Effectiveness of exercise interventions on physical function in community-dwelling frail older people: an umbrella review of systematic reviews Exercise and vitamin D in fall prevention among older women: a randomized clinical trial. Which impairments are most associated with high mobility performance in older adults? Implications for a rehabilitation prescription. Effects of three-monthly oral 150,000 IU cholecalciferol supplementation on falls, mobility, and muscle strength in older postmenopausal women: a randomized controlled trial. A randomized controlled trial of the effects of vitamin D on muscle strength and mobility in older women with vitamin D insufficiency. The role of vitamin D in improving physical performance in the elderly. The value of strength training for older adults. Effects of vitamin D supplementation on strength, physical function, and health perception in older, community-dwelling men. Effects of long-term resistive training on mobility and strength in older adults with diabetes. The effectiveness of a combined exercise intervention on physical fitness factors related to falls in community-dwelling older adults The effects of improved strength on obstacle negotiation in community-living older adults. Effects of Strength Training versus Power Training on Physical Performance in Prefrail Community-Dwelling Older Adults Nutritional Intervention as a Preventive Approach for Cognitive-Related Outcomes in Cognitively Healthy Older Adults: A Systematic Review. Nutritional, Physical, Cognitive, and Combination Interventions and Frailty Reversal Among Older Adults: A Randomized Controlled Trial. Muscle strength and mobility in vitamin D-insufficient female geriatric patients: a randomized controlled trial on vitamin D and calcium supplementation Efficacy of Nintendo Wii training on mechanical leg muscle function and postural balance in community-dwelling older adults: a randomized controlled trial. A Population-Based Survey of Factors Relating to the Prevalence of Falls in Older People Nutritional status, body composition, and quality of life in community-dwelling sarcopenic and non-sarcopenic older adults: A case-control study. Oral folic acid and vitamin B-12 supplementation to prevent cognitive decline in community-dwelling older adults with depressive symptoms--the Beyond Ageing Project: a randomized controlled trial. Effects of a long-term vitamin D and calcium supplementation on falls and parameters of muscle function in community-dwelling older individuals A community-based fitness and mobility exercise program for older adults with chronic stroke: a randomized, controlled trial. Vitamin D status affects strength gains in older adults supplemented with a combination of β-hydroxy-β-methylbutyrate, arginine, and lysine: a cohort study. Physical activity and functional limitations in older adults: a systematic review related to Canada's Physical Activity Guidelines
Objectives : This umbrella review aim ed to determine the effectiveness of exercise interventions , alone or in combination with other interventions , in improving physical function in community-dwelling older people identified as pre-frail or frail . Introduction : Exercise is said to have a positive impact on muscle mass and strength which improves physical function and hence is beneficial for the treatment of frailty . Several systematic review s discuss the effects of exercise interventions on physical function parameters , such as strength , mobility , gait , balance and physical performance , and indicate that multi-component exercise , including resistance , aerobic , balance and flexibility training , appears to be the best way in which to improve physical function parameters in frail older people . However , there is still uncertainty as to which exercise characteristics ( type , frequency , intensity , duration and combinations ) are the most effective and sustainable over the long-term . Inclusion criteria : Participants were adults , 60 years or over , living in the community and identified as pre-frail or frail . Quantitative systematic review s , with or without meta- analysis that examined the effectiveness of exercise interventions of any form , duration , frequency and intensity , alone or in combination with other interventions design ed to alter physical function parameters in frail older people , were considered . The quantitative outcome measures were physical function , including muscular strength , gait , balance , mobility and physical performance . Methods : An iterative search strategy for ten bibliometric data bases and gray literature was developed . Critical appraisal of seven systematic review s was conducted independently by two review ers using a st and ard Joanna Briggs Institute tool . Data was extracted independently by two review ers using a st and ard Joanna Briggs Institute data extraction tool and summarized using a narrative synthesis approach . Results : Seven systematic review s were included in this umbrella review , with a total of 58 relevant r and omized controlled trials and 6927 participants . Five systematic review s examined the effects of exercise only , while two systematic review s reported on exercise in combination with a nutritional approach , including protein supplementations , as well as fruit and dairy products . The average  exercise frequency was 2–3 times per week ( mean 3.0 ± 1.5 times per week ; range 1–7 weekly ) for 10–90 minutes per session ( mean of 52.0 ± 16.5 mins ) and a total duration of 5–72 weeks with the majority lasting a minimum of 2.5 months ( mean 22.7 ± 17.7 weeks ) . Multi-component exercise interventions can currently be recommended for pre-frail and frail older adults to improve muscular strength , gait speed , balance and physical performance , including resistance , aerobic , balance and flexibility tasks . Resistance training alone also appeared to be beneficial , in particular for improving muscular strength , gait speed and physical performance . Other types of exercise were not sufficiently studied and their effectiveness is yet to be established . Conclusions : Interventions for pre-frail and frail older adults should include multi-component exercises , including in particular resistance training , as well as aerobic , balance and flexibility tasks . Future research should adopt a consistent definition of frailty and investigate the effects of other types of exercise alone or in combination with nutritional interventions so that more specific recommendations can be made IMPORTANCE While vitamin D supplementation and exercise are recommended for prevention of falls for older people , results regarding these 2 factors are contradictory . OBJECTIVE To determine the effectiveness of targeted exercise training and vitamin D supplementation in reducing falls and injurious falls among older women . DESIGN , SETTING , AND PARTICIPANTS A 2-year r and omized , double-blind , placebo-controlled vitamin D and open exercise trial conducted between April 2010 and March 2013 in Tampere , Finl and . Participants were 409 home-dwelling women 70 to 80 years old . The main inclusion criteria were at least 1 fall during the previous year , no use of vitamin D supplements , and no contraindication to exercise . INTERVENTIONS Four study groups , including placebo without exercise , vitamin D ( 800 IU/d ) without exercise , placebo and exercise , and vitamin D ( 800 IU/d ) and exercise . MAIN OUTCOMES AND MEASURES The primary outcome was monthly reported falls . Injurious falls and the number of fallers and injured fallers were reported as secondary outcomes . In addition , bone density , physical functioning ( muscle strength , balance , and mobility ) , and vitamin D metabolism were assessed . RESULTS Intent-to-treat analyses showed that neither vitamin D nor exercise reduced falls . Fall rates per 100 person-years were 118.2 , 132.1 , 120.7 , and 113.1 in the placebo without exercise , vitamin D without exercise , placebo and exercise , and vitamin D and exercise study groups , respectively ; however , injurious fall rates were 13.2 , 12.9 , 6.5 , and 5.0 , respectively . Hazard ratios for injured fallers were significantly lower among exercisers with vitamin D ( 0.38 ; 95 % CI , 0.17 - 0.83 ) and without vitamin D ( 0.47 ; 95 % CI , 0.23 - 0.99 ) . Vitamin D maintained femoral neck bone mineral density and increased tibial trabecular density slightly . However , only exercise improved muscle strength and balance .  Vitamin D did not enhance exercise effects on physical functioning . CONCLUSIONS AND RELEVANCE The rate of injurious falls and injured fallers more than halved with strength and balance training in home-dwelling older women , while neither exercise nor vitamin D affected the rate of falls . Exercise improved physical functioning . Future research is needed to determine the role of vitamin D in the enhancement of strength , balance , and mobility . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00986466 OBJECTIVE To test which rehabilitative impairments are associated with higher mobility performance among community-dwelling , mobility-limited older adults . DESIGN Cross-sectional analysis of baseline data from participants within a r and omized controlled trial . SETTING Outpatient rehabilitation research center . PARTICIPANTS Community-dwelling older adults ( N=138 ; mean age , 75.4 y ) with mobility limitations as defined by the Short Physical Performance Battery ( SPPB ) . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Balance measured via the Berg Balance Scale , leg strength , leg velocity , submaximal aerobic capacity , body mass index ( BMI ) , and mobility performance as measured by the SPPB . RESULTS Each of the 5 physiologic attributes ( unipedal balance , leg strength , leg velocity , submaximal aerobic capacity , BMI ) was categorized into tertiles by using lower values as reference for impairment status . Within an adjusted model , measures associated with higher SPPB performance ( > 9 ) included a BBS score greater than or equal to 54 ( odds ratio [OR]=4.54 ; 95 % confidence interval [ CI ] , 1.11 - 18.60 ) , leg strength greater than or equal to 21.5 N/kg ( OR=30.35 ; 95 % CI , 5.48 - 168.09 ) , leg velocity .0101 to .0129 m.s(-1).kg(-1 ) ( OR=5.31 ; 95 % CI , 1.25 - 22.57 ) , and leg velocity greater than or equal to .0130 m.s(-1).kg(-1 ) ( OR=22.86 ; 95 % CI , 3.88 - 134.75 ) . CONCLUSIONS Our investigation highlights the importance of rehabilitative impairments in leg strength , leg velocity , and balance as being associated with mobility status as measured by the SPPB . In our sample of participants within an exercise trial , submaximal aerobic capacity and BMI status were not associated with mobility performance . These findings suggest that the augmentation of not only leg strength and balance but also leg velocity may be important in the rehabilitative care of mobility-limited older adults Daily vitamin D in addition to calcium supplementation reduces falls and fractures in older women . However , poor adherence to therapy is a common clinical problem . To examine the effects of supervised oral 3-monthly vitamin D therapy on falls , muscle strength , and mobility , we conducted a 9-month r and omized , double-blind , placebo-controlled trial in 686 community-dwelling ambulant women aged over 70 years . Participants received either oral cholecalciferol 150,000 IU every 3 months ( n = 353 ) or an identical placebo ( n = 333 ) . All participants were advised to increase dietary calcium intake . Falls data were collected 3-monthly . At baseline , 3 , 6 , and 9 months , muscle strength was measured by a h and held dynamometer and mobility by the Timed Up and Go ( TUG ) test . Serum 25 hydroxyvitamin D ( 25OHD ) was measured in a subgroup of 40 subjects . Mean age at baseline was 76.7 ± 4.1 years . The average serum 25OHD value at baseline was 65.8 ± 22.7 nmol/L. By 3 , 6 , and 9 months after supplementation , 25OHD levels of the vitamin D group were approximately 15 nmol/L higher than the placebo group . Calcium intake did not change significantly between baseline ( 864 ± 412 mg/day ) and 9 months ( 855 ± 357 mg/day ) . Faller rates in the two groups did not differ : vitamin D group , 102 of 353 ( 29 % ) ; placebo group , 89 of 333 ( 27 % ) . At 9 months , compared to placebo or baseline , muscle strength , and TUG were not altered by vitamin D. In conclusion , oral cholecalciferol 150,000 IU therapy administered 3-monthly had neither beneficial nor adverse effects on falls or physical function . These data together with previous findings confirm that intermittent large doses of vitamin D are ineffective or have a deleterious effect on falls . Thus despite adherence issues with daily vitamin D replacement , an intermittent , high-dose vitamin D regimen can not be supported as a strategy to reduce falls and fractures OBJECTIVES To evaluate the effects of vitamin D treatment on muscle strength and mobility in older women with vitamin D insufficiency . DESIGN One-year population -based , double-blind , r and omized , controlled trial . SETTING Perth , Australia ( latitude 32 ° S ) . PARTICIPANTS Three hundred two community-dwelling ambulant elderly women aged 70 to 90 with a serum 25-hydroxyvitamin D ( 25(OH)D ) concentration less than 24 ng/mL. INTERVENTION Vitamin D(2 ) 1,000 IU/d or identical placebo ; calcium citrate ( 1 g calcium/d ) in both groups . MEASUREMENTS Lower limb muscle strength and mobility as assessed using the Timed Up and Go Test ( TUAG ) . RESULTS At baseline , mean ± st and ard deviation serum 25(OH)D was 17.7 ± 4.2 ng/mL ; this increased to 24.0 ± 5.6 ng/mL in the vitamin D group after 1 year but remained the same in the placebo group . For hip extensor and adductor strength and TUAG , but not for other muscle groups , a significant interaction between treatment group and baseline values was noted . In those with baseline values in the lowest tertile , vitamin D  improved muscle strength and TUAG more than calcium alone ( mean ( st and ard error ) : hip extensors 22.6 % ( 9.5 % ) ; hip adductors 13.5 % ( 6.7 % ) , TUAG 17.5 % ( 7.6 % ) , P < .05 ) . Baseline 25(OH)D levels did not influence patient response to supplementation . CONCLUSION Vitamin D therapy was observed to increase muscle function in those who were the weakest and slowest at baseline . Vitamin D should be given to people with insufficiency or deficiency to improve muscle strength and mobility There is an ongoing debate over the role of serum 25(OH ) vitamin D [ 25(OH)D ] levels in maintaining or improving physical performance and muscle strength . Much of the controversy is because of the variability between studies in participants ' characteristics , baseline serum 25(OH)D levels , and baseline physical functioning . The aim of this ancillary study conducted within a r and omized controlled clinical trial was to investigate whether supplementation with 400 or 2000 IU vitamin D3 daily for 6 months would improve measures of physical performance and muscle strength in a community-dwelling elderly population aged 65 to 95 years . Those with the slowest gait speed improved their ability to do chair-st and tests after vitamin D supplementation . This finding remained significant after controlling for potential confounding variables . There was also an inverse correlation between serum 25(OH)D levels and fat mass index ( FMI ) among women , suggesting that higher supplementation with vitamin D is needed as weight increases . The results of this study suggest that supplementation with vitamin D may be most beneficial in older population s who have low baseline physical functioning Health in older adults can best be measured in terms of functional status . Skeletal muscle strength has been reported to be a determinant of functional status in older individuals . Two major contributors to the decline in muscle function as a person ages are disuse and physical inactivity . Declining muscle function through a loss of muscular strength may decrease functional independence and mobility and increase the risk for falls and injuries , physical frailty , and disability .  Older individuals lacking an appropriate amount of muscular strength may not be able to perform various activities of daily living , which are important indicators of independence OBJECTIVES To study the effects of vitamin D supplementation in healthier population s of men . DESIGN : R and omized , controlled trial . SETTING General clinical research center . PARTICIPANTS Sixty-five healthy , community-dwelling men ( mean age+/-st and ard deviation=76+/-4 , range 65 - 87 ) . INTERVENTION Cholecalciferol ( 1,000 IU/d ) or placebo supplementation for 6 months ; all received 500 mg supplemental calcium . MEASUREMENTS Upper and lower extremity muscle strength and power , physical performance and activity , health perception , calcium and vitamin D intake , and biochemical assessment , including 25-hydroxyvitamin D ( 25OHD ) , parathyroid hormone ( PTH ) , and ionized calcium levels . RESULTS The levels of 25OHD increased and PTH decreased in the cholecalciferol group , whereas there were no significant changes in the control group ( P<.001 ) . Baseline 25OHD levels correlated with baseline single-leg stance time and physical activity score . Baseline PTH levels correlated with baseline 8-foot walk time and physical activity score . No significant difference in strength , power , physical performance , or health perception was found between groups . CONCLUSION The 25OHD or PTH levels correlated with physical activity and physical performance in older , community-dwelling men with normal 25OHD status . Vitamin D supplementation increased 25OHD levels and decreased PTH levels but did not increase muscle strength or improve physical performance or health perception in this group of healthy , older men . Further investigations of the effects of vitamin D supplementation should focus on individuals with low levels of vitamin BACKGROUND Strength training has been shown to be beneficial in older adults . However , very little data exist on the effects of strength training in older diabetics . METHODS 31 community-dwelling older adults with diabetes ( mean age = 66.1 years ) were r and omly assigned to either an exercise ( EX ) or control ( CO ) group . The EX group trained the plantar flexors , knee extensors , knee flexors , hip extensors , and hip flexors muscle groups at 50 % , 60 % , and 70 % of 1-repetition maximum , 2.6 days a week , for 24 months . Mobility tests included the timed up and go , 50-foot walk , and walking up and down 8 stairs . Strength and mobility for both groups were evaluated at 6-month intervals . RESULTS There was a group and time effect as the EX group increased 31.4 % ( p < .001 ) in strength for all muscle groups after the first 6 months of training , and the strength gains were retained for the duration of the training intervention . There was also a group and time effect for mobility as performance increased 8.6 % and 9.8 % ( p = .032 and p = 0.031 ) for the first 6 and 12 months , respectively , but decreased to 4.6 % above baseline at the end of the intervention . There were essentially no changes from baseline strength or mobility values for the CO group . CONCLUSION In conclusion , these data suggest that a moderate-intensity resistive-training program can improve mobility and strength for the duration of a 24-month intervention in older adults with diabetes , thus potentially reducing the rate of mobility loss during aging This study aim ed to evaluate the effectiveness of an innovative exercise program on muscle strength , balance , and gait kinematics in elderly community-dwellers . The exercise program included strength and balance training and the 8-form Tai Chi Chuan . The measurements were carried out at baseline and 12 weeks , and consisted of four physical performance tests , joint isokinetic strength tests , and three-dimensional gait analysis . Fifty-six community-dwelling older adults aged 60–80 years old were r and omly assigned to an intervention or control group . After 12 weeks , the intervention group showed a 17.6 % improvement in the timed up and go test , accompanied by a 54.7 % increase in the 30-second chair st and test score . Significant increases in the score of star excursion balance tests , and the strength of the extensor and flexor muscles at knee and ankle joints were also observed . In addition , the intervention group walked at a faster speed with a longer step length , shorter support phase , and a greater sagittal plane range of motion at the hip and ankle joints . No statistical improvements were seen in the control group . This study provided an effective , evidence -based falls prevention program that can be implemented in community setting s to improve physical fitness and reduce fall risks among community-dwelling older adults .  The star excursion balance test could be a sensitive measure of physical performance for fall risk assessment in older people Poor mobility has been associated with age-related deterioration in muscle strength . While previous work has examined the effects of improved strength on level walking , we have quantified the effects of a resistance-training program on obstructed gait tasks using biomechanical-dependent measures . Forty-five community-dwelling participants aged 62 years or older were r and omised to either a control ( n=16 ) or experimental group ( n=29 ) . The experimental subjects exercised for 24 weeks on a progressive resistance-training program design ed to improve lower body strength . Dynamic strength was assessed at weeks 0 and 24 as well as specific laboratory gait kinetics and kinematics during stepping over an obstacle and negotiation of a raised surface set at 10 , 20 and 30 % of each subject 's leg length . Significant strength improvements ( P<0.05 ) , ranging between 197 and 285 % , were recorded in the experimental group . The strength gains in the experimental group were accompanied by significant increases in obstacle-crossing stride velocity ( range 5.5 - 15.5 % ) due to increases in stride length and decreases in stride duration for both gait tasks . Significant changes in the peak vertical and anterior-posterior ground reaction forces as well as in kinematic variables associated with a safe obstacle traverse such as vertical obstacle heel clearance , limb flexion at obstacle crossing , horizontal foot placement and vertical l and ing velocity result ed in an improved crossing strategy in the experimental subjects . These findings provide evidence of significant improvements in obstructed gait function of community-living older adults associated with a systematic resistance-training program Background : It has been unclear which training mode is most effective and feasible for improving physical performance in the risk group of prefrail community-dwelling older adults . Objective : The purpose of the present study was to compare the effects of strength training ( ST ) versus power training ( PT ) on functional performance in prefrail older adults . This study was registered at clinical trials.gov as NCT00783159 . Methods : 69 community-dwelling older adults ( > 65 years ) who were prefrail according to the definition of Fried were included in a 12-week exercise program . The participants were r and omized into an ST group , a PT group and a control group . All participants were supplemented with vitamin D3 orally before entering the intervention period . The primary outcome was the global score on the Short Physical Performance Battery ( SPPB ) . Secondary outcomes were muscle power , appendicular lean mass ( aLM ) measured by dual energy X-ray absorptiometry and self-reported functional deficits ( Short Form of the Late-Life Function and Disability Instrument , SF-LLFDI ) . Results : Regarding changes in the SPPB score during the intervention , significant heterogeneity between the groups was observed ( p = 0.023 ) . In pair-wise comparisons , participants in both training groups significantly ( PT : p = 0.012 , ST : 0.009 ) increased their SPPB score ( PT : Δmean = 0.8 , ST : Δmean = 1.0 ) compared to the control group , with no statistical difference among training groups ( p = 0.301 ) . No statistical differences were found in changes in aLM ( p = 0.769 ) , muscle power ( p = 0.308 ) and SF-LLFDI ( p = 0.623 ) between the groups . Muscle power significantly increased ( p = 0.017 ) under vitamin D3 intake . Conclusions : In prefrail community-dwelling adults , PT is not superior to ST , although both training modes result ed in significant improvements in physical performance . With regard to dropout rates , ST appears to be advantageous compared to PT . The high prevalence of vitamin D3 deficiency and the slight improvement of physical performance under vitamin D3 supplementation among study participants underline the relevance of this approach in physical exercise interventions The link diet-cognitive function/dementia has been largely investigated in observational studies ; however , there was a lack of evidence from r and omized clinical trials ( RCTs ) on the prevention of late-life cognitive disorders though dietary intervention in cognitively healthy older adults . In the present article , we systematic ally review ed RCTs published in the last four years ( 2014 - 2017 ) exploring nutritional intervention efficacy in preventing the onset of late-life cognitive disorders and dementia in cognitively healthy subjects aged 60 years and older using different levels of investigation ( i.e. , dietary pattern changes/medical food/nutraceutical supplementation/multidomain approach and dietary macro- and micronutrient approaches ) as well as possible underlying mechanisms of nutritional prevention . From the 35 included RCTs , there was moderate evidence that intervention through dietary pattern changes , medical food/nutraceutical supplementation , and multidomain approach improved specific cognitive domains or cognitive-related blood biomarkers . There was high evidence that protein supplementation improved specific cognitive domains or functional status in prefrail older adults without effect on cognitive function . For fatty acid supplementation , mainly long-chain polyunsaturated fatty acids , there was emerging evidence suggesting an impact of this approach in improving specific cognitive domains , magnetic resonance imaging ( MRI ) findings , and /or cognitive-related biomarkers also in selected subgroups of older subjects , although some results were conflicting . There was convincing evidence of an impact of non-flavonoid polyphenol and flavonoid supplementations in improving specific cognitive domains and /or MRI findings . Finally , there was only low evidence suggesting efficacy of intervention with homocysteine-related and antioxidant vitamins in improving cognitive functions , dementia incidence , or cognitive-related biomarkers in cognitively healthy older subjects BACKGROUND It is important to establish whether frailty among older individuals is reversible with nutritional , physical , or cognitive interventions , singly or in combination . We compared the effects of 6-month- duration interventions with nutritional supplementation , physical training , cognitive training , and combination treatment vs control in reducing frailty among community-dwelling prefrail and frail older persons . METHODS We conducted a parallel group , r and omized controlled trial in community-living prefrail and frail old adults in Singapore . The participants ' mean age was 70.0 years , and 61.4 % ( n = 151 ) were female . Five different 6-month interventions included nutritional supplementation ( n = 49 ) , cognitive training ( n = 50 ) , physical training ( n = 48 ) , combination treatment ( n = 49 ) , and usual care control ( n = 50 ) . Frailty score , body mass index , knee extension strength , gait speed , energy/vitality , and physical activity levels and secondary outcomes ( activities of daily living dependency , hospitalization , and falls ) were assessed at 0 months , 3 months , 6 months , and 12 months . RESULTS Frailty score and status over 12 months were reduced in all groups , including control ( 15 % ) , but were significantly higher ( 35.6 % to 47.8 % ) in the nutritional ( odds ratio [ OR ] 2.98 ) , cognition ( OR 2.89 ) , and physical ( OR 4.05 ) and combination ( OR 5.00 ) intervention groups . Beneficial effects were observed at 3 months and 6 months , and persisted at 12 months . Improvements in physical frailty domains ( associated with interventions ) were most evident for knee strength ( physical , cognitive , and combination treatment ) , physical activity ( nutritional intervention ) , gait speed ( physical intervention ) , and energy ( combination intervention ) . There were no major differences with respect to the small numbers of secondary outcomes . CONCLUSIONS Physical , nutritional , and cognitive interventional approaches were effective in reversing frailty among community-living older persons Background and aims : Insufficient vitamin D status , commonly found in older people , has been associated with muscle weakness which , in old age , impairs mobility and is a risk factor for falling . In a r and omized , double-blind placebo-controlled trial , we tested the hypothesis that vitamin D + calcium supplementation improves muscle strength and mobility , compared with calcium mono-therapy in vitamin D-insufficient female geriatric patients . Methods : Seventy female geriatric patients > 65 years of age with serum 25-hydroxyvitamin D3 ( 25OHD ) concentrations between 20 and 50 nmol/L , visiting an outpatient geriatric department , were included . Participants received either cholecalciferol 400 IU/day + calcium 500 mg/day ( D/Cal group ) or a placebo + calcium 500 mg/day ( Plac/Cal group ) for 6 months . At baseline and 6 months , muscle strength , power and functional mobility were tested . Results : At baseline , 25OHD was significantly ( p<0.05 ) associated with knee extension strength ( r=0.42 ) , h and grip strength ( r=0.28 ) , leg extension power ( r=0.34 ) , Timed Get Up and Go ( r=−0.31 ) and Modified Cooper test ( r=0.44 ) . At 6 months , a significant difference in 25OHD ( 77.2 vs 41.6 nmol/L , p<0.001 ) and 1,25OHD was found between the two groups . Significantly improving vitamin D status in the D/Cal group compared with the Plac/Cal group did not result in a significant difference in strength or functional mobility between the two groups . Conclusions : Daily 400IU vitamin D + 500 mg calcium supplementation is not enough to significantly improve strength or mobility in vitamin D-insufficient female geriatric patients BACKGROUND Older adults show increased risk of falling and major risk factors include impaired lower extremity muscle strength and postural balance . However , the potential positive effect of biofeedback-based Nintendo Wii training on muscle strength and postural balance in older adults is unknown . METHODS This r and omized controlled trial examined postural balance and muscle strength in community-dwelling older adults ( 75±6 years ) pre- and post-10 weeks of biofeedback-based Nintendo Wii training ( WII , n = 28 ) or daily use of ethylene vinyl acetate copolymer insoles ( controls [ CON ] , n = 30 ) . Primary end points were maximal muscle strength ( maximal voluntary contraction ) and center of pressure velocity moment during bilateral static stance . RESULTS Intention-to-treat analysis with adjustment for age , sex , and baseline level showed that the WII group had higher maximal voluntary contraction strength ( 18 % ) than the control group at follow up ( between-group difference = 269 N , 95 % CI = 122 ; 416 , and p = .001 ) . In contrast , the center of pressure velocity moment did not differ ( 1 % ) between WII and CON at follow-up ( between-group difference = 0.23 mm(2)/s , 95 % CI = -4.1 ; 4.6 , and p = .92 ) . For secondary end points , pre-to-post changes favoring the WII group were evident in the rate of force development ( p = .03 ) , Timed Up and Go test ( p = .01 ) , short Falls Efficacy Scale-International ( p = .03 ) , and 30-second repeated Chair St and Test ( p = .01 ) . Finally , participants rated the Wii training highly motivating at 5 and 10 weeks into the intervention . CONCLUSIONS Biofeedback-based Wii training led to marked improvements in maximal leg muscle strength ( maximal voluntary contraction ; rate of force development ) and overall functional performance in community-dwelling older adults . Unexpectedly , static bilateral postural balance remained unaltered with Wii training . The high level of participant motivation suggests that biofeedback-based Wii exercise may ensure a high degree of compliance to home- and /or community-based training in community-dwelling older adults Background : Research on older people ’s perception regarding their quality of life and services and supports needed to maintain their independence was identified as a priority for the South Australian Department of Health in 2000–2001 . This population survey was conducted to examine issues that older persons considered important in the areas of housing , transport , finances and information provision . Objective : The aim of this article is to present the characteristics of community-dwelling older adults who reported falling in the previous 12 months . Method : A r and om representative sample of community-dwelling adults , living in South Australia , and aged 65 years and over were selected based on a sample from the electronic white pages telephone directory . Overall , 2,619 interviews were conducted ( 70.5 % response rate ) using Computer-Assisted Telephone Interviewing technology . Results : Approximately 30 % of older adults had experienced a fall in the previous 12 months . The characteristics of people who had fallen included those in the older age groups , with fair or poor general health , whose health had worsened in the last 12 months , with lower socioeconomic status , those born in an English-speaking country , needing assistance at home , and with a home in need of repair . Of the respondents who had experienced a fall in the previous 12 months , 71.8 % did not consider that they were at risk of having another fall . Conclusion : There is a wide range of characteristics associated with community-dwelling older adults over the age of 65 who report falling in the previous 12 months . Perceptions of the risk of falling also vary . All factors need to be considered when targeting interventions to reduce the risk of both initial and multiple falls BACKGROUND & AIM Sarcopenia , the age-related decrease in muscle mass , strength , and function , is a main cause of reduced mobility , increased falls , fractures and nursing home admissions . Cross-sectional and prospect i ve studies indicate that sarcopenia may be influenced in part by reversible factors like nutritional intake . The aim of this study was to compare functional and nutritional status , body composition , and quality of life of older adults between age and sex-matched older adults with and without sarcopenia . METHODS In a multi-centre setting , non-sarcopenic older adults ( n = 66 , mean ± SD : 71 ± 4 y ) , i.e. Short Physical Performance Battery ( SPPB ) : 11 - 12 and normal skeletal muscle mass index , were recruited to match 1:1 by age and sex to previously recruited adults with sarcopenia : SPPB 4 - 9 and low skeletal muscle mass index . Health-related quality of life , self-reported physical activity levels and dietary intakes were measured using the EQ-5D scale and index , Physical Activity Scale for the Elderly ( PASE ) , and 3-day prospect i ve diet records , respectively . Concentrations of 25-OH-vitamin D , α-tocopherol ( adjusted for cholesterol ) , folate , and vitamin B-12 were assessed in serum sample s. RESULTS In addition to the defined components of sarcopenia , i.e. muscle mass , strength and function , reported physical activity levels and health-related quality of life were lower in the sarcopenic adults ( p < 0.001 ) . For similar energy intakes ( mean ± SD : sarcopenic , 1710 ± 418 ; non-sarcopenic , 1745 ± 513 , p = 0.50 ) , the sarcopenic group consumed less protein/kg ( -6 % ) , vitamin D ( -38 % ) , vitamin B-12 ( -22 % ) , magnesium ( -6 % ) , phosphorus ( -5 % ) , and selenium ( -2 % ) ( all p < 0.05 ) compared to the non-sarcopenic controls . The serum concentration of vitamin B-12 was 15 % lower in the sarcopenic group ( p = 0.015 ) , and all other nutrient concentrations were similar between groups . CONCLUSIONS In non-malnourished older adults with and without sarcopenia , we observed that sarcopenia substantially impacted self-reported quality of life and physical activity levels . Differences in nutrient concentrations and dietary intakes were identified , which might be related to the differences in muscle mass , strength and function between the two groups . This study provides information to help strengthen the characterization of this geriatric syndrome sarcopenia and indicates potential target areas for nutritional interventions BACKGROUND Evidence remains unclear as to whether folic acid ( FA ) and vitamin B-12 supplementation is effective in reducing depressive symptoms . OBJECTIVES The objective was to determine whether oral FA + vitamin B-12 supplementation prevented cognitive decline in a cohort of community-dwelling older adults with elevated psychological distress . DESIGN A r and omized controlled trial ( RCT ) with a completely crossed 2 × 2 × 2 factorial design comprising daily oral 400 μg FA + 100 μg vitamin B-12 supplementation ( compared with placebo ) , physical activity promotion , and depression literacy with comparator control interventions for reducing depressive symptoms was conducted in 900 adults aged 60 - 74 y with elevated psychological distress ( Kessler Distress 10-Scale ; scores > 15 ) . The 2-y intervention was delivered in 10 modules via mail with concurrent telephone tracking calls . Main outcome measures examined change in cognitive functioning at 12 and 24 mo by using the Telephone Interview for Cognitive Status-Modified ( TICS-M ) and the Brief Test of Adult Cognition by Telephone ( processing speed ) ; the Informant Question naire on Cognitive Decline in the Elderly was administered at 24 mo . RESULTS FA + vitamin B-12  improved the TICS-M total ( P = 0.032 ; effect size d = 0.17 ) , TICS-M immediate ( P = 0.046 ; d = 0.15 ) , and TICS-M delayed recall ( P = 0.013 ; effect size d = 0.18 ) scores at 24 mo in comparison with placebo . No significant changes were evident in orientation , attention , semantic memory , processing speed , or informant reports . CONCLUSION Long-term supplementation of daily oral 400 μg FA + 100 μg vitamin B-12 promotes improvement in cognitive functioning after 24 mo , particularly in immediate and delayed memory performance . This trial was registered at clinical trials.gov as NCT00214682 Summary In 242 community-dwelling seniors , supplementation with either 1000 mg of calcium or 1000 mg of calcium plus vitamin D result ed in a decrease in the number of subjects with first falls of 27 % at month 12 and 39 % at month 20 . Additionally , parameters of muscle function improved significantly . Introduction The efficacy of vitamin D and calcium supplementation on risk of falling in the elderly is discussed controversially . R and omized controlled trials using falls as primary outcome are needed . We investigated long-term effects of calcium and vitamin D on falls and parameters of muscle function in community-dwelling elderly women and men . Methods Our study population consisted of 242 individuals recruited by advertisements and mailing lists ( mean [ ± SD ] age , 77 ± 4 years ) . All serum 25-hydroxyvitamin D ( 25[OH]D ) levels were below 78 nmol/l . Individuals received in a double blinded fashion either 1000 mg of calcium or 1000 mg of calcium plus 800 IU of vitamin D per day over a treatment period of 12 months , which was followed by a treatment-free but still blinded observation period of 8 months . Falls were documented using diaries . The study took place in Bad Pyrmont , Germany ( latitude 52 ° ) and Graz , Austria ( latitude 46 ° ) . Results Compared to calcium mono , supplementation with calcium plus vitamin D result ed in a significant decrease in the number of subjects with first falls of 27 % at month 12 ( RR = 0.73 ; CI = 0.54–0.96 ) and 39 % at month 20 ( RR = 0.61 ; CI = 0.34–0.76 ) . Concerning secondary endpoints , we observed significant improvements in quadriceps strength of 8 % , a decrease in body sway of 28 % , and a decrease in time needed to perform the TUG test of 11 % . Discussion Combined calcium and vitamin D supplementation proved superior to calcium alone in reducing the number of falls and improving muscle function in community-dwelling older individuals OBJECTIVES To examine the effects of a community-based group exercise program for older individuals with chronic stroke . DESIGN Prospect i ve , single-blind , r and omized , controlled intervention trial . SETTING Intervention was community-based . Data collection was performed in a research laboratory located in a rehabilitation hospital . PARTICIPANTS Sixty-three older individuals ( aged > or = 50 ) with chronic stroke ( poststroke duration > or = 1 year ) who were living in the community . INTERVENTION Participants were r and omized into intervention group ( n=32 ) or control group ( n=31 ) . The intervention group underwent a fitness and mobility exercise ( FAME ) program design ed to improve cardiorespiratory fitness , mobility , leg muscle strength , balance , and hip bone mineral density ( BMD ) ( 1-hour sessions , three sessions/week , for 19 weeks ) . The control group underwent a seated upper extremity program . MEASUREMENTS Cardiorespiratory fitness ( maximal oxygen consumption ) , mobility ( 6-minute walk test ) , leg muscle strength ( isometric knee extension ) , balance ( Berg Balance Scale ) , activity and participation ( Physical Activity Scale for Individuals with Physical Disabilities ) , and femoral neck BMD ( using dual-energy x-ray absorptiometry ) . RESULTS The intervention group had significantly more gains in cardiorespiratory fitness , mobility , and paretic leg muscle strength than controls . Femoral neck BMD of the paretic leg was maintained in the intervention group , whereas a significant decline of the same occurred in controls . There was no significant time-by-group interaction for balance , activity and participation , nonparetic leg muscle strength , or nonparetic femoral neck BMD . CONCLUSION The FAME program is feasible and beneficial for improving some of the secondary complications result ing from physical inactivity in older adults living with stroke . It may serve as a good model of a community-based fitness program for preventing secondary diseases in older adults living with chronic conditions BACKGROUND Older adults supplemented for 1 year with β-hydroxy-β-methylbutyrate , arginine , and lysine ( HMB/ARG/LYS ) were previously shown to have significant gains in fat-free mass ( FFM ) but not muscular strength . OBJECTIVE Recently , increasing levels of serum vitamin D have been associated with an increase in muscle function , particularly in the elderly . To determine if vitamin D status may have limited strength gain in participants supplemented with HMB/ARG/LYS , the authors performed post hoc analysis of strength based on the participants ' vitamin D status . METHODS Elderly ( age 76.0 ± 1.6 years ) adults were recruited for a double-blinded , controlled study and were r and omly assigned to either an isonitrogenous control ( n = 37 ) or HMB/ARG/LYS ( n = 40 ) for the yearlong study . Participants were further segregated based on their vitamin D status of either < 30 or ≥30 ng 25OH-vitD(3)/mL serum , and an analysis was performed on the 4 cohorts . RESULTS Regardless of vitamin D status , HMB/ARG/LYS result ed in significantly increased FFM ( P < .02 ) , but only in those with vitamin D status ≥30 ng 25OH-vitD(3)/mL was there a significant increase in strength with HMB/ARG/LYS ( P < .01 ) . Control-supplemented participants , regardless of vitamin D status , and the HMB/ARG/LYS-supplemented participants with vitamin D status < 30 ng 25OH-vitD(3 ) failed to show improvements in strength . CONCLUSIONS The nutrient cocktail of HMB/ARG/LYS alone was effective in increasing muscle mass regardless of vitamin D status , but accompanying strength increases were observed only when participants also had adequate vitamin D status indicating a synergistic effect between the HMB/ARG/LYS and vitamin 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
In conclusion , we observed no improvement in muscle strength after the administration of vitamin D with or without calcium supplements .
We did find a small but significant deterioration of mobility .
BACKGROUND It has been suggested that vitamin D status or supplementation is important for maintaining or improving muscle strength and mobility in older adults .
The study results , however , do not provide consistent results .
We therefore aim ed to summarise the available evidence systematic ally , including only studies conducted in community-dwelling older persons .