, geriatric patients such as our study population, training programs should continue to keep patients active and to prevent the decline in strength and functional performance that precedes loss of autonomy.

Accidental Falls↗

PubMed1998

Measures of functional status in community-dwelling elders.

OBJECTIVE: To evaluate two performance-based measures of functional status and assess their correlation with self-report measures. DESIGN: Cross-sectional study. PARTICIPANTS: Of the 363 community-dwelling elders enrolled in a trial of comprehensive geriatric assessment who participated, all had at least one of four target conditions (urinary incontinence, depression, impaired functional status, or history of falling). MEASUREMENTS: Two performance-based measures, National Institute on Aging (NIA) Battery, and Physical Performance Test (PPT), and three self-report functional status measures, basic and intermediate activities of daily living and the Short-Form-36 (SF-36) physical functioning subscale, were used. Measures of restricted activity days, patient satisfaction and perceived efficacy were also used. MAIN RESULTS: All measures were internally consistent. There was a high correlation between the NIA and PPT (kappa = 0.71), while correlations between the performance-based and self-report measures ranged from 0.37 to 0.50. When patients with values above the median on the two performance-based measures were compared with those below, there were significant differences (p </=.0001) for age, number of medications, and the physical function, pain, general health, and physical role function SF-36 subscales. CONCLUSIONS: Performance-based measures correlated highly with each other and moderately with questionnaire-based measures. Performance-based measures also had construct validity and did not suffer from floor or ceiling effects.

Aged↗