Exercise Programs Enhance Physical Function in the Elderly

With a structured exercise program, inactive older people at high risk for becoming disabled can improve their physical functioning and reduce their likelihood of having difficulty walking, according to results from a pilot study by researchers at Yale School of Medicine and other institutions.

The Lifestyles Interventions and Independence for Elders (LIFE) pilot study findings were recently presented at the Gerontological Society of America’s annual meeting in Dallas, and published in the November issue of Journal of Gerontology: Medical Sciences. A consortium of research institutions around the country conducted the study.

According to the report, increasing the physical activity of inactive older adults improved their scores on the Short Physical Performance Battery (SPPB), a standardized test of lower extremity physical mobility. The test scale ranges from zero to 12 and lower SPPB scores predict a higher likelihood of becoming disabled, being institutionalized and dying.

LIFE evaluated 424 people with scores from four to nine to see if exercise could improve or prevent a decline in their scores. “Even an improvement as small as half a point on the SPPB test may translate into a major improvement in an older person’s ability to perform activities of daily living, such as walking across a room, dressing, eating or bathing,” said Thomas M. Gill, M.D., professor in the Departments of Medicine and Epidemiology & Public Health at Yale School of Medicine.

“Prior to these results, there was no definitive evidence that the score on the SPPB test could be modified,” he said. “Now that we’ve shown it is possible, we can test the exercise program in a full-scale clinical trial.”

Gill and his colleagues at Yale and several other institutions are planning to conduct a full-scale study of 2,500 adults at 10 different sites over four years. The study will be the longest to date to assess whether structured exercise can delay disability and promote independence. Participants aged 70 to 85 will be assigned to either a successful aging program or a physical activity program. One study site will be in the greater New Haven area.

As in the LIFE pilot study, those in the successful aging program will be given instructions on practices for healthy living, including information on nutrition, medications, foot care and preventive services. Those in the physical activity program will take part in structured physical activities including walking at moderate intensity, leg stretches and balance exercises. Members of both groups will be asked to undergo periodic clinical evaluations.

The LIFE pilot study showed that compared to those who received only health education, the group that participated in physical activity lowered the risk of being unable to walk a quarter mile by 29 percent.

“In the full-scale trial, we hope to learn about the impact both programs have on reducing mobility disability in older adults,” said Gill, who points out that as the life expectancy of older Americans increases, prevention of age-associated physical function decline and disabilities has emerged as a major clinical and public health priority.

Gill, who was recently invited to meet with Congresswoman Rosa DeLauro to share some of his results, noted  that their ongoing Yale Precipitating Events Project (PEP) and similar studies around the country have shown that mobility—the ability to move without assistance—is a critical factor in an older person’s capacity to function independently.

PEP seeks to better understand how older persons manage day-to-day activities and remain independent at home. Titled “Epidemiology of Disability and Recovery in Older Persons,” the PEP study includes 754 participants age 70 or older from the Greater New Haven area.

In addition to Yale, institutions that participated in the LIFE pilot study were the Cooper Institute, the University of Pittsburgh, Wake Forest University, Tufts University, University of California, San Diego and the University of California, Los Angeles. The research was supported by grants from the National Institute on Aging.

Citation: J. Gerontol. Med. Sci., Vol. No. (November, 2006)