Background: Although multimodal exercise is recommended to improve function and health in older adults, few studies have evaluated whether it is possible to implement exercise programs vigorous enough to improve muscle strength, endurance, and balance in this population. Baker and colleagues studied the feasibility and impact of an exercise prescription in the retirement community setting.

The Study: The randomized controlled study included patients 60 years and older from two retirement communities. Participants were randomly selected to receive a 10-week exercise program or were put on a waiting list for a program. Primary outcomes included muscle strength, endurance, and balance based on exercise capacity testing. Secondary outcomes included performance on physical tests and questionnaire answers. The exercise program consisted of strength training three days per week, aerobic endurance training twice per week, and balance training once per week. This regimen was less intense than the original protocol because participants indicated that they did not want to exercise at the originally planned level.

Of 358 retirement community residents, 86 expressed interest, and 38 (10.6 percent) were randomized. Loss of interest or willingness accounted for most of the attrition in those who originally expressed interest. The mean age of participants was 76.6 years, and 63.2 percent of participants were women. Two participants in the control group and four in the intervention group dropped out of the study.

Results: Persons in the intervention group had improved strength compared with those in the control group, with a broad variation (39 ± 31 percent, range 17.4 to 66.2 percent versus 21 ± 24 percent, range 5.9 to 47.2 percent). There was no difference in endurance between the groups, and there was some improvement in static balance over time in both groups. Significant improvements in stair-climb power and chair-stand time occurred in both groups, but neither group had overall improvement in gait velocity, depression, or exercise self-effectiveness.

Improvements in muscle strength were largely related to high-intensity progressive training. The lack of improvement in aerobic capacity was likely caused by the early modification of the exercise regimen. Although balance improved more in exercisers than in nonexercisers, the study did not have the power to show a statistically significant difference. Functional and psychological improvement was demonstrated only in those with the greatest baseline impairment.

Conclusion: The authors conclude that older patients have difficulty following a regimen strenuous enough for significant improvement. They recommend a staged approach to exercise that is tailored to the patient's level of function.