Functional tasks exercise improves daily function in older women

Abstract

Ageing is characterised by a reduction in physical reserve, the physiological capacity in excess of that needed for daily activities, that provides a margin of safety that absorbs age- or disease-related changes without a loss in function. When physical capacity falls below the ability required for the performance of daily tasks, functional limitations and a loss of independence may occur. Approximately 20% of people between 65 and 75 years of age report problems with activities of daily living (ADLs), a proportion which increases to 48% in people older than 85.

Exercise studies and exercise promotion for older adults offer the potential for improving the performance of daily activities and quality of life. However, the results of current exercise programmes are limited and inconsistent. The University Medical Center (UMC) Utrecht developed an exercise programme focusing on functional tasks of everyday life, tasks that are affected early in the ageing process. The aim of the studies described in this thesis was to study the difference in effect between functional tasks exercises and resistance strength exercises on the physical functional performance and health-related quality of life of older community-dwelling women.

A pilot study with 24 community-dwelling, medically stable women (mean age 74.6 ?4.8) demonstrated that both exercise programmes were feasible and well tolerated by women over the age of 70 years and living in the community.

Ninety-eight healthy women aged 70 and older were randomly assigned to either the function group (n = 33), the resistance group (n = 34) or a control group (n = 31). Participants attended exercise classes three times a week for 12 weeks. Functional task performance (ADAP test), isometric knee extensor strength (IKES), handgrip strength, isometric elbow flexor strength (IEFS) and leg extension power were measured at baseline, at the end of training (at 3 months) and 6 months after the end of training (at 9 months). The ADAP assessment of daily activity performance (ADAP) test includes 16 common tasks, such as transferring laundry and boarding a bus, performed at maximal effort. proved to be reliable and valid for measuring the performance of daily activities by community-dwelling older women.

The ADAP total score increased more in the function group than in the resistance group or the control group. The ADAP total score of the resistance group did not change compared with the control group. In contrast, IKES and IEFS increased significantly in the resistance group compared with the function group and the control group. Six months after the end of training, the increase in ADAP scores were sustained in the function group, whereas the strength gains of the resistance group had disappeared. Physical activity scores demonstrated that functional tasks exercises may positively influence daily habits more than resistance training, which means that older individuals may continue exercising and thus maintain the effects of exercise. Functional tasks exercises are more effective in improving physical functional performance than common resistance strength exercises and the effects are preserved for longer than the gain in muscle strength achieved with resistance exercises.