Exercise training in the debilitated aged: Strength and functional outcomes

Objective: Resistance and endurance training result in gains in fitness in the aged. It is unclear whether the debilitated elderly can perform moderat e-intensity training and whether such training results in short-term improv ements in strength, endurance, and function in this population. Design: Randomized, controlled trial. Settings and Patients: Subjects were from a Veterans Affairs nursing home and rehabilita tion unit and a community nursing home. They were older than 60yrs with imp airment in at least one physical activity of daily living. Seventy-eight su bjects volunteered and 58 (mean age, 75yrs; 9 women, 49 men) completed the intervention and initial posttest. Only one subject withdrew because of inj ury or disinterest, Intervention: Thrice-weekly resistance training (using an isokinetic dynamo meter) and twice-weekly endurance training for 4 to 8 weeks. Main Outcomes: Isometric strength in dominant arm and leg, heart rate respo nse to timed endurance test, and activities of daily Living score. Results: The mean change in isometric strength across the muscle movements tested was 32.8% in the training group and 10.2% in the control group (diff erence, 22.6%; 95% confidence interval, 6.2% to 39.0%). No change in heart rate during exercise was seen in the training group. Trained subjects tende d to have a greater improvement in functional activity than control subject s, which was statistically significant (p = .04) for those subjects who at enrollment were most dysfunctional (ie, activities of daily living score le ss than 13 [maximum score 26]). Conclusion: This group of debilitated elderly patients effectively performe d resistance training and increased their strength, with the most impaired gaining the most function. Few in the group could effectively perform endur ance training.