It’s Never too Late: Exercise Benefits Those in Their 90’s

by | Oct 8, 2013 | Aging, Fitness and Exercise

Written by Greg Arnold, DC, CSCS. 24 patients in their nineties participated in a 12 week weight training program that upon completion saw significant improvements in walking speed, speed of task completion, ease of rising from a chair and balance control.

In the elderly, the combined loss of muscle (sarcopenia) and bone density (osteopenia/osteoporosis) is called Frailty Syndrome and significantly increases the risk for falls which lead to disability, hospitalization, and death (1). In addition, fat becomes deposited in muscles (called fat infiltration) and leads to a decrease in overall muscle range of motion (2), causing impaired muscle function and manifests as low walking speed, fatigue, and low grip strength (3).

Fortunately, exercise programs in the elderly produce significant health benefits, with a recent review finding that 70% of studies showed a reduction in the incidence of falls, 54% showed improvements in walking ability, 80% showed improvements in balance, and 70% showed increases in muscle strength (4).

Now a new study (5) suggests exercise may improve health outcomes in the very elderly, even those in their 90’s (nonagenarians). In the study, 24 patients between the ages of 89 and 97 who satisfied Fried’s criteria for frailty (the presence of three or more of the following components: slowness, weakness, weight loss, exhaustion, and low physical activity (6) underwent either an exercise program (11 patients) or a control program (13 patients).

The exercise group completed a 12-week, twice-weekly program of weight training, with each exercise using weight at 40-60% of their maximum strength for 10 repetitions combined with balance and walking retraining exercises. There were at least 2 days of rest between exercise sessions; each session lasted 40 minutes and the subjects were supervised at all times.

For the control group, subjects performed mobility exercises 30 minutes per day, four days per week. The exercises consisted of small active and passive movements applied as a series of stretches in a rhythmic fashion to the individual joints.

By the end of 12 weeks, those in the weight training group saw significant improvements in four different strength and coordination tests compared to the control group:

  • 5-meter habitual gait velocity: Those in the weight training group saw a 5.2% increase in their walking velocity over 5 meters (0.76 to 0.80 meters/second) compared to a 11.2% decrease in the control group (0.68 to 0.60 m/s, p <0.05).
  • TUG: Called “Time Up and Go” task, those in the weight training group saw a 5.6% decrease in the time needed to complete TUG (19.9 to 18.8 seconds) compared to a 18.4% increase in the control group (18.4 to 21.8 seconds, p < 0.01)
  • Rise from a chair: When asked to do as many rises from a chair in 30 seconds as they could, those in the weight training group saw a 58% increase (6.2 to 9.8 times in 30 seconds) compared to a 14.3% decrease in the control group (6.3 to 5.4, p < 0.01)
  • Balance: Using the FICSIT-4 tests of static balance (Frailty and Injuries: Cooperative Studies of Intervention Techniques), those in the weightlifting group saw a 50% increase in their overall balance score (0.44 to 0.66) compared to a 16.7% decrease in the control group (0.36 to 0.30, p < 0.05).

Perhaps most important, those in the weightlifting group saw a complete eradication of falling episodes (defined as events where the participant unintentionally came to rest on objects that prevented the center of mass from exceeding the base of support (7). In the weightlifting group, subjects went from 0.70 falls per day to 0.00 falls per day compared to a 14% decrease in the control (0.93 to 080 falls per day, p < 0.001).

For the researchers, “routine multicomponent exercise intervention composed of resistance training, balance training, and gait exercises should be included for nonagenarians because it seems to be the most effective intervention for improving the overall physical outcomes of frail nonagenarians and preventing disability and other adverse outcomes.”  Although this study is unique and well done, it is small and should be confirmed with larger studies.

Source: Cadore, Eduardo L., Alvaro Casas-Herrero, Fabricio Zambom-Ferraresi, Fernando Idoate, Nora Millor, Marisol Gómez, Leocadio Rodriguez-Mañas, and Mikel Izquierdo. “Multicomponent exercises including muscle power training enhance muscle mass, power output, and functional outcomes in institutionalized frail nonagenarians.” Age 36, no. 2 (2014): 773-785.

© American Aging Association 2013

Posted October 8, 2013.

Greg Arnold is a Chiropractic Physician practicing in Hauppauge, NY.  You can contact Dr. Arnold directly by emailing him at PitchingDoc@msn.com or visiting his web site at www.PitchingDoc.com

References:

  1. Rodríguez ML. Viña J.  Vega E, on behalf of the FOD-CC group (2012) Searching for an operational definition of frailty: A Delphi method based consensus statement. The frailty operative definition-consensus conference project. J Gerontol A Biol Sci Med Sci 2012; 68:62–67.
  2. Visser M, Goodpaster BH, Kritchevsky SB, Newman AB, Nevitt M, Rubin SM, Simonsick EM, Harris TB.  Muscle mass, muscle strength, and muscle fat infiltration as predictors of incident mobility limitations in well-functioning older persons. J Gerontol A Biol Sci Med Sci 2005; 60:324–333.
  3. Garcia-Garcia FJ, Gutierrez Avila G.   Toledo Study Group.  The prevalence of frailty syndrome in an older population from Spain. The Toledo study for healthy aging. J Nutr Health Aging 2011; 15:852–865.
  4. Cadore EL, Rodríguez-Mañas L, Sinclair A, Izquierdo M. Effects of different exercise interventions on risk of falls, gait ability and balance in physically frail older adults: a systematic review. Rejuvenation Res 2013; 16:105–114. doi:10.1089/rej.2012.1397.
  5. Cadore EL.  Multicomponent exercises including muscle power training enhance muscle mass, power output, and functional outcomes in institutionalized frail nonagenarians.  Age (Dordr) 2013 Sep 13. [Epub ahead of print].
  6. Fried LP, Tangen CM, Waltson J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA (2001) Frailty in older adults: Evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2011;56:146–155.
  7. Wolf SL.  Reducing frailty and falls in older persons: an investigation of Tai Chi and computerized balance training. Atlanta FICSIT Group. Frailty and injuries: Cooperative studies of intervention techniques. J Am Geriatr Soc 1996; 44:489–497