Exercise to prevent and treat functional disability☆
Section snippets
Inactivity prevalance
There has been a gradually growing awareness among policy makers and health care professionals over the past several decades of the centrality of appropriate exercise habits to major public health outcomes. For example, in Healthy People 2010, the goal suggested for physical activity is to “improve the health, fitness, and quality of life of all Americans through the adoption and maintenance of regular, daily physical activity” [1]. Although it has been known for many years that physical
Theoretic relationship among physical activity, exercise, and disability
Physical activity can influence the development and expression of disability in old age in many ways. These theoretical relationships are now borne out in many epidemiologic investigations, as outlined below, and provide the rationale for both the experimental studies and exercise recommendations that are found in many recent reviews of this topic [17], [18], [19], [20], [21].
The most obvious conclusion after reviewing the literature in this area is that a great deal of overlap exists between
Evidence from cross-sectional and longitudinal epidemiologic studies
Over the past decades, many studies have emerged that identify relationships between measures of physical activity or physical fitness and prevalence or risk of disability. Although there are numerous cross-sectional studies, they provide less insight into the relationships than longitudinal studies because they can only determine association of factors not causality. For example, Laukkanen et al [97] reported that in 291 80-year-olds residing in the community in Finland, difficulty with ADL
Clinical trials of exercise interventions with disability as an outcome
Over the past few years, many studies have examined the potential of exercise to modify functional limitations in the elderly, in addition to proximate physiologic outcomes, such as strength, aerobic capacity, and balance. Although functional limitations bear a relationship to future disability, institutionalization, and death [102], [103], these studies of exercise and functional limitations, reviewed elsewhere [18], do not definitively address the potential of exercise to prevent or change
Exercise used to prevent disability
As outlined above, the risk of disability is related to both a lower level of physical activity and reduced physical capacity (strength, aerobic capacity, balance, flexibility). In addition, certain diseases that are implicated in the development of disability are more prevalent in sedentary individuals. Therefore, the exercise prescription for the prevention of disability should focus on four goals:
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changing sedentary behavior to a more active lifestyle;
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modifying risk factors for disability and
Conclusions
Recognition of the role of exercise and physical activity in the prevention and treatment of disability in the elderly is vital to optimal management of this problem. Exercise has direct effects on disability by virtue of its relationship to the attainment of peak physiologic capacity in young adulthood and on the prevention and treatment of disuse atrophy caused by aging, sedentariness, and diseases. The most important physical capacities include muscle strength and power, and control of
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