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Running Head: PHYSICAL PERFORMANCE AND QUALITY OF LIFE 1
Physical Performance and Health Related Quality of Life in Older Adults
Wendy Santos-Modesitt, BA
CSPP-Alliant International University
San Francisco
March 31, 2011
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Physical Performance and Health Related Quality of Life in Older Adults
As of the 2009 Census, almost 40 million adults are 65 years and older.
It is estimated that by the year 2020 the number of Americans who will be 65years or older is estimated to be 55 million and about 72 million by 2030 (A
Profile of Older Americans: 2008). The 2009 Profile of Older Americans
stated that only 39% of older persons reported being in excellent or very
good health, suggesting that approximately 60% of the older adult
population suffers from at least one (or more) of the most prevalent health
conditions affecting older adults. As the older adult population increases, so
does the number of individuals reporting less than favorable health, thus
reflecting a need for exploring efficacious physical and mental health
interventions.
In an attempt to understand how to reduce the risks of poor health in
older adults, prior studies have consistently found that physical activity and
better physical performance are associated with better health outcomes in
older adults (Seeman et al., 1994; Nelson et al., 2007). A 2007 report by the
American College of Sports Medicine and the American Heart Association
suggests (based on their study of the literature) that regular and increased
physical activity has a whole host of beneficial implications. The report
states that physical activity plays a role in reducing the risk of many of the
most prevalent ailments and diseases suffered by older adults including
physical and mental health complaints. In addition to the beneficial effects
to physical and mental health, physical activity has also been found to
improve health related quality of life (HRQoL) (Abell, Hootman, Zack,Moriarty & Helmick, 2005; Park, Park, Shephard & Aoyagi, 2010). In order to
develop and test effective intervention strategies, it is crucial to develop a
detailed understanding of the associations between aspects of physical
performance and quality of life outcomes, specifically the mental health and
physical health aspects of quality of life.
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Physical activity refers to any activity that causes the body to exert
itself above and beyond what is typical for an individual, including aerobic
and muscle strengthening activities not necessarily done in a gym or as part
of an exercise program (e.g., hiking or strenuous gardening) ( Physical
Activity Guidelines Advisory Committee, U.S. Department of Health and
Human Services, 2008). Physical performance, often referred to as physical
fitness, describes, objectively, an individuals ability to perform a desired
task or the safety and speed at which tasks can be completed (Resnik,
Baker, Holmquist, & Ntuen, 2002). Measured performance includes walking
speed, chair stand, grip strength, postural balance, etc. In a randomized
control trial (RCT), Pahor et al (2006) found that 70- to 89-year-old subjects,
at risk for disability based on sedentary lifestyles, in a structured physical
activity intervention group significantly improved their physical performance
scores compared to the control group. In addition those in the physical
activity group showed a decrease in mobility disability, suggesting a
beneficial improvement of physical performance across time. Another
assessment of the same cohort found a relationship between subjects who
engaged in more vigorous physical activity and their physical performance
scores (Chale-Rush, et al. 2010). Thus older adults who engage in more
intense physical activity show better performance or score better on physical
performance measures.
Physical performance has been found to have direct benefits on
individuals reports and perceptions of HRQoL. Wolin, Glynn, Coditz, Lee and
Kawachi (2007) explored data collected by the Nurses Health Study (data
from 121,700 female registered nurses, started in 1976) and found that,
when comparing women who had maintained a stable physical activity
regimen across time to those who had increased their level of physical
activity, the latter group reported higher HRQoL. In a RCT, Groessl (2007)
found that physical performance was more strongly associated with HRQoL
than was subjects index of co-morbidity (e.g., having diabetes and
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hypertension). Takata et al. (2009) found that among 80- and 85-year-old
Japanese older adults, those who performed better in measures of physical
performance also reported higher HRQoL.
Specific aspects of physical performance, including muscle strength
and body flexibility, are associated with HRQoL. A few studies have found
relationships between specific aspects of physical performance, such as
muscle strength, and benefits or improvements in HRQoL. Tomas-Carus, et
al. (2009), in a RCT of 30 women with fibromyalgia, found that women in the
intervention group, with improved lower body muscle strength, predicted
improvements in HRQoL. Eyigor, Karapolat and Durmanz (2007) found that
women, 65 years and over, who participated in an 8-week exercise group,designed to improve muscle strength, not only significantly improved in
physical performance scores but also significantly improved in HRQoL at
follow-up compared to baseline. Finally, another RCT (King, Pruitt, Phillips,
Oka, Rodenburg & Hasken. 2000) investigating the effects of different types
of physical activity revealed different aspects of physical performance being
associated with different aspects of quality of life. Subjects in this study
were randomly assigned to one of two exercise groups; either a Fit and
Firm class, focusing on aerobic, muscle strength and toning or a Stretch
and Flex class, focused on stretching and flexibility exercises. A main effect
for group found a relationship between improvements in body flexibility (an
aspect of physical performance) and reported improvements in bodily pain
(an aspect of quality of life). HRQoL improvements over time included,
significant improvements at 12-month follow-up in the energy/fatigue scale
of their HRQoL measure in the Fit and Firm group. And significant
improvements in the emotional well-being scale at 12-month follow-up for
the Stretch and Flex group (King, Pruitt, Phillips, Oka, Rodenburg & Hasken.
2000).
Physical performance has also been found to be associated with
mental health. Depression and anxiety are among the more prevalent
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mental health concerns among older adults. Prior studies have suggested
that physical activity is related to a decreased risk of mental health issues
(Nelson, et al., 2007). Deschamps, Onifade, Decamps and Buordel-
Marchasson (2009) compared two different types of exercise interventions,
Tai Chi vs. Cognitive Action Exercise, in which frail institutionalized older
adults were randomly assigned. While there were no significant differences
between the two groups, at follow up the researchers found all subjects
showed significant improvements in physical performance, HRQoL and
depression. A RCT, studying the effects of aerobic exercise on sedentary
males aged 60-75, found significantly decreased scores in depression and
anxiety and significantly improved HRQoL at six-month follow-up as
compared to the control group (Atunes, Stell, Santos, Bueno & de Mello,
2004). A review of the literature conducted by Fox (1999) found that there
was a significant amount of evidence suggesting that physical activity
improves depression, anxiety and mental wellbeing. An alternative
explanation may be that poor physical performance may increase
dependence on others which may increase symptoms of depression and
anxiety and decrease HRQoL; however, existing literature has not adequately
addressed this.
While there are many studies exploring physical activity and its influence
on health and quality of life, to date, there are not many randomized control
trials (Atuens, Stell, Santos, Bueno & de Mello, 2004; Devereux, Robertson, &
Briffa, 2005; King, et al., 2002) exploring these relationships, particularly
effects of physical performance on HRQoL. In order to explore causal effects,
more RCTs are needed. In addition, the majority of studies are long term
studies ranging from six months to three years. With the number of older
adults predicted to benefit from exercise treatment programs increasing,
shorter term programs will be more efficient and cost effective. Finally,
understanding the relationship between aspects of physical performance and
how these might differently influence aspects of quality of life will help
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clinicians design more effective exercise programs that more accurately
target specific impairments. The objective of this study was to determine
whether an intervention designed to improve physical performance was
associated with improvements in health-related quality of life in a relatively
shorter period of time compared to other studies and to examine the cross-
sectional correlations between specific aspects of physical performance
(strength vs. flexibility) and health-related quality of life (mental vs. physical)
in older adults. Studies tend to simply explore the relationship between
physical performance and HRQoL as a single variable. While other studies
have explored the various domains of quality of life, very few have
associated these with aspects of physical performance. Other studies might
explore physical performance and dichotomize HRQoL to further explore the
relationship to physical and mental quality of life. This study further explores
which aspects of physical performance (upper body strength vs. flexibility)
might influence mental health aspects of quality of life. In other words,
would individuals who might have difficulty getting up out of a chair have
lower score in the mental health quality of life vs. an individual who has
more difficulty with touching his/her toes? We were interested to see:
1. In this 12-week intervention, was there a significant improvement in
physical performance as measured by the Senior Fitness Test among
the four MAX Trial physical activity and mental activity groups?
2. Was there a significant improvement in physical performance as
measured by the Senior Fitness Test among the physical activity
intervention and control group?
3. Which aspects of physical functioning (upper body strength, lower
body strength, upper body flexibility, lower body flexibility, endurance
and agility/balance) are related to HRQoL, specifically the mental vs.
physical aspect of quality of life?
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4. Does a 12-week physical and mental activity intervention result in
improvements in physical performance and health related quality of
life among all participants?
5. Are changes/improvements in physical performance related to
change/improvements in HRQoL at follow up?
Methods:
Procedures
Intervention. The Mental Activity and Exercise (MAX) Trial study is a
randomized control trial (RTC) in which older adults (65 and over), who self-
reported a recent decline in memory or thinking, were randomly assigned
into one of four possible groups. Recent decline in memory and thinking was
assessed by self report. The potential participant was asked: Do you feel
your memory and thinking have recently gotten worse? If the potential
participant did not perceive having some difficulty in these aspects of
cognition, the individual would not be eligible for the study. If participant
self-reported having been diagnosed with Alzheimers disease or any other
form of dementia or neurological disorder, the participant was excluded fromparticipating in the study (e.g. Has a doctor ever told you that you have).
To confirm this report, the Telephone Interview for Cognitive Status-modified
(TICS-m) was administered as the last step in the telephone screening
process. Potential participants who scored in the dementia range, 0-18
points, would not be eligible to participate in the study. For the purposes of
this study, recent decline in memory and thinking may include forgetting
names, word finding difficulties, and difficulty with concentrating and
organization. The primary goal of the larger study was to explore the impact
of a physical and mental activity intervention on the primary outcome of
cognitive functioning. This secondary data analysis reports on the outcomes
of physical performance, health-related quality of life and their associations
with each other.
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Eligible participants were randomly assigned to one of four groups in a
two-by-two design: (1) mental activity control + physical control group, (2)
mental activity control + physical intervention group, (3) mental activity
intervention + physical control group, or (4) a mental activity intervention +
physical intervention group, resulting in approximately equal number of
participants in each group. Participants in the mental activity intervention
group used the Posit Science Brain fitness program, installed on computers
and laptops assigned to participants, for one hour a day, three days a week,
for twelve weeks. Participants in the mental activity control group were
asked to view educational DVDs one hour a day, three days a week, for
twelve weeks. The physical activity intervention consisted of participants
enrolling in a structured aerobics and strength building class, while the
physical activity control group consisted of a structured stretching and
toning class. Both physical activity regimens were designed for this age
group. Participants commitment consisted of attending classes held at a
local YMCA for one hour a day, three days a week, for twelve weeks.
Subjects/Participants:
Study participants were recruited primarily through direct mailing toolder adults in the zip codes surrounding the local YMCA. Additional
strategies included recruitment from databases of several university memory
clinics and from other medical clinics, advertisement in local newspapers,
postings in various sites including places of worship, pharmacies and
shopping centers, and referrals from current study participants. Individuals
who showed interest in participating in the study, by either calling the MAX
Trial phone line or mailing back a post card attached to a study brochure,
were first screened for eligibility over the phone by a research assistant.
Inclusion criteria stated individuals had to be 65 years or older, inactive,
endorse self reported recent decline in memory or thinking, able to commit
to the time restrictions of the study and able to get permission to participate
in the study from a physician or general practitioner. Exclusion criteria
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included self-report diagnosis of any form of dementia or any other
neurological disorder; recent brain injury (within the past year); psychiatric
disorder such as major depression or bipolar disease; heart disease; lung
disease; history of substance or alcohol abuse; physical disabilities such as
tremor, hearing or vision impairment; dependence on cane, walker or similar
device; or currently enrolled in another study. Eligible participants verbally
consented during the telephone screening and were scheduled for a formal
consent visit. Participants were also scheduled for a baseline visit, where
their mental and physical functioning was evaluated. After the twelve-week
intervention, a follow-up visit was scheduled, where mental and physical
functioning was re-evaluated. Six hundred and thirty-eight potential
participants showed interest. Of this, 360 were found ineligible, typically due
to being too active (engaging in moderately intense physical activity at least
once per week for one hour or more per week), 151 refused resulting in 127
eligible participants. Of the 127 eligible participants, 31 withdrew (due to
either medical reasons or time constraints) after the baseline visit, leaving
96 participants who successfully completed the study, meaning the
participants completed baseline evaluations, successfully completed the
exercise and mental activity training program and completed follow up
evaluations. Of the 31 participants who withdrew, four participants
volunteered to undergo 12 week follow up evaluations.
The MAX Trial study has been approved by the University of California,
San Franciscos Committee on Human Research and by the San Francisco
Veterans Affairs Medical Center Research Committee. The secondary data
analyses conducted for this study has been approved by the Institutional
Review Board of the California School of Professional Psychology at Alliant
International University.
Measures
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DemographicsParticipants were asked demographic information
such as age, gender, level of education, income, veteran status, race and
ethnicity.
Physical PerformanceThe Senior Fitness Test (SFT), developed by
Rikli and Jones (2001), was used to assess functional fitness of older adults.
The SFT measures functional fitness by assessing physical parameters.
Lower body strength was measured by counting how many times, in 30
seconds, the participant could stand from sitting position and return to a
seated position (Chair Stand); upper body strength was measured by
counting how many times, in 30 seconds the participant could lift a weight,
do an arm curl, using a five pound weight for women and an eight poundweight for men (Arm Curl). Aerobic endurance was measured by counting
how many steps the participant could take in two minutes, while raising both
knees to a specified height (the specified height was based on the distance
halfway between the participants hip bone and knee bone; 2-Minute Step
Test). Lower body flexibility and upper body flexibility were measured by
taking distance from the participant middle finger reaching towards or going
past their toes (Sit and Reach), and placing their preferred hand over the
same shoulder, palms facing down, and the other hand around their back,
palms facing out, in an attempt to touch middle fingers and measuring the
distance between their middle fingers or overlap (Back Scratch). And motor
ability/agility balance were measured by timing how quickly the participant
could stand from a chair, walk eight feet, go around a marker (a cone) and
walk back another eight feet, returning to the chair and sitting down (8 Foot
Up & Go). Norms have been established by assessing over 7,000 men and
women ages 60-94 (Jones & Rikli, 2002).
Health Related Quality of LifeThe Short Form 12 Health Survey
(SF-12; Ware, Kosinski & Keller, 1995; Ware, Kosinski & Keller, 1996) was
used to assess HRQoL. The SF-12 was developed from the longer version
Short Form 36 Health Survey and measures eight domains resulting in a
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Mental Component Summary (MCS) Score and a Physical Component
Summary (PCS) Score. The specific domains measured include mental
health, social functioning, energy/vitality, role emotional, general health,
physical functioning, role physical and bodily pain. The scores have been
standardized based on general population norms as well as gender and age
based norms. These have been established using a US sample of over 2300
subjects, ages 18 to over 75 years (Ware, Kosinski & Keller, 1995). The SF-
12 has been validated in the US as well as many European countries
(Gandek, et al., 1998). All participants were asked to read and answer all
questions on the form.
The Short Form-12 Health Survey (SF-12) and Senior Fitness Test (SFT)were administered as part of a comprehensive neuropsychological battery
administered to MAX Trial participants at baseline and after a twelve-week
intervention. The cognitive and physical evaluations were administered
according to a protocol, which was developed for the MAX Trial, by a
doctorate level graduate student. All interviewers underwent an extensive
training prior to administering the battery.
Analysis
Study data were analyzed using Stata 10.1 statistical software. The
distributions of all continuous variables were examined using means,
medians, standard deviations (SD) and histograms/box plots. One way
ANOVA analyses were used to determine if the difference or change
observed in SFT item scores, from baseline to follow up, were significantly
different among 1) the four identified groups and 2) more specifically the two
physical activity groups (intervention vs. control). In addition, the
researchers were interested in exploring which aspects of physical
performance correlated with the mental aspects of quality of life versus the
physical aspects of quality of life. Pairwise correlations were used to
determine relationships among SFT items and PCS and MCS scores.
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Significance level was set at .05. Paired T-tests were used to determine
significant differences in SFT performance and PCS and MCS scores from
baseline and post intervention. Change in performance on the SFT and the
change in the MCS and PCS scores was analyzed using pairwise correlations.
Results:
Table 1 displays a summary of the demographic characteristics of the
participants in the Max Trial. A large proportion of the participants identified
as non-white, 35.7%, mean age was 73.4 years and 63% were female. The
mean level of education or the mean highest grade completed was 16
(graduate degree/some graduate work). Baseline performance on SFT and
SF-12 are also reported.
The four groups, (1) mental activity control + physical control group,
(2) mental activity control + physical intervention group, (3) mental activity
intervention + physical control group, or (4) a mental activity intervention +
physical intervention group, were compared based on physical performance
difference (e.g. T2-T1) on all the SFT items. Oneway ANOVA analyses
revealed that improvements in physical performance did not differ by
randomization group. The ANOVA analyses yielded the following results:
Chair Stand F(3,96)=.63,p=.6, Arm Curl F(3,96)=.31,p=.82, 2-Min Step Test
F(3,96)=.30,p=.82, Sit and Reach F(3,96)=1.34,p=.27, Back scratch
F(3,96)=.43,p=.73 and 8-Foot Up and Go F(3,96)=.73,p=.54. Oneway
ANOVA analyses, comparing all participants assigned to the physical activity
control group and the physical activity intervention group, revealed no
significant difference among the two groups when comparing the difference
on the SFT items: Chair Stand F(1,98)=.13,p=.72, Arm Curl F(1,98)=.46,
p=.50, 2-Min Step Test F(1,98)=.04,p=.85, Sit and Reach F(1,98)=.12,
p=.73, Back scratch F(1,98)=.58,p=.45 and 8-Foot Up and Go F(1,98)=.35,
p=.55. Therefore, all participants were combined in the remaining analyses.
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Improvements in HRQoL did not differ by randomization group.
Oneway Anova analyses of four groups, as described above, found no
significant difference among the PCS-12 and MCS-12 change scores, PCS-12
F(3, 96)=2.02,p=.12 and MCS-12 F(3, 96)=.42,p=.74. Likewise, no
significance found for HRQoL when comparing participants in the physical
activity control versus intervention group F(1, 98)=.30,p=.59, MCS-12 F(1,
98)=.01,p=.93.
Physical Performance and Health Related Quality of Life.
Table 2 displays the cross-sectional correlations between measures of
physical performance and mental versus physical aspects of quality of life at
baseline. The following SFT items were significantly correlated with PCS
scores: Chair Stand (r=.32,p
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Paired t-test analyses were conducted in order to determine improvement in
physical performance over time. At baseline participants completed an
average of 10.8 (SD=3.8) chair stands in 30 seconds and 12.2 (SD=4.8) arm
curls in 30 seconds; took 74.3 (SD=23.3) steps during the 2-Min Step Test;
were 1.2 (SD=4.6) inches away from touching their toes and 4.0 (SD=5.0)
inches away from touching their fingers behind their backs; and took 6.7
(SD=2.2) seconds to complete the 8 Foot Up and Go task. After the twelve
week intervention period, participants could complete 1.7 (SD=3.2,
p=
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Discussion:
The mean difference, that is the participants performance on a Senior
Fitness Test (SFT) items, at follow up, subtracted from their performance at
baseline, was compared among the main four groups of the study, as
described above. The analysis revealed there was no significant difference
in the change (or difference) scores among the four groups. The same mean
difference comparison (or mean change) of all the participants in the
physical activity control group versus the physical activity intervention group
yielded no significance as well. One possible explanation is that the control
group was not a true control, as they too received some form of exercise. It
is possible that for this sample, both forms of exercise, either aerobic or
flexibility and stretching, were equally beneficial in improving physical
performance in a 12-week intervention.
At baseline several aspects of the physical performance measure, theSFT, were significantly associated with the Physical Component Summary
Score (PCS) of our HRQoL measure, the SF-12. These included: Chair Stands,
which measures lower body strength; 2-min Step Test, which measures
endurance; and 8-foot Up & Go, which measures agility and balance. At
baseline we also found that Arm Curl (upper body strength) was significantly
related to the Mental Component Summary Score (MCS). While these
relationship remain constant at follow-up for PCS, arm curl is no longer
associated with MCS at follow up, neither is any other physical performance
item of the SFT.
We were interested in learning whether or not this 12 week exercise
intervention could significantly improve physical performance and HRQoL in
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community dwelling adults with self-reported cognitive complaints. After
analysis, we discovered that this sample did improve significantly in 4 of the
6 physical performance items measured by the SFT, including upper and
lower body strength, endurance and lower body flexibility. PCS also
significantly improved in the group from baseline to follow up. There were
no significant improvements in the MCS, however, this groups MCS mean of
52.5, at baseline ,was higher than that of the general US population mean
(51.3; Ware, Kosinski & Keller, 1995). It is possible that this group was
relatively well, in terms of mental health factors, as assessed by this
measure, thus improvements in HRQoL would more likely load on the PCS.
In addition, more SFT items correlated with PCS at baseline than MCS.
We also wanted to explore whether or not the physical performance
improvements observed would correlate to the improvements observed in
HRQoL. For this analysis we found that none of the changes or
improvements for the SFT correlated with changes on the MCS or PCS scores.
Limitations.
This study recruited community dwelling participants living in the Bay
Area, thus based on geographical nature of their residence and
demographics of this region, study participants were relatively healthy,
active and highly educated. Hence this study cannot be generalized to other
populations, such as institutionalized or disabled older adults. RCTs with a
more representative US sample may yield more improvements in physical
performance and HRQoL. Secondly, the intervention was for only twelve
weeks. While this was efficacious enough for this sample, in terms of
improvements in physical performance and PCS, and may be cost effective
for adult treatment programs, exploring longer interventions may also yield
significant improvements in all physical functioning domains and HRQoL. It
is possible some aspects of physical performance (e.g. upper body flexibility,
agility and balance) required a longer intervention to show significant
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improvement. Perhaps a combination of short-term programs coupled with
home based interventions may also yield positive results. Finally, this study
does not include a true control group, that is, a group receiving no form of
treatment. This studys physical activity control group participated in an
exercise program focusing on stretching and flexibility for twelve weeks. It is
possible that including a control group that receives no form of exercise may
shed some light on whether or not the improvements we see on the SFT
items are related to the exercise program or simply being tested twice.
In summary, this study found that a short twelve week intervention
was sufficient in providing improvements in specific aspects of physical
performance, such as lower body strength (standing up out of a chair), upperbody strength (carrying/lifting groceries), endurance (walking/climbing stairs)
and lower body flexibility (reaching for dropped keys). These are all crucial
in an individuals ability to maintain independence as they age. In addition,
participation in this short intervention also significantly improved
participants PCS scores which are related to the physical aspects of quality
of life. As the Baby Boomer generation begins to join the current older adult
population it is crucial for community centers and agencies, providing
services to help reduce risk of disability and to help older adults maintain
independence, implement efficacious exercise interventions.
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References
Abell, J. E., Hootman, J. M., Zack, M. M., Moriarty, D., & Helmick, C. G. (2005).
Physical activity and health related quality of life among people with
arthritis.J Epidemiol Community Health, 59(5), 380-385.
Antunes, H. K., Stella, S. G., Santos, R. F., Bueno, O. F., & de Mello, M. T.
(2005). Depression, anxiety and quality of life scores in seniors after an
endurance exercise program. Rev Bras Psiquiatr, 27(4), 266-271.
A profile of older Americans: 2008. Administration on Aging, U.S. Department
on Health and Human Services.
A profile of older Americans: 2009. Administration on Aging, U.S. Department
on Health and Human Services.
Chale-Rush, A., Guralnik, J. M., Walkup, M. P., Miller, M. E., Rejeski, W. J.,
Katula, J. A., et al. Relationship between physical functioning and
physical activity in the lifestyle interventions and independence for
elders pilot.J Am Geriatr Soc, 58(10), 1918-1924.
Deschamps, A., Onifade, C., Decamps, A., & Bourdel-Marchasson, I. (2009).
Health-related quality of life in frail institutionalized elderly: effects of acognition-action intervention and Tai Chi.J Aging Phys Act, 17(2), 236-
248.
Devereux, K., Robertson, D., & Briffa, N. K. (2005). Effects of a water-based
program on women 65 years and over: a randomised controlled trial.
Aust J Physiother, 51(2), 102-108.
Eyigor, S., Karapolat, H., & Durmaz, B. (2007). Effects of a group-based
exercise program on the physical performance, muscle strength and
quality of life in older women.Arch Gerontol Geriatr, 45(3), 259-271.
Fox, K. R. (1999). The influence of physical activity on mental well-being.
Public Health Nutr, 2(3A), 411-418.
Groessl, E. J., Kaplan, R. M., Rejeski, W. J., Katula, J. A., King, A. C., Frierson,
G., et al. (2007). Health-related quality of life in older adults at risk for
8/6/2019 20110331 Paper-Wendy TIET
19/26
PHYSICAL PERFORMANCE QUALITY OF LIFE
19
disability.Am J Prev Med, 33(3), 214-218.
Jones, J., & Rikli, R. (2002). Measuring functional.J on Active Aging, 24-30
King, A. C., Pruitt, L. A., Phillips, W., Oka, R., Rodenburg, A., & Haskell, W. L.
(2000). Comparative effects of two physical activity programs on
measured and perceived physical functioning and other health-related
quality of life outcomes in older adults.J Gerontol A Biol Sci Med Sci,
55(2), M74-83.
King, M. B., Whipple, R. H., Gruman, C. A., Judge, J. O., Schmidt, J. A., &
Wolfson, L. I. (2002). The Performance Enhancement Project:
improving physical performance in older persons.Arch Phys Med
Rehabil, 83(8), 1060-1069.
Nelson, M. E., Rejeski, W. J., Blair, S. N., Duncan, P. W., Judge, J. O., King, A.
C., et al. (2007). Physical activity and public health in older adults:
recommendation from the American College of Sports Medicine and
the American Heart Association. Circulation, 116(9), 1094-1105.
Pahor, M., Blair, S. N., Espeland, M., Fielding, R., Gill, T. M., Guralnik, J. M., et
al. (2006). Effects of a physical activity intervention on measures of
physical performance: Results of the lifestyle interventions and
independence for Elders Pilot (LIFE-P) study.J Gerontol A Biol Sci MedSci, 61(11), 1157-1165.
Park, H., Park, S., Shephard, R. J., & Aoyagi, Y. Yearlong physical activity and
sarcopenia in older adults: the Nakanojo Study. Eur J Appl Physiol,
109(5), 953-961.
Resnik, M., Baker, G., Holmquist, J. & Ntuen, C. (2002). Integrating Human
Factors into the Design Process at NASA. Institute of Industrial
Engineers.
www.iienet2.org/uploadedfiles/IIE/Technical_Resources/Archives/39.pdf
Seeman, T. E., Charpentier, P. A., Berkman, L. F., Tinetti, M. E., Guralnik, J.
M., Albert, M., et al. (1994). Predicting changes in physical
performance in a high-functioning elderly cohort: MacArthur studies of
successful aging.J Gerontol, 49(3), M97-108.
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PHYSICAL PERFORMANCE QUALITY OF LIFE
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Taguchi, N., Higaki, Y., Inoue, S., Kimura, H., & Tanaka, K. (2010). Effects of a
12-month multicomponent exercise program on physical performance,
daily physical activity, and quality of life in very elderly people with
minor disabilities: an intervention study.J Epidemiol, 20(1), 21-29.
Takata, Y., Ansai, T., Soh, I., Awano, S., Yoshitake, Y., Kimura, Y., et al.
Quality of life and physical fitness in an 85-year-old population.Arch
Gerontol Geriatr, 50(3), 272-276.
Tomas-Carus, P., Gusi, N., Hakkinen, A., Hakkinen, K., Raimundo, A., &
Ortega-Alonso, A. (2009). Improvements of muscle strength predicted
benefits in HRQOL and postural balance in women with fibromyalgia:
an 8-month randomized controlled trial. Rheumatology (Oxford), 48(9),
1147-1151.
Ware, J. E., Jr., Kosinski, M., Bayliss, M. S., McHorney, C. A., Rogers, W. H., &
Raczek, A. (1995). Comparison of methods for the scoring and
statistical analysis of SF-36 health profile and summary measures:
summary of results from the Medical Outcomes Study. Med Care, 33(4
Suppl), AS264-279.
Ware, J., Jr., Kosinski, M., & Keller, S. D. (1996). A 12-Item Short-Form Health
Survey: construction of scales and preliminary tests of reliability and
validity. Med Care, 34(3), 220-233.
Wolin, K. Y., Glynn, R. J., Colditz, G. A., Lee, I. M., & Kawachi, I. (2007). Long-
term physical activity patterns and health-related quality of life in U.S.
women.Am J Prev Med, 32(6), 490-499.
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Table 2.
Relationships among Physical Performance Items and MCS
PCS SF-12 scores at Baseline
Baseline MCS-12
(r)
PCS-12
(r)
Chair Stand .12 .32***
Arm Curl .31*** .16
Step Test .05 .38***
Sit and Reach -.06 -.10
Back Scratch -.02 .13
8 Foot Up & Go .01 -.36***
***p
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Table 3.
Comparison of Physical Performance at Baseline and Follow up
Paired T-Tests
Baseline Follow-up
Senior Fitness Test
Items
n=100
Mean (SD)
n=100
Mean (SD) P-value
Chair Stand 10.8 (3.8) 12.6 (4.3)
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Table 4.
Relationship among change in physical performance (SFT)
and change in MCS and PCS SF-12 scores
ChangeMCS-12
(r)
PCS-12
(r)Chair Stand .19 -.02
Arm Curl .12 .04
Step Test .05 .10
Sit and Reach .03 -.11
Back Scratch .11 -.02
8 Foot Up & Go -.09 -.05
Note: none of the relationships were significant at a p < .05
25
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Figure 1. Comparison of MCS-12 and PCS-12 at baseline and follow up.
45
46
47
48
49
50
51
52
53
Mental Component Physical Component
Baseline Follow up
52.5 52.4
(7.8) (8.6)
P-Value= .99
47.5 49.0(8.8) (8.8)
*P-Value= .049
* P value significant at .05
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