Effectiveness of exercise interventions on physical function in community-dwelling frail older people: an umbrella review of systematic reviews Physical activity and functional limitations in older adults: a systematic review related to Canada's Physical Activity Guidelines The effect of three different exercise training modalities on cognitive and physical function in a healthy older population Promotion of self-management in vulnerable older people: a narrative literature review of outcomes of the Chronic Disease Self-Management Program (CDSMP) Effect of physical interventions on physical performance and physical activity in older patients during hospitalization: a systematic review Exercise and well-being: a review of mental and physical health benefits associated with physical activity Walking football as sustainable exercise for older adults – A pilot investigation Aerobic and Cognitive Exercise (ACE) Pilot Study for Older Adults: Executive Function Improves with Cognitive Challenge While Exergaming. Physical activity outcomes of CHAMPS II: a physical activity promotion program for older adults. Benefits of physical exercise training on cognition and quality of life in frail older adults. Physical activity and mental well-being in older people participating in the Better Ageing Project Exercise: effects on physical functional performance in independent older adults. Impact of aerobic exercise on neurobehavioral outcomes. Effects of combined physical and cognitive training on fitness and neuropsychological outcomes in healthy older adults Prevalence of Physical Activity in the United States: Behavioral Risk Factor Surveillance System, 2001 The Effectiveness of Exercise Interventions for the Management of Frailty: A Systematic Review Exercise for fall risk reduction in community-dwelling older adults: a systematic review. Impact of an exercise intervention on physical activity during pregnancy: the behaviors affecting baby and you study. Exercise is medicine, for the body and the brain Promoting exercise behavior in older adults: using a cognitive behavioral intervention. Comparative effects of two physical activity programs on measured and perceived physical functioning and other health-related quality of life outcomes in older adults. Exercise Is Associated with Reduced Risk for Incident Dementia among Persons 65 Years of Age and Older Effect of a Dual-Task Net-Step Exercise on Cognitive and Gait Function in Older Adults
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 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 Background Older adults are encouraged to participate in regular physical activity to counter the age-related declines in physical and cognitive health . Literature on the effect of different exercise training modalities ( aerobic vs resistance ) on these health-related outcomes is not only sparse , but results are inconsistent . In general , it is believed that exercise has a positive effect on executive cognitive function , possibly because of the physiological adaptations through increases in fitness . Indications are that high-intensity interval training is a potent stimulus to improve cardiovascular fitness , even in older adults ; however , its effect on cognitive function has not been studied before . Therefore , the purpose of this study was to compare the effects of resistance training , high-intensity aerobic interval training and moderate continuous aerobic training on the cognitive and physical functioning of healthy older adults . Methods Sixty-seven inactive individuals ( 55 to 75 years ) were r and omly assigned to a resistance training ( RT ) group ( n = 22 ) , high-intensity aerobic interval training ( HIIT ) group ( n = 13 ) , moderate continuous aerobic training ( MCT ) group ( n = 13 ) and a control ( CON ) group ( n = 19 ) for a period of 16 weeks . Cognitive function was assessed with a Stroop task and physical function with the Timed-Up- and -Go ( TUG ) and submaximal Bruce treadmill tests . Results No significant GROUP x TIME interaction was found for Stroop reaction time ( P > .05 ) . The HIIT group showed the greatest practical significant improvement in reaction time on the information processing task , i.e. Stroop Neutral ( ES = 1.11 ) . MCT group participants had very large practical significant improvements in reaction time on the executive cognitive tasks , i.e. Stroop Incongruent and Interference ( ES = 1.28 and 1.31 , respectively ) . The HIIT group showed the largest practically significant increase in measures of physical function , i.e. walking endurance ( ES = 0.91 ) and functional mobility ( ES = 0.36 ) . Conclusions MCT and RT proved to be superior to HIIT for the enhancement of older individuals ’ executive cognitive function ; whereas HIIT were most beneficial for improvement in information processing speed . HIIT also induced the largest gains in physical function With ageing , older people can become frail , and this has been shown to be associated with a decrease in well-being . Observational studies provide evidence of a positive effect of coping re sources on well-being . The question is : can coping re sources be improved in vulnerable older people ? The Chronic Disease Self-Management Program ( CDSMP ) is a target group-specific intervention which aims to promote the self-management of older people who are confronted with deteriorating health . The aim of this study was to review intervention studies focusing on the CDSMP and to draw conclusions on the benefits of the program . A systematic search was conducted in PubMed and PsychINFO to identify r and omized controlled trials ( RCTs ) focusing on the CDSMP .  Nine RCTs focusing on relatively young older adults , 75 % of whom with an average age between 49 and 65 years , were included . We found that the CDSMP was consistently beneficial for Health behaviour , especially with regard to the variables of exercise and self-care . For Health status , the majority of studies only showed improvement in the domain of health distress . Most of the studies that investigated Self-efficacy showed convincing improvement in self-efficacy , cognitive symptom management and mental stress management . In Health care utilization , there was no significant decrease . On the whole , the studies showed that CDSMP led to an increase in physical exercise , a decrease in health distress , an improvement in self-care , and it had a beneficial effect on self-efficacy Background To counteract decline in physical performance and physical activity in older patients during hospitalization , multiple physical interventions were developed . However , it is unknown whether these are effective in this particular population . This systematic review aim ed to identify the effect of physical interventions on physical performance and physical activity in older patients during hospitalization . Methods The systematic search included PubMed , EMBASE , Cinahl , the Trials data base of The Cochrane Library and SPORTd iscus from inception to 22 November 2017 . Studies were included if the mean age of the patient cohort was 65 years and older and the effect of physical interventions on  physical performance or physical activity  was evaluated during hospitalization . Results Fifteen r and omized controlled trials met the inclusion criteria . Overall , the effect of physical interventions on physical performance was inconsistent . Patient tailored interventions , i.e. continuously adapted to the capabilities of the patient were not found to be superior over interventions that were not . Physical activity as outcome measure was not addressed . Reporting of intensity of the interventions and adherence were frequently lacking . Conclusions Evidence for the effect of physical interventions on physical performance in older patients during hospitalization was found uncertain . Further research on the efficacy of the intervention is needed , comparing types of intervention with detailed reporting of frequency , intensity and duration Purpose of review This review highlights recent work evaluating the relationship between exercise , physical activity and physical and mental health . Both cross-sectional and longitudinal studies , as well as r and omized clinical trials , are included . Special attention is given to physical conditions , including obesity , cancer , cardiovascular disease and sexual dysfunction . Furthermore , studies relating physical activity to depression and other mood states are review ed . The studies include diverse ethnic population s , including men and women , as well as several age groups ( e.g. adolescents , middle-aged and older adults ) . Recent findings Results of the studies continue to support a growing literature suggesting that exercise , physical activity and physical-activity interventions have beneficial effects across several physical and mental-health outcomes . Generally , participants engaging in regular physical activity display more desirable health outcomes across a variety of physical conditions . Similarly , participants in r and omized clinical trials of physical-activity interventions show better health outcomes , including better general and health-related quality of life , better functional capacity and better mood states . Summary The studies have several implication s for clinical practice and research . Most work suggests that exercise and physical activity are associated with better quality of life and health outcomes . Therefore , assessment and promotion of exercise and physical activity may be beneficial in achieving desired benefits across several population s. Several limitations were noted , particularly in research involving r and omized clinical trials . These trials tend to involve limited sample sizes with short follow-up periods , thus limiting the clinical implication s of the benefits associated with physical activity . Abbreviations CAD : coronary artery disease ; COPD : chronic obstructive pulmonary disease ; CRP : cardiac rehabilitation program ; CVD : cardiovascular disease ; GMCB : group-mediated cognitive – behavioural ; HRQOL : health-related quality of life Abstract The health benefits of playing football and the importance of exercise and social contact for healthy ageing are well established , but few older adults in the UK take enough exercise . Football is popular , flexible in format and draws players into engrossing , effortful and social exercise , but the physical dem and s of play at full speed may make it unsustainable for some older adults . Restricted to walking pace , will play still be engaging ? Will health benefits be retained ? Will physical dem and s remain manageable ? This pilot study aims to investigate : ( 1 ) the experience of older adults playing walking football  every week , is it sustainable and rewarding , ( 2 ) the intensity and locomotor pattern of walking football , ( 3 ) the scale and nature of walking football  health benefits and ( 4 ) possible cognitive benefits of playing walking football through measures of processing speed , selective and divided attention and updating and inhibition components of executive function .  ‘ Walking football ’ and ‘ waiting list ’ groups were compared before and after 12 weeks of one-hour per week football . Walking football was found to be engaging , sustainable for older adults and moderately intensive ; however , selective health and cognitive benefits were not found from this brief intervention . Highlights Walking football is a lower impact but authentic form of football that enables older players to extend their active participation . Walking football is enjoyable and moderately dem and ing and may be a sustainable form of exercise for older adults . Health and cognitive benefits to playing walking football were not found Dementia cases are increasing worldwide ; thus , investigators seek to identify interventions that might prevent or ameliorate cognitive decline in later life . Extensive research confirms the benefits of physical exercise for brain health , yet only a fraction of older adults exercise regularly . Interactive mental and physical exercise , as in aerobic exergaming , not only motivates , but has also been found to yield cognitive benefit above and beyond traditional exercise . This pilot study sought to investigate whether greater cognitive challenge while exergaming would yield differential outcomes in executive function and generalize to everyday functioning . Sixty-four community based older adults ( mean age=82 ) were r and omly assigned to pedal a stationary bike , while interactively engaging on-screen with : ( 1 ) a low cognitive dem and task ( bike tour ) , or ( 2 ) a high cognitive dem and task ( video game ) .  Executive function ( indices from Trails , Stroop and Digit Span ) was assessed before and after a single-bout and 3-month exercise intervention . Significant group × time interactions were found after a single-bout ( Color Trails ) and after 3 months of exergaming ( Stroop ; among 20 adherents ) . Those in the high cognitive dem and group performed better than those in the low cognitive dose condition . Everyday function improved across both exercise conditions . Pilot data indicate that for older adults , cognitive benefit while exergaming increased concomitantly with higher doses of interactive mental challenge BACKGROUND Despite well-known benefits of physical activity for older adults , about two thirds are underactive . Community-based programs are needed to facilitate increased physical activity . We examine the effectiveness of CHAMPS II , an inclusive , choice-based physical activity promotion program to increase lifetime physical activity levels of seniors . CHAMPS guided participants to choose activities that took into account their health , preferences , and abilities . It offered information on ways for them to exercise safely , motivate themselves , overcome barriers , and develop a balanced exercise regimen . METHODS A 1-year r and omized controlled trial was conducted with physically underactive seniors in a multispecialty group practice . Changes in self-reported physical activity by group were evaluated using ANCOVA , controlling for age and sex . RESULTS Of 173 r and omized subjects , 164 ( 95 % ) completed the trial . Subjects were aged 65 to 90 years ( M = 74 , SD = 6 ) ; 66 % were female . The intervention group increased estimated caloric expenditure by 487 calories/week in moderate ( or greater ) intensity activities ( MET > /= 3.0 ; p < .001 ) and by 687 calories/week in physical activities of any intensity ( p < .001 ) . Control group changes were negligible . Between-group analyses found that the changes were significantly different in both measures ( p values < .05 ) . Overweight persons especially benefited from this program . The program was as effective for women , older adults ( 75 + ) , and those who did not set aside time to exercise at baseline . CONCLUSIONS The program led to meaningful physical activity increases . Individually tailored programs to encourage lifestyle changes in seniors may be effective and applicable to health care and community setting OBJECTIVES Frailty is a state of vulnerability associated with increased risks of fall , hospitalization , cognitive deficits , and psychological distress . Studies with healthy senior suggest that physical exercise can help improve cognition and quality of life . Whether frail older adults can show such benefits remains to be documented . METHOD A total of 83 participants aged 61 - 89 years were assigned to an exercise-training group ( 3 times a week for 12 weeks ) or a control group ( waiting list ) . Frailty was determined by a complete geriatric examination using specific criteria . Pre- and post-test measures assessed physical capacity , cognitive performance , and quality of life . RESULTS Compared with controls , the intervention group showed significant improvement in physical capacity ( functional capacities and physical endurance ) , cognitive performance ( executive functions , processing speed , and working memory ) , and quality of life ( global quality of life , leisure activities , physical capacity , social/family relationships , and physical health ) . Benefits were overall equivalent between frail and nonfrail participants . DISCUSSION Physical exercise training leads to improved cognitive functioning and psychological well-being in frail older adults Increasing evidence suggests that physical activity can prevent some aspects of mental illness in older people such as depression , dementia and Alzheimer ’s disease . Additionally , limited research has shown that engagement in structured exercise can improve aspects of psychological well-being such as mood and self-perceptions in older adults . However , the relationship between incidental daily activity such as walking or time spent sedentary , with psychological well-being has not been investigated . The Better Ageing Project provided an opportunity to assess well-being and quality of life using st and ardised question naires with 176 adults aged 70 and over .  Accelerometry was used to objective ly assess daily energy expended in physical activity at different levels of intensity . In addition , an assessment of the impact of the 12-month Better Ageing structured group exercise programme was assessed through question naires and interviews . Total daily physical activity energy expenditure ( joules/day ) and amount of time spent in activity of at least moderate intensity were weakly related ( r = 0.20–0.28 ) to quality of life , subjective well-being and physical self-perceptions . Time spent sedentary ( min/day ) was weakly and negatively related to several mental health indicators . The quantitative data showed only minor psychological benefits of the exercise intervention . In contrast , interviews with 27 research participants and 4 exercise leaders suggested that important improvements in perceived function and social benefits had been experienced BACKGROUND Age-related loss in physiologic capacities contributes to the decline in physical function in the elderly population . Despite the beneficial effects of exercise interventions on maximal physiologic capacity measures , the functional benefits have not been shown in independently living older adults . The objective of this study was to evaluate exercise in independent older adults for significant and meaningful improvements in physical function , not detected by commonly used measures of physical function . METHODS In a r and omized controlled study , 49 independently living men and women were assigned to either a nonexercise control group ( Control ; n = 26 ) or an exercise training group ( Exercise ; n = 23 ) . Participants ( age = 76+/-4 ) in good general health were recruited from retirement communities or apartments . The combined endurance and strength training was performed at 75 % to 80 % intensity ; the groups met 3 times/week for 6 months of supervised sessions . Outcome measures included physical capacity , health status , and physical function using a newly developed performance test -- the Continuous Scale-Physical Functional Performance test ( CS-PFP ) . RESULTS Compared to the Control group , the Exercise group showed significant increases in maximal oxygen consumption ( 11 % ) and muscle strength ( 33 % ) . No significant differences were found between groups for changes in the Sickness Impact Profile , SF-36 scales , or the 6-minute walk . However , the CS-PFP score improved significantly in the Exercise group ( 14 % , effect size 0.80 ) . CONCLUSIONS Independent older adults gain meaningful functional benefits from several months of exercise training . The public health importance of physical activity may relate not just to its role in preventing decline , but also to its role in enhancing physical function Numerous studies have examined the relationship between physical activity and cognitive function , demonstrating that greater physical activity is associated with lower incidence of cognitive impairment in later life . Due to an increasingly large number of older adults at risk for cognitive impairment , the relationship between physical activity and cognition has garnered increasing public health relevance and multiple r and omized trials have demonstrated that exercise interventions among sedentary adults improve cognitive performance in multiple domains of function . This article will examine the relationship between physical activity and cognitive function by review ing several different areas of literature , including the prevalence of cognitive impairment , assessment methods , observational studies examining physical activity and cognition , and intervention studies . The present review is intended to provide a historical tutorial of existing literature linking  physical activity , exercise , and cognitive function among both healthy and clinical population Purpose Physical exercise and cognitive training have been shown to enhance cognition among older adults . However , few studies have looked at the potential synergetic effects of combining physical and cognitive training in a single study . Prior trials on combined training have led to interesting yet equivocal results . The aim of this study was to examine the effects of combined physical and cognitive interventions on physical fitness and neuropsychological performance in healthy older adults . Methods Seventy-six participants were r and omly assigned to one of four training combinations using a 2 × 2 factorial design . The physical intervention was a mixed aerobic and resistance training program , and the cognitive intervention was a dual-task ( DT ) training program . Stretching and toning exercises and computer lessons were used as active control conditions  . Physical and cognitive measures were collected pre- and postintervention . Results All groups showed equivalent improvements in measures of functional mobility . The aerobic – strength condition led to larger effect size in lower body strength , independently of cognitive training . All groups showed improved speed of processing and inhibition abilities , but only participants who took part in the DT training , independently of physical training , showed increased task-switching abilities . The level of functional mobility after intervention was significantly associated with task-switching abilities . Conclusion Combined training did not yield synergetic effects . However , DT training did lead to transfer effects on executive performance in neuropsychological tests . Both aerobic-resistance training and stretching-toning exercises can improve functional mobility in older adults Introduction The health benefits of regular cardiovascular exercise are well-known . Such exercise , however , has traditionally been defined as vigorous physical activity , such as jogging , swimming , or aerobic dance . Exercise of moderate intensity also promotes health , and many U.S. adults may be experiencing the health benefits of exercise through lifestyle activities of moderate intensity , such as yard work , housework , or walking for transportation . Until recently , public health surveillance systems have not included assessment s of this type of physical activity , focusing on exercise of vigorous intensity . We used an enhanced surveillance tool to describe the prevalence and amount of both moderate-intensity and vigorous-intensity physical activity among U.S. adults . Methods We analyzed data from the 2001 Behavioral Risk Factor Surveillance System , a state-based , r and om-digit  – dialed telephone survey administered to U.S. adults aged 18 years and older ( n = 82,834 men and 120,286 women ) .  Physical activity behavior was assessed using questions design ed to quantify the frequency of participation in moderate- or vigorous-intensity physical activities performed during leisure time or for household chores and transportation . Results Overall , 45 % of adults ( 48 % of men and 43 % of women ) were active at recommended levels during nonworking hours ( at least 30 minutes five or more days per week in moderate-intensity activities , equivalent to brisk walking , or at least 20 minutes three or more days per week in vigorous activities , equivalent to running , heavy yard work , or aerobic dance ) . Less than 16 % of adults ( 15 % of men and 17 % of women ) reported no moderate or vigorous activity in a usual week . Conclusion Integrating surveillance of lifestyle activities into national systems is possible , and doing so may provide a more accurate representation of the prevalence of recommended levels of physical activity . These results , however , suggest that the majority of U.S. adults are not active at levels associated with the promotion and maintenance of health This systematic review examines the effectiveness of current exercise interventions for the management of frailty . Eight electronic data bases were search ed for r and omized controlled trials that identified their participants as “ frail ” either in the title , abstract , and /or text and included exercise as an independent component of the intervention . Three of the 47 included studies utilized a vali date d definition of frailty to categorize participants . Emerging evidence suggests that exercise  has a positive impact on some physical determinants and on all functional ability outcomes reported in this systematic review . Exercise programs that optimize the health of frail older adults seem to be different from those recommended for healthy older adults . There was a paucity of evidence to characterize the most beneficial exercise program for this population . However , multicomponent training interventions , of long duration ( ≥5 months ) , performed three times per week , for 30–45 minutes per session , generally had superior outcomes than other exercise programs . In conclusion , structured exercise training seems to have a positive impact on frail older adults and may be used for the management of frailty PURPOSE To evaluate the influence of exercise on falls and fall risk reduction  in community-dwelling older adults and to present an up date d synthesis of outcome measures for the assessment of fall risk in community-dwelling older adults . METHOD A systematic review was performed , considering English- language articles published from 2000 to 2006 and accessible through MEDLINE , CINAHL , PEDro , EMBASE , and /or AMED . Included were r and omized controlled clinical trials ( RCTs ) that used an exercise or physical activity intervention and involved participants over age 50 . Screening and method ological quality for internal validity were conducted by two independent review ers . RESULTS The search retrieved 156 abstract s ; 22 articles met the internal validity criteria . Both individualized and group exercise programmes were found to be effective in reducing falls and fall risk . The optimal type , frequency , and dose of exercise to achieve a positive effect have not been determined . A variety of outcome measures have been used to measure fall risk , especially for balance . CONCLUSIONS Falls and fall risk can be reduced with exercise interventions in the community-dwelling elderly , although the most effective exercise variables are unknown . Future studies in population s with comorbidities known to increase fall risk will help determine optimal , condition-specific fall-prevention programmes . Poor balance is a key risk factor for falls ; therefore , the best measure of this variable should be selected when evaluating patients at risk of falling OBJECTIVES We examined the impact of a prenatal exercise intervention on physical activity in 260 women at risk for gestational diabetes mellitus . METHODS We r and omized participants in the Behaviors Affecting Baby and You ( BABY ) Study , which took place from 2007 to 2012 , to either a 12-week individually tailored , motivationally matched exercise intervention ( n=132 ) or to a comparison health and wellness intervention ( n=128 ) . We assessed physical activity with the Pregnancy Physical Activity Question naire . We used linear mixed models to evaluate the impact of the interventions on change in physical activity according to intensity and type , total walking , and sedentary behavior . RESULTS Compared with the health and wellness arm , the exercise arm had significantly greater increases in sports or exercise activity ( 0.3 vs 5.3 metabolic equivalent of task [ MET ] hours/week ; P<.001 ) , and smaller declines in total activity ( -42.7 vs -2.1 MET hours/week ; P=.02 ) and activities of moderate to vigorous intensity ( -30.6 vs -10.6 MET hours/week ; P=.05 ) , and was more likely to achieve recommended guidelines for physical activity ( odds ratio=2.12 ; 95 % confidence interval=1.45 , 3.10 ) . CONCLUSIONS These findings extend the previous literature by demonstrating the benefits of a clinical ly feasible exercise intervention in an ethnically and socio-economically diverse population . Given the increased risk of adverse maternal health outcomes in ethnic minority groups , these findings may have important implication s for reducing health disparities Cognitive decline is one of the most pressing healthcare issues of the 21st century . Worldwide , one new case of major cognitive decline ( ie , dementia ) is detected every 4 s.1 Given that no effective pharmacological treatment to alter the progress of cognitive decline exists , there is much interest in lifestyle approaches for preventing or treating dementia . Ideally , such strategies should be cost-efficient and widely accessible at a societal level to have the largest benefit for older adults with varying income and functional status levels . One attractive solution that aligns with the above criteria is exercise . However , despite a large and consistent pool of evidence generated over the past five decades linking exercise to improved cognitive functions in older adults,2 there is a reluctance among academics , healthcare practitioners and the public alike to embrace exercise as a prevention and treatment strategy for cognitive decline . For example , the National Institutes of Health ( NIH ) consensus statement from 20103 concedes that there appears to be preliminary data to support the efficacy of exercise in improving cognitive function . However , they caution that there is currently no strong evidence to suggest that modifiable lifestyle factors can alter the trajectory of cognitive decline . Adding fuel to the fire are publications such as a 2013 systematic review of r and omised controlled trials ( RCTs ) ( prior to 31 October 2011 ) reporting ‘ weak ’ evidence for the effects of exercise on cognition.4 We must highlight that the search strategy used in that systematic review failed to capture many pertinent papers providing evidence from RCTs that exercise  promotes cognitive and brain plasticity not only in healthy older adults but also in those with cognitive impairment . Furthermore , there are a number of animal studies that provide insight into the molecular and cellular mechanisms by which exercise  promotes neuroplasticity.5 In a previous commentary , Health benefits associated with exercise are only obtained when exercise is maintained . The purpose of this pilot study was to examine the effects of a cognitive behavioral therapy ( CBT ) intervention on exercise behavior and physical outcomes in older adults . All participants were taught progressive flexibility , strength , and endurance exercises . The control group received no additional treatment . The experimental group was taught to recognize negative thoughts related to exercise and to counter these thoughts with more positive ones . Subsequent exercise behavior and physical outcomes were measured in all participants . Cognitive behavioral therapy was moderately to largely effective in improving the majority of physical outcomes assessed . In addition , CBT was moderately effective in improving several components of self-reported exercise behavior and mildly effective in improving exercise behavior overall . Results suggest that nurses can train older adults to identify and modify thoughts that interfere with or reduce their exercise behavior and thus improve physical functioning BACKGROUND Although inactivity is an important contributor to impaired functioning and disability with age , little is known concerning how improvements in physical functioning and well-being in older adults vary with the type of physical activity undertaken . METHODS One hundred three adults age 65 years and older , recruited via population -based methods , were r and omized to 12 months of community-based , moderate-intensity endurance and strengthening exercises ( Fit & Firm ) or stretching and flexibility exercises ( Stretch & Flex ) . A combination of class- and home-based exercise formats was used . Measured and self-rated physical performance along with perceived functioning and well-being were assessed pre- and postintervention . RESULTS Fit & Firm subjects showed greater 12-month improvements in both measured and self-rated endurance and strength compared to Stretch & Flex subjects . Stretch & Flex subjects reported greater improvements in bodily pain , and Stretch & Flex men evidence d greater improvements in flexibility relative to Fit & Firm subjects . Although overall exercise adherence was high in both exercise conditions ( approximately 80 % ) , subjects in both conditions showed better adherence to the home- versus class-based portions of their exercise prescriptions . CONCLUSIONS Community-based programs focusing on moderate-intensity endurance and strengthening exercises or flexibility exercises can be delivered through a combination of formats that result in improvement in important functional and well-being outcomes . This represents one of the first studies to report significant improvements in an important quality of life outcome -bodily pain-with a regular regimen of stretching and flexibility exercises in a community-based sample of older adults Context Some studies suggest that people with high levels of physical activity are less likely to develop dementia . Content All 1740 participants in this cohort study were 65 years of age or older and were cognitively intact at baseline . Over 6.2 years , the rate of dementia was 13.0 per 1000 person-years in those who exercised 3 or more times per week and 19.7 per 1000 person-years in those who exercised less than 3 times per week . Limitations The only measure of exercise intensity was self-reported frequency . The cohort was largely white and well-educated . Implication s This study adds to the evidence that regular exercise is associated with a lower risk for dementia . However , the existing evidence does not prove that regular exercise is associated with a lower dementia risk . The Editors Alzheimer disease and other dementing illnesses are major sources of morbidity and mortality ( 1 - 3 ) that affect millions of persons in the increasingly aging society of the United States . Research design ed to discover strategies to delay onset and progression of these potentially devastating illnesses is ongoing worldwide . Effective prevention strategies would result in substantial benefits through improved quality of life , prolonged independent life expectancy , and reduced economic cost and social burdens .  Regular physical exercise is an important element in overall health promotion ( 4 ) and might also be an effective strategy to delay onset of dementia ( 5 ) . A biological basis for how physical exercise might preserve brain function includes improved cerebral blood flow and oxygen delivery ( 6 ) and inducing fibroblast growth factor in the hippocampus ( 7 ) . More recent evidence suggests that reduced loss of hippocampal brain tissue in the aging brain is related to level of physical fitness ( 8) . Evidence from some longitudinal studies and r and omized trials suggests that physical exercise enhances cognitive function in older adults ( 9 - 15 ) , whereas other studies have failed to observe the benefits of physical exercise in preserving cognitive function ( 16 - 19 ) . Many people regard Alzheimer disease as one of the most dreaded consequences of aging . If regular physical exercise were shown to be effective in reducing the risk or delaying the onset of dementing illnesses , it would be another compelling reason to promote physical exercise . Few population -based longitudinal studies have examined the role of physical exercise on the risk for dementia in elderly persons . One recent longitudinal study showed that physical exercise was associated with decreased risk for decline in cognitive function ( odds ratio [ OR ] , 0.58 ) , Alzheimer disease ( OR , 0.50 ) , and any dementia ( OR , 0.63 ) ( 11 ) , whereas another longitudinal study showed no association between physical exercise and dementia ( 16 ) . More recent studies showed that walking was associated with a reduced risk for dementia and Alzheimer disease in a cohort of Japanese-American men ( 20 ) and that engaging in more diverse physical activities was associated with a reduced risk for dementia in the Cardiovascular Health Study ( 21 ) . The purpose of this study was 2-fold : 1 ) to determine whether regular exercise is associated with a reduced risk for incidence of dementia ( in particular , Alzheimer disease ) in a cohort followed biennially over 6 years and 2 ) to examine whether the association of physical exercise with incident dementia is modulated by other potential risk factors , such as depression , cardiovascular and cerebrovascular disease , diabetes , apolipoprotein E 4 allele , cognitive function , physical function , self-rated health , and lifestyle characteristics . Methods Study Sample The Adult Changes in Thought ( ACT ) study is a population -based , longitudinal study of aging and dementia . The ACT study was design ed to determine the incidence of Alzheimer disease , other types of dementia , and cognitive impairment as well as to determine risk factors for these conditions . The details of the ACT study have been described elsewhere ( 22 , 23 ) . Briefly , a r and om sample of 6782 individuals was drawn from Seattle-area members of Group Health Cooperative ( GHC ) , a consumer-governed health maintenance organization . The participants were 65 years of age and older when the study began in 1994 to 1996 . Those who had an existing diagnosis of dementia , were current residents of a nursing home , or were participating in other studies were ineligible ( n= 1360 ) . Of 5422 eligible persons , 2581 participated and 2841 declined participation . Age , sex , and ethnicity of the remaining 2581 participants did not differ significantly from those who were excluded . Nonresponse has been described elsewhere ( 22 ) . Declining to participate was more common among the oldest age group ( > 85 years ) , women , and African-American and minority groups ( 22 ) . Additional details regarding the incident rates of dementia and Alzheimer disease from the ACT study have been published elsewhere and are consistent with rates reported in U.S. and European cohort studies ( 22 ) . The institutional review boards of the University of Washington and Group Health Cooperative approved the ACT study . Participants received the  Cognitive Ability Screening Instrument ( CASI ) ( 24 ) as initial screening for cognitive function and were interviewed with structured question naires to obtain data , including demographic characteristics , medical history , memory and general functioning , and potential epidemiologic risk factors . Persons scoring 86 or higher on the CASI were entered directly into the ACT cohort as being cognitively intact . ( The CASI scores range from 0 to 100 ; a score of 86 corresponds to a Mini-Mental State Examination score of 25 to 26 . ) Persons with a score lower than 86 had additional medical record review and st and ardized clinical and neuropsychological evaluation for dementia . Persons who did not meet established criteria for dementia ( 25 ) were included in the ACT cohort . The current study sample was selected from the 2581 ACT participants to examine the temporal relationship of physical exercise preceding development of dementia . By design , we selected the 1895 persons whose CASI scores were above the 25th percentileCASI scores 91 to 100 . We excluded 686 persons whose CASI scores were in the lowest quartileCASI scores 62 to 90because the lowest quartile group might include persons who had mild cognitive impairment or impending dementia ( 26 ) . We did not collect information about the history of exercise before the participants entered the study . Therefore , in the group with low CASI scores , we could not be certain whether a reported low level of physical exercise preceded the development of dementia or was a consequence of the development of cognitive impairment or dementia . Of 1895 participants selected , 155 withdrew after the baseline visit and did not have a follow-up examination and were thus excluded from the analyses , leaving the analytic sample of 1740 persons . Incident Dementia We conducted biennial examinations to identify cases of incident dementia , when participants were rescreened with the CASI . Those who scored 86 or higher on the CASI remained in the ACT cohort . Scores on the CASI that were less than 86 at follow-up prompted a full st and ardized clinical examination . The results of rescreening by the CASI and by the clinical and neuropsychological examinations were review ed at a consensus diagnosis conference that included at least the examining physician , a neuropsychologist , another study physician , and the study nurse . Persons who did not meet the criteria for dementia were considered as not having dementia and were followed in the ACT cohort ( 22 , 23 ) . Persons who met the Diagnostic and Statistical Manual of Mental Disorders , fourth edition ( DSM-IV ) , criteria ( 25 ) for dementia were considered to have incident dementia . Dementia type was determined by the National Institute of Neurological and Communicative Diseases and Stroke-Alzheimer 's Disease and Related Disorders Association ( NINCDS-ADRDA ) criteria ( 27 ) for Alzheimer disease and by the DSM-IV criteria ( 25 ) for other types of dementia . Level of physical activity was not considered at the consensus conference . Physical Exercise Physical exercise was assessed at baseline by asking participants the number of days per week they did each of the following activities for at least 15 minutes at a time during the past year : walking , hiking , bicycling , aerobics or calisthenics , swimming , water aerobics , weight training or stretching , or other exercise . The frequency of exercise was calculated by the times per week that participants engaged in any of these forms of exercise . In this study , persons who exercised at least 3 times a week , above the lowest quartile , were classified as exercising regularly . Baseline Variables as Potential Confounders Numerous factors may influence the relationship between exercise and risk for dementia , including physical functioning , cognitive function , depression , health conditions , and lifestyle characteristics . Physical function was assessed by a performance-based physical function ( PPF ) test ( 23 ) , which consisted of 4 performance tests : 10-foot timed walk , time to st and from a seated position in a chair to a st and ing position 5 times , balance test , and grip strength in the dominant h and . Each test was scored from 0 to 4 points . The final PPF score was the sum of the scores for the 4 performance tests and ranged from 0 to 16 ; higher scores indicated better physical function . Details of the PPF test have been reported elsewhere ( 23 ) . Cognitive function was assessed by using the CASI , which provides quantitative assessment of attention , concentration , orientation , short-term memory , long-term memory , language ability , visual construction , list-generating fluency , abstract ion , and judgment ( 24 ) . At baseline , depression was measured by using the 11-item Center for Epidemiologic Studies Depression ( CES-D ) scale ( 28 ) . The CES-D scores ranged from 0 to 33 , with higher scores Background and Purpose : Participation in generally recommended aerobics or strength exercises may be challenging for older adults . Therefore , it is necessary to consider the types and levels of physical activities suited for them to improve their cognitive and gait function and adherence to exercise programs . This has prompted efforts to identify exercises that require less physical strength and frequency of performance , while still offering cognitive and health benefits . Here , we aim ed to assess the effect of a novel dual-task net-step exercise ( NSE ) performed once a week for 8 consecutive weeks on improvements in cognitive performance and gait function in an older population . Methods : In this pretest/posttest experimental case control study , 60 healthy older adults ( mean age 76.4 years ) were recruited from community-dwelling people and separated r and omly into 2 groups : a dual-task NSE group and a control group . The NSE group was asked to walk across a net without stepping on the ropes or being caught in the net . Two computer panel-type cognitive functional assessment s , the Touch-M and Touch Panel-Type Dementia Assessment Scale , were administered at baseline and after 8 weeks of intervention to determine the effects of NSE . Improvements in gait function were also evaluated using Timed Up and Go test scores . Mixed-effect models with repeated measures ( group × time ) ( analysis of variance , F test ) were used to test the effects of NSE . Adjustments were made for covariates including age and sex ( analysis of covariance ) . Results : The NSE group showed significant improvement in cognitive performance ( 6.8 % change ; total Touch-M score 5.4 points ; P = .04 ) and gait performance ( 11.5 % change ; Timed Up and Go time −0.98 second ; P < .001 ) over the 8-week period . In the control group , there was no significant improvement . Conclusions : This study shows that dual-task NSE is capable of improving cognitive and gait performance in healthy older adults . Our results indicate that NSE offers an option for a large segment of the older population who need an easier way to maintain their cognitive health and gait function
Conclusions The current literature suggests the effectiveness of low-intensity exercise on improved physical and cognitive health for older adults .
It may be a desired intensity level in promoting health among older adults with better compliance , lower risk of injuries , and long-term sustainability
Background It is well known that physical exercise is important to promote physical and cognitive health in older population .
However , inconsistent research findings were shown regarding exercise intensity , particularly on whether low-intensity exercise ( 1.5 metabolic equivalent tasks ( METs ) to 3.0 METs ) can improve physical and cognitive health of older adults .
This systematic review aim ed to fill this research gap .
The objective of this study is to conduct a systematic review of the effectiveness of low-intensity exercise interventions on physical and cognitive health of older adults .