Current Aging Science (v.5, #1)

There is a general aging of the population in developed countries. This aging, coupled with the low birth rate, means thatthere are already some countries in which the number of deaths exceeds the number of births. Aging does not, however, have tobe seen as a disease, but rather as a complex process inherent to all the structures of the organism which leads to a progressivedecline whose degree of involvement varies according to the individual and the environment in which they are living. In thiscontext, it is well documented that physical activity – physical exercise in particular –is beneficial for the population as a whole. In the elderly, the specific benefits are improved or maintained endurance, strength, and flexibility, thus enablingimprovement also in functional capacity and autonomy, and in the response to certain diseases. This makes "Physical Activity,Exercise, and Aging" a topic of major current relevance.The Special Issue presented here consists of ten high quality articles involving researchers and academics from eightcountries (Australia, Germany, Israel, Japan, Spain, Sweden, the United Kingdom, and the United States of America). Eacharticle has been rigorously peer reviewed by at least two referees from 11 countries (in addition to the eight above: Belgium,Finland, and Vietnam), involving over 40 researchers and 20 institutions. Six of the contributions are of original research. Theydeal with the effects of physical activity in general and exercise programs in particular (Tai Chi and walking), the imaging ofglucose uptake, the perception of physical decline, psychological and physical health, and precision pinch force control andurinary incontinence. Another of these papers presents public health recommendations among community-dwelling elderly.There are also four contributions which review and update the literature. Two of them deal are on the effects of exercise (withtreadmill) on Parkinson's disease and knee osteoarthritis, a third on the general practitioner's promotion of physical activity, anda fourth on the risks involved in physical activity performed by the elderly, which obviously also exist.Finally, we wish to thank the Editor-in-Chief, Prof. Debomoy K. Lahiri for the trust and responsibility deposited in us forthe preparation of this Special Issue. We hope and trust that it will meet with the approval of the readers of Current AgingScience.

The Effects of Age on Precision Pinch Force Control Across Five Days of Practice by Karen L. Francis, Priscilla G. MacRae, Waneen W. Spirduso, Tim Eakin (2-12).
The effects of age on control of fingertip forces, across five days of practice, were determined for an isometricprecision pinch grip task. The task involved controlling a computer cursor so that it traveled upward and horizontally on a45 degree template line by applying X-axis isometric force with contraction of the thumb, and Y-axis force with the indexfinger. Upon reaching a reverse circle target, the cursor was returned to the start by controlling the steady release of isometricforce. Participants’ control across the 6 segments of the template line (3 applying and 3 releasing force) was examined.Healthy participants comprised three age groups: Y20 (mean = 21 + 4 years), O70 (mean = 70 + 3 years) and O80(mean = 79 + 3 years). The results indicated that 1) overall the Y20 group was faster in completing the task than the O80group, 2) age differences in task duration time (speed) increased over 4 days, 3) the Y20 and O70 groups, but not the O80group, improved performance (increased accuracy and decreased within-participant variability for time and accuracy) withpractice, 4) circle target proximity (segments 3 and 6) was a potent factor; all groups were slower, less accurate, and lessconsistent irrespective of force direction in the segments approaching a circle target goal (reverse/end). A task maneuverpreceding a directional reversal of force modulation, from increasing to decreasing, was the most difficult element for theO80 group followed by the O70 and Y20 groups. These old adults improved tracing accuracy and consistency, but notperformance speed with practice on this precision pinch force control task.

Compensating, Controlling, Resigning and Accepting-Older Person’s Perception of Physical Decline by Anna Ekwall, Ingalill Rahm Hallberg, Jimmie Kristensson (13-18).
It is important to know about how frail older people experience their physical decline and how they adapt totheir bodily changes so that the health system can design preventive interventions targeting this group early on in the disabilityprocess.The aim of this study was to explore how older people perceive their physical decline. The study is qualitativein design and based on interviews with older persons, who were in an acute care process. Fourteen people, five menand nine women, aged 74 – 92 years (mean 81 years) were included in the study. Content analysis was used. The mainfinding was that physical decline was marked as occurring in two dimensions. One dimension was the physical declineand its impact on the individual’s physical body (labelled individual body). The other dimension was the impact on thebody in its environmental context such as the home or the society (labelled contextual body). The strategies for adaptingconstituted the two sub-themes, which were labeled compensating/controlling and accepting/resignation. The strategieswere executed both on an intellectual level and practical level. For healthcare workers striving to increase physical activity,knowledge about how closely related self-image and physical ability are is useful when helping the frail older people.Increasing coping strategies for handling the general life situation may be a useful way of increasing physical activity andmaking it feel meaningful, despite the person’s frail health situation with limited physical and sometimes psychologicalresources.

Tai Chi is a traditional Chinese form of conditioning exercise derived from martial arts and rooted in easternphilosophy and Chinese Medicine. Based on the inter-relatedness of mind, body and spirit this form of exercise focuses onproducing an inner calmness which is thought to have both physical and psychological therapeutic value. This article providesa brief overview of selected current evidence examining the relationship between Tai Chi and physical, neurocognitiveand psychosocial outcomes in older people. This is an emerging and growing area of research and improvements haveoften been reported in health functioning, physical and emotional health, reducing falls, fear of falling and risk of falls,and possibly enhancing cardiovascular functioning in older adults although the effects on bone density, cognitive and immunologicalfunctioning are less clear. Results overall are inconsistent and health improvements have not been evident inall studies. Tai Chi is becoming increasingly popular in practice, and more recent evidence is emerging which is based onexperimental and longitudinal designs, although many of the proposed benefits of Tai Chi are yet to be validated in large,randomised controlled trials.

How Does the Treadmill Affect Gait in Parkinson’s Disease? by Olalla Bello, Miguel Fernandez-Del-Olmo (28-34).
Parkinson’s disease (PD) is clinically characterized by symptoms of akinesia, rigidity, and resting tremor,which are related to a dopaminergic deficiency of the nigrostriatal pathway. Disorders of gait are common symptoms ofPD that affect the quality of life in these patients. One of the main focuses of physical rehabilitation in PD is to improvethe gait deficits in the patients. In the last decade, a small number of studies have investigated the use ofthe treadmill for the rehabilitation of gait in PD patients. Although, the results of these studies are promising,the mechanisms underlying the therapeutic effect of the treadmill in PD are still largely unknown. This paperreviews 10 years of investigation of treadmill training in PD, focusing on the possible mechanisms involvedin the therapeutic effect of the treadmill. Understanding these mechanisms may improve the prescription and designof physical therapy programs for PD patients.

Background: Urinary incontinence (UI) is a distressing condition that affects the lifestyle of older people. Toinvestigate the relationship between UI and physical activity among older adults, a community-based study was conductedin Japan.Methods: A total of 700 men and 300 women (mean age 66.2, SD 7.7 years) were recruited from the community in middleand southern Japan. The International Consultation on Incontinence Questionnaire-Short Form was administered byface-to-face interviews to ascertain UI status. Habitual physical activity levels (walking, moderate and vigorous activities)were assessed using the International Physical Activity Questionnaire and measured in terms of energy expenditure asmetabolic equivalent tasks (MET).Results: The prevalence of UI was 7.2% (n = 49) among the 683 eligible male participants and 27.5% (n = 82) among the298 female participants, who had experienced urine leakage for 2.6 (SD 1.9) years and 4.2 (SD 5.1) years, respectively.Habitual walking levels were lower among incontinent subjects than others without the condition. The adjusted risk of UIwas 0.36 (95% confidence interval (CI) 0.14, 0.92) for men and 0.43 (95% CI 0.20, 0.96) for women, when comparingfrequent walkers with over 1000 MET minutes of walking per week to completely sedentary participants. The prevalenceof UI also decreased with total and moderate activity levels, but the corresponding reductions in risk were not statisticallysignificant.Conclusion: The finding of an inverse association between UI and walking has important implications for the preventionand treatment of this distressing condition.

Positive influences of physical activity both on many chronic diseases and on preservation of mobility are welldocumented. But chronically ill or mobility restricted elderly living in their own homes are difficult to reach for interventions.The general practitioner's (GP) surgery offers one of the few opportunities to give advice for physical activity tothose people.We used program theory to sound out knowledge on GP-centered physical activity counseling. The "conceptual theory"(evidence for training effects in old age) and the "implementation theory" (unique position of the GP) were reviewed narratively.The "action theory" (effects of GP counseling) was reviewed systematically. According to program theory, appropriateMeSH (Medical subject headings) concepts were Aged OR Aged, 80 and over (Target group), Physicians, FamilyOR Primary Health Care (Implementation/Setting), Counseling OR Patient Education as Topic OR Disease ManagementOR Health promotion (Intervention), Exercise OR Motor Activity OR Physical Fitness OR Sports (Determinants).The resulting six review papers (Pubmed, 2000-2009) were presented using the STARLITE mnemonic.Authors agree, that the GP plays a central role in the promotion of physical activity to elderly people, but there is conflictingevidence concerning counseling effectiveness. Utilizing behavioral change strategies and the collaboration betweenGPs and specialised professions are recommended and currently under research.

Gait disorders have been identified as one of the most influential physical impairments associated with deteriorationin daily living activities among the elderly. A better understanding of the mechanisms responsible for gait disordersis important for developing intervention strategies for the elderly. In recent years, positron emission tomography (PET)and [18F]fluorodeoxyglucose (FDG) have been used to monitor glucose uptake by skeletal muscle during exercise. Thisreview discusses recent studies in which FDG PET has been used to measure muscular glucose uptake, differences betweenyoung adults and the elderly in muscular glucose uptake during walking, and the usefulness of FDG PET for determiningthe effects of exercise intervention in the elderly.

Background: Although regular physical activity can facilitate healthy aging, improve functional capacity, andprevent chronic diseases in the elderly, many of the Japanese elderly are not sufficiently active. Thus, examining the determinantsis an important prerequisite for designing effective programs. The present study investigated the demographic,behavioral, psychosocial, and environmental determinants of meeting the national pedometer-determined physical activityrecommendations for the elderly Japanese.Method: Data were analyzed for 137 community-dwelling elderly Japanese aged 70 to 89 years (47% male, mean age =74.5 years), who completed a questionnaire and wore a pedometer. Demographic (gender, age, marital status), behavioral(BMI, smoking, alcohol consumption), psychosocial (self-efficacy, social support, health professional advice), and environmental(perceived neighborhood environment) variables were self-reported. Averaged daily steps were obtained using1-year pedometer measurements. Based on the national physical activity recommendations in Japan (males: 6700 steps;females: 5900 steps), the participants were divided into two categories—sufficiently active and insufficiently active. Anadjusted logistic regression model was utilized.Results: Totally, 47.4% of the participants (males: 51.5%; females: 43.8%) met the national recommendations. When adjustingfor all other variables, a higher self-efficacy for exercise (AOR = 1.16; 95% CI: 1.04-1.28) and positive perceptionof the neighborhood environment (AOR = 1.43; 95% CI: 1.03-1.98) significantly influenced the meeting of the nationalrecommendations.Conclusions: The findings clarified the need to identify effective intervention strategies to promote physical activity andsuggest that an intervention design that accounts for these determinants may more effectively promote physical activityamong the elderly Japanese.

Background: The benefits of physical activity in old age are well documented. However, studies have shownthat older adults are insufficiently active. One of the reported barriers to physical activity is fear of injuries.Objective: To review available data on the rate of injuries related to sport and purposeful physical activity in advancedaged.Methods: A systematic review of reports published in English, identified by searching four data bases and the referencelists of reviewed articles. Eligible reports were full articles in a peer-reviewed journal, and the study report had to includethe injury rate of individuals aged 45 and above and the kind of activities that led to the injury. Seven reports met the inclusioncriteria.Results: Studies on injuries in advanced age are scarce, and lack information on the rate of injuries relative to the extent ofexercise. The rate of injuries occurring during physical activity in advanced age, based on existing data, is very low comparedto other ages. The injury rate of men is almost twice that of women. Men tend to get injured while engaging in ballgames and bicycling, while women mostly during exercise. The most frequent reported injuries in the general populationincluding older adults are strains and sprains, followed by fractures in the lower and upper extremities.Conclusions: Since older adults are being encouraged to increase their habitual physical activity even beyond the basicrecommended guidelines, more studies are needed to assess the risk of injuries relative to the extent of exercise.

Individuals with knee osteoarthritis, a painful debilitating joint disease affecting many aging adults, are commonlyencouraged to pursue a variety of exercise regimens. However, very few studies have specifically focused on barriersand facilitators of exercise adherence as related to knee osteoarthritis.This review focuses on what is known about exercise adherence, as well as those factors that influence exercise adherence,both generally, and in the context of knee osteoarthritis. To this end, a wide array of related studies were retrievedand reviewed. The objective was to better understand the relationship between this disabling health condition and exercise,and factors that might specifically determine long-term exercise participation among this population.Results of this search revealed: 1) strong support for the application of exercise to allay the progression and/or severity ofknee osteoarthritis and its consequences, but poor adherence rates in reality; 2) a vast array of disease-associated, as wellas other exercise adherence barriers; 3) many recommendations for promoting exercise adherence including improving thenature of the patient-provider relationship, and the importance of individualized exercise prescriptions.It is concluded that life-long exercise is crucial for maximizing the well-being and function of adults with knee osteoarthritis,but recommendations to exercise are often pursued inconsistently. To encourage exercise adherence amongthis cohort, a comprehensive individualized assessment, active patient involvement in the decision-making process, andlong-term monitoring are indicated.

Acknowledgment to the Reviewers by Bentham Science Publishers (84-85).
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