Habitual physical activity and health-related quality of life in older adults: interactions between the amount and intensity of activity (the Nakanojo Study) Cardiovascular fitness associated with cognitive performance in heart failure patients enrolled in cardiac rehabilitation Older adults recently discharged from the hospital: effect of aerobic interval exercise on health-related quality of life, physical fitness, and physical activity. Poor Aerobic Fitness May Contribute to Cognitive Decline in HIV-infected Older Adults. The effect of three different exercise training modalities on cognitive and physical function in a healthy older population Physical activity and mental well-being in older people participating in the Better Ageing Project Reduction in cardiovascular disease risk factors: 6-month results from Project Active. Energy Cost of Single‐Set Resistance Training in Older Adults Physical activity and functional limitations in older adults: a systematic review related to Canada's Physical Activity Guidelines Effect of two physical exercise protocols on cognition and depressive symptoms in oldest-old people: A randomized controlled trial. A high-intensity functional weight-bearing exercise program for older people dependent in activities of daily living and living in residential care facilities: evaluation of the applicability with focus on cognitive function. A structured physical activity and fitness programme for older adults with intellectual disabilities: results of a cluster‐randomised clinical trial Effect of low-intensity versus high-intensity resistance training on the functioning of the institutionalized frail elderly Promoting physical activity for elders with compromised function: the lifestyle Interventions and Independence for elders (LIFE) study physical activity intervention Exercise Is Associated with Reduced Risk for Incident Dementia among Persons 65 Years of Age and Older Changes in cognitive function in a randomized trial of physical activity: results of the lifestyle interventions and independence for elders pilot study. Enhanced Risk Assessment in Asymptomatic Individuals With Exercise Testing and Framingham Risk Scores
Purpose This study examined relationships between health-related quality of life ( HRQOL ) and objective assessment s of habitual physical activity in older adults , focusing on interactions between the amount and intensity of activity . Methods Subjects were healthy Japanese aged 65–85 years ( 74 men and 109 women ) .  Pedometer/accelerometers measured their step counts and the intensity of physical activity in metabolic equivalents ( METs ) continuously 24 h per day for 1 year . Each individual ’s final HRQOL was assessed using the Medical Outcomes Study 36-Item Short-Form Health Survey ( SF-36 ) instrument . Results The daily step count and the daily duration of physical activity at an intensity > 3 METs were quite closely correlated ( quadratic r2 = 0.93 , P < 0.05 ) . After controlling for age , sex , and daily step count , the overall SF-36 score and four constituent dimensions ( physical functioning , freedom from pain , vitality , and mental health ) were all significantly higher in individuals spending > 25 % of their total activity at an intensity > 3 METs . However , engagement in activity > 3 METs was not significantly associated with the remaining SF-36 components ( physical limitations , general health , social functioning , and emotional limitations ) . Conclusions Associations between moderate-intensity physical activity and HRQOL in older adults merit further evaluation by prospect i ve studies and /or r and omized controlled trials Background Reduced cognitive function is common in persons with heart failure ( HF ) . Cardiovascular fitness is a known contributor to cognitive function in many patient population s , but has only been linked to cognition based on estimates of fitness in HF . The current study examined the relationship between fitness as measured by metabolic equivalents ( METs ) from a st and ardized stress test and cognition in persons with HF , as well as the validity of office-based predictors of fitness in this population . Methods Forty-one HF patients enrolled in cardiac rehabilitation completed a st and ardized exercise stress test protocol , a brief neuropsychological battery , the 2-minute step test ( 2MST ) , and a series of medical history and self-report question naires . Results Maximum METs from stress testing demonstrated incremental predictive validity for attention ( β = .41 , p = .03 ) , executive function ( β = .37 , p = .04 ) , and memory domains ( β = .46 , p = .04 ) . Partial correlations accounting for key medical and demographic characteristics revealed greater METs was associated with the 2MST ( r ( 32 ) = .41 , p = .02 ) but not with the Duke Activity Status Index ( DASI ) ( r(32 ) = .24 , p = .17 ) . Conclusion The current findings indicate that better fitness levels measured by METs is independently associated with better cognitive function in older adults with HF . Results also showed that METs was closely associated with one office-based measure of fitness ( 2MST ) , but not another ( DASI ) . Prospect i ve studies are needed to clarify the mechanisms linking fitness and cognitive function in HF OBJECTIVES To compare the effect of high-intensity aerobic interval exercise ( HIA ) with home-based exercise ( HB ) in older adults with chronic disease soon after discharge from the hospital . DESIGN R and omized controlled trial . SETTING Hospital . PARTICIPANTS Community-dwelling older adults aged 70 to 92 ( N = 115 ) were recruited while in the hospital . After discharge , they were r and omized to HIA group ( n = 59 ) or HB ( n = 56 ) . INTERVENTION High-intensity aerobic interval exercise ( HIA ) consisted of endurance , strength , and balance exercises . The HB consisted of low-intensity exercises and telephone follow-up from a physical therapist . MEASUREMENTS Health-related quality of life ( HRQOL ) was assessed using the Medical Outcomes Study 36-item Short Form Survey , physical fitness was measured using the Senior Fitness Test , and physical activity was assessed using the Physical Activity Scale for the Elderly . RESULTS Intention-to-treat analysis showed that both groups improved their HRQOL and physical activity after 3 months . Improvements on the Senior Fitness Test ( chair st and , arm curl and 6-minute walk ( 6MWT ) ) were significantly greater in the HIA group than the HB group . The mean difference was 25.9 m on the 6MWT ( P = .001 , effect size d = 0.2 ) , 1.3 per 30 seconds on the chair st and s mean ( P = .001 , effect size d = 0.3 ) , and 1.6 per 30 seconds on the arm curl ( P = .001 , effect size d = 0.4 ) . CONCLUSION High-intensity aerobic interval exercise ( HIA ) participants significantly improved their physical fitness . Both groups increased their HRQOL and physical activity . The findings suggest that exercise therapy should be incorporated as a part of the treatment for older people at risk for functional decline The HIV-infected older adult ( HOA ) community is particularly vulnerable to cognitive impairment . Previous studies in the general older adult population have reported that lower scores on tests of cognitive function often correlate negatively with aerobic fitness [ 5 - 7 ] . HIV-infected individuals have significantly reduced aerobic fitness and physical function compared to HIV-uninfected individuals . Determining important correlates of cognitive ability may be beneficial in not only detecting precursors to future cognitive impairments , but also target areas for interventions . The purpose of this study was to investigate the relationship between cognitive ability and aerobic fitness in HIV-infected older adults . We conducted a cross-sectional study of HOA on antiretroviral therapy ( ART ) > 50 years of age . Domain specific cognitive function was assessed by means of a neuropsychological battery . Aerobic fitness ( VO2peak ) was assessed using a grade d , progressive treadmill test .  Thirty-seven HOA on ART ( mean±SD : age 59±6 years , BMI 28±5 , CD4 663±337 cells/ml , duration since HIV diagnosis 17±7 years ; 81 % males ) completed the cognitive tests . Several domains of cognition were significantly associated with VO2peak by Spearman correlation analysis ( p<0.05 ) . By step-wise adjusted regression VO2peak was most frequently and significantly related to many cognitive domains such as verbal and visual memory , visual perception , and language ( p<0.05 ) . We found that participants with higher Vo2peak were less likely to have more severe forms of HIV-associated neurocognitive disorders ( H AND ) such as mild neurocognitive disorder ( OR=0.65 ; p=0.01 ) and HIV-associated dementia ( OR=0.64 ; p=0.0006 ) . In HOA and in conclusion , aerobic fitness is related to cognitive performance on various tasks . The likelihood of cognitive impairment increased with lower fitness levels . Therefore , increased fitness may serve an important factor in maintenance of cognition and neural integrity for aging HIV-infected individuals . Future prospect i ve and large scale studies are needed to evaluate the effect of fitness and vascular stiffness and function on cognition and brain structure among HOA Background Older adults are encouraged to participate in regular physical activity to counter the age-related declines in physical and cognitive health . Literature on the effect of different exercise training modalities ( aerobic vs resistance ) on these health-related outcomes is not only sparse , but results are inconsistent . In general , it is believed that exercise has a positive effect on executive cognitive function , possibly because of the physiological adaptations through increases in fitness . Indications are that high-intensity interval training is a potent stimulus to improve cardiovascular fitness , even in older adults ; however , its effect on cognitive function has not been studied before . Therefore , the purpose of this study was to compare the effects of resistance training , high-intensity aerobic interval training and moderate continuous aerobic training on the cognitive and physical functioning of healthy older adults . Methods Sixty-seven inactive individuals ( 55 to 75 years ) were r and omly assigned to a resistance training ( RT ) group ( n = 22 ) , high-intensity aerobic interval training ( HIIT ) group ( n = 13 ) , moderate continuous aerobic training ( MCT ) group ( n = 13 ) and a control ( CON ) group ( n = 19 ) for a period of 16 weeks . Cognitive function was assessed with a Stroop task and physical function with the Timed-Up- and -Go ( TUG ) and submaximal Bruce treadmill tests . Results No significant GROUP x TIME interaction was found for Stroop reaction time ( P > .05 ) . The HIIT group showed the greatest practical significant improvement in reaction time on the information processing task , i.e. Stroop Neutral ( ES = 1.11 ) . MCT group participants had very large practical significant improvements in reaction time on the executive cognitive tasks , i.e. Stroop Incongruent and Interference ( ES = 1.28 and 1.31 , respectively ) . The HIIT group showed the largest practically significant increase in measures of physical function , i.e. walking endurance ( ES = 0.91 ) and functional mobility ( ES = 0.36 ) . Conclusions MCT and RT proved to be superior to HIIT for the enhancement of older individuals ’ executive cognitive function ; whereas HIIT were most beneficial for improvement in information processing speed . HIIT also induced the largest gains in physical function Increasing evidence suggests that physical activity can prevent some aspects of mental illness in older people such as depression , dementia and Alzheimer ’s disease . Additionally , limited research has shown that engagement in structured exercise can improve aspects of psychological well-being such as mood and self-perceptions in older adults . However , the relationship between incidental daily activity such as walking or time spent sedentary , with psychological well-being has not been investigated . The Better Ageing Project provided an opportunity to assess well-being and quality of life using st and ardised question naires with 176 adults aged 70 and over .  Accelerometry was used to objective ly assess daily energy expended in physical activity at different levels of intensity . In addition , an assessment of the impact of the 12-month Better Ageing structured group exercise programme was assessed through question naires and interviews . Total daily physical activity energy expenditure ( joules/day ) and amount of time spent in activity of at least moderate intensity were weakly related ( r = 0.20–0.28 ) to quality of life , subjective well-being and physical self-perceptions . Time spent sedentary ( min/day ) was weakly and negatively related to several mental health indicators . The quantitative data showed only minor psychological benefits of the exercise intervention . In contrast , interviews with 27 research participants and 4 exercise leaders suggested that important improvements in perceived function and social benefits had been experienced BACKGROUND Project Active is a r and omized clinical trial that compares a lifestyle physical activity intervention with a traditional structured exercise intervention . The purpose of this paper is to report 6-month results of these interventions on cardiovascular disease ( CVD ) risk factors among healthy , sedentary , middle-aged men and women , and to examine the psychological strategies used in each group ( Lifestyle and Structured ) to reach the level of physical activity recommended by the Centers for Disease Control and Prevention ( CDC ) and American College of Sports Medicine ( ACSM ) and to achieve changes in these CVD risk factors . METHODS A total of 116 initially sedentary men ( mean + /- SD self-reported physical activity , 33.2 + /- 1.4 kcal.kg-1.day-1 ) and 119 women ( 32.9 + /- 1.0 kcal.kg-1.day-1 ) , ages 35 - 60 years ( 46.0 + /- 6.7 years ) were r and omly assigned to a 6-month lifestyle physical activity counseling intervention or a 6-month gymnasium-based structured program . At baseline and 6 months , changes in lipid and lipoprotein-cholesterol concentrations , blood pressure , and body composition and cognitive and behavioral measures of change were assessed . One-way analyses of variance with covariate adjustment were used to test for between-group differences in CVD risk factors . Associations between achieving the CDC/ACSM criterion and changes in cognitive and behavioral measures were assessed with multiple logistic regression models . RESULTS After 6 months of intervention , 78 % of Lifestyle participants and 85 % of Structured participants were meeting or exceeding the CDC/ACSM recommendation of accumulating 30 min or more of moderate-intensity physical activity on most , preferably all , days of the week . This was verified by a significant increase in cardiorespiratory fitness in both groups . The adjusted mean increase in maximal METs ( VO2peak divided by 3.5 ml.kg-1.min-1 ) between treadmill tests was 0.4 kcal.kg-1.hr-1 ( P < 0.001 ) for Lifestyle and 1.1 kcal.kg-1.hr-1 ( P < 0.001 ) for Structured . There was a significant difference between intervention groups for this outcome . Both groups had significant reductions in total cholesterol , total cholesterol/HDL-C ratio , diastolic blood pressure , and percentage of body fat . There were no significant between-group differences in changes in these outcomes . Adjusted mean changes in total cholesterol , systolic blood pressure , and percentage of body fat in Lifestyle [ in Structured ] participants were -0.2 [ -0.3 ] mmol . L-1 , -3.2[-1.8 ] mm Hg , and -1.4 [ -1.7 ] % , respectively . There were significant associations between achieving the CDC/ACSM physical activity criterion and greater use of the cognitive and behavioral strategies of change . Both groups changed self-efficacy and many of the behavioral measures , but there were no significant differences between intervention groups . CONCLUSIONS These results demonstrate that lifestyle physical activity counseling is as effective as structured exercise programs in increasing physical activity and improving CVD risk factors after 6 months among initially sedentary men and women . Furthermore , specific cognitive and behavioral counseling strategies were increased significantly as a result of the intervention . These strategies are effective and could be used in a wide variety of setting & NA ; Phillips , W.T. , and J.R. Ziuraitis . Energy cost of single‐set resistance training in older adults . J. Strength Cond . Res . 18(3):606–609 . 2004.—The purpose of this study was ( a ) to assess the intensity and energy cost of a single‐set resistance training ( RT ) protocol as recommended by the recent American College of Sports Medicine ( ACSM ) guidelines for older adults and ( b ) to compare obtained values to those recently reported as eliciting health benefits via endurance‐based physical activity ( PA ) . Five males and 5 females ( 73.1 ± 5.5 years ) performed 1 set of 15 repetitions of 8 RT exercises while connected to a portable metabolic unit ( CosMed K4b2 ) . The RT intensity ( metabolic equivalents [ METs ] ) was 3.3 ± 0.7 ( males ) and 3.0 ± 0.6 ( females ) . Energy cost ( kcal ) was 84.2 ± 14.6 ( males ) and 69.7 ± 17.4 ( females ) . We conclude that a single‐set 8‐exercise RT protocol may be a feasible alternative for achieving moderate intensity ( 3–6 METs ) for older adults but that additional sets and /or repetitions appear to be necessary to accumulate moderate amounts ( 150–200 kcal ) of PA Background The purpose was to conduct systematic review s of the relationship between physical activity of healthy community-dwelling older ( > 65 years ) adults and outcomes of  functional limitations , disability , or loss of independence .  Methods Prospect i ve cohort studies with an outcome related to functional independence or to cognitive function  were search ed , as well as exercise training interventions that reported a functional outcome . Electronic data base search strategies were used to identify citations which were screened ( title and abstract ) for inclusion . Included articles were review ed to complete st and ardized data extraction tables , and assess study quality . An established system of assessing the level and grade of evidence for recommendations was employed . Results Sixty-six studies met inclusion criteria for the relationship between physical activity and functional independence , and 34 were included with a cognitive function outcome . Greater physical activity of an aerobic nature ( categorized by a variety of methods ) was associated with higher functional status ( expressed by a host of outcome measures ) in older age . For functional independence , moderate ( and high ) levels of physical activity appeared effective in conferring a reduced risk ( odds ratio ~0.5 ) of functional limitations or disability . Limitation in higher level performance outcomes was reduced ( odds ratio ~0.5 ) with vigorous ( or high ) activity with an apparent dose-response of moderate through to high activity . Exercise training interventions ( including aerobic and resistance ) of older adults showed improvement in physiological and functional measures , and suggestion of longer-term reduction in incidence of mobility disability . A relatively high level of physical activity was related to better cognitive function and reduced risk of developing dementia ; however , there were mixed results of the effects of exercise interventions on cognitive function indices . Conclusions There is a consistency of findings across studies and a range of outcome measures related to functional independence ; regular aerobic activity and short-term exercise programmes confer a reduced risk of functional limitations and disability in older age . Although a precise characterization of a minimal or effective physical activity dose to maintain functional independence is difficult , it appears moderate to higher levels of activity are effective and there may be a threshold of at least moderate activity for significant outcomes AIM To compare the effect of multicomponent and resistance training and detraining on cognition and depressive symptoms in oldest-old community-dwelling people . METHODS A total of 69 sedentary older adults aged older than 80 years were assessed and r and omized into three groups ( control , multicomponent and resistance training ) . The multicomponent group performed protocol consisting of aerobic , strength and balance exercises . The resistance group participated in strength exercises using six machines . The control group did not perform any intervention . The training sessions had progressive intensity , lasted 16 weeks and included three sessions per week . The volunteers were assessed at baseline , at the end of the 16-week training sessions and after the 6-week detraining period . The assessment consisted of anamneses , Geriatric Depression Scale and cognition ( Montreal Cognitive Assessment , Clock Drawing Test , verbal fluency and dual task ) . RESULTS There were no significant differences between groups and times in any of variables ; however , the adherence to training was low , mainly in the multicomponent group . CONCLUSIONS R and omized controlled trials using adherence strategies and longer times comparing training variations are required to verify which training protocol s are more effective and consistent on cognition and depression in oldest-old people BACKGROUND AND PURPOSE Knowledge concerning the applicability and the effect of high-intensity exercise programs is very limited for older people with severe cognitive and physical impairments . The primary aim of this study was to evaluate the applicability of a high-intensity functional weight-bearing exercise program among older people who are dependent in activities of daily living and living in residential care facilities . A second aim was to analyze whether cognitive function was associated with the applicability of the program . SUBJECTS The subjects were 91 older people ( mean age=85.3 years , SD=6.1 , range=68 - 100 ) who were dependent in personal activities of daily living and r and omly assigned to participate in an exercise intervention .  Their mean score for the Mini-Mental State Examination ( MMSE ) was 17.5 ( SD=5.0 , range=10 - 29 ) . METHODS A high-intensity functional weight-bearing exercise program was performed in groups of 3 to 7 participants who were supervised by physical therapists . There were 29 exercise sessions over 13 weeks . Attendance , intensity of lower-limb strength and balance exercises , and occurrence and seriousness of adverse events were the outcome variables in evaluating the applicability of the program . RESULTS The median attendance rate was 76 % .  Lower-limb strength exercises with high intensity were performed in a median of 53 % of the attended exercise sessions , and balance exercises with high intensity were performed in a median of 73 % of the attended exercise sessions . The median rate of sessions with adverse events was 5 % . All except 2 adverse events were assessed as minor and temporary , and none led to manifest injury or disease . No significant differences were observed in applicability when comparing participants with dementia and participants without dementia . In addition , there was no significant correlation between applicability and the MMSE score . DISCUSSION AND CONCLUSION The results suggest that a high-intensity functional weight-bearing exercise program is applicable for use , regardless of cognitive function , among older people who are dependent in activities of daily living , living in residential care facilities , and have an MMSE score of 10 or higher BACKGROUND The physical activity level of older adults with intellectual disabilities ( ID ) is extremely low , and their fitness levels are far beneath accepted norms for older people with normal intelligence and comparable with frail older people . A physical activity programme , including an education programme , was developed for older adults with ID using behaviour change techniques . The programme aim ed at improving or maintaining adequate levels of physical activity ( primary outcome measure ) and motor fitness , cardio respiratory fitness , morphologic and metabolic fitness , activities of daily living , cognitive functioning and depressive symptoms ( secondary outcome measures ) . METHOD The programme 's efficacy was evaluated in a cluster-r and omised clinical trial among people aged 43 years and over with mild-moderate levels of ID . Five day-activity centres were r and omised to the participation group . In these centres , 81 older adults participated in groups of 8 to 10 in the programme , three times a week during 8 months . The programme was executed by physical activity instructors and staff of day-activity centres . Five other day-activity centres were r and omised to the control group ; 70 older adults in these centres received care as usual . The generalised linear model with mixed effects was used to test the programme 's effectiveness . RESULTS Significant effects were found on physical activity , muscle strength , systolic and diastolic blood pressure , serum cholesterol level and cognitive functioning , in favour of the programme 's participants . No significant improvements were found on balance , serum glucose , weight , waist circumference , walking speed , mobility , depression or instrumental activities of daily living . CONCLUSIONS The physical activity and fitness programme has established small but significant effects in this sample , but generalising the findings to other setting s is difficult due to significant participant dropout . Implementation of evidence -based physical activity programmes among older adults with ID is recommended . Further research is needed to investigate the effectiveness of physical activity on daily life functioning and the development on chronic diseases in the long run Frailty has emerged as an important risk factor for disability . Age-related declines in physical and physiological function lead to increased risk of loss of independence and poor quality of life . Recent evidence has shown the effectiveness of physical exercise programmes in preventing or reversing frailty . The aim of this study was to evaluate changes in the functioning of frail elderly individuals after undergoing  resistance training  for 3 days a week for 8 weeks . The effectiveness of exercise training was investigated in 48 frail elderly individuals who were r and omly assigned to the following intervention groups : high-intensity ( HI ; n=16 ; age : 69–96 years ) or low-intensity ( LI ; n=16 ; age : 77–93 years ) strength training groups or a control group ( n=16 ; age : 76–93 years ) with no specific exercise programme . Participants were assessed for muscle strength , physical function , activities of daily living , depression and quality of life . The HI group had significantly better results ( P<0.05 ) on the Short Physical Performance Test than the LI group ; however , the LI group did show a significant improvement in those scores , whereas the scores of the control group worsened . Results for the other evaluations were similarly favourable in both exercise groups ( P>0.05 ) . The study showed that LI exercise was as effective as HI exercise for most parameters tested . Exercise training is useful for the prevention or treatment of frailty , as it improves functioning by contributing positively to muscle strength , gait , balance and quality of life The Lifestyle Interventions and Independence for Elders ( LIFE ) Study is a Phase III r and omized controlled clinical trial ( Clinical trials.gov identifier : NCT01072500 ) that will provide definitive evidence regarding the effect of physical activity ( PA ) on major  mobility disability in older adults ( 70–89 years old ) who have compromised physical function . This paper describes the methods employed in the delivery of the LIFE Study PA intervention , providing insight into how we promoted adherence and monitored the fidelity of treatment . Data are presented on participants ’ motives and self-perceptions at the onset of the trial along with accelerometry data on patterns of PA during exercise training . Prior to the onset of training , 31.4 % of participants noted slight conflict with being able to meet the dem and s of the program and 6.4 % indicated that the degree of conflict would be moderate . Accelerometry data collected during PA training revealed that the average intensity – 1,555 counts/minute for men and 1,237 counts/minute for women – was well below the cutoff point used to classify exercise as being of moderate intensity or higher for adults . Also , a sizable subgroup required one or more rest stops . These data illustrate that it is not feasible to have a single exercise prescription for older adults with compromised function . Moreover , the concept of what constitutes “ moderate ” exercise or an appropriate volume of work is dictated by the physical capacities of each individual and the level of comfort/stability in actually executing a specific prescription Context Some studies suggest that people with high levels of physical activity are less likely to develop dementia . Content All 1740 participants in this cohort study were 65 years of age or older and were cognitively intact at baseline . Over 6.2 years , the rate of dementia was 13.0 per 1000 person-years in those who exercised 3 or more times per week and 19.7 per 1000 person-years in those who exercised less than 3 times per week . Limitations The only measure of exercise intensity was self-reported frequency . The cohort was largely white and well-educated . Implication s This study adds to the evidence that regular exercise is associated with a lower risk for dementia . However , the existing evidence does not prove that regular exercise is associated with a lower dementia risk . The Editors Alzheimer disease and other dementing illnesses are major sources of morbidity and mortality ( 1 - 3 ) that affect millions of persons in the increasingly aging society of the United States . Research design ed to discover strategies to delay onset and progression of these potentially devastating illnesses is ongoing worldwide . Effective prevention strategies would result in substantial benefits through improved quality of life , prolonged independent life expectancy , and reduced economic cost and social burdens .  Regular physical exercise is an important element in overall health promotion ( 4 ) and might also be an effective strategy to delay onset of dementia ( 5 ) . A biological basis for how physical exercise might preserve brain function includes improved cerebral blood flow and oxygen delivery ( 6 ) and inducing fibroblast growth factor in the hippocampus ( 7 ) . More recent evidence suggests that reduced loss of hippocampal brain tissue in the aging brain is related to level of physical fitness ( 8) . Evidence from some longitudinal studies and r and omized trials suggests that physical exercise enhances cognitive function in older adults ( 9 - 15 ) , whereas other studies have failed to observe the benefits of physical exercise in preserving cognitive function ( 16 - 19 ) . Many people regard Alzheimer disease as one of the most dreaded consequences of aging . If regular physical exercise were shown to be effective in reducing the risk or delaying the onset of dementing illnesses , it would be another compelling reason to promote physical exercise . Few population -based longitudinal studies have examined the role of physical exercise on the risk for dementia in elderly persons . One recent longitudinal study showed that physical exercise was associated with decreased risk for decline in cognitive function ( odds ratio [ OR ] , 0.58 ) , Alzheimer disease ( OR , 0.50 ) , and any dementia ( OR , 0.63 ) ( 11 ) , whereas another longitudinal study showed no association between physical exercise and dementia ( 16 ) . More recent studies showed that walking was associated with a reduced risk for dementia and Alzheimer disease in a cohort of Japanese-American men ( 20 ) and that engaging in more diverse physical activities was associated with a reduced risk for dementia in the Cardiovascular Health Study ( 21 ) . The purpose of this study was 2-fold : 1 ) to determine whether regular exercise is associated with a reduced risk for incidence of dementia ( in particular , Alzheimer disease ) in a cohort followed biennially over 6 years and 2 ) to examine whether the association of physical exercise with incident dementia is modulated by other potential risk factors , such as depression , cardiovascular and cerebrovascular disease , diabetes , apolipoprotein E 4 allele , cognitive function , physical function , self-rated health , and lifestyle characteristics . Methods Study Sample The Adult Changes in Thought ( ACT ) study is a population -based , longitudinal study of aging and dementia . The ACT study was design ed to determine the incidence of Alzheimer disease , other types of dementia , and cognitive impairment as well as to determine risk factors for these conditions . The details of the ACT study have been described elsewhere ( 22 , 23 ) . Briefly , a r and om sample of 6782 individuals was drawn from Seattle-area members of Group Health Cooperative ( GHC ) , a consumer-governed health maintenance organization . The participants were 65 years of age and older when the study began in 1994 to 1996 . Those who had an existing diagnosis of dementia , were current residents of a nursing home , or were participating in other studies were ineligible ( n= 1360 ) . Of 5422 eligible persons , 2581 participated and 2841 declined participation . Age , sex , and ethnicity of the remaining 2581 participants did not differ significantly from those who were excluded . Nonresponse has been described elsewhere ( 22 ) . Declining to participate was more common among the oldest age group ( > 85 years ) , women , and African-American and minority groups ( 22 ) . Additional details regarding the incident rates of dementia and Alzheimer disease from the ACT study have been published elsewhere and are consistent with rates reported in U.S. and European cohort studies ( 22 ) . The institutional review boards of the University of Washington and Group Health Cooperative approved the ACT study . Participants received the  Cognitive Ability Screening Instrument ( CASI ) ( 24 ) as initial screening for cognitive function and were interviewed with structured question naires to obtain data , including demographic characteristics , medical history , memory and general functioning , and potential epidemiologic risk factors . Persons scoring 86 or higher on the CASI were entered directly into the ACT cohort as being cognitively intact . ( The CASI scores range from 0 to 100 ; a score of 86 corresponds to a Mini-Mental State Examination score of 25 to 26 . ) Persons with a score lower than 86 had additional medical record review and st and ardized clinical and neuropsychological evaluation for dementia . Persons who did not meet established criteria for dementia ( 25 ) were included in the ACT cohort . The current study sample was selected from the 2581 ACT participants to examine the temporal relationship of physical exercise preceding development of dementia . By design , we selected the 1895 persons whose CASI scores were above the 25th percentileCASI scores 91 to 100 . We excluded 686 persons whose CASI scores were in the lowest quartileCASI scores 62 to 90because the lowest quartile group might include persons who had mild cognitive impairment or impending dementia ( 26 ) . We did not collect information about the history of exercise before the participants entered the study . Therefore , in the group with low CASI scores , we could not be certain whether a reported low level of physical exercise preceded the development of dementia or was a consequence of the development of cognitive impairment or dementia . Of 1895 participants selected , 155 withdrew after the baseline visit and did not have a follow-up examination and were thus excluded from the analyses , leaving the analytic sample of 1740 persons . Incident Dementia We conducted biennial examinations to identify cases of incident dementia , when participants were rescreened with the CASI . Those who scored 86 or higher on the CASI remained in the ACT cohort . Scores on the CASI that were less than 86 at follow-up prompted a full st and ardized clinical examination . The results of rescreening by the CASI and by the clinical and neuropsychological examinations were review ed at a consensus diagnosis conference that included at least the examining physician , a neuropsychologist , another study physician , and the study nurse . Persons who did not meet the criteria for dementia were considered as not having dementia and were followed in the ACT cohort ( 22 , 23 ) . Persons who met the Diagnostic and Statistical Manual of Mental Disorders , fourth edition ( DSM-IV ) , criteria ( 25 ) for dementia were considered to have incident dementia . Dementia type was determined by the National Institute of Neurological and Communicative Diseases and Stroke-Alzheimer 's Disease and Related Disorders Association ( NINCDS-ADRDA ) criteria ( 27 ) for Alzheimer disease and by the DSM-IV criteria ( 25 ) for other types of dementia . Level of physical activity was not considered at the consensus conference . Physical Exercise Physical exercise was assessed at baseline by asking participants the number of days per week they did each of the following activities for at least 15 minutes at a time during the past year : walking , hiking , bicycling , aerobics or calisthenics , swimming , water aerobics , weight training or stretching , or other exercise . The frequency of exercise was calculated by the times per week that participants engaged in any of these forms of exercise . In this study , persons who exercised at least 3 times a week , above the lowest quartile , were classified as exercising regularly . Baseline Variables as Potential Confounders Numerous factors may influence the relationship between exercise and risk for dementia , including physical functioning , cognitive function , depression , health conditions , and lifestyle characteristics . Physical function was assessed by a performance-based physical function ( PPF ) test ( 23 ) , which consisted of 4 performance tests : 10-foot timed walk , time to st and from a seated position in a chair to a st and ing position 5 times , balance test , and grip strength in the dominant h and . Each test was scored from 0 to 4 points . The final PPF score was the sum of the scores for the 4 performance tests and ranged from 0 to 16 ; higher scores indicated better physical function . Details of the PPF test have been reported elsewhere ( 23 ) . Cognitive function was assessed by using the CASI , which provides quantitative assessment of attention , concentration , orientation , short-term memory , long-term memory , language ability , visual construction , list-generating fluency , abstract ion , and judgment ( 24 ) . At baseline , depression was measured by using the 11-item Center for Epidemiologic Studies Depression ( CES-D ) scale ( 28 ) . The CES-D scores ranged from 0 to 33 , with higher scores BACKGROUND Cognitive impairment is an important contributor to disability . Limited clinical trial evidence exists regarding the impact of physical exercise on cognitive function ( CF ) . We report results of a pilot study to provide estimates of the relative impact of physical activity ( PA ) on 1-year changes in cognitive outcomes and to characterize relationships between changes in mobility disability and changes in cognition in older adults at increased risk for disability . METHODS Sedentary persons ( 102 ) at increased risk for disability ( aged 70 - 89 years ) were r and omized to moderate-intensity PA or health education .  Participants were administered the  Digit Symbol Substitution Test ( DSST ) , Rey Auditory Verbal Learning Test ( RAVLT ) , modified Stroop test , and Modified Mini-Mental State Examination  at baseline and 1 year . RESULTS Group differences were not significant but improvements in cognitive scores were associated with improvements in physical function . Specifically , the DSST significantly correlated with change in the Short Physical Performance Battery score ( r = .38 , p = .0002 ) , in chair st and score ( r = .26 , p = .012 ) , in balance score ( r = .21 , p = .046 ) , and in 400-m gait speed ( r = .15 , p = .147 ) . Change recall on the RAVLT and in the Stroop test was also positively correlated with changes in chair st and and balance , respectively . CONCLUSIONS These results provide further support for the benefits of exercise on CF in older adults . An adequately powered clinical trial of PA involving older adults at increased risk for cognitive disability is needed to exp and the indications for prescribing exercise for prevention of decline in brain function Background —National Cholesterol Education Program Adult Treatment Panel III ( ATP III ) guidelines recommend the use of Framingham risk scores ( FRS ) for cardiovascular assessment of asymptomatic individuals . We hypothesized that risk prediction could be improved with 2 non-ECG exercise test measures , exercise capacity ( metabolic equivalents , or METs ) and heart rate recovery ( HRR ) . Methods and Results —An asymptomatic cohort with baseline treadmill tests ( n=6126 ; 46 % women , FRS < 20 % ) was followed up prospect ively for 20 years . Individuals with low ( median or less ) HRR or METs experienced 91 % of all cardiovascular disease ( CVD ) deaths ( 225/246 ) . After FRS adjustment , low HRR and METs individually were highly significant predictors of CVD death , but low HRR and METs together were associated with substantially higher risk ( adjusted hazard ratio compared with high HRR/high METs for women 8.51 , 95 % CI 3.65 to 19.84 ; for men , 3.53 , 95 % CI 2.03 to 6.15 ; P<0.001 for both ) . At 10-year follow-up , FRS-adjusted CVD death risk associated with low HRR/low METs was less than at 20 years but remained significant ( women 3.83 , 95 % CI 1.09 to 13.47 , and men 2.70 , 95 % CI 1.11 to 6.55 ) . The application of HRR/METs information to FRS assessment identified those at high risk ( > 0.5 % annual CVD mortality ) in half of women with FRS 6 % to 9 % and 10 % to 19 % and just under half of men with FRS 10 % to 19 % . Low HRR/low METs was also associated with an increased relative risk of CVD death in individuals with low-risk FRS ( FRS < 6 % in women and < 10 % in men ) , but absolute CVD mortality rates were low in this subgroup . Conclusions —Exercise testing may be a useful adjunct for clinical risk assessment in asymptomatic women with FRS 6 % to 19 % and men with FRS 10 % to 19 %
Conclusions The current literature suggests the effectiveness of low-intensity exercise on improved physical and cognitive health for older adults .
It may be a desired intensity level in promoting health among older adults with better compliance , lower risk of injuries , and long-term sustainability
Background It is well known that physical exercise is important to promote physical and cognitive health in older population .
However , inconsistent research findings were shown regarding exercise intensity , particularly on whether low-intensity exercise ( 1.5 metabolic equivalent tasks ( METs ) to 3.0 METs ) can improve physical and cognitive health of older adults .
This systematic review aim ed to fill this research gap .
The objective of this study is to conduct a systematic review of the effectiveness of low-intensity exercise interventions on physical and cognitive health of older adults .