Although the benefits of exercise have been well documented, only about 30 percent of adults exercise regularly. Among the elderly, barriers to regular exercise include physical disability and lack of accessibility and transportation. Jette and colleagues evaluated the effectiveness of a program called “Strong-for-Life,” which was developed for use in sedentary older persons who also had some component of physical disability.
Patients were recruited for the randomized, controlled study through mailings and referrals from social service agencies, senior centers or housing sites. Study subjects were required to be at least 60 years old and to have some sort of functional limitation. Persons with significant medical problems, including current treatment for cancer, hemodialysis, blindness, recent fracture, uncontrolled diabetes or the need for daily use of a wheelchair, were excluded from participation. A physical therapist performed a baseline assessment and obtained informed consent during the initial screening of volunteers. The patients who met eligibility criteria were then randomized to an exercise group or a control group that was placed on a waiting list.
The Strong-for-Life program included viewing of a 35-minute videotape that demonstrated 11 resistance exercise routines. The videotape showed five minutes of warm-up exercises, 25 minutes of strengthening exercises and five minutes of cool-down exercises. The exercises could be performed in a seated or standing position. The subjects were instructed to increase the resistance levels (designated by different colored elastic bands) after a specific routine could be completed 10 times without significant fatigue. For follow-up the patients received two additional home visits from the physical therapist, who also provided telephone support to answer questions and encourage adherence. The participants were asked to complete and return a log that recorded compliance with the program. The goal was performance of the exercises three times a week for six months. Assessments of strength, mobility, functional status and emotional state were performed at baseline, three months and six months.
A total of 215 patients in the study were randomized into one of the two groups. The mean age of the subjects was approximately 75 years, three fourths were women and over 90 percent were white. Baseline differences in terms of disability or psychologic function were not significant. Members of the exercise group received an average of seven to eight telephone contacts from their physical therapist. The overall adherence rate was 89 percent over the six months of the study, and in 57 percent of the study subjects 100 percent compliance with the exercises was noted. Areas of definite improvement were hip and shoulder abduction, lower extremity strength and tandem gait steps. In addition, the exercise group had a net reduction of 15 to 18 percent in physical disability at three and six months, as well as an 18 percent reduction in overall disability at six months. No difference in psychologic mood states was apparent between the two groups.
The authors conclude that the home-based exercise program is effective in improving the functional status of elderly persons with varying degrees of disability. It is safe and inexpensive and may provide significant public health benefits in this patient population.