Stephen Ball has dedicated his career to improving the health of older Missourians through exercise. In 2005, he launched the University of Missouri’s ‘Stay Strong Stay Healthy’ strength training program, which has reached more than 20,000 older adults since its inception.
For years, Ball has heard anecdotally about the physical and mental health benefits older adults have experienced from the eight-week strength training program – now he has scientific proof.
According to a recent research study, adults over age 60 who participated in the group exercise program experienced improved muscle strength and flexibility, balance and coordination, sleep quality and overall self-confidence to increase physical activity, all while reducing the risk of falling and the expensive medical bills that may follow.
“We give undergraduates valuable hands-on experience in teaching exercise, conduct life-changing research in the lab and then with our partnerships through MU Extension, we go out in rural communities and implement the research to improve the health of everyday Missourians.”
In the study, Ball collaborated with Missouri Orthopedic Institute to evaluate the effectiveness of the ‘Stay Strong Stay Healthy’ strength training program in a group setting among adults over the age of 60. Participants in the instructor-led courses, which last one hour and are held twice a week for eight weeks, are taught how to safely complete strength training exercises, including squats and bicep curls.
By completing various baseline tests for strength, balance and flexibility before and after the program, the study found participants improved not only their physical health outcomes but also their self-confidence in their ability to exercise, which increased their physical activity in their daily lives and reduced the risk of falls, which is a major concern for aging adults.
“We keep hearing from participants that in addition to feeling stronger, healthier and more active, another major reason they enjoy the group classes is the social aspect of making friends with others their age and engaging with community members in a stress-free environment.”
Ball earned a William T. Kemper Fellowship from MU in 2012 for his undergraduate teaching and extension work. With more than a dozen peer-reviewed studies highlighting the efficacy of the ‘Stay Strong Stay Healthy’ program since 2005, Ball said the strength training program has been approved by the Missouri Department of Health and Senior Services as an evidence-based program that can be implemented throughout the state.
By building out even more peer-reviewed, evidence-based research findings on the physical and mental health benefits of the program, Ball’s body of literature may soon help the program receive national recognition as an evidence-based falls prevention program.
“I have heard from participants that the program saved their life, and it is very rewarding to be serving our community members and improving their health,” Ball said.
“We have undergraduate students at MU that help instruct classes, we have graduate students that help with research and our MU Extension regional faculty implement the program across the state serving all 114 counties in Missouri, so it is a real team effort meeting all three missions of a land grant university.”
This study aimed to investigate the association of physical activity with cognitive functioning in older adults with a gender lens by utilising the PSM method of estimating the impact of a specific intervention. To our knowledge, this study was the first to have added empirical evidence regarding gender differences in cognitive functioning among older Indian adults considering their physical activity status by constructing an artificial control group.
A proportion of 24.6% of older men and 12.0% of older women in the current study were found to be frequently physically active. The higher prevalence of vigorous physical activities in older adults may be explained by the definition of physical activity (vigorous) in this paper which includes the farm-related activities. A large proportion of older population in rural areas of the country are engaged in agricultural labor50.
Another study based on the data from the LASI pilot survey, using the same definition of vigorous activity, has estimated that 27% of the participants were engaged in vigorous activities 37. On the other hand, the significant gender difference in the prevalence of physical activity may be attributed to the fact that traditionally, in India, men have been considered as income earners while women are confined to the household.
Similarly, studies based in other developing countries reported gender differences in the prevalence of vigorous physical activities 51,52. The previous study reported that the prevalence of vigorous activities during the farming season was nearly 33% and highlighted the existing gender differences by reporting that vigorous activities among the male farmers were greater than female farmers irrespective of the season of farming52.
Our results suggest that older adults who engaged in physical activity have higher cognitive functioning score compared with older adults without physical activity. The finding is consistent with previous reviews of observational studies that have concluded that interventions that promote higher levels of physical activity in old age are associated with a slower rate of cognitive decline14,53,54.
Evidence also suggest that regular physical activity through management of cardiovascular risk factors such as hypertension, diabetes and obesity may protect the cognitive abilities and reduce the risk of late-life dementia55. Several studies based on cross-sectional/ prospective cohort design as well as randomized controlled trials (RCTs) have shown similar findings that suggest a significantly larger hippocampal or grey matter volumes and associated better spatial memory and improved cognitive functioning among physically fit older individuals compared with their unfit counterparts56, 57.
Hence, exercise and physical activity interventions for older adults may help ameliorate age-related deficits in cognitive functioning by providing a better executive functioning and appropriate decision making, that in turn result in avoiding adverse life habits in later years of life.
However, it is also plausible that a reciprocal association is present, such that remaining cognitively active may positively influence being physically active. In particular, this effect might occur through higher performance in executive functioning that have a positive impact on independence and functionality among older adults as shown in the previous studies 58,59,60.
Again, as documented, further cognitive deficits could possibly be explained by the decline in physical activity in people in later years of life with cognitive impairment or with lower score in cognitive functioning. On the other hand, multiple studies have found no evidence of slowing down the cognitive decline in people doing more physical activity 61,62,63,64,65.
Another study suggests that although physical activity levels were found lower in the years leading up to diagnosis of dementia, such a reduction in physical activity might simply be a part of preclinical symptoms of dementia66. Nevertheless, by using the PSM method in the current study which mimics the experimental design with balanced baseline characteristics, a potential positive causal association between physical activities and cognitive functioning among Indian older adults is suggested.
Another important finding of our study is that after including for critical confounding factors, such as socio-demographics and health behaviours, women had a stronger cognitive score compared to men while they were assumedly treated with physical activity.
Recent studies showed that women’s lower cognitive functioning is importantly explained by the individual attributes such as differences in educational and occupational levels and poor health status67,68,69. Moreover, in comparison to men, a shorter duration of formal education, longest occupation being domestic worker and the psychiatric disorders associated with widowhood and lack of social resource accounted for steeper cognitive decline in women than in men70,71,72,73.
Hence, the increased physical activity in women might have a stronger influence on their cognitive abilities. Similarly, the longer life expectancy of women could also explain observed gender differences in the association between physical activity and cognitive functioning Women have a larger burden of impairment than men 74,75.
Thus, as the current results suggest the interventional programs that focus on promoting physical activity in old age may have greater impact on cognitive health especially among women. Furthermore, women’s increased engagement in group activities and social interactions that have beneficial effects on their brain volume and executive functioning may reduce the gender gap observed in cognitive functioning15.
There are several limitations to this study. Importantly, the study is conducted with a cross-sectional design and relies upon self-report for physical activity. Also, the possibility of unobserved confounding factors may exist since the method of PSM is limited by the fact that it can only control for observed confounders. This again suggests the need for future longitudinal studies to test the current conclusions.
Although the cognitive functioning module was based on multiple domains and was multi-faceted, mechanisms underlying the physical and executive functioning that directly affect cognitive domains are not taken into account in the study.
Further, finding of the relationship of physical activity and cognitive functioning is often attributed to the underlying neurobiological differences between older adults with cognitive deficits.
For example, compared to cognitively healthy older adults, those with mild cognitive impairment have greater amounts of beta-amyloid accumulation; accelerated atrophy in the medial temporal lobe; and decreased connectivity of the hippocampus with the brain 76,77,78,79.
These underlying changes in the brain may potentially alter the relationships of behavioural factors with cognitive functioning, leading to an attenuation of the relationship between physical activity and cognitive functioning observed in our study. This reveals the need for further investigation with more clinical information as well as longitudinal design.
Nevertheless, the findings of our study have important public health implications because the analyses are conducted in a large sample of older adults derived from a nationally-representative survey, and explored the treatment effects of physical activity on cognitive functioning with comparing to an artificial control group that is untreated with such intervention, which in turn provides a potential causal effect of such treatment. The data also provided exhaustive and comprehensive information on aging population by which the major confounding factors could be controlled throughout the analyses.
Conclusion
Given rapid increase in life expectancy, cognitive disability is increasingly a public health challenge. The findings of the present study suggest physical activity as one of the modifiable risk factors that prevent or delay the onset of cognitive impairment.
Owing to its cardio-protective effect, physical activity can be considered as a potential factor that stimulates the brain activities and cognitive functioning in old age and can be accommodated in interventions related to active aging.
Therefore, health practitioners aiming to improve the cognitive functioning of older patients or clients might benefit from the development of the interventions related to physical activities designed to reduce the decline of cognitive resources. Moreover, in terms of cognitive enrichment in older population and in women in particular by initiating behavioural interventions that can also contribute to optimizing a successful aging, further longitudinal studies are warranted.
reference link :https://www.nature.com/articles/s41598-022-06725-3
Original Research: Closed access.
“Efficacy of an 8-Week Resistance Training Program in Older Adults: A Randomized Controlled Trial” by Breanne S. Baker et al. Journal of Aging and Physical Activity
