Swiss Junior Doctors and Undergraduate Perspective on Sport and Exercise Medicine Blog Series

By Michiel R.M. Twiss (@physiotwiss)

Which exercise methods are most effective for improving physical fitness (PF) and functional performance fitness (FPF) in older adults? Exercise (EX) enables participation in physical pursuits, including sports and contributes to personal independence, self-care and quality of life in healthy as well as vulnerable older adults. Recognizing exercise medicine has influential rehabilitative, preventive and curative potential, investigating exercise in older adults remains of great importance (Singh, 2002; Frankel, Bean, & Frontera, 2006; McDermott & Mernitz, 2006).

Physical Fitness (PF), Physical Activity (PA), Exercise (EX)

PF relates to the ability to perform physical activity (PA) and includes cardiorespiratory fitness, muscle strength, muscle power, body composition and flexibility (Caspersen et al., 1985; Shephard & Balady, 1999). PA and EX are important contributors to maintaining high levels of activity and independence among elderly men and women. PA can be defined as all bodily movement that results from the contraction of skeletal muscles and results in increased energy expenditure. EX in older adults is an important aspect of PA behavior. EX can be defined as a subset of PA that is planned, structured and repetitive and aims to improve or maintain PF (Caspersen, Powell, & Christenson, 1985). As an essential contributor to PF and FPF in older adults and a powerful non-pharmaceutical activity with preventive, rehabilitative and curative effects, PA and in particular EX affect risk factors for a multitude of chronic diseases (Pedersen & Saltin, 2015). In addition, EX’s influential effects have been shown to be similar and sometimes superior compared to standard pharmaceutical care in the treatment of certain diseases (Naci & Loannidis, 2015; Fiuza-Luces, Garatachea, Berger, & Lucia, 2013).

Through EX, healthy and independently living older individuals are able to maintain or improve PF and FPF. Chronically diseased, vulnerable older adults may too benefit from EX as a way to maintain or increase PF and FPF, ultimately and perhaps profoundly affecting multimorbidity, disease risk, risk of falling and fall related injuries, disability and premature mortality. Despite this, Chase et al (2017) write that ‘Clinicians and researchers may be hesitant to recommend and conduct physical activity interventions among frail older adults’.

EX as a way to improve PF and FPF may have strong effects on self-care, mobility and independence in vulnerable older adults. EX has been shown to improve PF and FPF components such as aerobic fitness, muscle strength, muscle power, balance and flexibility up to very advanced ages and reduces age-related physical and mental changes (Taylor, 2014; Schreier et al., 2016; Borde, Hortobágyi, & Granacher, 2015; American College of Sports Medicine et al., 2009; McDermott & Mernitz, 2006).

Functional Performance Fitness (FPF)

FPF can also be described as functional task performance. Functional task performance is measured through specific tests or questionnaires and typically depicts the ability of an individual to execute activities of daily living.The distinction between PF and FPF is important as PF parameters not necessarily reflect performance or ‘true ability’ of performing functional tasks. For example, performing, i.e. executing a typical functional task such as climbing of a flight of stairs reflects the successful integration and coordination of various PF elements such as balance, coordination, strength, power, flexibility and endurance in a time-dependent fashion. Counterintuitively, strength training alone may not be as important for improving task performance in e.g. stair climbing. In fact, previous research has found that strength training may be less relevant compared to power training in improving functional outcomes in elderly persons (Tschopp, Sattelmayer, & Hilfiker, 2011). Recently published research by Unhjem and colleagues highlights the importance of strength training for functional performance for healthy aging. The authors write: ‘our results reveal that maintaining a high muscle force–generating capacity into older age is related to beneficial effects on functional performance, which may not be achieved with recreational activity, thus highlighting strength training as an important contribution to healthy aging’.(Unhjem, van den Hoven, Nygård, Hoff, & Wang, 2019).

Clinical exercise, exercise prescription, exercise medicine specialists

A considerable amount of research reports on a multitude of supervised and unsupervised training methods for improving parameters of PF and FPF in the elderly. Examples of training methods are aerobic exercise, high intensity interval training, resistance training, reaction and balance training, music-based multitask training and whole-body vibration. It has become evident that exercise methods for improving PF or FPF need to be specific to the target population, the setting and goals. Research however is lacking in providing a clear overview of the best method(s) for improving PF and FPF.

A systematic review and network meta-analysis may help provide such an overview which will help guide the implementation of clinical exercise by way of exercise prescription by an exercise medicine specialist such as sports medicine doctors, primary care physicians, exercise scientists and physiotherapists.

In conclusion, EX is a drug-free, low-cost and relatively safe, i.e. with minimal adverse effects intervention with strong potential to reduce symptoms of chronic disease, decrease risk of disease, prevent falls and fall related injuries and reduce premature mortality. It has been proven to be feasible and well tolerated in many clinical older populations.

Current and future investigations on the relationship between PF and FPF as well as the quest for superior exercises are intended to help guide the implementation of clinical exercise by way of exercise prescription by exercise medicine specialists.

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Michiel R.M. Twiss (@physiotwiss) is a Dutch physiotherapist. He is interested in systematic reviews and meta-analyses on sports and gerontology research. He holds a private practice in Buchs, Sankt Gallen, Switzerland. Email: mrmtwiss@gmail.com Website: www.twiss-therapie.ch

If you would like to contribute to the “Swiss Junior Doctors and Undergraduate Perspective on Sport and Exercise Medicine” Blog Series please email justin.carrard@gmail.com for further information.

References

American College of Sports Medicine, Chodzko-Zajko, W. J., Proctor, D. N., Fiatarone Singh, M. A., Minson, C. T., Nigg, C. R., … Skinner, J. S. (2009). American College of Sports Medicine position stand. Exercise and physical activity for older adults. Medicine and Science in Sports and Exercise, 41(7), 1510–1530. https://doi.org/10.1249/MSS.0b013e3181a0c95c

Borde, R., Hortobágyi, T., & Granacher, U. (2015). Dose-Response Relationships of Resistance Training in Healthy Old Adults: A Systematic Review and Meta-Analysis. Sports Medicine (Auckland, N.Z.), 45(12), 1693–1720. https://doi.org/10.1007/s40279-015-0385-9

Caspersen, C. J., Powell, K. E., & Christenson, G. M. (1985). Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Reports (Washington, D.C.: 1974),100(2), 126–131.

Chase, J.-A. D., Phillips, L. J., & Brown, M. (2017). Physical Activity Intervention Effects on Physical Function Among Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis. Journal of Aging and Physical Activity, 25(1), 149–170. https://doi.org/10.1123/japa.2016-0040

Fiuza-Luces, C., Garatachea, N., Berger, N. A., & Lucia, A. (2013). Exercise is the real polypill. Physiology (Bethesda, Md.), 28(5), 330–358. https://doi.org/10.1152/physiol.00019.2013

Frankel, J. E., Bean, J. F., & Frontera, W. R. (2006). Exercise in the elderly: research and clinical practice. Clinics in Geriatric Medicine, 22(2), 239–256; vii. https://doi.org/10.1016/j.cger.2005.12.002

McDermott, A. Y., & Mernitz, H. (2006). Exercise and older patients: prescribing guidelines. American Family Physician, 74(3), 437–444.

Naci, H., & Loannidis, J. P. A. (2015). Comparative effectiveness of exercise and drug interventions on mortality outcomes: metaepidemiological study. British Journal of Sports Medicine, 49(21), 1414–1422. https://doi.org/10.1136/bjsports-2015-f5577rep

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Schreier, M. M., Bauer, U., Osterbrink, J., Niebauer, J., Iglseder, B., & Reiss, J. (2016). Fitness training for the old and frail: Effectiveness and impact on daily life coping and self-care abilities. Zeitschrift Für Gerontologie Und Geriatrie, 49(2), 107–114. https://doi.org/10.1007/s00391-015-0966-0

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Tschopp, M., Sattelmayer, M. K., & Hilfiker, R. (2011). Is power training or conventional resistance training better for function in elderly persons? A meta-analysis. Age and Ageing, 40(5), 549–556. https://doi.org/10.1093/ageing/afr005

Unhjem, R., van den Hoven, L. T., Nygård, M., Hoff, J., & Wang, E. (2019). Functional Performance With Age: The Role of Long-Term Strength Training. Journal of Geriatric Physical Therapy, 42(3), 115–122. https://doi.org/10.1519/JPT.0000000000000141