Yonago Acta medica 2002; 45:75–88

Effect of Long-Term Exercise on Physical Function and Medical Examination in Elderly Women
Toshiaki Kato and Youichi Kurosawa*
Division of Medical Science in Sports and Exercise and *Division of Health Administration andPromotion, Department of Social Medicine, School of Medicine, Tottori University Faculty of
Medicine, Yonago 683-8503 JapanThe objective of this study was to evaluate the effects of exercise on physical functions(activities of daily living, physical fitness) and medical examination parameters as risk
factors for lifestyle-related diseases in 65- to 75-year-old women living independently
at home. The women were provided instruction on aerobic exercises and resistancetraining for 20 weeks. This was followed by a voluntary continuation of the exercisesfor 3 years (140 weeks). The subjects included 69 women who participated in an exercise
instruction program in a fitness class. Thirty-eight of the women voluntarily continued
with the exercise program [exercise (EX) group] and 31 women did not [sedentary(SED) group]. A control group of 44 women was also established. In the control group,
most of the physical function parameters tended to deteriorate after 160 weeks. The
medical examination parameters also tended to worsen, with many values above thenormal limits. In the EX group, however, the physical function actually improved
after 160 weeks. The improved control of hypertension, hyperlipidemia and hyperglycemia was also observed. In the SED group, physical function improved after 20
weeks of exercise instruction but began to deteriorate once exercise was stopped. These
results suggest that exercise instruction and continued exercise programs, based on an
appropriate exercise prescription, are effective in improving physical function andcontrolling the risk factors for lifestyle-related diseases in elderly women living at home.
Key words: activities of daily living; elderly woman; exercise prescription; physical function;
quality of life

1994; Ohta et al., 2001). Such an approachseems to contribute to self-support of elderly
people and a longer, healthier life. The evaluation of activities of daily living (ADL) is usefulin assessing the ability to function independently. Methods of evaluating ADL include the useof questionnaires (Lowton, 1963; Mahoney andBarthel, 1965; Demura et al., 2000) and combined testing with simulations of ADL (e.g., asitting and standing up test, a zigzag walking
test, a hand working test with a pegboard for
dexterity evaluation, and a rope working test for

Health assessment of elderly people must include both medical examination results and theability of the person’s functional capacity indaily activities (World Health Organization,1984). In the elderly, who often have multiple
chronic disorders, the focus must not be exclusively on medical evaluation parameters. A
broader perspective must be considered to improve the quality of life (QOL) for each person.
This includes controlling risk factors for chronic diseases and maintenance of physical function to continue daily activities (Roberts et al.,Abbreviations: ADL, activities of daily living; BMI, body mass index; CA, chronological age; ECG,
electrocardiograph; EX, exercise; HDLC, high-density lipoprotein cholesterol; HFA, health-related fitness
age; LDLC, low-density lipoprotein cholesterol; QOL, quality of life; SBP, systolic blood pressure; SED,
sedentary; TC, total cholesterol; TG, triglycerides; VO˙ 2max, maximal oxygen uptake

75

T. Kato and Y. Kurosawa

self-care evaluation) (Oida et al., 1996). Fromthe viewpoint of health-related physical fitness,
the factors of physical fitness for performance(cardiorespiratory fitness, muscular strength,
muscular endurance and flexibility) are
important parameters (American Alliance for
Health, Physical Education, Recreation andDance, 1980; MiSook et al., 1996).
The aging process in older individuals is
associated with a loss of muscle strength and adecrease in muscle cross-sectional area. If thisprocess were irreversible, an elderly person increasing functional capacity and maintaining
ADL function through exercise and training
would be impossible. However, studies on
muscle morphology and function in the elderly
have been positive in this regard; for example,
even the selective atrophy of fast muscle fibers
with aging may be due to a relative lack of daily
activity and a reduced demand on the muscles(Aniansson et al., 1983). Other studies showthat long-term training for 50 weeks by womenin their 70s causes thigh muscle hypertrophy(Cress et al., 1991) and that the recovery ofmuscle function and hypertrophy occur readilyin elderly males (Aniansson et al., 1984). Thesefindings suggest that training can enhancephysical fitness even in elderly individuals.
Improved physical fitness can prevent orreverse a decline in ADL function that is often
associated with aging. This fact is supported by
the results of several studies (Larsson, 1982;
Frontera et al., 1988). Healthy lifestyle habits,with an emphasis on exercise, help to maintainor improve ADL function. However, further research is needed to establish the protocols forprescribing exercise and to determine optimum
duration for exercise. The studies to date, forexample, have not fully evaluated the long-term
effects of combining aerobic exercise and resistance training. In particular, there has been alack of research on the effects of training formuscle strength and endurance in elderly females, who may be more susceptible to somepathologic conditions than males. Females are
weaker than males at all ages, and the incidenceof falls and hip fractures in females is 2 to 3
times that of males (Cook et al., 1982). The

ability of these women to function independently is closely related to ADL function.
The present study investigated the longterm effects of physical training in elderly
females. The effects of fitness training were
evaluated with an emphasis on exercise and its
importance in long-term health management.

Subjects and Methods
Subjects
We initially enrolled a total of 125 elderly
women living independently at home. Based on
examination by a physician, each of the womencompleting the study was free of orthopedic,
neuromuscular, cardiovascular, pulmonary andchronic diseases. In order to ensure the safety
during the exercises and to positively confirm
their effect of the exercise, the subjects taking
the following were excluded: steroids (including estrogen) and cardiac stimulants, and medication for angina pectoris, hypertension, hyperlipidemia, diabetes and arrhythmia. As a result,
12 of the women were excluded from analysis.
The remaining 113 women (age, 67. 8 ± 4. 4
years, mean ± SD; range, 65 to 75 years) weredivided into the fitness class participation group(69 women) and a control group (44 women)
according to whether the person can participate
in the fitness class. However, there were no
significant differences between the fitness classparticipants and the control group in age, fitness
and examination parameters. Also, no differences were found between the 2 groups in termsof academic background, occupation and morbidity.
Based on a follow-up survey after the fitnessclass was completed, the fitness class group was
further divided into those who continued to exercise on their own [exercise (EX) group: 38
women] and those who did not [sedentary(SED) group: 31 women]. Concerning occupation, lifestyle and morbidity among the 3 groups(control group, EX group and SED group) there
were some slight differences. Details of thestudy were explained to all the subjects and a76

Effect of exercise in elderly womenconsent was obtained. The study began in May
1997 and ended in May 2001.

meter (Mampokei ET-450, Yamasa Tokei Keiki,Tokyo) as an index to the amount of daily
physical activity (Hatano et al., 1995).
The following medical examinations werecarried out. For blood tests, total cholesterol(TC), high-density lipoprotein cholesterol(HDLC), low-density lipoprotein cholesterol(LDLC), triglycerides (TG), fasting plasma
glucose, Hb and hematocrit were adopted fromthe results of periodical health examinations by
the local government during the year. Body
mass index (BMI) was measured using height(m) and weight (kg). The percentage of body
fat was calculated by bioelectrical impedance
analysis (Sakamoto et al., 1992). Systolic bloodpressure (SBP) while resting was measured
with a mercurical sphygmomanometer. A 17cm 2-step exercise electrocardiographic (ECG)
stress test (rate, 60 times/min) was also performed.
The above testing at the baseline (start ofstudy) allowed the assessment of the suitability(safety risk and potential effect) of the exercise
program in each subject. Repeat testing was
performed at the end of the physical fitnessclass (20 weeks) and the end of the voluntary
exercise period (140 weeks) to evaluate theeffects of exercising.

Performance testing and medical examination
All subjects underwent performance testing anda medical examination at the start of the study.
The performance testing included assessmentof ADL function (Meiji Health and PhysicalFitness Research Institute: e.g., a sitting andstanding up test, a zigzag walking test, a handworking test with a pegboard for dexterity evaluation and a rope working test for self-careevaluation) (Oida et al., 1996) and a healthrelated physical fitness evaluation. The latterincluded an assessment of grip strength asmuscle strength for the static muscle strength
index (Grip-D, Takei Kiki Kogyo, Tokyo, Japan),leg extension power as an index to leg muscle
power output which is similar to the load experienced in daily life (isokinetic leg extension
power measurement device, fixed speed 80 cm/
s, Takei Kiki Kogyo) (Ito and Yoda, 1992), side
stepping as an index to neuro-muscle coordination and agility (distance between lines, 80 cm),forward body bending in a sitting position as aflexibility test which is related to backache(Ministry of Education, Culture, Sports, Scienceand Technology physical fitness guidelines),balance with the eyes closed while standing as
an equilibrium test which is related to instability and falls (GS-200HIV Statokinesogram,
Anima Corp., Tokyo), a rhythm step test for
estimating maximum oxygen consumption
˙ 2max) as an index to cardiorespiratory fit(VOness (Hatano et al., 1995) and the number ofsteps walked each day as measured by a pedo-

Exercise prescription and training protocol
The results of the physical fitness testing andmedical examination at the baseline were used
to establish an exercise program for each subject. The exercise prescription included aerobic
exercise (walking) and resistance training (withdumbbells or tubing) (Table 1). The intensity

Table 1. Exercise prescription in the fitness program
Aerobic exercise

Resistance exercise

Type of exercise
Intensity of exercise
Frequency of exercise
Duration of exercise
Amount of exercise
Type of exercise
Intensity of exercise
Frequency of exercise

Walking (slow walk–fast walk )50% VO˙ 2max and under arrhythmia appearance
5 times/week
30 min300 kcal/day
Exercise by rubber tube or dumbbell; 10 kinds of motion in
the trunk, legs and arms
30–40% of maximum strength (20–30 repetition maximum)
3 times/week77

T. Kato and Y. Kurosawa

˙ 2maxof the aerobic exercise was set to 50% VO
as determined by the rhythm step test. The exercise included slow walking and fast walking
for 30 min (2500–4000 steps) 5 times/week.
This resulted in each woman walking more thana total of 10,000 steps daily, with an energy expenditure in excess of 300 kcal/day.
The intensity of the resistance training was
set at 30–40% of the maximum muscle strength(20–30 repetition maximum). Two sets of 10
types of motions were performed 3 times/week.
Each subject was free to use either dumbbells or
tubing. Instruction was also given on stretchingfor “warming up” and “cooling down” before
and after exercising.
Instruction for this aerobic-resistance exercise program was given for 20 weeks in thefitness class. Performance testing was done at
the completion of the fitness class, with modification of the exercise prescription made asnecessary. Each woman was requested tovoluntarily continue the exercise program,including any modifications, for 140 weeks
after the fitness class was completed. The
overall rate of attendance in the fitness class
was 86%. Of these 69 subjects, 31 (44%)
continued the exercise program after the class.

calculated using the factor representations as
explanatory variables and chronological age(CA) as a target variable (i.e., a multiple regression formula using a standardized regression
coefficient and explanatory variables where thet-test for regression coefficients satisfies a value of P < 0.05) using the same method used in aprevious study (Kato et al., 2000).

Results
Subject characteristics
Average age was 66.9 ± 6.1 years in the control
group, 67.5 ± 4.4 years in the fitness class participants (67.8 ± 4.5 years in the EX group, and67.1 ± 4.1 years in the SED group). Tables 2
and 3 show ADL function and physical fitness
test data. No significant differences in the baseline values were observed between the groups
studied. The distribution of the measured values, which included averages and SDs, wassimilar to the mean values in the comparable
age groups. The number of steps/day, an indicator of daily activity level, was about 7000 ineach group. This approximates the mean value
for adult women in “Health Japan 21: a guideline for national health promotion in the 21
century by the Ministry of Health and Welfare”(Health Japan 21 Planning Association, 2000),
validating the mean ADL function and physicalfitness parameter values; that is, the women ineach group at the baseline were similar to other
women of the same age range in the general
population.
Table 4 shows the selected medical examination parameters for each group. No significant differences in any baseline values were observed among the groups. There are many
people who show the values in which TC, SBP,
fasting plasma glucose and BMI were higher
than the reference values. However, the elderly
women in our study were not a unique group.
The relatively high incidences of medical examination values exceeding the normal limits
are typical risk factors for diseases in manyelderly individuals (Krumholz et al., 1994).

Statistical analysis
Statistical analysis was performed using SAS
software (SAS Institute, Tokyo). ADL function
and physical fitness data at the end of the fitnessclass (20 weeks) and at the end of the voluntary
exercise program period (160 weeks) werecompared to the baseline data. The data for
women with the medical examination parameter values exceeding the normal limits werealso compared with the data after 160 weeks. A
t-test was used to expose any statistical significant differences, at a level of P < 0. 05.
A correlation matrix of all 25 variables atthe baseline was determined, and a factor analysis (after varimax orthogonal rotation) wasapplied to identify factors for elderly womenwith respect to physical function. The variables
for each factor with absolute high loading values (r > 4. 00) were selected for the factor representation. A multiple regression formula was78

Effect of exercise in elderly women

Table 2. Changes in ADL function parameters and activity level

Group

Age
(year)

Sitting andstanding up(s)Control group [44]Baseline
66.9 ± 6.1
5.8 ± 2.6
160 weeks
70.7 ± 6.4
6.2 ± 2.3
Change+0.4 ± 0.6*
Participants in the fitness class [69]Baseline
67.5 ± 4.4
5.9 ± 2.5
160 weeks
71.3 ± 4.4
5.7 ± 2.1
Change–0.2 ± 0.9

Zigzagwalking(s)

Hand
working(s)

Ropeworking(s)

Steps/day(step)

7.0 ± 1.4
7.3 ± 1.5
+0.3 ± 0.4*

34.6 ± 3.1
6.8 ± 1.9
35.2 ± 3.0
7.1 ± 1.8
+0.6 ± 0.9* +0.3 ± 0.5*7310 ± 2105
6823 ± 2238
–487 ± 1215*

7.0 ± 1.2
6.8 ± 1.3
–0.2 ± 0.7

34.8 ± 3.8
33.7 ± 3.6–1.1 ± 1.1

6.8 ± 1.8
6.3 ± 1.4
–0.5 ± 0.97022 ± 2045
8123 ± 2106
+1165 ± 2136

35.0 ± 4.4
33.3 ± 2.9
32.3 ± 3.7–2.7 ± 1.1*

6.8 ± 1.7
6969 ± 2212
5.9 ± 1.1
8188 ± 1877
5.8 ± 1.49005 ± 2001
–1.0 ± 0.8* +2036 ± 1876*

34.5 ± 2.9
33.2 ± 3.1
34.9 ± 3.1+0.4 ± 0.9

6.8 ± 1.8
6.5 ± 1.4
6.9 ± 1.5
+0.1 ± 0.37124 ± 1905
7792 ± 1342
7107 ± 1604
–17 ± 238

Side
steps
(time)

Trunk
flexion(cm)

Balance(cm2)VO2max(mL/kg/min)

29.0 ± 6.8
26.8 ± 6.0–2.2 ± 1.2*

38.0 ± 8.9
38.2 ± 8.5–0.2 ± 2.4

3.9 ± 1.4
20.8 ± 3.3
4.5 ± 1.5
19.6 ± 3.2+0.6 ± 0.7* –1.2 ± 0.9

29.8 ± 6.9
30.2 ± 6.8+0.4 ± 2.6

38.5 ± 8.3
39.1 ± 8.4+0.6 ± 2.5

4.0 ± 1.5
4.1 ± 1.6
+0.1 ± 0.6

EX group [38] in the fitness class participants
Baseline
67.8 ± 4.5
5.9 ± 2.9
7.0 ± 1.0
20 weeks
68.4 ± 4.6
5.8 ± 1.9
6.8 ± 1.0
160 weeks
71.6 ± 4.5
5.2 ± 1.6
6.4 ± 0.7
Change–0.7 ± 0.8* –0.6 ± 0.6*
SED group [31] in the fitness class participants
Baseline
67.1 ± 4.1
5.8 ± 2.1
6.9 ± 1.3
20 weeks
67.8 ± 4.0
5.8 ± 2.0
6.7 ± 1.3
160 weeks
70.9 ± 4.2
6.2 ± 2.2
7.2 ± 1.3
Change+0.4 ± 0.6* +0.3 ± 0.3*
Values expressed as mean ± SD.
EX, exercise; SED, sedentary.
[ ], number of subjects.
Change = 160-week value – baseline value.
* Significant change of 5% level.

Table 3. Changes in physical fitness parameters

Group

Grip
strength
(kg)

Leg
power
(W/kg)

Control group [44]Baseline
24.1 ± 4.0
4.8 ± 2.0
160 weeks
23.7 ± 3.5
4.1 ± 1.9
Change–0.4 ± 0.7–0.7 ± 0.8*
Participants in the fitness class [69]Baseline
24.3 ± 5.5
4.8 ± 1.9
160 weeks
24.0 ± 4.5
5.1 ± 1.6
Change–0.3 ± 0.7+0.3 ± 1.0

EX group [38] in the fitness class participants
Baseline
24.5 ± 5.9
4.9 ± 1.8
29.1 ± 6.5
38.2 ± 8.4
3.8 ± 1.5
20 weeks
24.8 ± 5.9
5.4 ± 1.9
29.7 ± 6.4
39.5 ± 8.3
3.6 ± 1.7
160 weeks
24.7 ± 4.5
5.9 ± 1.7
33.0 ± 5.8
40.6 ± 8.9
3.6 ± 1.3
Change+0.2 ± 0.3+1.0 ± 0.9* +3.9 ± 3.2* +2.6 ± 2.6* –0.2 ± 0.6
SED group [31] in the fitness class participants
Baseline
23.8 ± 3.6
4.7 ± 1.9
30.3 ± 7.6
38.6 ± 8.1
4.3 ± 1.6
20 weeks
23.5 ± 3.6
5.4 ± 1.8
30.5 ± 8.6
39.0 ± 8.6
4.1 ± 1.7
160 weeks
23.3 ± 3.6
4.2 ± 1.5
27.9 ± 5.8
38.1 ± 8.2
4.7 ± 1.7
Change–0.5 ± 1.3–0.5 ± 0.4* –2.4 ± 1.4*
–0.5 ± 2.3+0.4 ± 0.5
Values expressed as mean ± SD.
EX, exercise; SED, sedentary; VO˙ 2max, maximal oxygen uptake.
[ ], number of subjects.
Change = 160-week value – baseline value.
* Significant change of 5% level.

79

˙

20.2 ± 3.3
20.0 ± 3.4–0.2 ± 2.3
19.9 ± 3.1
21.8 ± 3.6
23.3 ± 3.7+3.4 ± 2.9*
20.6 ± 3.1
20.8 ± 3.1
19.2 ± 3.0–1.4 ± 1.9*

T. Kato and Y. Kurosawa

Table 4. Changes in medical examination parameters

Group

BMI
(kg/m2)SBP(mmHg)

TC(mg/dL)HDLC(mg/dL)TG(mg/dL)

Plasmaglucose(mg/dL)

Control group [44]Baseline
160 weeks
Change24.0 ± 4.0
24.4 ± 4.1+0.4 ± 2.1

136 ± 18
138 ± 19
+2 ± 4226 ± 35
231 ± 39
+5 ± 1154 ± 1751 ± 19–3 ± 4125 ± 62
127 ± 61
+2 ± 997 ± 2299 ± 24+2 ± 7

Participants in the fitness class [69]Baseline
23.9 ± 4.1
160 weeks
23.8 ± 3.9
Change–0.1 ± 2.5

136 ± 20134 ± 19
–2 ± 7225 ± 37
218 ± 36
–7 ± 1253 ± 1755 ± 19+2 ± 6127 ± 61
121 ± 60
–6 ± 1096 ± 2395 ± 24–1 ± 5EX group [38] in the fitness class participants
Baseline
24.2 ± 4.2
138 ± 20160 weeks
23.5 ± 3.8
130 ± 18
Change–0.7 ± 2.8–8 ± 8*224 ± 38
206 ± 31–18 ± 21*53 ± 1661 ± 18+8 ± 7*129 ± 62
112 ± 59
–17 ± 10*95 ± 2290 ± 20–5 ± 6

SED group [31] in the fitness class participants
Baseline
23.8 ± 3.9
134 ± 17160 weeks
24.1 ± 4.0
136 ± 20
Change+0.3 ± 2.0+2 ± 5228 ± 36229 ± 41
+1 ± 453 ± 1752 ± 19–1 ± 4121 ± 62130 ± 60
+9 ± 1198 ± 2498 ± 26+0 ± 3

Values expressed as mean ± SD.
[ ], number of subjects.
Change = 160-week value – baseline value.
BMI, body mass index; EX, exercise; HDLC, high-density lipoprotein cholesterol; SBP, systolic bloodpressure; SED, sedentary; TC, total cholesterol; TG, triglycerides.
* Significant change of 5% level.

In the control group, the evaluation after
160 weeks demonstrated a significant deterioration in all ADL functions (Table 2). In addition,a significant decrease was observed in the number of steps/day (about 500) after 160 weeks.
Physical fitness evaluation revealed a significant decrease in leg extension power, side steps,
balance function and VO2max (Table 3). However, among the fitness class participants, many
fitness function parameters have the aspect of
the improvement; the statistically significant
change could not be recognized in either ADL
functions and fitness parameters (Tables 2 and3).
In the EX group, the evaluation after 160
weeks demonstrated a significant improvement
in all ADL functions (Table 2). A significant
increase was observed in the number of steps/
day (about 2000). Physical fitness evaluation
revealed a significant increase in those parameters (leg extension power, side steps, forward body bending and VO 2max), with the

Effect of exercise on physical function
parameters
The ADL function parameters shown in Table 2(sitting and standing up test, zigzag walking
test, hand working test with a pegboard for
dexterity evaluation, and rope working test for
self-care evaluation) are tests to assess the ability to perform specified maneuvers in a shortperiod of time. The shorter times required toperform tasks therefore reflect improved function while longer times mean a decrease infunction. The physical fitness parameters
shown in Table 3 are, with the exception ofbalance, tests that measure strength, number ofrepetitions or distance. In these situations, thehigher numbers mean improved performance.
For balance function, stability is evaluated bymeasuring the area of motion away from thecenter of gravity. A lower number thus indicates improved function.

˙

˙

80

Effect of exercise in elderly women

Physical functional change rate after 160 weeks
Variables 0.8

0.9

1.0

1.1

1.2

1.3

*

Steps/day*

Leg power*V˙ O2max*

Rope working*

Side steps*

Sitting and standing up*

Zigzag walking*

Hand working
Trunk flexion
Balance

EX group
SED group
Control group

Grip strength

Fig. 1. Effect of long-term exercise on physical function variables. Change rate after 160 weeks, withbaseline value as 1.0. Data arranged in order of magnitude of effect in the EX group. *Significant change of
5% level from baseline value. EX, exercise group; SED, sedentary group; VO
˙ 2max, maximal oxygen uptake.

exception of grip strength and balance function(Table 3).
In the SED group, evaluation after 20 weeks
revealed some improvement in ADL function
and physical fitness parameters. After 160
weeks, however, a significant functional depression in sitting and standing up, and zigzag
walking were observed (Table 2). Physical fitness evaluation demonstrated a significant decrease in leg extension power, side steps andVO2max (Table 3). Figure 1 depicts the rates ofchange in physical function after 160 weeks
with a relative baseline value of 1. 0 for eachparameter. The items are shown in order starting with the highest rates of change in the EX
group. The parameter with the largest change
in the EX group was the total number of steps/
day as an index to the amount of daily physicalactivity. A mean increase of 2000 steps/day
was observed.
The parameter with the next highest rate ofchange was leg extension power. In the EX˙81

T. Kato and Y. Kurosawa

group, a significant increase of 20% (mean, 2.0
W/kg in body weight) from the baseline was observed. In the SED and control groups, leg

extension power decreased by 10–15% (0.5–0.7
W/kg). The parameter with the next greatest
change was VO2max as evaluated by cardiores-˙TC ≥ 220 mg/dL(mg/dL)(mg/dL)

HDLC ≤ 40 mg/dL
[7]

[11]

[48]

[20]

260

60

240

50

*
[6]

[17]

[19]

*

220

40

200

30

Baseline Control EX
SED
After 160 weeks

Baseline Control EX
SED
After 160 weeks

TG ≥ 150 mg/dL(mg/dL)[35]

LDLC ≥ 140 mg/dL(mg/dL)

[9]
[14]

180

*

120

120

Baseline Control EX
SED
After 160 weeks*

Baseline Control EX
SED
After 160 weeks

SBP ≥ 140 mmHg

Plasma glucose ≥ 110 mg/dL(mmHg)

150

[7]

[11]

130

(mg/dL)
[13]

[13]

140

140

155

[31]

150

[12]

160

160

[6]

[10]

[24]

[39]

[9]

[9]

140
120

[16]

[6]

*

110

145

*

100

Baseline Control EX
SED
After 160 weeks

Baseline Control EX
SED
After 160 weeks

Fig. 2. Effect of long-term exercise on medical examination parameters. Change after 160 weeks was shownon persons who had deviated from the reference value in each group. *Significant change of 5% level frominitial value. EX, exercise group; HDLC, high-density lipoprotein cholesterol; LDLC, low-density
lipoprotein cholesterol; SBP, systolic blood pressure; SED, sedentary group; TC, total cholesterol; TG,
triglycerides.

82Effect of exercise in elderly women˙

piratory fitness. In the EX group, the VO2max
significantly increased by 17% (3.4 mL/kg/min) from the baseline.
In the EX group, the ADL function parameters related to rope working for self-care,sitting and standing up, and zigzag walking
demonstrated significant improvements fromthe baseline (8–15% improvements). No
statistically significant changes were observedin balance function, hand working, forward
body bending or grip strength.

48 women who had baseline TC levels higher
than the reference value (220 mg/dL) (Fig. 2).
Among these 48 subjects, 17 individuals of theEX group had a significant decrease of 26 ± 19
mg/dL that was observed in TC from thebaseline. Eleven individuals of the control and
20 individuals of the SED group had a significant decrease. In addition, 35 women displayedbaseline TG levels higher than the reference
value (150 mg/dL). Among these 35 subjects,
12 individuals from the EX group had a significant decrease of 17 ± 10 mg/dL in the TG fromthe baseline.
Thirty-six women displayed baseline SBPlevels higher than the reference value (140mmHg). Their pathema was the 140–180
mmHg mild essential hypertention. Amongthese 36 subjects, 16 individuals of the EX
group showed a significant decrease of 9 ± 8mmHg in the SBP from the baseline. Nineteen
women displayed baseline HDLC levels lower
than the reference value (40 mg/dL). Amongthese 19 subjects, 7 individuals from the EX
group showed a significant increase of 9 ± 7
mg/dL in the HDLC from baseline. A total of
31 women demonstrated baseline LDLC values
above the reference value (140 mg/dL).
Among these 31 subjects, 11 individuals fromthe EX group showed a significant decrease of
21 ± 19 mg/dL in the LDLC from the baseline.
Furthermore, 24 women displayed baseline
fasting blood glucose levels higher than thereference value (115 mg/dL). Among these 24
subjects, 6 individuals from the EX group
showed a significant decrease of 16 ± 17 mg/dL
in the fasting plasma glucose levels from thebaseline.

Effect of exercise on medical examination parameters
In the control group, the evaluation of the BMI,
SBP, serum lipids (TC, HDLC, TG) and fasting
plasma glucose did not show any statisticallysignificant changes (Table 4). The percentage
of body fat, LDLC, Hb and hematocrit also did
not show any statistically significant change.
The incidence of abnormalities on the 2-step
stress exercise ECG testing did not change fromthe baseline to 160 weeks (from 12% to 12%).
Among all of the fitness class participants,
these medical examination parameter values
did not change significantly. However, in the
EX group, SBP, TC and TG significantly decreased, and the HDLC significantly increased(Table 4). The incidence of abnormalities on 2step stress exercise ECG testing decreased
significantly (from 12% to 6%). In the SED
group, no statistically significant changes wereobserved in any of the medical examination
parameter values (Table 4). The incidence ofabnormalities on the 2-step stress exercise ECG
testing decreased slightly (from 11% to 9%),but the difference was not statistically significant.
In order to evaluate the improvement in the
medical examination parameters, not only thechange of mean value, it is necessary to consider whether it improved in cases which deviatedfrom the reference value. Figure 2 shows thechanges after 160 weeks in cases which deviated from the reference value in each of theparameters in the 3 (control, EX, SED) groups.
The effects of exercising were evaluated in

Effect of exercise on health-related fitness age
A multiple regression formula was calculatedusing the factor representations as explanatory
variables and CA as a target variable. The biological age, which differs from CA, was termed
the health-related fitness age (HFA). The
formula was as follows:

83T. Kato and Y. Kurosawa

Table 5. Changes in HFAGroup

CA (year)

HFA (year)

Change (year)

Control group [44]Baseline
160 weeks

66.9 ± 6.1
70.7 ± 6.4

66.1 ± 8.2
69.3 ± 9.1–0.8 ± 2.1–1.4 ± 2.9

Participants in the fitness class [69]Baseline
160 weeks

67.5 ± 4.4
71.3 ± 4.4

66.6 ± 7.8
64.7 ± 8.9–1.0 ± 3.1–6.7 ± 6.8

EX group [38] in the fitness class participants
Baseline
160 weeks

67.8 ± 4.5
71.6 ± 4.5

66.6 ± 7.9
60.9 ± 8.8–1.2 ± 3.2–10.7 ± 7.4*

SED group [31] in the fitness class participants
Baseline
160 weeks

67.1 ± 4.1
70.9 ± 4.2

66.5 ± 7.8
68.2 ± 9.0–0.7 ± 3.0–2.8 ± 2.3

Values expressed as mean ± SD.
CA, chronological age; EX, exercise; HFA, health-related fitness age; SED, sedentary.
[ ], number of subjects.
Change = HFA – CA.
* Significant change of 5% level.

Discussion

HFA = 84.3 + 0.734X1 – 0.253X2 – 0.920X3– 0.347X4 + 0.633X5 – 0.075X6+ 0.0102X7 + 0.0131X8 – 0.133X9– 0.000561X10 ............................................ (1)Very few reports have been published to date on
the effects of long-term exercise training programs in elderly women. The present study
evaluated such a program in which elderly
women received instruction in aerobic-resistance training in a fitness class for 20 weeks.
This was followed by a 3-year period (140weeks) in which the subjects could voluntarily
continue the exercise program.

where X 1, sitting and standing up; X 2, grip
strength; X3, leg extension power; X4, VO2max;
X5, balance function; X6, HDLC; X7, TC; X8,
TG; X9, Hb; X10, total steps/day.

˙

Table 5 shows baseline HFA and the subsequent changes in each group as calculated by
the formula (1). No significant differenceswere observed between CA and HFA at thebaseline in any group. In addition, no significant changes were observed between CA and
HFA in the control or SED groups at 160
weeks. However, CA and HFA differed significantly in the EX group at 160 weeks. The mean
HFA was 10.7 years lower than the mean CA.
The findings show that long-term exercise indeed exerts an effect on physical function andmedical examination parameters. The result isa slowing or reversal in the biological aging process in elderly women.

Effect on physical function
The physical function parameter with the largest change in the EX group was the amount of
the daily physical activity (number of steps/day). This corresponded to the exercise
prescription for walking and showed a significant increase of 29% from the baseline. A total
number of 9000 steps/day is equivalent to a daily energy expenditure of about 300 kcal. This
amounts to more than 2000 kcal each week,
which has been shown to significantly decreasemortality rate (Paffenbarger et al., 1993).
It was shown that long-term exercise had asignificant effect on leg muscle power. De-84

Effect of exercise in elderly womencreased leg power is commonly seen in middleaged and elderly women (Ito and Yoda, 1992)
and is related to the care required for these
women (Cress et al., 1991). Kato et al. (2000)
have noted that leg extension power of less than
2.0 W/kg is associated with difficulty in selfambulation and usually requires the use of awalking device. Sawai (1996) reported that a
leg extension power of 8 W/kg is generally necessary for elderly women to participate in daily
activities. It is understood that a decrease inmuscle power does not allow the recruitment of
fast-twitch motor units in later life, but it isbecause of ADL that they become slower andmovement requires less force (Aniansson et al.,1983). This emphasizes the need for appropriate resistance training of the leg muscles to prevent a decline in leg power. Our findings suggest that long-term aerobic-resistance exercise
can improve leg power even in the elderly.
Long-term exercising is also effective inlowering the control needed for cardiorespiratory fitness (VO2max). A VO2max of at least
13 mL/kg/min is necessary for independentfunctioning in daily activities (Shephard, 1987).
However, active people require about twice thislevel. The mean VO2max for all of the subjects
in this study was about 20 mL/kg/min. A continued decline in this value during aging would
likely have a profound effect on the ability tofunction independently in daily activities. Thissuggests the need for appropriate aerobic exercises for the improvement of the cardiorespiratory fitness in elderly women.
Improvement in physical performance parameters by long-term exercising was reflected in
the improvement of ADL function. For example, shoulder joint mobility and balance areparticularly important in self-care performance.
Leg muscle power is likewise important instanding and walking. It was formulated that
improvement contributed to a longer, healthierlife for elderly women.
Balance function was evaluated by measuring motion away from the center of gravity
while each subject stood with both eyes closed.
In the EX group, there was no significant improvement from the baseline observed. However, the SED and control groups demonstrated

˙

marked decreases in balance. This resulted in asignificant difference between the EX and control groups, suggesting an age-related decreasein balance function concerning the absence of
exercise. Regular exercise thus appears usefulfor maintaining one’s balance function.
There was no significant improvement fromlong-term exercise on forward body bending
and grip strength. The absence of a strong association between aging or regular exercise
with forward bending has also been reported(Ono, 1963). This suggests that changes inmorphology or tension of the hamstrings, theantagonist muscles in forward bending, do notoccur readily with exercise. Grip strength may
be a highly reliable indicator of age-relatedchanges in the elderly (Demura et al., 1996).
However, training itself may have a slight effecton grip strength (Ono, 1963). Elderly people
still perform many daily activities that require
grip strength, making them less susceptible tothe effects of disuse atrophy.

˙

Effect on medical examination parameters

˙

When the results of exercise therapy are examined, the conditions of pharmacotherapy ofthe subjects must be considered. In this study,
the persons who took medicine for hyperlipidemia, hypertension, diabetes, angina pectoris
and arrhythmia treatment in the baseline were
excluded from the subjects. Therefore, theeffects of drug involvement seem to be slight;
however, all pharmacotherapies were not forbidden in this study progression, because it is
not possible to completely deny that some combined effect with pharmacotherapy is also included in the results.
Many reports have described an improved
lipid and glucose metabolism with exercise(Powell et al., 1987). The results were goodeven in the present study. The cause of the improvement seems to be because the exercise
which we prescribed was aerobic-resistancetraining. Resistance training helps activate
muscles, which is probably attributable to theincreased glucose metabolism by muscle andincreased insulin sensitivity. Also, aerobic85

T. Kato and Y. Kurosawa

exercise increases the total energy consumption
and the promotion of the lipid metabolism. Another reason for the markedly beneficial effects
was the long duration (160 weeks) of the exercise program.
Levels of HDLC below 40 mg/dL are generally considered suboptimal. Moreover, theselevels tend to decrease in postmenopausal
women (Gordon, 1977). In the elderly womenwith HDLC deficiency, it was indicated that
long-term exercise could create improvement in
the deficiency.
Hypertension in elderly people is often
characterized by isolated systolic hypertension.
Exercise therapy is effective for mild hypertension. Mild hypertension in the present study
also showed an average lowering of 9 mmHg,
which was significant in the EX group. Ourfindings are similar to previously reported
studies of exercise therapy in patients with mild
hypertension (Arakawa, 1993).

the EX and SED groups after completion of thefitness class revealed that HFA was profoundly
influenced by whether or not the exercise program was continued. In the EX group, the improvement in the physical function parametersand medical examination resulted in a 10.7-year
younger mean in HFA than CA. Our findings
suggest that their health related to fitness was
synthetically improved according to a continuous exercise program.
In conclusion, the evaluation of the physical function parameters after 160 weeks ofexercising revealed significant improvements.
The number of steps/day increased by a mean of
29% (2000 steps). Improvements in leg extension power, VO2max, rope working for selfcare, side steps, sitting and standing up, andzigzag walking (by 20%, 17%, 15%, 13%, 12%
and 9%, respectively) were also observed.
Furthermore, the evaluation of medical examination parameters after 160 weeks of exercise
revealed that hyperlipidemia and hyperglycemia improved significantly. HDLC significantly increased (by 9 mg/dL), and TC, TG, LDLC
and fasting plasma glucose significantly decreased in women with values higher than thenormal limits at baseline (by 26 mg/dL, 17 mg/
dL, 21 mg/dL and 16 mg/dL, respectively). In
women with mild hypertension, a significant
decrease in mean SBP (by 9 mmHg) was observed. Our findings suggest that long-term
aerobic-resistance exercise in elderly women
suppresses the reduction of their health-related
physical fitness.

˙

Effect of fitness program on HFA
The results of many studies support the hypothesis that a lack of regular physical activity
leads to a decline in fitness level and increases
the risk factors for the development of lifestylerelated disease (Tanaka and MiSook, 1996).
The American Alliance for Health, Physical
Education, Recreation and Dance (1980) has
established exercise and fitness guidelines andrecommends a fitness level, that is associatedwith one’s health. Low fitness levels are associated with the development of lifestyle-relateddiseases. This has given rise to the concept of“health-related fitness.” In such an approach,many studies evaluate physical fitness basedon biological age, which differs from CA(Nakamura, 1990; Tanaka et al., 1990; Demura
et al., 1996). However, few studies have been
performed exclusively in elderly women andincluded longitudinal follow-up studies.
In the present study, HFA was calculated as
an index of the overall fitness in the elderly
women. HFA significantly decreased (representing a “younger” age) in both the EX andSED groups after completion of the fitnessclass. A subsequent follow-up of the changes in

Acknowledgments: The authors are grateful to Professor Takuji Kishimoto, Division of Environmental
and Preventive Medicine, Professor Takayuki Nose,
Division of Health Administration and Promotion
and Professor Katsuya Shimizu, Division of Medical
Science in Sports and Exercise, Department of Social Medicine, School of Medicine, Tottori University
Faculty of Medicine for reviewing the manuscript.
This study was supported in part by a Research
Grant No. 08457131 from the Ministry of Education,
Culture, Sports, Science, and Technology.

86

Effect of exercise in elderly women

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Received July 18, 2002; accepted July 31, 2002
Corresponding author: Toshiaki Kato88