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Senior Fitness & Exercise
Inability of Elderly to Walk Quarter-Mile is
Predictor of Death, Poor Health
May 2, 2006 Elderly people, who cannot walk 400
meters, or about a quarter mile, may not be here to try it six years
from now and may suffer considerable illness and disability during that
time, according to a study of senior citizens ages 70 through 79.
Walking fitness makes a significant difference in predicting the
likelihood of future disability in the elderly, according to a study
published today in the Journal of the American Medical Association.
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Researchers at the University of Pittsburgh
Graduate School of Public Health (GSPH) and their collaborators found
that the ability to walk 400-meters, or about a quarter mile, was an
important determinant not only of whether elderly participants would be
alive six years later but also how much illness and disability they
would experience within that time frame.
"The ability to complete this walk was a powerful
predictor of health outcomes. In fact, we found that the people who
could not complete the walk were at an extremely high risk of later
disability and death," said lead author, Anne B. Newman, M.D., M.P.H.,
professor of epidemiology at GSPH and professor of medicine in the
department of medicine, University of Pittsburgh School of Medicine.
Dr. Newman and her co-workers, collaborating with
researchers at five other institutions, asked a group of almost 2,700
community-dwelling white and African-American men and women aged 70 to
79 to complete, as quickly as they could--without running--and at a
consistent pace, ten 40-meter laps in a corridor.
All of the participants previously had reported no
difficulty walking a quarter of a mile, climbing one flight of stairs
without resting or performing basic activities of daily living.
Participants were excluded from attempting the walk if they had an
abnormal electrocardiogram, elevated blood pressure or resting heart
rate or recently had a procedure for, or symptoms of, heart disease.
Those participants who qualified for the quarter-mile walk were told to
stop if they experienced any signs of fatigue or persistent rapid heart
rate.
Of the 2,680 elderly people eligible for the test,
2,324 (86 percent) completed the full 400-meters, while 356 (13 percent)
did not complete the test. The investigators followed the medical
histories of all participants--whether they completed the walk or
not--for about six years.
Among those excluded from or who stopped the walk,
death rates were significantly higher six years later than those who
completed the walk. In addition, of the more than 2,200 participants who
did not have a clinical diagnosis of cardiovascular disease at the time
of the test, those who did not complete the walk had significantly more
heart-related incidents six years later compared to those who did. The
former group also had a significantly higher risk of persistent
limitations in their mobility and related disabilities than did those
who completed the full 400-meters.
"A significant portion of people in the study could
not complete the walk, even though they believed they were in fairly
good health. Moreover, there was a big gap in health outcomes between
people who could complete the longer walk and people who could not, with
the latter being at an extremely high risk of becoming disabled or
dying. What was really surprising is that these people were not aware of
how limited they actually were," explained Dr. Newman, who also is a
collaborator with the University of Pittsburgh Institute on Aging.
Even among those who completed the walk, those in
the slowest 25 percent for walk time had a three- to four-fold higher
risk of death than those in the fastest 25 percent for walk time. Those
in the slowest 25 percent of walk time also had a higher risk of
cardiovascular disease-related complications and limitation in their
mobility and mobility-related disabilities than those in the fastest 25
percent.
Based on these results, Dr. Newman and her
collaborators believe the 400-meter long-distance corridor walk offers a
relatively simple but powerful way to discriminate levels of function,
particularly among the elderly with normal performances on lower
extremity tests or on short walking tests. More importantly, it can
point out who needs intervention.
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On the other
hand... |
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Elderly Men Who Can Walk Two Miles a Day Cut Heart
Attack Risk in Half
Elderly men who walked about two miles a day had
half the risk of heart attack of males who walked a quarter mile,
according to a study in the July 6, 2005 issue of Circulation: Journal
of the American Heart Association.
The study of 2,678 men, whose ages ranged from 71
to 93, also found that the risk of a first heart attack dropped 15
percent for every additional half mile a day walked. The men, all of
whom were enrolled in the Honolulu Heart Program (HHP) and were
participants in a larger study of men of Japanese ancestry living on
Oahu, walked from less than a quarter mile a day to eight miles daily.
Robert D. Abbott, Ph.D., professor of biostatistics
at the University of Virginia School of Medicine, and one of the study's
authors, says the research suggests, "Encouraging the elderly to walk
and to become active could have important health benefits. This is
especially important because walking can be easily incorporated into a
person's lifestyle and daily routine."
In an accompanying editorial, Peter G. Snell,
Ph.D., assistant professor of internal medicine at the University of
Texas Southwestern Medical Center in Dallas, and Jere H. Mitchell, M.D.,
chief of the cardiopulmonary division at the same institution, say that
walking helps prevent heart disease by reducing the risk of
atherosclerosis -- the buildup of fatty deposits that can clog heart
arteries -- and of blood clots and irregular heartbeat, both of which
can trigger a heart attack.
The study's findings may extend to younger men as
well as women, according to Snell and Mitchell. They point to similar
studies such as the Nurses' Health Study and the Harvard Alumni Study,
both of which found that walking can reduce a person's risk of heart
disease.
Snell and Mitchell remind older people to consult
with a physician before beginning an exercise program. However, they
add, "From a public health standpoint, the finding that exercise that is
neither strenuous nor prolonged can benefit an individual at any age is
encouraging. As personal computers invade our lives and society becomes
increasingly successful at reducing our need to move, opportunities for
everyone to become more physically active should be given a high
priority."
Researchers ranked distance walked by the men in
the study into three ranges:
less than one-quarter mile a day; one-quarter to 1.5 miles a day; and
more than 1.5 miles a day.
The risk of heart attack in the two-to-four year
study for those who walked less than a quarter mile a day was 5 percent
compared to 2.5 percent of those who walked more than 1.5 miles a day.
Men who had walked one-quarter to 1.5 miles per day had a 4.5 percent
risk of developing heart disease compared to 2.5 percent for those who
walked more.
A total of 109 of the men experienced a heart
attack. Forty-one of them were among the 805 men who walked less than a
quarter mile, 48 were among the 1,067 who walked a quarter to 1.5 miles,
and 20 were among the 806 who walked more than a mile and a half.
All the men were physically capable of walking at
least one hour at slight, moderate or heavy activity on a regular daily
basis.
The study used data from medical records of 2,678
men ages 71 to 93 enrolled in the HHP, which has monitored more than
8,000 men of Japanese ancestry living in Oahu. Interviews conducted
during examinations between 1991 and 1993 were used as a baseline. The
men walked daily anywhere from a quarter-mile or less to as many as
eight miles a day. Researchers kept track of each man's health status
for two to four years after the exams.
Even after accounting for differences in other
measures of physical function and cardiovascular risk factors, walking
continued to be associated with a reduced risk of heart attack.
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"Our study found that many people who performed
well on lower extremity tests or short walking tests did not perform
well on the 400-meter walking test. Although quite simple, the 400-meter
walk appears to be a highly accurate way to predict whether or not
someone may be experiencing early problems and needs an immediate
referral into an intervention program to help them increase their
activity and physical stamina," she explained.
Unfortunately, many communities have structural
barriers that prevent the elderly from maintaining physical fitness, so
these findings have public policy as well as public health implications,
said the authors. According to Dr. Newman, it is difficult for many
older people to find safe places to walk, and many can't afford indoor
exercise equipment, such as treadmills. As a result, the elderly tend to
become more and more sedentary as they grow older, setting them up for
major problems as they age.
"Individuals who remain physically active into
their 70s have a big advantage in their 80s in terms of living longer
and reducing their risk of cardiovascular disease and disability. So, we
really need to focus on developing programs in the community that will
help the elderly stay active and healthier longer," she said.
Previous Report
Dr. Newman reported in May of 2005 that she had
found performance on a 400-meter walk is predictive of mortality in able
70- to 79-year-olds.
Volunteers who could not complete the roughly
quarter-mile walk had a 30% to 40% increase in five-year mortality risk
compared with those who finished the walk, she reported at a American
Geriatrics Society meeting in 2005.
Moreover, participants who took more than 5.5
minutes to complete the walk also had an increased risk of dying in five
years -- a 35% increase in risk for every minute over the 5.5 minute
pace.
Failure to complete the walk, or exclusion from the
walk test, was also associated with a 60% to 100% increase in risk of
disability, she said last year.
More About the Study
This study was funded, in part, by a grant from the
National Institute on Aging, National Institutes of Health. In addition
to Dr. Newman, others participating in the study include Jennifer S.
Brach, Ph.D., Robert M. Boudreau, Ph.D., Barbara L. Naydeck, M.P.H., and
Stephanie A. Studenski, M.D., M.P.H., of the University of Pittsburgh;
Eleanor M. Simonsick, Ph.D., and Tamara B. Harris, M.D., of the National
Institute of Aging; Stephen B. Kritchevsky, Ph.D., of Wake Forest
University; Michael C. Nevitt, Ph.D., of the University of California,
San Francisco; Marco Pahor, M.D., of the University of Florida,
Gainesville; and Suzanne Satterfield, M.D., Dr.P.H., of the University
of Tennessee, Memphis.
Founded in 1948 and fully accredited by the Council
on Education for Public Health, GSPH is world-renowned for contributions
that have influenced public health practices and medical care for
millions of people. One of the top-ranked schools of public health in
the United States, GSPH was the first fully accredited school of public
health in the Commonwealth of Pennsylvania, with alumni who are among
the leaders in their fields of public health. A member of the
Association of Schools of Public Health, GSPH currently ranks third
among schools of public health in NIH funding received. The only school
of public health in the nation with a chair in minority health, GSPH is
a leader in research related to women's health, aging, HIV/AIDS and
human genetics, among others. For more information about GSPH, visit the
GSPH Web site at
http://www.publichealth.pitt.edu.
The University of Pittsburgh Institute on Aging is
a comprehensive resource providing expertise and information on aging
and geriatric care for seniors, caregivers, educators, students and
health care professionals. Learn more about the Institute on Aging by
visiting
www.aging.upmc.com.
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