Strokes, injuries and the aging process often rob elderly people of the ability to care for themselves, but pumping iron can help restore some independence to the most incapacitated, according to a new study by researchers at the University of Florida and the Malcom Randall Veterans Affairs Medical Center in Gainesville.
After doing weight resistance exercises for as little as a month or two, the weakest study participants, most of whom were in wheelchairs, significantly boosted their strength, enabling them to perform independently more of the simple activities of daily life.
The findings show promise for reversing muscle weakness among the elderly, which contributes to falls and limits the ability to move around. They also show potential for lowering costs of hospital stays, which were shorter for those who exercised compared with a control group who did not, according to the UF study.
"There's been a little bit of fear that you might harm older people who are this frail, that if you push them too hard that they'll either strain a muscle, have a heart attack, get short of breath or that something else might happen to them," said Dr. John Meuleman, an associate professor of internal medicine at UF's College of Medicine and associate director of the VA's Geriatric Research, Education and Clinical Center.
"Our study strongly suggests you can push these people without injury or adverse outcomes, and that they really enjoy doing it and get a lot stronger. It makes a big impact on the quality of their lives," said Meuleman, who also is affiliated with the universitywide Institute on Aging.
Prior studies during the past decade have shown that healthy elderly people benefited from exercise, Meuleman said. However, little research has been done on how it affects people as debilitated as the UF study participants, who were living in nursing homes or the VA hospital's geriatric ward.
For the latest study, published in the March issue of the Archives of Physical Medicine and Rehabilitation, researchers tracked 58 participants whose average age was 75 and who initially needed help performing one or more of 13 simple activities of daily living. Such activities included walking, bathing, dressing, eating, getting in and out of bed and getting around indoors.
At the start, after the training period and twice during the following year, the nurses caring for the participants scored them 0, 1 or 2 based on whether they needed complete help, partial help or were totally independent for each of the activities. The scores were totaled, with 26 the maximum possible.
About half were randomly assigned to an exercise regimen that lasted four to eight weeks. With supervision, they worked out on a weight resistance machine three times a week and did aerobic endurance exercises twice a week. The remaining participants, who did not exercise, served as a control group.
While few of the people could perform the aerobic exercise, the resistance training led to about a 20 percent overall increase in arm and leg strength, particularly for the most impaired.
Participants who worked out also markedly boosted the amount of weight they were able to lift. On a knee extension exercise, they were able to lift 78 percent more on average. The gains were even more pronounced on the study's seven other exercises, where the participants, on average, lifted double or triple the amount of weight at the end of the training. For example, on a shoulder extension exercise, the group lifted an average of nearly 18 pounds at the start, and by the end of the training they lifted an average of nearly 47 pounds.
The most incapacitated, who initially scored less than 13 points on the 26-point living activity scale, also were able to perform their daily activities more independently at the end of the training. They scored an average of about three points higher after the training compared with .2 points higher in the most debilitated among the control group.
Although the effects of the short-term exercise program had waned a year later, training participants had fewer VA hospitalizations and deaths during that time. In addition, the average length of hospitalization was shorter -- two days vs. more than seven days -- among those in the exercising group compared with the control group. The study was not able to track stays outside the VA for either the training or control group members, but Meuleman said the study's results are still a good indicator of the benefits exercise has on hospitalizations.
He collaborated on the study with Dr. David Lowenthal, a UF professor of medicine, pharmacology and exercise science and director of the VA's Geriatric Research, Education and Clinical Center, and former UF scientists William Brechue and Paul Kubilis. The research was supported by a grant from the U.S. Department of Veterans Affairs.
Kathye Light, associate professor of physical therapy in UF's College of Health Professions, agrees and says the results are important.
"There's been very strong sentiment among the public and the medical community that really frail old people are done for -- that all we can do is take care of them until they don't exist anymore," said Light, who works with the most incapacitated elderly to help them regain strength and balance to prevent falls. "This study is further evidence that old people can get better. That seems simple, but it's just not something people believe."