Fitness effects of resistance tube exercise in women over 60 years of age

CHAPTER XI WELLNESS AND AGE 1 Department of Anatomy, Wroclaw Medical University Katedra i Zakład Anatomii Człowieka, Uniwersytet Medyczny we Wrocławiu 2 Department of Biostructure, University of Physical Education in Wroclaw Katedra Biostruktury, Akademia Wychowania Fizycznego we Wrocławiu 3 Academy of Physioterapy in Wroclaw Wyższa Szkoła Fizjoterapii z siedzibą we Wrocławiu 4 Physioterapy and Prevention Center SALUBER in Wroclaw Ośrodek Profilaktyki i Rehabilitacji SALUBER we Wrocławiu ROHAN ANNA 1, FUGIEL JAROSŁAW 2, BURACZYŃSKA SANDRA 3, KOWALSKI HENRYK 4, PINKOWSKA AGNIESZKA 1, GWORYS BOHDAN 1 Fitness effects of resistance tube exercise in women over 60 years of age Efekty ćwiczeń z wykorzystaniem elastomerów u kobiet po 60 roku życia Słowa kluczowe: ćwiczenia auksotoniczne, kobiety starsze, efekty treningu Key words: auxotonic exercises, older women, effects of training INTRODUCTION Many European countries have rapidly aging populations. For example, current estimates in Poland project that 35% of the population in 2050 will be in older age (GUS). This shift in demographics has instigated wide-scale research on how to improve the quality of life of this increasing age group. One area of focus has been the role of physical activity and its recognition as an essential component of a healthy lifestyle [6, 21]. The literature unequivocally states that systematic exercise, performed at an appropriate intensity and volume, improves physical fitness and health [7, 9, 19]. These effects have been observed across all life stages. As a result,

WELLNESS AND AGE in recent years there has been an upsurge of interest in the application of various exercise modalities and protocols in older adults [, 8, 13, 14, 16, 27]. Most focus primarily on enhancing physical fitness, as the aging process involves an inevitable decrease in function and the onset of numerous physiological limitations [20, 24, 25, 33]. However, research has indicated that the rate of aging differs between individuals [21]. Regardless of chronological age and its non-correlation with biological age, interventions involving regular physical activity are conducive to the anti-aging process [4, 14]. Exercise induces a number of beneficial structural and functional adaptations that can be observed in tissue composition and measures of performance and physical fitness. In addition, individuals who frequently exercise show improved well-being and greater living independence and autonomy, factors of considerable importance among older adults [2, 5, 29, 30, 32]. While the literature has confirmed the applicability of various forms of physical activity in improving physical fitness in older populations [7, 9, 19, 27], interventions to promote physical activity among older adults are marked with complications. Old age is a period marked with significant differences in motor function between individuals. Another issue is that some older individuals are reluctant to engage in new forms of exercise or increase physiological effort [22, 27]. Therefore, the types of exercises introduced to seniors need to be properly selected and modulated. However, while physical activity interventions in older adults frequently involve a wide share of exercises, there is a paucity of information if the applied exercise induces similar adaptations. Senior fitness classes enhance motor performance by executing a range of exercises and routines, although their selection is frequently dependent on local spatial constraints, the adopted program, and therapist experience. The aim of this study was to assess the effects of general fitness program involving resistance tube (band) exercises in older women and compare them with an age-matched control group executing a traditional general fitness program. 138 MATERIAL The study was conducted in 2015 and involved two groups of women over 60 years of age. The first group involved 41 participants (mean age 72.3) attending the Saluber Health Clinic and the second group involved 41 participants (mean age 74.3 years) from the Community Social Center, both in the city of Wrocław, Poland. The groups did not significantly differ in age. The inclusion criterion was good overall health. Participants were excluded if they presented any contraindications for exercise testing as determined by their doctor. Informed consent to voluntarily participate in the study was obtained. The study procedures were explained in full during an interview in which health status was confirmed. METHODS The study was conducted over a period of 12 weeks in which both groups attended fitness classes twice a week in the morning. The duration of each class was 60 min and led by a physical therapist. The first group (TUBE) from the Saluber Health

Rohan Anna, Fugiel Jarosław, Buraczyńska Sandra, Kowalski Henryk, Pinkowska Agnieszka, Gworys Bohdan Fitness effects of resistance tube exercise in women over 60 years of age Clinic performed exercises with the use of the Pragma resistance tube device [35] as part of a comprehensive fitness program designed by the authors. The second group (GEN) from the Community Social Center performed general conditioning exercises that involved gymnastics elements. Pre- and post-intervention fitness was assessed with the Senior Fitness Test (Fullerton Functional Fitness Test) [25]. Only four items measuring strength and endurance were selected from this test battery as the remaining two items only examined flexibility, a component not included in either group s exercise programs. These four items were the: Arm Curl Test (n) of upper body strength (dominant arm), Chair Stand Test (n) of lower body strength, 8-Foot Up and Go Test (s) of agility and dynamic balance, and the 2-Min Step in Place Test of aerobic fitness. The test battery was administered before the 12-week program was scheduled to begin and 1 day after its conclusion. The normality of the distribution was confirmed using the Kolmogorov Smirnov test after which basic descriptive statistics were calculated including min and max, mean ( x ), and standard deviation (s) values. Repeated measures analysis of variance (ANOVA) was used to compare group means. Statistically significant results were analyzed post-hoc with Tukey's honest significant difference (HSD) test. The significance level for all statistical procedures was set at α = 0.05. Data processing was performed with the Statistica 9.1 software package. RESULTS Between-group comparisons revealed that upper body strength was significantly higher in the resistance tube exercise group (TUBE) in pre- and post-intervention testing. However, significant improvements were observed in both groups although in group GEN this difference was of a greater magnitude (Tab. I IV, Fig. 1). A similar relationship was found in lower body strength, in which the TUBE group showed greater improvement. The increase in the number of post-intervention chair stands was significant in both groups although the improvement (Tab. I IV, Fig. 2). The same was observed in the 8-Foot Up and Go Test, in which the TUBE group achieved significantly better results than the GEN group. Significantly shorter times to finish were observed in both pre- and post-intervention testing although the magnitude was similar in both groups (Tab. I IV, Fig. 3). The fourth test on aerobic fitness also indicated that the TUBE group achieved significantly better results than the GEN group in both pre- and post-intervention testing. One change from the previous testing was that while the improvement between time points was significant in group TUBE, no significant differences in group GEN were observed (Tab. I IV, Fig. 4). 139

WELLNESS AND AGE 28 26 Mean ± 0,95 conf idence interv al SALUBER Group MCUS Group 24 Arm Curl [n] 22 20 18 16 14 12 pre- Fig. 1. Descriptive characteristics of pre- and post-intervention Arm Curl Test results 19 18 17 Mean ± 0,95 conf idence interv al SALUBER Group MCUS Group 16 15 Chair Stand [n] 14 13 12 11 10 9 8 pre- post- post- Fig. 2. Descriptive characteristics of pre- and post-intervention Chair Stand Test results 140

Rohan Anna, Fugiel Jarosław, Buraczyńska Sandra, Kowalski Henryk, Pinkowska Agnieszka, Gworys Bohdan Fitness effects of resistance tube exercise in women over 60 years of age 22 20 Mean ± 0,95 conf idence interv al SALUBER Group MCUS Group 18 8-Foot Up and Go [s] 16 14 12 10 8 6 4 pre- Fig. 3. Descriptive characteristics of pre- and post-intervention 8-Foot Up and Go Test results 75 70 65 Mean ± 0,95 conf idence interv al SALUBER Group MCUS Group 60 2-Min Step in Place [n] 55 50 45 40 post- 35 30 25 20 pre- post- Fig. 4. Descriptive characteristics of pre- and post-intervention 2-Min Step in Place Test results 141

WELLNESS AND AGE Tab. I. Descriptive characteristics of pre- and post-intervention physical fitness in the resistance tube exercise group (TUBE) 142 Test Time point x s Min Max Pre- 21.9 4.3 13.0 30.0 Arm Curl Test [n] Post- 23.7 4.0 17.0 32.0 Chair Stand Test [n] Pre- 14.2 3.9 4.0 25.6 Post- 16.4 4.1 5.0 22.2 8-Foot Up and Go Test [s] Pre- 9.6 3.5 5.3 22.3 Post- 8.3 2.9 5.0 18.3 2-Min Step in Place [n] Pre- 58.3 15.0 19.0 83.0 Post- 62.2 15.1 22.0 90.0 Tab. II. Descriptive characteristics of pre- and post-intervention physical fitness in the general conditioning exercise group (GEN) Test Time point x s Min Max Pre- 15.4 4.6 6.0 26.0 Arm Curl Test [n] Post- 16.0 4.7 5.0 26.0 Chair Stand Test [n] Pre- 10.4 4.1 5.0 21.0 Post- 11.1 3.9 5.0 20.0 8-Foot Up and Go Test [s] Pre- 19.3 5.2 10.6 30.2 Post- 18.3 4.5 10.0 25.9 2-Min Step in Place [n] Pre- 28.8 11.7 7.0 50.0 Post- 28.3 10.9 8.0 53.0 Tab. III. Main effects and interactions of two-way ANOVA Main effects Test Group Time point Group x Time point F p F P F p Arm Curl Test 54.703 0.0000 43.625 0.0000 10.466 0.0018 Chair Stand Test 68.311 0.0000 68.322 0.0000 24.879 0.0000 8-Foot Up and Go Test 156.14 0.0000 26.714 0.0000 4.006 0.0487 2-Min Step in Place 117.99 0.0000 23.508 0.0000 39.860 0.0000 Statistically significant differences at p < 0.05 are marked in bold Tab. IV. Post-hoc analysis of significant differences in group fitness test means Test TUBE GEN Pre Post Pre Post TUBE GEN Arm Curl Test 0.0002 0.0002 0.0002 0.0887 Chair Stand Test 0.0002 0.0002 0.0002 0.0887 8-Foot Up and Go Test 0.0001 0.0001 0.0006 0.0112 2-Min Step in Place 0.0002 0.0002 0.0002 0.7290 Statistically significant differences at p < 0.05 are marked in bold

Rohan Anna, Fugiel Jarosław, Buraczyńska Sandra, Kowalski Henryk, Pinkowska Agnieszka, Gworys Bohdan Fitness effects of resistance tube exercise in women over 60 years of age DISCUSSION While the effects of senescence are inevitable, the decreases in physical fitness and motor function with age are largely dependent on lifestyle [6, 22]. The literature has confirmed the benefits of physical activity in aging adults. Increased physical activity shows a number of protective effects on age-related functional limitations, and an active lifestyle is considered to be one of the main factors significantly affecting the health, independence, and quality of life of older individuals [10, 16]. Research finds that the long-term effects of exercise are the most beneficial in terms of improving independent living and quality of life in older adults [31]. However, exercise frequency and intensity decrease with age, commonly explained by this population's reluctance to perform exercise or overexert themselves [11]. Therefore, it is important to motivate older individuals to adopt exercise strategies that are interesting and willingly executed. However, it is important that the executed exercises also provide the greatest improvement in fitness. One such exercise strategy attempting to combine these requirements was developed by the Saluber Health Clinic based on the application of resistance tube exercises. Resistance tube, while still a relatively new exercise methodology, allows for a natural movement pattern. The aim of the present study was to assess the effects of such resistance tube training on physical fitness. Our results indicated that the proposed training methodology improved fitness in all four assessed fitness components. In the group performing general conditioning exercises (GEN), significant improvements were observed only the test assessing agility and dynamic balance (8-Foot Up and Go Test). No significant improvements were found in any of the remaining fitness tests. Besides a general lack of improvement, the TUBE group obtained significantly higher results than the GEN group. This was found in testing performed before and after the 12-week period of observation. Due to the non-significant changes in fitness levels in most of the tests, the post-intervention between-group differences increased even further. Such differences in the physical fitness between older adults of different physical activity levels have been reported by Skrzek et al. [30] primarily in tests of muscle strength. This finding is important in light of the fact that muscle strength is significantly correlated with fall risk as well as activities of daily living including standing from a chair, climbing stairs, or carrying various objects [18, 26, 28]. Demographic data on the health status of Poles in 2009 found that poor physical fitness was endemic among the older population (GUS). Other studies on older populations have indicated that many older adults (25% of 60-year-olds and 60% of 70-year-olds or older individuals) have considerable problems with walking over even short distances or climbing even one flight of stairs without assistance [34]. Hence, there is an acute need for exercise programs that can improve the physical status of older age adults. Besides a purely functional component, regular physical activity has been shown to have a positive effect on mental performance in late age [12] and associated with both psychological and social well-being [3, 17]. Besides the type of exercise (aerobic vs. anaerobic) and use of specialized equipment, the type of exercises and their execution are of undeniable importance particularly in older adults. There is no consensus on what exercises are best suited for this population in terms of training effects that, at the same time, are simple to execute, willingly performed, but also easily modulated to meet different ability levels. While additional investigation is needed to confirm training applicability and efficacy, the use of resistance tube shows promising results. 143

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WELLNESS AND AGE 31. Spirduso W.W., Cronin D.L. Exercise dose-response effects on quality of life and independent living in older adults. Med Sci Sports Exerc 2001, 33, 598-608. 32. Warburton D.E.R. i wsp. Health benefits of physical activity: the evidence. Can. Med. Assoc. J. 2006, 174, 801 809. 33. Weiss E.P. i wsp. Gender differences in the decline in aerobic capacity and its physiological determinants during the lates decades of life. J Appl Physiol 2006, 101, 938 944. 34. Wizner B. i wsp. Ocena stanu funkcjonalnego u osób w starszym wieku. [W:] Mossakowska M., Więcek A., Błędowski P. (red.) Aspekty medyczne, psychologiczne, socjologiczne i ekonomiczne starzenia się ludzi w Polsce. Termedia Wydawnictwa Medyczne, Poznań 2012. 35. www.saluber.pl [data dostępu: 12.04.2015]. ABSTRACT The aim was to assess the effects of general fitness program involving resistance tube exercises in older women group and compare them with an age-matched control group executing a traditional general fitness program. The study was conducted in 2 groups of women over 60 years of age. The 1st group performed exercises with the use of resistance tube devices. The 2nd group performed general conditioning exercises that involved gymnastics elements. The study was conducted over a period of 12 weeks, twice a week. Pre- and post-intervention fitness was assessed with the Senior Fitness Test: Arm Curl Test, Chair Stand Test, 8-Foot Up and Go Test, 2-Min Step in Place Test. Physical activity improved the fitness of both groups of older women although significant differences were observed between the two types of exercise interventions, indicating that exercising with resistance tube is more effective than a general fitness exercise protocol. STRESZCZENIE W pracy oceniano efekty ćwiczeń z elastomerami. Porównano je do grupy, w której prowadzono ćwiczenia ogólnoustrojowe. Badania wykonano u kobiet po 60 r.ż., z 2 grup. W 1. stosowano ćwiczenia przy użyciu gum tubingowych. W 2. prowadzono gimnastykę ogólnoustrojową. Program trwał 12 tyg., 2 razy w tyg., przez 60 min. Do oceny sprawności fizycznej wykorzystano próby z Senior Fitness Test. Przeprowadzono testy: uginanie przedramienia, wstawanie z krzesła, wstań i idź, 2-minutowe wchodzenie na stopień. Badania wykonano 2 razy: przed rozpoczęciem programu ćwiczeń i po ich zakończeniu. Zaobserwowano, że aktywność fizyczna wpływa na poprawę sprawności motorycznej kobiet w okresie starości. Istotny był również dobór ćwiczeń prowadzonych w ramach programów profilaktycznych dla seniorów. Ćwiczenia z wykorzystaniem elastomerów, w postaci gum tubingowych, przynoszą większe efekty niż ćwiczeń ogólnorozwojowe. Artykuł zawiera 20832 znaki ze spacjami + grafika 146