|Year : 2019 | Volume
| Issue : 2 | Page : 82-92
Physical activity as preventive therapy for older adults: A narrative review
Chidiebere Emmanuel Okechukwu1, Abdalla Ali Deb2, Shady Emara3, Sami A Abbas4
1 Department of Physical Activity and Health Promotion, Faculty of Medicine and Surgery, University of Rome Tor Vergata, Roma RM, Italy
2 Department of Urology, National Health Service (NHS), UK
3 Department of Urology, Western General Hospital, Edinburgh, Scotland
4 Department of Urology, National Institute of Urology and Nephrology, Cairo, Egypt
|Date of Submission||17-Jul-2019|
|Date of Decision||29-Sep-2019|
|Date of Acceptance||07-Oct-2019|
|Date of Web Publication||02-Apr-2020|
Chidiebere Emmanuel Okechukwu
Department of Physical Activity and Health Promotion, Faculty of Medicine and Surgery, University of Rome Tor Vergata, Via Montpellier, 1, 00133 Roma RM
Source of Support: None, Conflict of Interest: None
Sedentary behavior is one of the major risk factors for cardiovascular mortality; hence there is a need to promote physical activity (PA) among adults aged 60–86 years. The aim of this narrative review was to evaluate the role of PA in the prevention and treatment of chronic diseases among older adults. Relevant studies (original articles, systematic reviews, and meta-analyses) that reported on the effects of PA in older adults from 1998 to 2019 were selected. The following electronic databases were searched: PubMed, ScienceDirect, PsycINFO, Embase, Medline, Sports Discus, Web of Science, and Cochrane database. Physical exercise at different intensities was shown to be effective in the prevention and treatment of overweight, functional decline, and mood disorders in older adults. Moderate-to-high intensity endurance exercise can be effective in the prevention of diabetes type 2, hypertension, and cancer in older adults. Resistance training at different intensities was shown to be effective in the prevention and treatment of obesity in the elderly. Mobility and balance training were effective in preventing falls in older individuals. Combined exercise training regimen comprising moderate-to-vigorous intensity aerobic and resistance exercise is beneficial in the prevention of disability, osteoporosis, hypertension, and falls among older adults. Moreover, combined exercise training improves immune function and antioxidant capacity in older adults. Based on the studies reviewed, PA was found to be an effective tool for the prevention and treatment of chronic diseases among older adults.
Keywords: Aerobic, elderly, exercise, physical activity, resistance
|How to cite this article:|
Okechukwu CE, Deb AA, Emara S, Abbas SA. Physical activity as preventive therapy for older adults: A narrative review. Niger J Exp Clin Biosci 2019;7:82-92
|How to cite this URL:|
Okechukwu CE, Deb AA, Emara S, Abbas SA. Physical activity as preventive therapy for older adults: A narrative review. Niger J Exp Clin Biosci [serial online] 2019 [cited 2020 Jul 13];7:82-92. Available from: http://www.njecbonline.org/text.asp?2019/7/2/82/281619
| Introduction|| |
Sedentary behavior is one of the major risk factors for cardiovascular mortality, hence there is a need to promote physical activity (PA) among adults aged 60–86 years. Moderate-intensity aerobic activity, muscle-strengthening activity and decrease in sedentary behavior should be encouraged among older adults. Older adults are expected to accumulate up to 30–60 min/day (≥150 min/week) of moderate-intensity exercise, or 20–60 min/day (≥75 min/week) of vigorous-intensity exercise, or a combination of moderate- and vigorous-intensity exercise daily to attain the recommended targeted volumes of exercise. Absolute intensity of exercise is estimated using any of the following methods: caloric expenditure (kcal/min), absolute oxygen uptake (VO2; mL/min or L/min), and metabolic equivalents (METs). Relative intensity of exercise is estimated using any of the following methods: Percentages of heart rate reserve (%HRR), percentage maximal heart rate (HR), %VO2R, %VO2, %METs, rating of perceived exertion (RPE), affective valence, OMNI scale, talk test, and feeling scale, and these are relevant tools for exercise prescription, dosing, and therapy among aged adults.
Physiological changes such as steady and persistent rise in pro-inflammatory cytokines due to aging are associated with an increase in the level of free radicals, low production of nitric oxide, low bioavailability of antioxidants, increase in plasma lipid profiles, rise in atherogenic index of plasma, and oxidative stress are associated with aging. These physiological changes during the aging process are associated with endothelial dysfunction which leads to cardiovascular disease and increase in mortality among aged adults, and PA can modify these changes. Exercise improves antioxidant activity, thereby minimizing oxidative stress, and increasing longevity among older individuals. Some of the barriers to PA among aged adults are illness, lack of time, fear of falls, functional limitations, low confidence, doubt about the benefits of PA, lack of fitness and energy, history of traumatic experiences with PA, work obligations, environmental barriers, and pain associated with exercise., PA improves mood and prevents depression in older adults, hence regular physical exercise should be encouraged among aging men and women to enhance their quality of life. One of the positive health outcomes associated with regular PA, is that it improves functional capacity among aging adults.
Owing to the high prevalence of chronic diseases worldwide, and based on the fact that, an active lifestyle is essential for longevity, it is necessary to promote PA and to know the volume and intensity of PA that is effective in producing a positive change in chronic disease conditions with regards to individual's or patient's clinical features. The aim of this narrative review was to evaluate the role of PA in the prevention and treatment of chronic diseases among older adults.
| Methods|| |
Relevant studies (original articles, systematic reviews, and meta-analyses) that reported on the effects of PA in older adults from 1998 to 2019 were selected for this narrative review. The following electronic databases were searched: PubMed, ScienceDirect, PsycINFO, Embase, Medline, Sports Discus, Web of Science, and Cochrane database. The following search strategies were modified for the various databases: Exercise, PA, older adults, chronic diseases, and health benefits of exercise training among older adults. The MeSH system was used to search for articles on PubMed.
Effectiveness of physical activity in the prevention and treatment of chronic diseases among older adults
Exercise is associated with improvements in cardiovascular, musculoskeletal, and metabolic health through reductions in oxidative stress, inflammation, and modulations of cellular processes within various tissues in physically active older adults. The combination of two or more exercises as a therapeutic regimen may be more effective than a single exercise regimen, combined training program is associated with an improvement in cardiovascular and psychological well-being among aged adults. Resistance training (RT) improved the lean body mass in aged men, thereby preventing sarcopenia, frailty and functional impairment. Eight weeks of RT reduced the lipid levels in obese women, thereby preventing the pathogenesis of atherosclerosis. Six months of supervised exercise training improved the immune function in elderly people that were formerly sedentary, which illustrates the importance of proper exercise supervision in order to achieve a positive outcome. Regular participation in PA was found to induce suppression of tumor necrosis factor (TNF-α), which shows that PA defends the body against TNF-α-induced insulin resistance, thereby preventing type 2 diabetes mellitus. 12 weeks regular Tai Chi Chuan Program-enhanced regulatory T-cell function, thereby improving immune function, apart from that, Tai Chi improves muscle strength, coordination, and balance. It is a mind exercise that is effective in preventing anxiety, improve mood, quality of sleep, and self-confidence among the elderly. It is effective in the management of stroke and Parkinson's disease.
Short-term exercise training increases the rates of wound healing among healthy older adults. Functional capacity is the major predictive factor of survival in individuals with and without cardiovascular disease and in individuals with specific cardiovascular risk factors. There was an improvement in functional capacity in chronic heart failure patients after participating in aerobic training. Aged individuals who are physically active have lower risk of mortality., However, the intensity of an exercise training regimen, determines its effects and impact. The more the PA levels in older adults, the lesser the chances of morbidity and mortality., PA was able to minimize the risk of falling and monthly fall rate among older men and women, and this shows that PA improves physical functioning and mobility.,,,, Aerobic endurance activity reduced the risk of falling sick due to the prevention of chronic diseases, thus minimizing hospital admission rates in older adults.
There is a lower risk of stroke among physically active older adults, due to the improvements in endothelial function associated with exercise., Endurance training and strength training (ST) reduces systolic blood pressure in older men and women, because exercise improves autonomic cardiac control by decreasing sympathetic activity, increasing vagal activity, and baroreflex control of HR.,, PA lowers the risk of cardiovascular disease in older adults by improving peripheral mechanisms and neurovegetative control of the heart. PA lowered the risk of breast cancer up to 50%,,, and colon cancer up to 30%. Exercise enhances cardiovascular, mental, and physical functioning, thus improving functional capacity, and cognitive performance,,, among older adults. PA improves neuromuscular performance by preventing sarcopenia and decrease in muscle strength in aged adults.,, Exercise improves renal function and lowers the progression of kidney disease in older adults. ST Improves bone mineral density, thus preventing osteoporosis in older men and postmenopausal women., Exercise reduces central obesity and improves insulin sensitivity, thereby minimizing the risk of diabetes type 2. Sedentary behavior is associated with depression in older people and exercise prevents depression, anxiety, and low self-esteem., Older adults who exercise regularly have lesser chances of becoming disabled when compared to those that are sedentary.,
Higher intensity exercises were effective in improving endothelial function in heart failure patients undergoing cardiac rehabilitation. Supervised treadmill PA was more effective when compared to unsupervised treadmill PA; both exercise regimens were helpful in the reduction of intermittent claudication in older patients. Combined exercise training regimen was more effective in improving the global quality of life among older people when compared to single-dose exercise regimen.,, Aerobic exercise such as cycling is effective in improving aerobic capacity and ventilatory efficiency in older individuals. Exercise reduces the risk of osteoarthritis and fatigue in older people by improving bone strength, bone mineral density, and physical functioning.,, Exercise when combined, exerts more positive effects toward preventing functional limitations in older adults.,,, Weight training exercise leads to improvements in muscle strength and activities of daily living among the elderly, moreover, exercise improved the muscle strength, power, functional capacity, and quality of life among patients with dementia and Parkinson's disease, which shows that exercise is effective in the secondary and tertiary prevention of chronic diseases.,,, Exercise is an important tool in health promotion, physical, and rehabilitation medicine for primary, secondary, and tertiary prevention of chronic diseases among aged adults.,,, Cardiovascular morbidity and mortality are due to an increase in workload on the cardiovascular system, and PA increases vagal tone and decreases sympathetic tone, thereby improving cardiac function. Low HR variability (HRV) and baroreflex sensitivity (BRS) are associated with poor cardiovascular health. Iellamo et al. observed that individualized aerobic continuous training and aerobic interval training significantly improved HRV and BRS in patients with chronic heart failure, the training was prescribed using a technique for the individualization of exercise training according to patients' clinical and functional capacity known as session rating of perceived exertion (RPE). RPE is an effective tool for exercise prescription and quantifying of internal training load both in normal and disease state using the Borg CR-10 scale (moderate-intensity activity is at the level of 6 or below on a 1–10 scale, while vigorous intensity is at the level of 7–8 on the 1–10 scale) [Figure 1].
|Figure 1: Borg CR-10 scale (Moderate-intensity activity is at the level of 6 or below on a 1–10 scale, while vigorous intensity is at the level of 7–8 on the 1–10 scale)|
Click here to view
Aging men experience decrease in testosterone levels which leads to unfavorable physiological changes. A decline in men's sexual function is often associated with loss of libido, potency, and depression. In an animal experimental study, aerobic exercise (swimming >3 times/week and >30 min each session or >90 min/week) improved testicular function in male Wistar rats. Cho et al. found that the combination of exercise and testosterone replacement therapy (TRT) showed significant improvements in serum testosterone levels and decrease in the symptoms of late-onset hypogonadism among physically inactive older patients with erectile dysfunction and low serum total testosterone compared to the application of TRT alone. These improvements were maintained with continuous exercise after the cessation of TRT. Twelve-week lifestyle modification program involving aerobic exercise training and dietary modifications increased serum testosterone levels in overweight and obese men. PA is important in the primary and secondary prevention of obesity, and there was an association between obesity and late-onset hypogonadism, because morbid obesity is a major risk factor for hypogonadism. Prevention of central obesity through regular physical exercise and smoking cessation may decrease the risk of hypogonadism in aging males. Walking pace lowered the progression of prostate cancer among men diagnosed with prostate cancer, independently of walking duration, and this might be due to the fact that PA modulates p53, p21, and caspase activities resulting in prostatic tumor growth inhibition, apoptosis, suppression, suppressed metastasis, and carcinogenesisin vitro and in transgenic model.,, Moreover, exercise lowered the side effects associated with androgen deprivation treatment among men diagnosed with prostate cancer.
Exercise prescription for older adults
PA slows down the decrease in quality of life among older adults, by improving physical functioning and minimizing disability among older individuals.
According to the American College of Sports Medicine, older adults should engage in moderate-intensity aerobic exercise training (30 min/day on 5 days/week for a total of 150 min/week), or vigorous-intensity aerobic exercise training (20 min/day on 3 days/week for 75 min/week), or a combination of moderate- and vigorous-intensity aerobic exercise training to achieve a total energy expenditure of 500–1000 MET/min/week, on 2–3 days/week aged adults should also perform resistance exercises for each of the major muscle groups, and neuromotor exercise involving balance, agility, and coordination. To maintain range of joint movement, completing a series of flexibility exercises for each of the major muscle–tendon groups for a total of 60 s per exercise on 2 days/week is recommended. Exercise training regimen should be tailored according to individual's PA levels, physical function/functional capacity, health/clinical status, exercise responses, and goals. Older adults can also benefit from engaging in amounts of exercises less than the recommended dose [Table 1]. [Table 2] illustrates the prescription of PA based on intensity using MET level, HRR, and RPE, which are the easiest methods of PA prescription. [Table 3] shows exerciseprescription for high blood pressure control. [Table 4] described exercise prescription for diabetes type 1 and type 2 patients.
|Table 1: American College of Sports Medicine exercise recommendation suitable for older adults|
Click here to view
|Table 2: Physical activity prescription based on intensity using metabolic equivalent level, heart rate reserve and rating of perceived exertion|
Click here to view
Exercise contraindications, safety, and precautions outside a supervised environment for aging adults
According to Gill et al., prior to the prescription and commencement of an exercise training program for aging adults, participants should be assessed by their physicians, and their complete medical history should be thoroughly evaluated. However, a thorough physical examination should be carried out to identify any salient and potential cardiac contraindications to exercise outside a supervised environment; the reason is to prevent sudden cardiac arrest. Cardiac contradictions include occurrence of myocardial infarction in the past 6 months, angina, signs and symptoms of congestive heart failure (e.g., shortness of breath with or without pedal edema), and a resting systolic blood pressure of 200 mmHg or higher or diastolic blood pressure of 110 mmHg or higher. Cardiovascular reserve can be tested through simple techniques such as getting up and down from the bed, walking for 15 m, climbing 1 flight of stairs, and cycling in the air for 1 min while sitting or lying on the bed. Aging adults who develop chest pain or substantial shortness of breath climbing 1 flight of stairs, would not be advised to carry out a home-based and unsupervised exercise training. Electrocardiogram (ECG) test should be conducted and a resting ECG should be reviewed for new Q waves, ST-segment depressions, or T-wave inversions. Older individuals with an overt cardiovascular disease should be categorized and managed accordingly.
To Inorder to prevent sudden death during exercise. All formerly sedentary older adults without obvious cardiovascular disease, at first, should start with a low-intensity exercise program, choosing from 1 or more of the following regimens: gait training, balance exercises, Tai Chi, self-paced walking, and lower extremity RT with elastic tubing or ankle weights. The aged should be well informed and instructed in proper exercise techniques, depending on the type of exercise, should be supervised by clinicians at least in one occasion to ensure adherence and safety. The intensity and volume of exercise should be gradually increased as the person's aerobic and functional capacity increases.
Each exercise session should include a warm-up and cool-down period. If chest pain, shortness of breath, or dizziness develops during the unsupervised training, older individuals are instructed to rest and to see their physician if these symptoms continue with further exercise. Older adults that tolerate low-intensity exercise may progress to moderate-intensity exercise which is the benchmark (e.g., ST using weight machines, fast walking, swimming, or bicycling) of exercise recommendation. At the commencement of a moderate-intensity exercise program, it is important to monitor blood pressure and heart rate. Aging adults who have an abnormal cardiac response (decrease in systolic blood pressure of ≥20 mmHg, increase in systolic blood pressure to ≥250 mmHg or in diastolic blood pressure to ≥120 mmHg, or repeated increase in heart rate ≥90% of age-specific maximum) are not advised to continue with the moderate-intensity exercise program, and they should continue with less intensive exercise program. To monitor and regulate the intensity of exercise, older adults should be taught to use the RPE, and it is easy to use and cost-effective. The RPE scale could be used to monitor exercise intensity; it is an easy method to quantify exercise intensities during exercise training.
Barriers to physical activity in the elderly and possible solutions
Time is one of the major barriers to PA among older adults, because most older adults are busy with their daily activities and hardly create time for PA; another factor that hinders PA among older adults is functional limitation such as arthritis, osteoporosis, low back pain, and falls. Moreover, depression and anxiety contribute to sedentariness in older adults. Behavioral addiction such as Gambling and substance abuse disorders could hinder participation in PA among the elderly. Environmental barriers to PA are weather conditions, lack of recreational facilities, sidewalk quality, infrastructure, and insecurity in the neighborhood. There is need to educate older adults on the benefits of regular PA through health promotion strategies, and the risk associated with PA, such as adverse cardiovascular events, can be minimized through routine PA supervision in a gym or exercise laboratory by a physician, physiotherapist, or an exercise physiologist, because recent studies suggests that exercise training supervised by an exercise professional could improve glycemic control among type 2 diabetes Mellitus patients, prevent neurodegenerative diseases in older adults, and minimize the risk of prostate cancer progression, because a physician, or physiotherapist will ensure that a patient adheres to the instructions with regards to the prescribed exercise regimen. There is need to establish more recreational parks and infrastructures with good sports and exercise facilities, most especially in the urban areas, and this can encourage PA among the elderly. A green environment is another factor that encourages people to exercise; there is need to plant flowers and trees in the urban areas, and construct more sidewalks on the roadside, where people can jog, run, or walk.
The limitation of this review was lack of information on the exact dose of PA that can be prescribed for the prevention and in support of the clinical treatment of various chronic disease conditions. However, the optimal dose of PA for various chronic disease conditions is yet to be established.
The optimal dose of exercise required to achieve improvements in functional and prognostic parameters remains an issue of global debate among health-care practitioners. However, further research studies are needed in this specialty in order to determine the optimal dose (volume and intensity) and the exact physical exercise training regimen that can be prescribed by physicians, generally to improve treatment outcomes/goals for various chronic diseases, prior to the individualization of the therapeutic exercise regimen according to patient's functional and clinical status in different disease conditions.
| Conclusion|| |
Based on the outcome of the evaluated studies with regards to this narrative review, PA was found as an effective tool for the prevention and treatment of chronic diseases among older adults. For aging adults who are functionally limited, or have chronic diseases that affect their ability to perform PA, physicians should prescribe a light intensity PA such as light walking, or light calisthenics, at an intensity of 1.1–3.0 METs, or 35%–50% HRR or 1–3 RPE, at the beginning of the exercise training routine, at a duration of 30 min, for 5 days/week. Progression to moderate-intensity exercise training regimen depends on the tolerance and functional capacity of the individual. However, exercise training should be tailored according to the individual's tolerance, functional capacity, health status, and preferences.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Nelson ME, Rejeski WJ, Blair SN, Duncan PW, Judge JO, King AC, et al.
Physical activity and public health in older adults: Recommendation from the American College of Sports Medicine and the American Heart Association. Circulation 2007;116:1094-105.
Sparling PB, Howard BJ, Dunstan DW, Owen N. Recommendations for physical activity in older adults. BMJ 2015;350:h100.
Gebel K, Ding D, Chey T, Stamatakis E, Brown WJ, Bauman AE. Effect of moderate to vigorous physical activity on all-cause mortality in middle-aged and older Australians. JAMA Intern Med 2015;175:970-7.
Wilcox S, Oberrecht L, Bopp M, Kammermann SK, McElmurray CT. A qualitative study of exercise in older African American and white women in rural South Carolina: Perceptions, barriers, and motivations. J Women Aging 2005;17:37-53.
Schutzer KA, Graves BS. Barriers and motivations to exercise in older adults. Prev Med 2004;39:1056-61.
Schuch FB, Vancampfort D, Rosenbaum S, Richards J, Ward PB, Veronese N, et al.
Exercise for depression in older adults: A meta-analysis of randomized controlled trials adjusting for publication bias. Braz J Psychiatry 2016;38:247-54.
American College of Sports Medicine position stand. Exercise and physical activity for older adults. Med Sci Sports Exerc 1998;30:992-1008.
Ross M, Lithgow H, Hayes L, Florida-James G. Potential cellular and biochemical mechanisms of exercise and physical activity on the ageing process. In: Harris J, Korolchuk V, editors. Biochemistry and Cell Biology of Ageing: Part II Clinical Science. Subcellular Biochemistry. Vol. 91. Singapore: Springer; 2019.
Ruangthai R, Phoemsapthawee J. Combined exercise training improves blood pressure and antioxidant capacity in elderly individuals with hypertension. J Exerc Sci Fit 2019;17:67-76.
James AP, Whiteford J, Ackland TR, Dhaliwal SS, Woodhouse JJ, Prince RL. Effects of a 1-year randomised controlled trial of resistance training on blood lipid profile and chylomicron concentration in older men. Eur J Appl Physiol 2016;116:2113-23.
Tomeleri CM, Ribeiro AS, Souza MF, Schiavoni D, Schoenfeld BJ, Venturini D. Resistance training improves inflammatory level, lipid and glycemic profiles in obese older women: A randomized controlled trial. Exp Gerontol 2016;84:80-7.
Woods JA, Ceddia MA, Wolters BW, Evans JK, Lu Q, McAuley E. Effects of 6 months of moderate aerobic exercise training on immune function in the elderly. Mech Ageing Dev 1999;109:1-9.
Petersen AM, Pedersen BK. The anti-inflammatory effect of exercise. J Appl Physiol (1985) 2005;98:1154-62.
Yeh SH, Chuang H, Lin LW, Hsiao CY, Eng HL. Regular Tai Chi Chuan exercise enhances functional mobility and CD4CD25 regulatory T cells. Br J Sports Med 2006;40:239-43.
Emery CF, Kiecolt-Glaser JK, Glaser R, Malarkey WB, Frid DJ. Exercise accelerates wound healing among healthy older adults: A preliminary investigation. J Gerontol A Biol Sci Med Sci 2005;60:1432-6.
Myers J, Prakash M, Froelicher V, Do D, Partington S, Atwood JE. Exercise capacity and mortality among men referred for exercise testing. N
Engl J Med 2002;346:793-801.
Iellamo F, Manzi V, Caminiti G, Vitale C, Castagna C, Massaro M, et al.
Matched dose interval and continuous exercise training induce similar cardiorespiratory and metabolic adaptations in patients with heart failure. Int J Cardiol 2013;167:2561-5.
Nocon M, Hiemann T, Müller-Riemenschneider F, Thalau F, Roll S, Willich SN. Association of physical activity with all-cause and cardiovascular mortality: A systematic review and meta-analysis. Eur J Cardiovasc Prev Rehabil 2008;15:239-46.
Knoops KT, de Groot LC, Kromhout D, Perrin AE, Moreiras-Varela O, Menotti A, et al.
Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: The HALE project. JAMA 2004;292:1433-9.
Lan TY, Chang HY, Tai TY. Relationship between components of leisure physical activity and mortality in Taiwanese older adults. Prev Med 2006;43:36-41.
Schooling CM, Lam TH, Li ZB, Ho SY, Chan WM, Ho KS, et al.
Obesity, physical activity, and mortality in a prospective Chinese elderly cohort. Arch Intern Med 2006;166:1498-504.
Leitzmann MF, Park Y, Blair A, Ballard-Barbash R, Mouw T, Hollenbeck AR, et al.
Physical activity recommendations and decreased risk of mortality. Arch Intern Med 2007;167:2453-60.
Chang JT, Morton SC, Rubenstein LZ, Mojica WA, Maglione M, Suttorp MJ, et al.
Interventions for the prevention of falls in older adults: Systematic review and meta-analysis of randomised clinical trials. BMJ 2004;328:680.
Sherrington C, Whitney JC, Lord SR, Herbert RD, Cumming RG, Close JC. Effective exercise for the prevention of falls: A systematic review and meta-analysis. J Am Geriatr Soc 2008;56:2234-43.
Cameron ID, Murray GR, Gillespie LD, Robertson MC, Hill KD, Cumming RG, et al.
Interventions for preventing falls in older people in nursing care facilities and hospitals. Cochrane Database Syst Rev 2010;1:CD005465.
Li F, Harmer P, Fisher KJ, McAuley E, Chaumeton N, Eckstrom E, et al.
Tai chi and fall reductions in older adults: A randomized controlled trial. J Gerontol A Biol Sci Med Sci 2005;60:187-94.
Voukelatos A, Cumming RG, Lord SR, Rissel C. A randomized, controlled trial of tai chi for the prevention of falls: The central Sydney tai chi trial. J Am Geriatr Soc 2007;55:1185-91.
Davies EJ, Moxham T, Rees K, Singh S, Coats AJ, Ebrahim S, et al.
Exercise based rehabilitation for heart failure. Cochrane Database Syst Rev 2010;4:CD003331.
Wendel-Vos GC, Schuit AJ, Feskens EJ, Boshuizen HC, Verschuren WM, Saris WH, et al.
Physical activity and stroke. A meta-analysis of observational data. Int J Epidemiol 2004;33:787-98.
Warburton DE, Charlesworth S, Ivey A, Nettlefold L, Bredin SS. A systematic review of the evidence for Canada's physical activity guidelines for adults. Int J Behav Nutr Phys Act 2010;7:39.
Kelley GA, Sharpe Kelley K. Aerobic exercise and resting blood pressure in older adults: A meta-analytic review of randomized controlled trials. J Gerontol A Biol Sci Med Sci 2001;56:M298-303.
Taylor RS, Brown A, Ebrahim S, Jolliffe J, Noorani H, Rees K, et al.
Exercise-based rehabilitation for patients with coronary heart disease: Systematic review and meta-analysis of randomized controlled trials. Am J Med 2004;116:682-92.
Huang G, Thompson CJ, Osness WH. Influence of a 10-week controlled exercise program on resting blood pressure in sedentary older adults. J Appl Res 2006;6:188-95.
Mozaffarian D, Wilson PW, Kannel WB. Beyond established and novel risk factors: Lifestyle risk factors for cardiovascular disease. Circulation 2008;117:3031-8.
Monninkhof EM, Elias SG, Vlems FA, van der Tweel I, Schuit AJ, Voskuil DW, et al.
Physical activity and breast cancer: A systematic review. Epidemiology 2007;18:137-57.
Bardia A, Hartmann LC, Vachon CM, Vierkant RA, Wang AH, Olson JE, et al.
Recreational physical activity and risk of postmenopausal breast cancer based on hormone receptor status. Arch Intern Med 2006;166:2478-83.
Dallal CM, Sullivan-Halley J, Ross RK, Wang Y, Deapen D, Horn-Ross PL, et al.
Long-term recreational physical activity and risk of invasive and in situ
breast cancer: The California teachers study. Arch Intern Med 2007;167:408-15.
Chao A, Connell CJ, Jacobs EJ, McCullough ML, Patel AV, Calle EE, et al.
Amount, type, and timing of recreational physical activity in relation to colon and rectal cancer in older adults: The cancer prevention study II nutrition cohort. Cancer Epidemiol Biomarkers Prev 2004;13:2187-95.
Paterson DH, Warburton DE. Physical activity and functional limitations in older adults: A systematic review related to Canada's physical activity guidelines. Int J Behav Nutr Phys Act 2010;7:38.
van Uffelen JG, Chin A Paw MJ, Hopman-Rock M, van Mechelen W. The effects of exercise on cognition in older adults with and without cognitive decline: A systematic review. Clin J Sport Med 2008;18:486-500.
Weuve J, Kang JH, Manson JE, Breteler MM, Ware JH, Grodstein F. Physical activity, including walking, and cognitive function in older women. JAMA 2004;292:1454-61.
Abbott RD, White LR, Ross GW, Masaki KH, Curb JD, Petrovitch H. Walking and dementia in physically capable elderly men. JAMA 2004;292:1447-53.
Scarmeas N, Luchsinger JA, Schupf N, Brickman AM, Cosentino S, Tang MX, et al.
Physical activity, diet, and risk of Alzheimer disease. JAMA 2009;302:627-37.
Hughes VA, Roubenoff R, Wood M, Frontera WR, Evans WJ, Fiatarone Singh MA. Anthropometric assessment of 10-y changes in body composition in the elderly. Am J Clin Nutr 2004;80:475-82.
Goodpaster BH, Chomentowski P, Ward BK, Rossi A, Glynn NW, Delmonico MJ, et al.
Effects of physical activity on strength and skeletal muscle fat infiltration in older adults: A randomized controlled trial. J Appl Physiol (1985) 2008;105:1498-503.
Park H, Park S, Shephard RJ, Aoyagi Y. Yearlong physical activity and sarcopenia in older adults: The Nakanojo study. Eur J Appl Physiol 2010;109:953-61.
Robinson-Cohen C, Katz R, Mozaffarian D, Dalrymple LS, de Boer I, Sarnak M, et al.
Physical activity and rapid decline in kidney function among older adults. Arch Intern Med 2009;169:2116-23.
Bonaiuti D, Shea B, Iovine R, Negrini S, Robinson V, Kemper HC, et al.
Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database Syst Rev 2002;7:CD000333.
Park H, Togo F, Watanabe E, Yasunaga A, Park S, Shephard RJ, et al.
Relationship of bone health to yearlong physical activity in older Japanese adults: Cross-sectional data from the Nakanojo study. Osteoporos Int 2007;18:285-93.
Thomas DE, Elliott EJ, Naughton GA. Exercise for type 2 diabetes mellitus. Cochrane Database Syst Rev 2006;3:CD002968.
DiPietro L, Dziura J, Yeckel CW, Neufer PD. Exercise and improved insulin sensitivity in older women: Evidence of the enduring benefits of higher intensity training. J Appl Physiol (1985) 2006;100:142-9.
Demakakos P, Hamer M, Stamatakis E, Steptoe A. Low-intensity physical activity is associated with reduced risk of incident type 2 diabetes in older adults: Evidence from the English longitudinal study of ageing. Diabetologia 2010;53:1877-85.
Lampinen P, Heikkinen RL, Ruoppila I. Changes in intensity of physical exercise as predictors of depressive symptoms among older adults: An eight-year follow-up. Prev Med 2000;30:371-80.
Strawbridge WJ, Deleger S, Roberts RE, Kaplan GA. Physical activity reduces the risk of subsequent depression for older adults. Am J Epidemiol 2002;156:328-34.
Ku PW, Fox KR, Chen LJ. Physical activity and depressive symptoms in Taiwanese older adults: A seven-year follow-up study. Prev Med 2009;48:250-5.
Binder EF, Schechtman KB, Ehsani AA, Steger-May K, Brown M, Sinacore DR, et al.
Effects of exercise training on frailty in community-dwelling older adults: Results of a randomized, controlled trial. J Am Geriatr Soc 2002;50:1921-8.
Kritchevsky SB, Nicklas BJ, Visser M, Simonsick EM, Newman AB, Harris TB, et al.
Angiotensin-converting enzyme insertion/deletion genotype, exercise, and physical decline. JAMA 2005;294:691-8.
Wisløff U, Støylen A, Loennechen JP, Bruvold M, Rognmo Ø, Haram PM, et al.
Superior cardiovascular effect of aerobic interval training versus moderate continuous training in heart failure patients: A randomized study. Circulation 2007;115:3086-94.
Bendermacher BL, Willigendael EM, Teijink JA, Prins MH. Supervised exercise therapy versus non-supervised exercise therapy for intermittent claudication. Cochrane Database Syst Rev 2006;8:CD005263.
Hung C, Daub B, Black B, Welsh R, Quinney A, Haykowsky M. Exercise training improves overall physical fitness and quality of life in older women with coronary artery disease. Chest 2004;126:1026-31.
Marigold DS, Eng JJ, Dawson AS, Inglis JT, Harris JE, Gylfadóttir S. Exercise leads to faster postural reflexes, improved balance and mobility, and fewer falls in older persons with chronic stroke. J Am Geriatr Soc 2005;53:416-23.
Luctkar-Flude MF, Groll DL, Tranmer JE, Woodend K. Fatigue and physical activity in older adults with cancer: A systematic review of the literature. Cancer Nurs 2007;30:E35-45.
Clemente-Suarez VJ. Changes in biochemical, strength, flexibility, and aerobic capacity parameters after a 1700 km ultraendurance cycling race. Biomed Res Int 2014;2014:602620.
Fransen M, McConnell S. Exercise for osteoarthritis of the knee. Cochrane Database Syst Rev 2008;4:CD004376.
Suetta C, Aagaard P, Rosted A, Jakobsen AK, Duus B, Kjaer M, et al.
Training-induced changes in muscle CSA, muscle strength, EMG, and rate of force development in elderly subjects after long-term unilateral disuse. J Appl Physiol (1985) 2004;97:1954-61.
Callahan LF, Mielenz T, Freburger J, Shreffler J, Hootman J, Brady T, et al.
Arandomized controlled trial of the people with arthritis can exercise program: Symptoms, function, physical activity, and psychosocial outcomes. Arthritis Rheum 2008;59:92-101.
Kay SJ, Fiatarone Singh MA. The influence of physical activity on abdominal fat: A systematic review of the literature. Obes Rev 2006;7:183-200.
Davidson LE, Hudson R, Kilpatrick K, Kuk JL, McMillan K, Janiszewski PM, et al.
Effects of exercise modality on insulin resistance and functional limitation in older adults: A randomized controlled trial. Arch Intern Med 2009;169:122-31.
Güell R, Resqueti V, Sangenis M, Morante F, Martorell B, Casan P, et al.
Impact of pulmonary rehabilitation on psychosocial morbidity in patients with severe COPD. Chest 2006;129:899-904.
Sjösten N, Kivelä SL. The effects of physical exercise on depressive symptoms among the aged: A systematic review. Int J Geriatr Psychiatry 2006;21:410-8.
Heyn P, Abreu BC, Ottenbacher KJ. The effects of exercise training on elderly persons with cognitive impairment and dementia: A meta-analysis. Arch Phys Med Rehabil 2004;85:1694-704.
Goodwin VA, Richards SH, Taylor RS, Taylor AH, Campbell JL. The effectiveness of exercise interventions for people with Parkinson's disease: A systematic review and meta-analysis. Mov Disord 2008;23:631-40.
Mehrholz J, Friis R, Kugler J, Twork S, Storch A, Pohl M. Treadmill training for patients with Parkinson's disease. Cochrane Database Syst Rev 2010;8:CD007830.
Forster A, Lambley R, Hardy J, Young J, Smith J, Green J, et al.
Rehabilitation for older people in long-term care. Cochrane Database Syst Rev 2009;1:CD004294.
Irwin MR, Olmstead R, Motivala SJ. Improving sleep quality in older adults with moderate sleep complaints: A randomized controlled trial of Tai Chi Chih. Sleep 2008;31:1001-8.
Petterson SC, Mizner RL, Stevens JE, Raisis L, Bodenstab A, Newcomb W, et al.
Improved function from progressive strengthening interventions after total knee arthroplasty: A randomized clinical trial with an imbedded prospective cohort. Arthritis Rheum 2009;61:174-83.
Galvão DA, Taaffe DR. Resistance exercise dosage in older adults: Single – Versus multiset effects on physical performance and body composition. J Am Geriatr Soc 2005;53:2090-7.
Broman G, Quintana M, Lindberg T, Jansson E, Kaijser L. High intensity deep water training can improve aerobic power in elderly women. Eur J Appl Physiol 2006;98:117-23.
Iellamo F, Manzi V, Caminiti G, Vitale C, Massaro M, Cerrito A, et al.
Validation of rate of perceived exertion-based exercise training in patients with heart failure: Insights from autonomic nervous system adaptations. Int J Cardiol 2014;176:394-8.
Okechukwu CE. Effects of mobile phone radiation and exercise on testicular function in male Wistar rats. Niger J Exp Clin Biosci 2018;6:51. [Full text]
Cho DY, Yeo JK, Cho SI, Jung JE, Yang SJ, Kong DH, et al.
Exercise improves the effects of testosterone replacement therapy and the durability of response after cessation of treatment: A pilot randomized controlled trial. Asian J Androl 2017;19:602-7.
] [Full text]
Kumagai H, Zempo-Miyaki A, Yoshikawa T, Tsujimoto T, Tanaka K, Maeda S. Lifestyle modification increases serum testosterone level and decrease central blood pressure in overweight and obese men. Endocr J 2015;62:423-30.
Corona G, Vignozzi L, Sforza A, Mannucci E, Maggi M. Obesity and late-onset hypogonadism. Mol Cell Endocrinol 2015;418 Pt 2:120-33.
Laaksonen DE, Niskanen L, Punnonen K, Nyyssönen K, Tuomainen TP, Valkonen VP, et al.
The metabolic syndrome and smoking in relation to hypogonadism in middle-aged men: A prospective cohort study. J Clin Endocrinol Metab 2005;90:712-9.
Richman EL, Kenfield SA, Stampfer MJ, Paciorek A, Carroll PR, Chan JM. Physical activity after diagnosis and risk of prostate cancer progression: Data from the cancer of the prostate strategic urologic research endeavor. Cancer Res 2011;71:3889-95.
Leung PS, Aronson WJ, Ngo TH, Golding LA, Barnard RJ. Exercise alters the IGF axisin vivo
and increases p53 protein in prostate tumor cells in vitro
. J Appl Physiol (1985) 2004;96:450-4.
Barnard RJ, Leung PS, Aronson WJ, Cohen P, Golding LA. A mechanism to explain how regular exercise might reduce the risk for clinical prostate cancer. Eur J Cancer Prev 2007;16:415-21.
Esser KA, Harpole CE, Prins GS, Diamond AM. Physical activity reduces prostate carcinogenesis in a transgenic model. Prostate 2009;69:1372-7.
Gardner JR, Livingston PM, Fraser SF. Effects of exercise on treatment-related adverse effects for patients with prostate cancer receiving androgen-deprivation therapy: A systematic review. J Clin Oncol 2014;32:335-46.
Groessl EJ, Kaplan RM, Rejeski WJ, Katula JA, Glynn NW, King AC, et al.
Physical activity and performance impact long-term quality of life in older adults at risk for major mobility disability. Am J Prev Med 2019;56:141-6.
Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee IM, et al.
American College of Sports Medicine Position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: Guidance for prescribing exercise. Med Sci Sports Exerc 2011;43:1334-59.
Stefani L, Galanti G, Klika R. Clinical implementation of exercise guidelines for cancer patients: adaptation of ACSM's guidelines to the Italian model. J Funct Morphol Kinesiol 2017;2:4.
Wallace JP. Exercise in hypertension. A clinical review. Sports Med 2003;33:585-98.
Colberg SR, Sigal RJ, Yardley JE, Riddell MC, Dunstan DW, Dempsey PC, et al.
Physical activity/exercise and diabetes: A position statement of the American Diabetes Association. Diabetes Care 2016;39:2065-79.
Gill TM, DiPietro L, Krumholz HM. Role of exercise stress testing and safety monitoring for older persons starting an exercise program. JAMA 2000;284:342-9.
Borg G. Borg's Perceived Exertion and Pain Scales. Champaign, IL: Human Kinetics; 1998.
Watts AS, Mortby ME, Burns JM. Depressive symptoms as a barrier to engagement in physical activity in older adults with and without Alzheimer's disease. PLoS One 2018;13:e0208581.
Okechukwu CE. Role of exercise in the treatment of gambling disorder. Niger J Exp Clin Biosci 2019;7:50-4. [Full text]
Eronen J, von Bonsdorff MB, Törmäkangas T, Rantakokko M, Portegijs E, Viljanen A, et al.
Barriers to outdoor physical activity and unmet physical activity need in older adults. Prev Med 2014;67:106-11.
Okechukwu CE. Exercise improves glycemic control among patients with type 2 diabetes mellitus: A summary of meta-analysis and systematic reviews. Int J Prev Med 2019;10:164. [Full text]
Okechukwu CE. Exercise as preventative therapy against neurodegenerative diseases in older adults. Int J Prev Med 2019;10:165. [Full text]
Deb AA, Okechukwu CE, Emara S, Sami AA. Physical activity and prostate cancer: A systematic review. Urol Nephrol Open Access J 2019;7:117-129.
[Table 1], [Table 2], [Table 3], [Table 4]