Aerobic Exercise Versus Spinal Flexibility + Aerobic Exercise for Sedentary & Functionally Limited Adults

Physical activity is associated with decreased mortality and morbidity from cancer and other chronic diseases, and with general functional decline in older people. Despite these benefits, only 30% of older men and 15% of older women engage in regular sustained physical activity. Exercise interventions that aim to increase physical activity among older adults rarely focus on spinal flexibility, despite decreases of between 25% and 50% for such flexibility as people age. Individuals with restricted spinal flexibility have increased difficulty achieving minimum goals for exercise associated with improved health and with everyday activities (e.g., accessing public and private modes of transportation, reaching above their heads, climbing stairs).

The program is a specialized exercise intervention for older adults to enhance spinal flexibility and improve physical functioning. Beginning at 5-minute intervals, aerobic activity is increased over a 4- to 8-week period until participants can tolerate 20 minutes of continuous aerobic activity. Spinal flexibility is improved during 20-30 minutes of holding various postures, focusing on deep breathing, and relaxed movements that isolate the hip, shoulder, and cervical area. New exercises are added each week to increase spinal and extremity range of motion. For each position, suggestions are made for incorporating that activity into daily life, such as getting on and off the bed, rising from a seated position, and driving a car.

Thirty-six, 1-hour sessions include 10 minutes of warm-up and cool-down and 40 minutes of the spinal mobility-aerobic exercises. Sessions are supervised by an exercise leader three times a week over 3 months and precede a 6-month home-based portion where the same spinal mobility regime is carried out four times per week.

Participants were Black and White men and women, aged 65 years and older, who were considered at-risk because they did not regularly exercise, but who had stable hearts, controlled hypertension, and normal neurological exams.

This intervention is suitable for implementation in the hospital, community, and home settings.

Required resources include a participant manual and video and a therapist's manual and video. Costs associated with the program's implementation are not provided.

Participants were recruited through mailings and telephone calls from the Duke Aging Center Registry. A comprehensive functional and psychosocial evaluation was completed before participants were randomly assigned to the spinal flexibility-plus-aerobic intervention group, or the aerobic-only comparison group. Both groups met for 1-hour supervised sessions, 3 days a week for 3 months at the VA Medical Center before moving onto the 6-month home-based portion of the intervention. Both groups engaged in 20 minutes of such aerobic activity as brisk-walking or stationary bicycling. The aerobic-only group continued with this activity for another 20 minutes, and the spinal flexibility-plus-aerobics group engaged in 20-30 minutes of stretching, deep breathing, and various exercises to increase spinal and extremity flexibility. In preparation for the home-based portion of the trial, participants in both groups were instructed to exercise one time at home every weekend. After 3 months of supervised exercise, participants began their home-based exercises following the same exercise program they had been randomly assigned. Functional and psychosocial evaluations were completed after 3 months of supervised exercise and again after 6 months of home-based exercise.

Results indicated:

• During the supervised portion of the study, participants in both groups had improved axial rotation (p =0.001), maximal oxygen consumption (p =0.0001), and physical functioning (p =0.0016). Improvements in both groups tended to return towards baseline following the home-based portion of the study.

  
• At 3-month follow-up, the aerobic-only group improved on maximal oxygen consumption twice as much as the spinal flexibility-plus-aerobic group.