Task Specific Exercise for the Prevention of Disability

The purpose of this research study is to evaluate the effect of two different exercise programs on physical function in men and women 60 years of age and older.

Pre-clinical disability is an early warning system in the disablement process as it is characterized by selecting to perform everyday tasks less often and compensating for those tasks still being performed. This phase serves as an ideal target for preventative strategies because treatments can be designed for individuals on the verge of disability thus interrupting the occurrence of outright disability. One such strategy that optimizes the transfer of adaptations to real-life situations is task-specific exercise (TSE). This type of intervention holds promise to determine how pre-clinically disabled older adults might interrupt the disablement process and instead begin an enablement process and thus lead us to better interventions to treat and prevent disability from occurring. However, because of the complexity of the disablement process, it has been extremely challenging to objectively identify outcomes that represent changes in selection, optimization, and compensation of tasks (the SOC domains). The objective of the current application is first, to ask what are the short and long-term responses of TSE in the pre-clinically disabled older adults (aged 60+ years). Thirdly, we will shed exciting new light on whether TSE alters neuromechanical and psychological factors. We want to know this, in part, from a mechanistic perspective to gain insight into the processes by which TSE improves disablement outcomes. Also, this will help us to better understand how to enhance the TSE intervention to treat pre-clinically disabled patients. Thus, we offer two hypotheses: Hypothesis #1: TSE increases selection and optimization of everyday tasks, while reducing compensation to achieve task performance. Hypothesis #2. TSE mediates changes in SOC domains through both neuromechanical (decrease variability of movement and increase muscle work capacity) and psychological (increased confidence to perform tasks and increased executive function) properties. These data are expected to guide us in designing a randomized controlled trial that will test whether TSE in the pre-clinically disabled can reduce future incidence of outright disability.

Eligibility Criteria:
Inclusion Criteria:

* Age: 60+ years
* Self-report no difficulty walking ½ mile, climbing steps, stooping-crouching-kneeling, getting up off the floor, or lifting/carrying something as heavy as 10 lbs
* Modified the method of frequency of walking ½ mile, climbing steps, stooping-crouching-kneeling, getting up off the floor or lifting/carrying something as heavy as 10 lbs
* Observed use of 7 or more modifications plus a score of 2 or greater on at least two tasks on the MOD scale
* Sedentary lifestyle ( \< 125 minutes walking or performing aerobic exercise)
* Successful completion of the behavioral run-in without the assistance of a spouse or other family or friend
* Willing and able to participate in all aspects of the pilot study, i.e., randomization, pre- and post-testing, home evaluation
* Willing to give and informed consent

Exclusion Criteria:

* Self-reporting having "any difficulty" walking ½ mile, climbing steps, stooping-crouching-kneeling, getting up off the floor, or lifting/carrying something as heavy as 10 lbs
* Failure to give consent
* Active Treatment for cancer
* Stroke (\<6 mo)
* Neurological disorder
* Peripheral vascular disease
* Congestive heart failure (NYHA class II, III or IV), coronary artery disease (myocardial infarction \<6 mo) or valvular heart disease
* Major psychiatric disease
* Severe anemia
* Liver or renal disease
* Uncontrolled diabetes or hypertension
* Macular degeneration
* Blindness or deafness
* Orthopedic impairment
* Rheumatoid arthritis or severe osteoarthritis
* Fracture in upper or lower extremity within last 6 months
* Upper or lower extremity amputation
* Participation in another intervention trial
* Inability to perform exercise due to severe physical disability
* MMSE \< 24
* Plans to move within the next year