Grow Strong, Live Long:

 

Fitness Study with Elderly Retirement Home Independent Living Residents - Part 2

 

Robert Simons, Ph.D., CHES, MS

 

Subjects

 

We started the study with 64 physician-cleared elderly subjects (45 women, 19 men) who resided at The Fountains at Boca Ciega Bay, Saint Petersburg, Florida. Participants were essentially sedentary and resided in the independent living facility of the Fountains. Upon volunteering for the fitness study, they were randomly assigned to the control group or one of the two exercise groups. Twenty-one subjects (14 women, 7 men) completed the 16-week strength-training program. Eighteen subjects (11 women, 7 men) completed the 16-week cardiovascular training program, and twenty-one subjects (14 women, 7 men) completed the fitness study as control group subjects. Two participants encountered non-study related illnesses that prevented them from training, and two discontinued the program for personal reasons. On average, the subjects were 84 years of age, 63.4 inches in height, and 143.6 pounds in weight. The range in age was from 66 to 96 years, with only fourteen residents who participated in the study being younger than 80 years old, and only 8% of the study population being under 75 years of age. Twelve percent or 9 participants were age 90 or older.

 

Methods

Testing Protocol

All study volunteers were pre-tested using a battery of tests described below, then received 16 weeks of intervention treatments of health education and exercise (exercise groups), then post-tested on the same battery of tests. The tests assessed functional ability, muscle strength, joint-flexibility, and health knowledge.

Functional ability was assessed utilizing the American Alliance for Health Physical Education, Recreation, and Dance (AAHPERD) Functional Fitness Assessment for Adults Over the Age of 60 Years, which included a) Ponderal Index, b) Flexibility, c) Endurance (cardiovascular) 880-yard walk, d) Strength test, e) Coordination test, and the f) Agility test. Ponderal index is a numerical value logarithmically assigned based upon height-weight ratio. The importance of this value is the direction of change. This value takes into account body composition norms.

Subjects were tested for lower body muscle strength (quadriceps, hamstrings, gluteus maximus) by the 1 repetition maximum (1RM) method using the Keiser leg extension, leg-curl, and leg press machines. Subjects were tested for upper body muscle strength (triceps, pectoralis major, latisumus dorsi, biceps, anterior deltoid) by the one repetition maximum (1RM) using the Keiser upper back, lower back, and chest press machines. All testing repetitions were initially demonstrated and performed with strict adherence to proper form, for aspects of testing accuracy and safety.

Joint flexibility was assessed with a mechanical goniometer at the shoulder joint and the hip joint. Shoulder abduction was measured from the side position (arm vertical) to the highest point attained without torso movement. Shoulder flexion was measured from the side position (arm vertical) to the highest point attained without torso movement Hip flexion was measured from the supine position (thigh horizontal) to the highest point attained with knee bent. All flexibility assessments were taken on the right side of the body.

The psychological Health Knowledge test consisted of the Fast-Simons Senior Adult Health Knowledge Test. This was a specially designed, fifty-five question, multiple choice test assessing health knowledge in the areas of: personal health, exercise and fitness, nutrition and diet, consumer health, contemporary health problems, tobacco, alcohol, drugs and narcotics, safety and first aid, communicable and non-communicable diseases, mental health, healthy aging. This test was developed by the author in coordination with Dr. Charles Fast and was derived from the 100-question Fast-Tyson Health Knowledge Test, used at major universities reliably. A series of six one-hour health lectures were given at approximately three-week intervals throughout the 16-week intervention. All participants were strongly encouraged to attend each lecture. The lecture subjects were: Aging in the 21st Century, Senior Fitness Program Development, Balance and Stability Training, Aging and the mind, Aging and Nutrition I, Aging and Nutrition II.

Frequency of falls was calculated by a simple correlation of recorded falls six months prior to the fitness study and recorded falls six months after commencement of the study.

All of the data were analyzed for differences in pre-training and post-training values by means of paired t-tests. The level of statistical significance was set at p<0.05.

 

Strength Training Program

The strength-training program was 16 weeks in length with two exercise sessions per week. The initial weight per exercise machine, representing pounds of resistance, was set at 75% of the individuals one-repetition maximum (1RM) from the initial assessment pre-test. Each workout consisted of six strength exercises performed on six Keiser machines as presented in Table 1.

Table 1. Training exercises, target muscles, and Keiser machines. 

Each exercise was performed for one set of 10 repetitions, usually to the point of momentary muscle fatigue. When 10 repetitions were completed with proper exercise form for 3 to 5 consecutive workouts the weight load was increased by 5 percent.

Our definition of proper exercise form was relatively slow movement speed and full range of motion. All training repetitions were performed in approximately six seconds, with two seconds for each lifting movement (concentric muscle action) and four seconds for each lowering movement (eccentric muscle action). All training repetitions were executed through the full range of joint movement as determined by the subject's functional ability and freedom from discomfort. The duration of the training sessions varied depending upon the subject's physical and cognitive abilities, but typically required between 15 and 20 minutes for completion. The actual time spent doing resistance exercise averaged six minutes per workout, as each of the six training exercises required about one minute of muscle activity.

Trained instructors from the Fountains Fountain of Youth Fitness Center or Simons Fitness Enterprises personal training staff individually supervised every exercise session. The instructors initially assisted subjects getting on and off the machines, setting the seat positions, and designating the weight at the appropriate resistance level. They also provided participants with encouragement, feedback, and reinforcement throughout the workout. Some participants, after a period of time, were paired up to perform the exercise circuit with someone of similar abilities. However, all participants were supervised throughout the duration of the study, especially for periodic resistance increases. It was the desire of the researcher that familiarity with the process would lead to a comfortable lifestyle change for those participants that were able and willing.

 

Cardiovascular Training Program

The cardiovascular training program or walking program was also 16 weeks in length with an average of two exercise sessions per week. The initial walk length per exercise session, per participant was set at the approximate walk length and elapsed time of the individuals 880-yard walk from the initial assessment pre-test (AAHPERD Functional Fitness Assessment for Adults Over the Age of 60 Years). Participants were monitored individually and encouraged to gradually increase the distance of their walks and/or reduce the elapsed time. An outdoor walk course and an indoor inclement weather course were designated. All participants were asked to perform their walks on the same day at the same time to enhance exercise adherence and lessen the supervisory task. All walks were supervised and recorded.

PART 1    PART 3

The author wishes to express his sincere appreciation to the Executive Director of the Fountains at Boca Ciega Bay, Mr. Peter Brooks and all the administrators, professional staff, and residents whose leadership, cooperation, and participation made this study a tremendous success. Without the extraordinary vision and sincere desire of Mr Peter Brooks for the improvement in quality of life for so many residents this fitness study would not have been possible. The author also wishes to acknowledge the valuable assistance provided by Katherine Donigan, Susan Wright, and Tammy Makinen.

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