A randomised controlled trial of Tai Chi and resistance exercise

on bone health, muscle strength and balance in community-living elderly people

WOO et al

Abstract

Background: the beneficial role of exercise in improving bone mineral density, muscle strength and balance, has been documented predominantly in younger populations. These findings may not apply to elderly populations with limited ability to perform exercises of high intensity.

Objective: to examine the effects of Tai Chi (TC) and resistance exercise (RTE) on bone mineral density (BMD), muscle strength, balance and flexibility in community living elderly people.

Design: randomised controlle trial, usng blocked randomization with stratification by sex.

Setting: a community in the New Territories Region of Hong Kong, China.

Subjects: one hundred eighty subjects (90 men, 90 women) aged 65–74, were recruited through advertisements in community centres.

Methods: subjects were assigned to participate in TC, RTE three times a week, or no intervention (C) for 12 months. Measurements were carried out at baseline, 6 and 12 months. Analyses of covariance (ANCOVA) adjusted for age, and baseline values of variables that were significantly different between groups: i.e. smoking and flexibility for men; quadriceps strength for women.

Results: compliance was high (TC 81%, RTE 76%). In women, both TC and RTE groups had less BMD loss at total hip compared with controls. No effect was observed in men. No difference in either balance, flexibility or the number of falls was observed between either intervention or controls after 12 months.

Conclusion: the beneficial effects of TC or RTE on musculoskeletal health are modest and may not translate into better clinical outcomes.

Key words

• Tai Chi
• resistance exercise
• bone mineral density
• muscle strength
• balance
• elderly

Quelle:

http://ageing.oxfordjournals.org/content/36/3/262.short


Full Text / pdf  / online im internet - Zugriff vom 09.10.2012:

http://ageing.oxfordjournals.org/content/36/3/262.full.pdf+html



Kritisch anzumerken ist hier, dass es sich bei dem Resistance Training, und ein Thera-Band -Training (mittlere Stärke) mit 8 Übungen handelte,  und nicht um ein Krafttraining an Geräten oder ein Krafttraining an Hanteln oder freien Gewichten.

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Effects of exercise programs on falls and mobility in frail and pre-frail older adults

A multicenter randomized controlled trial.

FABER et al

Abstract

OBJECTIVES:

To determine the effects of moderate intensity group-exercise programs on falls, functional performance, and disability in older adults; and to investigate the influence of frailty on these effects.

DESIGN:

A 20-week, multicenter randomized controlled trial, with 52-week follow-up.

SETTING:

Fifteen homes for the elderly.

PARTICIPANTS:

Two hundred seventy-eight men and women (mean age +/- standard deviation, 85+/-6y).

INTERVENTIONS:

Two exercise programs were randomly distributed across 15 homes. The first program, functional walking (FW), consisted of exercises related to daily mobility activities. In the second program, in balance (IB), exercises were inspired by the principles of Tai Chi. Within each home participants were randomly assigned to an intervention or a control group. Participants in the control groups were asked not to change their usual pattern of activities. The intervention groups followed a 20-week exercise program with 1 meeting a week during the first 4 weeks and 2 meetings a week during the remaining weeks.

MAIN OUTCOME MEASURES:

Falls, Performance Oriented Mobility Assessment (POMA), physical performance score, and the Groningen Activity Restriction Scale (GARS) (measuring self-reported disability).

RESULTS:

Fall incidence rate was higher in the FW group (3.3 falls/y) compared with the IB (2.4 falls/y) and control (2.5 falls/y) groups, but this difference was not statistically significant. The risk of becoming a faller in the exercise groups increased significantly in the subgroup of participants who were classified as being frail (hazard ratio [HR] = 2.95; 95% confidence interval [CI], 1.64-5.32). For participants who were classified as being pre-frail, the risk of becoming a faller decreased; this effect became significant after 11 weeks of training (HR = .39; 95% CI, .18-.88). Participants in both exercise groups showed a small, but significant improvement in their POMA and physical performance scores. In the FW group, this held true for the GARS score as well. Post hoc analyses revealed that only the pre-frail participants improved their POMA and physical performance scores.

CONCLUSIONS:

Fall-preventive moderate intensity group-exercise programs have positive effects on falling and physical performance in pre-frail, but not in frail elderly.

Quelle:  http://www.ncbi.nlm.nih.gov/pubmed/16813773

Full Text  pdf   online im internet  Zugriff vom 09.10.2012:

http://www1.nisb.nl/bewegenengezondheid/downloads/Archives-Faber-july2006.pdf

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Effect of Dissemination of Evidence in Reducing Injuries from Falls

TINETTI et al / 2008 / Full Text (siehe Link unten):

Fall-related injuries are among the most common, morbid, and expensive health conditions involving older adults.1-5 Falls account for 10% of emergency department visits and 6% of hospitalizations among persons over the age of 65 years and are major determinants of functional decline, nursing-home placement, and restricted activity.6-9
 
The rate of falling rises after the age of 70 years.1,2,4 Several factors — such as postural hypotension, the use of multiple medications, and impairments in cognition, vision, balance, gait, and strength — increase the risk of falling and fall injuries.1,2,4,5 Risk increases as the number of these factors increases.1,4,5 Randomized, controlled trials support the effectiveness of multicomponent fall-prevention strategies in reducing these risks.10,11
 
The voluntary Physician Quality Reporting Initiative (PQRI) of the Centers for Medicare and Medicaid Services (CMS) includes an assessment for the risk of falls.12 The Joint Commission on the accreditation of health care organizations and the Medicare Payment Advisory Commission mandate attention to the prevention of falls.13,14
 
Despite evidence and mandates, falls remain largely ignored in clinical practice.15 Furthermore, data are lacking on whether fall prevention is effective in the fragmented environment in which older Americans receive their health care. The components of the assessment and management of fall-related risk factors are under the purview of physicians, rehabilitation specialists, home care agencies, and other clinicians practicing in different settings under varying incentives and reimbursement mechanisms.16 Several groups have called for improving the transfer of evidence from randomized, controlled trials into practice.17-19 Reported barriers to incorporating evidence about fall prevention into practice include ignorance about falling as a preventable condition, competing time demands, a perceived lack of expertise, insufficient reimbursement, and inadequate referral patterns among clinicians. Factors that were reported to facilitate fall prevention included efforts to market new services and to develop referral networks.16,20
 
The Connecticut Collaboration for Fall Prevention (CCFP) encouraged clinicians and facilities to incorporate evidence from the Yale-based Frailty and Injuries: Cooperative Studies of Intervention Techniques (FICSIT) study and other trials into their practice.10,11,20-25 The aim of our study was to compare the rates of serious fall-related injuries and the fall-related use of medical services among persons who were 70 years of age or older in the CCFP intervention and usual-care regions.

Methods

Setting and Design

We used a nonrandomized design to compare two regions in Connecticut.26 We chose ZIP Code tabulation areas (ZCTAs; bounded areas that correspond to ZIP Codes) as the experimental units to maintain the anonymity of persons living in the regions while ensuring an adequate number of sampling units.27 Anonymity was necessary because informed consent was not feasible. Clinicians and facilities in the two regions were identified through professional-licensing databases operated by the Connecticut Department of Public Health. Other than the CCFP project, there were no coordinated fall-prevention efforts under way before or during the study period in either the intervention region or the usual-care region. The study was approved by the Human Investigation Committee at Yale School of Medicine. The committee understood and agreed that informed consent was not required from the participating practitioners and patients.

Quelle:  http://www.nejm.org/doi/full/10.1056/NEJMoa0801748#t=articleResults


Online m internet 09.10.2012

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Randomised controlled trial of a general practice programme of home based exercise

to prevent falls in elderly women

Campbell et al

Abstract

Objective: To assess the effectiveness of a home exercise programme of strength and balance retraining exercises in reducing falls and injuries in elderly women.

Design: Randomised controlled trial of an individually tailored programme of physical therapy in the home (exercise group, n=116) compared with the usual care and an equal number of social visits (control group, n=117).

Setting: 17 general practices in Dunedin, New Zealand.

Subjects: Women aged 80 years and older living in the community and registered with a general practice in Dunedin.

Main outcome measures: Number of falls and injuries related to falls and time between falls during one year of follow up; changes in muscle strength and balance measures after six months.

Results: After one year there were 152 falls in the control group and 88 falls in the exercise group. The mean (SD) rate of falls was lower in the exercise than the control group (0.87 (1.29) v 1.34 (1.93) falls per year respectively; difference 0.47; 95% confidence interval 0.04 to 0.90). The relative hazard for the first four falls in the exercise group compared with the control group was 0.68 (0.52 to 0.90). The relative hazard for a first fall with injury in the exercise group compared with the control group was 0.61 (0.39 to 0.97). After six months, balance had improved in the exercise group (difference between groups in change in balance score 0.43 (0.21 to 0.65).

Conclusions: An individual programme of strength and balance retraining exercises improved physical function and was effective in reducing falls and injuries in women 80 years and older.

Key messages

• Modifiable risk factors for falls in elderly people have been well defined; they include loss of muscle strength and impaired balance
• A programme to improve strength and balance in women aged 80 years and older can be set up safely with four home visits from a physiotherapist
• This programme reduced falls and moderate injuries appreciably over the subsequent year in Dunedin, New Zealand
• The benefit was most noticeable in elderly people who fell often
  
  

Quelle:  http://www.bmj.com/content/315/7115/1065

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Effect of strength training on human patella tendon mechanical properties of older individuals

REEVES et al.

Abstract

This study investigated the effect of strength training on the mechanical properties of the human patella tendon of older individuals. Subjects were assigned to training (n = 9; age 74.3 ± 3.5 years, body mass 69.7 ± 14.8 kg and height 163.4 ± 9.1 cm, mean ±s.d.) and control (n = 9; age 67.1 ± 2 years, body mass 73.5 ± 14.9 kg and height 168.3 ± 11.5 cm) groups. 

Strength training (two series of 10 repetitions at 80 % of five-repetition maximum) was performed three times per week for 14 weeks using leg extension and leg press exercises. 

Measurements of tendon elongation during a ramp isometric knee extension were performed before and after training and control periods in vivo using ultrasonography. Training caused a decreased tendon elongation and strain at all levels of force and stress (P < 0.01). 

Baseline tendon elongation and strain at maximal tendon load were 4.7 ± 1.1 mm and 9.9 ± 2.2 %, respectively (maximum force: 3346 ± 1168 N; maximum stress: 40 ± 11 MPa). After training, these values decreased to 2.9 ± 1.2 mm and 5.9 ± 2.4 % (P < 0.01), respectively (maximum force: 3555 ± 1257 N; maximum stress: 42 ± 11 MPa). 

Tendon stiffness increased by 65 % (2187 ± 713 to 3609 ± 1220 N mm⁻¹; P < 0.05) and Young's modulus increased by 69 % (1.3 ± 0.3 to 2.2 ± 0.8 GPa; P < 0.01). As a result of these changes, the rate of torque development increased by 27 % (482.8 ± 302.5 to 612.6 ± 401 N m s⁻¹; P < 0.01) following training. No significant changes occurred in any measured variables in the control group (P > 0.05). 

This study shows for the first time that strength training in old age increases the stiffness and Young's modulus of human tendons. This may reduce the risk of tendon injury in old age and has implications for contractile force production and the rapid execution of motor tasks.

Quelle:  http://jp.physoc.org/content/548/3/971.short

Full Text / pdf / online im internet - Zugriff vom 09.10.2012:

http://jp.physoc.org/content/548/3/971.full.pdf+html

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A multi-component exercise regimen to prevent functional decline

and bone fragility in home-dwelling elderly women: randomized, controlled trial   / Karinkanta et al.

Summary  

This study showed that combination of strength, balance, agility and jumping training prevented functional decline and bone fragility in home-dwelling elderly women. The finding supports the idea that it is possible to maintain good physical functioning by multi-component exercise program and thus postpone the age-related functional problems.

Introduction  

This 1-year randomized, controlled exercise intervention trial assessed the effects of two different training programs and their combination on physical functioning and bone in home-dwelling elderly women.

Methods  

One hundred and forty-nine healthy women aged 70–78 years were randomly assigned into: group 1—resistance training (RES), group 2—balance-jumping training (BAL), group 3—combination of resistance and balance-jumping training (COMB), and group 4—controls (CON). Self-rated physical functioning, leg extensor force, dynamic balance, and bone mass and structure were measured.

Results  

Self-rated physical functioning improved in the COMB group, but was reduced in the CON group; the mean inter-group difference was 10% (95% CI: 0–22%). Mean increase in the leg extensor force was higher in the RES (14%; 4–25%) and COMB (13%; 3–25%) compared with the CON groups. Dynamic balance improved in the BAL (6%; 1–11%) and in the COMB (8%; 3–12%) groups. There were no inter-group differences in BMC at the proximal femur. In those COMB women who trained at least twice a week, the tibial shaft structure weakened 2% (0–4%) less than those in the CON group.

Conclusions  

Strength, balance, agility, and jumping training (especially in combination) prevented functional decline in home-dwelling elderly women. In addition, positive effects seen in the structure of the loaded tibia indicated that exercise may also play a role in preventing bone fragility.

Keywords  Balance training - Bone fragility - Bone strength - Functional decline - Osteoporosis - Strength training

Quelle:   http://www.springerlink.com/content/e71532tn413j3731/

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Physical Activity

Physical Activity Outcomes of CHAMPS II

A Physical Activity Promotion Program for Older Adults

Stewart et al

Abstract

Background. 

 Despite well-known benefits of physical activity for older adults, about two thirds are underactive. Community-based programs are needed to facilitate increased physical activity. We examine the effectiveness of CHAMPS II, an inclusive, choice-based physical activity promotion program to increase lifetime physical activity levels of seniors. CHAMPS guided participants to choose activities that took into account their health, preferences, and abilities. It offered information on ways for them to exercise safely, motivate themselves, overcome barriers, and develop a balanced exercise regimen. 

Methods. 

A 1-year randomized controlled trial was conducted with physically underactive seniors in a multispecialty group practice. Changes in self-reported physical activity by group were evaluated using ANCOVA, controlling for age and sex. 

Results. 

Of 173 randomized subjects, 164 (95%) completed the trial. Subjects were aged 65 to 90 years (M = 74, SD = 6); 66% were female. The intervention group increased estimated caloric expenditure by 487 calories/week in moderate (or greater) intensity activities (MET ≥ 3.0; p < .001) and by 687 calories/week in physical activities of any intensity (p < .001). Control group changes were negligible. Between-group analyses found that the changes were significantly different in both measures (p values < .05). Overweight persons especially benefited from this program. The program was as effective for women, older adults (75+), and those who did not set aside time to exercise at baseline. 

Conclusions. 

The program led to meaningful physical activity increases. Individually tailored programs to encourage lifestyle changes in seniors may be effective and applicable to health care and community settings.

Quelle:   http://biomedgerontology.oxfordjournals.org/content/56/8/M465.short

Full Text / HTML / online im internet - Zugrff vom 09.10.2012:

http://ukpmc.ac.uk/articles/PMC1780022

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Tai Chi Chuan

Tai Chi and Falls Prevention in Older People


Harmer P, Li F

Hong Y (ed): Tai Chi Chuan. State of the Art in International Research. Med Sport Sci. Basel, Karger, 2008, vol 52, pp 124-134 (DOI: 10.1159/000134293)

Abstract:

Background:

Considerable research evidence has been accumulated since 1990 that practicing Tai Chi can ameliorate multiple characteristics in older adults that place them at increased risk of falling, including poor balance, loss of strength, limited flexibility, and fear of falling. However, relatively few studies have directly examined the influence of Tai Chi practice on falls in this population.

Results:

 Nine randomized controlled trials utilizing Tai Chi (n = 6), or Tai Chi-inspired exercise (n = 3), were published between 1996 and July, 2007. The studies varied considerably on study settings, participant characteristics, sample size, type of Tai Chi intervention, length of intervention and quality of the study design. Of the six studies that used Tai Chi forms, three showed significant improvement in fall-related outcomes. One study using Tai Chi-inspired exercise also had a significant fall-related outcome. Conclusion: Despite the evidence demonstrating the beneficial influence of Tai Chi practice on known risk factors for falling in older adults, evidence indicating an actual impact on falls-related outcomes is equivocal. More large-scale, longitudinal studies with consistent intervention parameters and clinically meaningful outcome variables are needed to a clarify the role of Tai Chi in effective falls prevention programs. The recent development of a standardized, research-to-practice Tai Chi falls prevention program may be an important step in this process.


Quelle:  http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowAbstractBuch&ArtikelNr=134293&ProduktNr=234196

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Kettlebells und Kettlebelltraining – oder: Warum Sie mit Eisenkugeln abnehmen können

Kettlebells und Kettlebelltraining – oder: Warum Sie mit Eisenkugeln abnehmen können