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Johansson C1, Hildebrand C1, Trieger K1, Sullivan B1, Witherspoon K1, Borrowman M1
1Elon University, Department of Physical Therapy Education, Elon, United States
Background: Functional outcome measure norms are routinely used for screening, goal setting, and discharge decisions for older adults. However, these norms are typically based on the performance of community-dwelling older adults, a population that research has shown to be relatively sedentary. The American College of Sports Medicine (ACSM) recommends that older adults engage in at least 150 minutes of moderate-intensity cardiorespiratory exercise per week for optimal health. This discrepancy calls into question the appropriateness of existing functional outcome measure norms as wellness standards for older adults.
Purpose: The purpose of this study was to determine whether older adults who met ACSM cardiorespiratory exercise guidelines performed significantly better on 4 functional measuresthe six-minute walk test (6MWT), Timed Up and Go (TUG), single-leg stance (SLS), and Five-Times Sit-to-Stand test (FTSTS)than their age- and gender-adjusted norms.
Methods: Older adults in the southeastern United States who reported being physically active were recruited from the community to take part in a multicomponent fitness test. Of the 71 who volunteered, 50 people between the ages of 60 and 89 were found to meet the ACSM recommendation of at least 150 minutes of moderate-intensity aerobic exercise per week as confirmed by one week of activity monitor (activPal®) data. Subjects had a mean age of 71.9 years and included 32 women, 18 men, and 0 transgender. Compliance with ACSM guidelines was determined using activPal®'s software conversion of activity to MET values and the Center for Disease Control's classification of moderate activity as 3-6 METs. Functional measures were conducted using standard procedures under the supervision of a licensed physical therapist. Participants' 6MWT, SLS, TUG, and FTSTS scores were compared to existing norms using one-sample t-tests.
Results: Groups that outperformed their related norms were: 6MWT men 60-69 (p=0.015) and 80-89 (p=0.020), women 60-69 (p=0.000) and 70-79 (p=0.014); TUG men 60-69 (p=0.025), 70-79 (p=0.000), and 80-89 (p=0.000), and women 60-69 (p=0.000), 70-79 (p=0.000), and 80-89 (p=0.006); SLS women 60-69 (p=0.000) and 70-79 (p=0.005); and FTSTS men and women 60-69, 70-79, and 80-89 (p=0.000).
Conclusion(s): Overall, participants who met ACSM's aerobic exercise guidelines tended to outperform their age- and gender-adjusted norms, suggesting that current norms do not reflect the performance of healthily active older adults. Results differed among outcome measures, however. For example, active men outperformed their norms on the FTSTS and TUG but not on the SLS. Future studies with larger sample sizes are needed to verify these preliminary findings. In particular, studies should address other functional measures and the influence of ACSM-recommended strengthening and neuromotor exercises. Additionally, data from active participants 90 years old and older are needed to address changing demographics worldwide.
Implications: Given the discrepancy between current norms and performance of healthily active older adults, caution should be used when using existing norms to guide clinical expectations. When establishing target functional outcome performance of older adults, clinicians may wish to use these preliminary normative values. The data also suggest that all future norming studies for functional outcome measures should factor in participants' types and amounts of activity to promote wellness standards.
Keywords: Exercise, elderly, wellness
Funding acknowledgements: None
Purpose: The purpose of this study was to determine whether older adults who met ACSM cardiorespiratory exercise guidelines performed significantly better on 4 functional measuresthe six-minute walk test (6MWT), Timed Up and Go (TUG), single-leg stance (SLS), and Five-Times Sit-to-Stand test (FTSTS)than their age- and gender-adjusted norms.
Methods: Older adults in the southeastern United States who reported being physically active were recruited from the community to take part in a multicomponent fitness test. Of the 71 who volunteered, 50 people between the ages of 60 and 89 were found to meet the ACSM recommendation of at least 150 minutes of moderate-intensity aerobic exercise per week as confirmed by one week of activity monitor (activPal®) data. Subjects had a mean age of 71.9 years and included 32 women, 18 men, and 0 transgender. Compliance with ACSM guidelines was determined using activPal®'s software conversion of activity to MET values and the Center for Disease Control's classification of moderate activity as 3-6 METs. Functional measures were conducted using standard procedures under the supervision of a licensed physical therapist. Participants' 6MWT, SLS, TUG, and FTSTS scores were compared to existing norms using one-sample t-tests.
Results: Groups that outperformed their related norms were: 6MWT men 60-69 (p=0.015) and 80-89 (p=0.020), women 60-69 (p=0.000) and 70-79 (p=0.014); TUG men 60-69 (p=0.025), 70-79 (p=0.000), and 80-89 (p=0.000), and women 60-69 (p=0.000), 70-79 (p=0.000), and 80-89 (p=0.006); SLS women 60-69 (p=0.000) and 70-79 (p=0.005); and FTSTS men and women 60-69, 70-79, and 80-89 (p=0.000).
Conclusion(s): Overall, participants who met ACSM's aerobic exercise guidelines tended to outperform their age- and gender-adjusted norms, suggesting that current norms do not reflect the performance of healthily active older adults. Results differed among outcome measures, however. For example, active men outperformed their norms on the FTSTS and TUG but not on the SLS. Future studies with larger sample sizes are needed to verify these preliminary findings. In particular, studies should address other functional measures and the influence of ACSM-recommended strengthening and neuromotor exercises. Additionally, data from active participants 90 years old and older are needed to address changing demographics worldwide.
Implications: Given the discrepancy between current norms and performance of healthily active older adults, caution should be used when using existing norms to guide clinical expectations. When establishing target functional outcome performance of older adults, clinicians may wish to use these preliminary normative values. The data also suggest that all future norming studies for functional outcome measures should factor in participants' types and amounts of activity to promote wellness standards.
Keywords: Exercise, elderly, wellness
Funding acknowledgements: None
Topic: Older people; Health promotion & wellbeing/healthy ageing; Cardiorespiratory
Ethics approval required: Yes
Institution: Elon University
Ethics committee: Institutional Review Board
Ethics number: 17-175
All authors, affiliations and abstracts have been published as submitted.
