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The performance enhancement project: Improving physical performance in older persons,☆☆,,★★,,♢♢

Presented in part at the Gerontological Society of America's 51st Annual Scientific Meeting, November 20-24, 1998, Philadelphia, PA.
https://doi.org/10.1053/apmr.2002.33653Get rights and content

Abstract

King MB, Whipple RH, Gruman CA, Judge JO, Schmidt JA, Wolfson LI. The Performance Enhancement Project: improving physical performance in older persons. Arch Phys Med Rehabil 2002;83:1060-9. Objective: To determine the effects of center-based exercise on physical performance in older persons at risk for decline in physical functioning. Design: Randomized controlled trial. Setting: Senior centers. Participants: A total of 155 community-dwelling persons, 78.7% women, ages 70 years and older (mean ± standard deviation, 77.0±4.5y), with mobility impairments. Intervention: Intervention volunteers (n=80) exercised at a center (endurance, strength, balance, flexibility) 3 times weekly, for months 1 to 6; once weekly, for months 7 to 12 with home exercise 2 sessions a week; and at home only, for months 13 to 18. Home control volunteers (n=75) were instructed in home endurance exercise. Main Outcome Measures: MacArthur battery, Physical Performance Test (PPT-8), and 6-Minute Walk Test (6MWT) at baseline and 3, 6, 12, and 18 months. Results: MacArthur battery scores improved in intervention compared with home control at 3, 6, and 12 months (repeated-measures analysis of variance: group × time, P<.05) but not 18 months. PPT-8 and 6MWT did not improve. Intervention group assignment, younger age, and better baseline physical function and self-perceived health were independent predictors of long-term MacArthur battery score improvement. Conclusions: Compared with home control, center-based exercise improved gait, chair rise time, and balance over 1 year. Improvements were not sustained with transition to home exercise for months 13 to 18. Classes may be necessary to maintain improvements in older persons attending center-based exercise. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Section snippets

Methods

The University of Connecticut Health Center's Institutional Review Board approved this randomized, controlled intervention study.

Baseline characteristics

There were 80 volunteers in the intervention group and 75 in the home control group (table 2).

Table 2: Baseline characteristics of the performance enhancement project home control and intervention volunteers

Empty CellHome Control (n=75)Intervention (n=80)Empty CellEmpty Cell
Characteristicn (%)Mean ± SDn (%)Mean ± SDX2 P*t P*
Age77.9±4.477.0±4.6.222
Gender.428
 Women60 (80.0)62 (77.5)
 Men15 (20.0)18 (22.5)
Education (y)13.2±3.312.6±2.6.260
MMSE score (0–30)28.3±1.428.0±1.6.125
Marital status.267
 Widowed, divorced, single45 (60.0)43

Discussion

This center-based exercise program that trained strength, endurance, balance, and flexibility in older persons at risk for loss of ADL function and mobility improved MacArthur battery scores, compared with the home control group, over the first year of the program. The MacArthur battery improvements were driven by small but clinically significant improvements in balance (tandem plus single stance) time and, to a lesser extent, by faster chair-rise time. At 6 months, the end of the intensive

Conclusion

A comprehensive center-based program for older persons with mobility problems initially resulted in modest improvements in physical performance. Gains were maintained with classes once a week and home practice in the second 6 months of the study. After 1 year, however, with no class supervision, there were no differences between groups. The lack of robust differences was probably due to several factors, including numerous adverse health events unrelated to the exercise program and declining

Acknowledgements

The authors gratefully acknowledge the assistance of Khamis Abu-Hasaballah, PhD, in managing testing protocols and data entry and storage, and the help of the Balance and Gait Enhancement Laboratory staff, who assisted with recruitment, testing, exercise classes, and data entry. The authors also thank the directors of the 3 senior centers for permitting the use of their facilities.

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    Supported by the National Institute on Aging (grant no. 5 U01 AGO9675-07).

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    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

    Reprint requests to Mary B. King, MD, Hartford Hospital Geriatric Program, Burlingame Bldg, 2nd Fl, 400 Washington St, Hartford, CT 06106, e-mail: [email protected].

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