Journal of Gerontological Nursing

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Effects of a Physical Activity Program: The Study of Selected Physical Abilities Among Elderly Women

Matsouka Ourania, PhD; Harahousou Yvoni, PhD; Kabitis Christos, PhD; Trigonis Ionannis, MA

Abstract

ABSTRACT

This study evaluated the effects of a 12-week exercise program on the physical abilities of 55 sedentary women ages 60 to 75. The variables tested were dynamic balances, muscular endurance, sit and reach flexibility, and muscular coordination. Participants were grouped into three exercise groups (n = 45) and one control group (n = 10). Exercise was performed for 1 hour, once, twice, and three times a week for the three experimental groups. Participants were pre- and post-tested for the selected variables. Significant differences (p < .05) were found between exercise and non -exercise groups. The main effects of the training program were significant for all four variables examined, indicating that even those who participated in an exercise group once a week had a significantly higher levels of physical abilities than the control group. The improvement of the experimental groups was proportional to the frequency of the training program applied.

Abstract

ABSTRACT

This study evaluated the effects of a 12-week exercise program on the physical abilities of 55 sedentary women ages 60 to 75. The variables tested were dynamic balances, muscular endurance, sit and reach flexibility, and muscular coordination. Participants were grouped into three exercise groups (n = 45) and one control group (n = 10). Exercise was performed for 1 hour, once, twice, and three times a week for the three experimental groups. Participants were pre- and post-tested for the selected variables. Significant differences (p < .05) were found between exercise and non -exercise groups. The main effects of the training program were significant for all four variables examined, indicating that even those who participated in an exercise group once a week had a significantly higher levels of physical abilities than the control group. The improvement of the experimental groups was proportional to the frequency of the training program applied.

Aging is a complex process ging p a complex process involving many variables (e.g., genetics, lifestyle factors, chronic diseases) that interact with one another, greatly influencing the manner in /which one ages (Spirduso, 1995). In 1991, an estimated 31.8 million older adults resided in the United States, consisting of 19 million elderly women and 12.8 million elderly men (American Association of Retired Persons, 1992). In addition, it is estimated that by the year 2030, more than 22% of all Americans will be 65 or older (Bronfenbrenner, McClelland, Wethingtdft, Moen, & Ceci, 1996). Thus, it is critically important to understand the biological and physiological changes that occur in increasing age, especially in women. Motor control research about older women is warranted because of the higher ratio of women tof men in this age group and the high risk of limiting conditions involving afunctional capacity (Horton, 1992).

Age-related declines have been documented for many motor functions, including endurance, reaction time, balance, flexibility, gait velocity, and muscle strength (Agre, Pierce, Raad, Mc Adam, & Smith, 1988; Judge, Underwood, & C%nnosa, 1993; Raad, Agre, McAdajn, & Smith, 1988; Rikli & Edwards, 1991). For years, these performance declines were thought to be a normal and necessary consequence of aging. Several recent studies, however^ indicate these declines relate moreno lifelong physical activity level Cían to age. Older physically active women, for example, were found to have performance patterns of flexibility, balance, and reaction timé tasks more similar to younger participants than to, their older inactive peers (Rikli & Busch, 1986).

Based on these findings* interest in examining the relationship between musculoskeletal health and exercise in older adults has emerged (Vuori, 1995). Muscle mass, strength, power, and endurance are all important components of functional ability, and also are the major causes of limited mobility and activity (Avhind, Schroll, Davidsen, Lovborg, & Rantanen, 1994), especially for women! (Horton, 1992). It is worthwhile to emphasize that the improvement in muscle strength in old or very old adults has been shown to be accompanied by better coordination, better balance, shorter reaction,: time, increased gait speed, and increased flexibility, all of which are important elements or indicators of mob|ity (Fiatarone et al., 1990).

Elderly women participating in a 25-weefc exercise program significantly incfieased their range of motion in ankle plantar flexion, shoulder flexion, pioulder abduction, and left neck (Raad et al., 1988). Healthy elderly women were found to have higher performance levels, in comparison to frail elderly women, on grip strength, movement time, kinematics movement characteristics, and basic functional movement abilities, Stronger individuals, especially, reacted and moved faster, spent less absolute time in acceleration and deceleration, produced fewer adjustments in movements, and generated higher peak velocity and impulse (Meyer, Goggin, & Jackson, 1995).

Photo 1. Flexibility test (photo taken from video tape).

Photo 1. Flexibility test (photo taken from video tape).

Spirduso and MacRae (1990) stated that it would be useful to know the contribution different levels of muscle strength and power might make toward the prevention of injuries, accidents, and fatalities in very old adults. In support of this position, Fiatarone, et al. (1990) demonstrated that enhanced motor unit recruitment and control was important in strength improvement as a result of resistance training. Thus, stronger or strengthtrained older individuals are more likely to show improved gross motor movements. Bassay et al. (1992) found significant correlation between leg power and functional and gross motor performance activities, such as rising from a chair and walking up stairs, in frail older participants.

Except for the finding from a study based on lengthy intervention programs and their effect on functional ability of women 60 and older (Meyer, Goggin, & Jackson 1995), little is known about the minimal amount of exercise needed for improvement. The authors of the present study hypothesized that:

* Older women's participation in regular physical activity programs would improve their status on selected physical abilities in a relatively short time.

* This improvement would be proportional to the frequency of their participation in the program.

The purpose of this study was:

* To evaluate the effects of a 12week exercise program on the basic physical abilities of sedentary older women.

Photo 2. Timed agility test (photo taken from video tape).

Photo 2. Timed agility test (photo taken from video tape).

* To identify the minimum frequency per week required to produce significant results on the selected parameters.

* To examine the relationship between the improvement and the frequency of participation to the program.

METHOD

Participants

Participants in this study were 55 healthy women living independently. Their ages ranged from 60 to 75 (M = 64.76, SD = 4.74) and their body weight from 138.6 pounds and 189.2 pounds (M = 166.73, SD = 12.21) Their height ranged between 60.62 inches and 64.17 inches (M = 61.41). Participants were permanent residents in three towns located in Northern Greece who had not been involved in any physical activity for at least 6 months before the exercise program began. According to their place of residence, they were assigned into three experimental groups and one control group.

Physiological Measures

Because national physical fitness norms do not exist for individuals older than 60, the evaluation of the four parameters of functional ability of senior women was based on American Association for Health Physical Education Recreation and Dance (AAHPERD) Functional Fitness Assessment for Adults Over 60 (Osness et al., 1990). The correct procedures were explained and demonstrated to all participants, and any questions about the testing were answered. The assessment for each participant was approximately 1 hour. The tests were administered in the following order:

* Flexibility of the lower back, hip, and posterior thigh was evaluated using the sit-and-reach test. The test used a box, placed on the floor, and a scale measuring in centimeters with the 0 mark set at 23 cm (Photo 1). Each woman sat with both legs extended, knees in contact with the floor, and placed her flexed feet against the lateral surface of the box. She then reached as far as possible toward or beyond her feet using smooth, consistent movement. The highest score of three trials was recorded.

* The timed agility test was conducted on 31 -foot course marked by traffic cones. The participant started from seated position, stood up and walked as quickly and safely as possible around the marked course (Photo 2).

* The timed manual coordination test required participants to sit at a table and manipulate three soda cans on designated markings in the correct order (Photo 3).

* The muscular strength and endurance test measured the number of seated biceps curls completed in 30 seconds using the dominant hand. Women curled a 4-pound weight (Photo 4).

Procedures

The duration of the entire program was 12 weeks, with 1 week of pre-testing, 10 weeks of a training intervention program, and 1-week post-testing. The training program was based on the Long Term Physical Activity Workshop (TudorLocke, Ecclestone, Paterson, & Cunningham, 1997), and consisted of exercises for the improvement of general strength and flexibility, as well as leisure activities. Prior to program onset, a trained exercise specialist demonstrated proper form and technique for each activity.

Photo 3. Manual coordination test (photo taken from video tape).

Photo 3. Manual coordination test (photo taken from video tape).

Preprogram Procedures. Prior to enrollment in the training program, all participants of experimental groups were required to provide a signed letter of clearance from their personal physician approving their participation in the program. At the onset of the program, individuals were informed they would be participating in a 12-week program and were given a brief demonstration of the program's content.

During the first week, both experimental and control groups completed the Revised Physical Activity Readiness Questionnaire (PAR-Q; Thomas, Reading, & Shephard, 1992) and a short demographic questionnaire assessing age, height, and weight. Before and after the training program, each participant was tested for the selected variables of dynamic balance, muscular endurance, sit-and-reach flexibility, and muscular coordination.

Intervention Program. The three experimental groups participated in the 12-weeks intervention program three times, twice, and once a week (Group A, B, and C, respectively), with each exercise session lasting approximately 45 minutes. The control group (Group D) did not follow any physical activity program. In an effort to ensure maximal compliance to the program, the same instructor conducted the intervention program for all groups in the Public Care Institutes for the Elderly. The program was funded by the Greek Secretariat of Sport and advertised through local papers. The individuals who responded to this advertisement participated free of charge in the program on a voluntary basis.

Photo 4. Muscular strength and endurance test (photo taken from video tape).

Photo 4. Muscular strength and endurance test (photo taken from video tape).

Post-program Procedures. At the conclusion of the 10-week training program, during Week 12, each participant from the four groups repeated the functional ability measures.

RESULTS

The normality of the distribution and the equality of variances for each group for the four selected variables were checked through the Kolmogorov-Smirnov test. The results for all variables revealed a normal distribution and equality of variances in all groups, with values in some cases approaching 1. The Bartlett-Box and Cochran's C tests used to check the differences among groups in the selected variables at the pre-test revealed no difference beyond the .05 level of significance for any of the groups.

The mean scores for pre- and posttest were examined using the t test for paired groups analysis to determine which of the four groups had significantly improved in each of the four physical abilities. The analysis revealed that dynamic balance had significantly improved in the three experimental groups (Group A, t = 7.99, p = .001; Group B, t = 11.54,/» = .001; Group C, t = 3.14,/? = .007), and no significant difference was observed in the control group (Group D, t = 1.56, p = .153). The difference between pre- and post-test scores for the other three physical abilities were the same. The r values for muscular endurance were as follows:

* Group A; t = -10.38, p = .001.

* Group B; t = -6.72, p = .001.

* Group C; t = -3.58, p = .003.

* Group D (control); t = .71, p = .494.

For flexibility, the t values were as follows:

* Group A; t = -12.62, p = .001.

* Group B; r = -1421, p = .001.

* Group C; t = -3.17, p = .007.

Table

TABLEMEANS AND STANDARD DEVIATIONS ON SELECTED PHYSICAL ABILITIES AMONG ELDERLY WOMEN

TABLE

MEANS AND STANDARD DEVIATIONS ON SELECTED PHYSICAL ABILITIES AMONG ELDERLY WOMEN

* Group D (control); t = -.69, p = .509.

Finally, for muscular coordination the equivalent t values were as follows:

* Group A; t = 3.70, p = .002.

* Group B; t = 6.24, p = .001.

* Group C; t = 3.76, p = .002.

* Group D (control); t = .81, p = .437.

The scores for the pre- and posttest for each group on the selected variables are presented in the Table.

The MANOVA with two factors, one of which is repeated (4 groups X 2 measurements) was used to determine which of the four different programs applied (i.e., three times a week, twice a week, once a week, no exercise at all) produced the larger improvement on dynamic balance, muscular endurance, sit-and-reach flexibility, and muscular coordination. The analysis revealed a main effect for the factor measurement (significant differences between preand post-test for all variables), but also an interaction between the two factors for all variables - indicating a different effect of the program applied to each group. Specifically, for dynamic balance the values of F for the main effect and the interaction were F,^, = 126.96, p < .05 and F(ifil) = 18.21, p < .05, respectively. For muscular endurance, the values of F for the main effect and the interaction were F(1>51) = 1 10.25, p < .05 and F(3fii) = 15.91, p < .05, respectively. For flexibility, the values of F for the main effect and the interaction were -Fz151)= 251.92, p < .05 and /7^51J= 68.96, p < .05, respectively. For muscular coordination, the values of F for the main effect and the interaction were F(1 5n = 50.16, p < .05 and F..3l. = 5.95, p < .05, respectively.

Post-hoc examination of the means for the four groups using the Scheffe test showed significant differences for dynamic balance and for muscle coordination between groups A and C, groups A and D, groups B and C, and groups B and D; and no significant differences were observed between groups A and B and groups C and D. For muscular endurance and for flexibility, significant differences were observed between groups A and B, groups A and C, and groups A and D; and no significant differences were observed between groups B and C, groups B and D, or groups C and D. The improvement between pre- and post-test (net effect of the program) for each group for the four selected variables (i.e., flexibility, muscular endurance, dynamic balance, and muscular coordination) are shown in the Figure.

DISCUSSION

The results of this study reveal that using the exercise training program with the sedentary women of the three experimental groups produced significant improvements to all the selected physical abilities. The lack of improvement for the control group participants gives additional support to the idea that the program was responsible for the experimental group participants' improvement. It seems that participation in even a 12- week program can result in significant changes to basic physical abilities, such as those selected for the present study.

Various researchers have reported significant improvements in a number of physical abilities after an elderly adult training program. Several researchers have reported significant improvements in strength (Agre et al., 1988; Brown, McCartney, & Sale, 1990; Frontera, Meredith, O'Reilly, Knuttgen, & Evans, 1988; Nichols, Omizo, Peterson, & Nelson, 1993; Welsh & Rutherford, 1996), and Raad et al. (1988) and Rikli and Edwards (1991) have found significant improvements in flexibility. Improvements in dynamic balance have been reported in several studies (Lord, Caphan, & Ward, 1993; Lord, Ward, & Williams, 1996; Shumway-Cook, Gruber, Baldwin, & Liao, 1997), and Rikli and Edwards (1991) and Bouchard, Shephard, and Stephens (1994) have reported significant improvements in muscular coordination.

Figure. Improvement according to the program applied on selected physical abilities among elderly women.

Figure. Improvement according to the program applied on selected physical abilities among elderly women.

Although most intervening programs last between 3 and 6 months, Mihalko and McAuley (1996) have reported significant strength improvements in participants 71 to 101 years old after following an 8-week training program. Nichols, Hitzberger, Sherman, and Patterson (1995) have also reported significant strength improvements in men and women older than 60 after following a strength training program twice a week for 12 weeks. Brown and Holloszy (1993) report significant differences in the flexibility of older participants after following a training program for 12 weeks, and Wolfson et al. (1996) state elderly individuals participating in a training program three times a week can significantly improve their dynamic balance after 12 weeks. Frontera, Meredith, O'Reilly, and Evans (1990) also say two thirds of the improvement in strength in elderly individuals can be achieved in between 12 and 16 weeks.

In the present study, the rate of improvement of the three experimental groups was proportional to the frequency of participation in the training program. The following are the rates for three times a week, twice a week, and once a week programs, respectively:

* Muscular endurance; 27.5%, 23.5%, and 11%.

* Flexibility; 33.7%, 17.1%, and 3.1%.

* Muscular coordination; 21.7%, 27%, and 14%.

* Dynamic balance; 11%, 15.7%, and 5%.

These findings were not unexpected, although for muscular coordination and dynamic balance, the rate of improvement for Group B (twice a week) was higher than Group A (three times a week). This is probably because Group B had a lower level at the starting point (i.e., pre-test), which means it was easier for this group to improve.

The most important finding from this study is that participation in the exercise program even once a week produced significant improvements to the abilities of the sedentary women. This result is important because it shows that sedentary older women with limited free time can benefit from participating in exercise programs once a week. Once-a-week programs also showed slightly reduced dropout rates (i.e., 27% with 1 day a week compared to 36% with 3 days a week) (Oldridge, 1991). There was not a single dropout during the application of the program, and this strengthens the findings of the study because no experimental mortality threatened the results.

SUMMARY

Based on the findings of the study the following conclusions were drawn:

* Physical abilities of sedentaryelderly women can significantly improve after 10 weeks of exercise.

* The magnitude of improvement in physical abilities is proportional to the frequency of exercise.

* Once-a-week participation in an exercise program is capable of significantly improving the physical abilities of sedentary elderly women.

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TABLE

MEANS AND STANDARD DEVIATIONS ON SELECTED PHYSICAL ABILITIES AMONG ELDERLY WOMEN

10.3928/0098-9134-20030701-10

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