Elsevier

Experimental Gerontology

Volume 61, January 2015, Pages 142-146
Experimental Gerontology

Criterion-referenced fitness standards for predicting physical independence into later life

https://doi.org/10.1016/j.exger.2014.12.012Get rights and content

Highlights

  • Maintaining a minimum physical fitness level is necessary for physical independence.

  • Fitness standards can be used to predict physical independence later in life.

  • These criterions provide a tool for personalized exercise prescription.

Abstract

Objectives

The aim of the current study was to develop sex and age-adjusted criterion-referenced fitness standards to predict independent physical functioning into later life.

Design

Cross-sectional.

Setting

National Survey of Physical Fitness and Physical Activity, Portugal.

Participants

A national representative sample of 3074 non-institutionalized older adults (65–84 years).

Measurements

Projected capacity for physical independence was assessed by the Composite Physical Function (CPF) scale, and physical fitness was assessed using the Senior Fitness Test battery. ROC analyses were used to evaluate the classification accuracy of physical fitness components, and determine the best cutoff values of functional fitness to predict loss of independence. Stepwise multivariate logistic regression was used to identify sex and age category fitness components that were predictors of independence with follow-up ROC analysis to verify the model's discriminative capability.

Results

ROC curve analysis showed that the fitness tests were good in diagnosing physical independence (AUC > 0.7). Logistic regression models demonstrated that different fitness components should be targeted according to age and sex, but with an emphasis on aerobic endurance and agility/dynamic balance. Overall, models provided higher AUC (males: 0.79–0.86; females: 0.73–0.85) when comparing the best fitness tests for each sex and age category. The sensitivity of newly developed models ranged from 80.5 to 87.7 in males and from 68.2 to 86.3 in females, while the specificity ranged from 62.1 to 73.8 in males and between 58.2 and 82.9 in females.

Conclusion

The Senior Fitness Test provides a good field tool that allows the identification of fitness levels that older adults need to achieve to be physically independent later in life, and permits the accurate planning and implementation of exercise-based interventions for older adults.

Introduction

Age-related physiological changes affect a wide range of tissues, organ systems, and functions, which, cumulatively, can impact the preservation of physical independence (Chodzko-Zajko et al., 2009), resulting in a reduction in quality of life, life expectancy, and elevated long-term health-care costs (Paterson and Warburton, 2010). About 20% to 30% of community-dwelling older adults report disability in mobility, and impairments in instrumental and basic activities of daily living, such as, household tasks and basic self-care (Fried et al., 2004).

The 12-item Composite Physical Functional scale allows for the identification of older adults who are at risk for losing physical independence later in life (Rikli and Jones, 1998, Rikli and Jones, 2013). The scale discriminates across a wide range of functional abilities and has age-adjusted norms that allow for the early prediction of independent functioning in later years (90 years old) (Rikli and Jones, 2013). This novel approach represents a new early diagnostic tool to identify older adults at risk for later functional impairment.

Maintaining physical fitness is a key factor in preserving mobility and physical independence later in life (Paterson et al., 2007). It is of extreme importance that older adults preserve a minimum level of physical fitness necessary to perform common everyday activities without additional assistance; this includes the ability to independently perform daily tasks such as, simple housework, lifting and carrying objects, negotiating steps, and walking far enough to do one's own shopping and errands (Rikli and Jones, 2013). Several physical fitness components including aerobic endurance, muscle strength, agility, gait speed, or dynamic balance have been shown to be significant determinants of physical independence (den Ouden et al., 2013a, den Ouden et al., 2013b, Kuo et al., 2006, Paterson et al., 2004, Paterson et al., 2007, Wennie Huang et al., 2010).

The Senior Fitness Test (Rikli and Jones, 1999, Rikli and Jones, 2013) is commonly used to assess physical fitness in older adults as it represents an easy-to-use field test battery that allows for the assessment of physical fitness components that are important for maintaining independent functioning. Recently, Rikli and Jones (2013) have developed criterion standards for the Senior Fitness Test in North American older adults that estimate the minimum fitness level necessary to maintain physical independence in later years. However, it is unclear to what degree these standards can be generalized to other populations.

Structured physical activity programs reduce major mobility disability among older adults (Pahor et al., 2014) and identifying the physical fitness level that a person needs to achieve in order to be physically independent later in life is essential if we are to develop successful physical activity interventions that are effective in preserving physical independence. Therefore, the aim of the current study was to develop sex and age-adjusted criterion-referenced physical fitness standards to predict physically independent functioning in old age (90 years old).

Section snippets

Design and subjects

A total of 3074 participants were considered for data analysis (1021 males and 2053 females). Data for the present study were derived from a cross-sectional representative sample of community-dwelling Portuguese older adults aged 65 and over, who were sampled from five regions of mainland Portugal (Marques et al., 2013). Study participants were volunteers who were recruited from community senior centers, public and private institutions, sport clubs, and at sports and social events. The study

Results

Characteristics of the study population are shown in Table 1.

Table 2 summarizes the results for the classification accuracy analysis provided by the receiver-operating characteristic analysis for males and females. The best cutoffs for identifying participants with projected moderate functioning were selected as the threshold that maximized the sensitivity and specificity.

The areas under the ROC curve ranged between 0.651 (65–69 years, arm curl test) and 0.818 (75–79 years, 6­minute walk test)

Discussion

In the current investigation the authors propose minimum threshold values for important physical fitness parameters that can serve as goals, targets, or criterion-reference standards for use in exercise programs for older adults. Using these cut-points will allow for the maximization of the prediction of projected physical independence at the age of 90 years. Additionally, in order to make the best use of all physical fitness components, for each sex and age category, a model that included all

Conclusions

The present study provides sex and age-adjusted sensitivity and specificity data for the establishment of individual and combines physical fitness cut-points using the physical fitness tests included in the Senior Fitness Test battery. These criterion-referenced standards can be used to predict physical independence later in life (90 years old) using population specific physical fitness standards. These standards provide a tool for practitioners to understand when physical fitness levels are

Conflict of interest

The authors have no conflicts of interests.

Role of the funding source

None.

Author contributions

Concept and design: LBS, JM; data collection: DAS, EAM; analysis and interpretation: LBS, DAS, EAM; preparation of manuscript: LBS, DAS, EAM; critical revision of the manuscript for important intellectual content: LBS, JM; final approval of the version for publication: LBS, DAS, EAM, JM.

Acknowledgments

The authors are grateful to all technical staff involved in data collection procedures. DAS is supported by the Portuguese Foundation for Science and Technology (Grant: SFRH/BPD/92462/2013).

References (21)

  • M.E. den Ouden et al.

    Physical functioning is related to both an impaired physical ability and ADL disability: a ten year follow-up study in middle-aged and older persons

    Maturitas

    (2013)
  • M.E. den Ouden et al.

    Identification of high-risk individuals for the development of disability in activities of daily living. A ten-year follow-up study

    Exp. Gerontol.

    (2013)
  • S.B. Adamson et al.

    Extremely short-duration high-intensity training substantially improves the physical function and self-reported health status of elderly adults

    J. Am. Geriatr. Soc.

    (2014)
  • J.S. Brach et al.

    The association between physical function and lifestyle activity and exercise in the health, aging and body composition study

    J. Am. Geriatr. Soc.

    (2004)
  • W.J. Chodzko-Zajko et al.

    American College of Sports Medicine position stand. Exercise and physical activity for older adults

    Med. Sci. Sports Exerc.

    (2009)
  • L.P. Fried et al.

    Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care

    J. Gerontol. A Biol. Sci. Med. Sci.

    (2004)
  • L.W. Gerson et al.

    Recreational injuries among older Americans, 2001

    Inj. Prev.

    (2004)
  • J.M. Hootman et al.

    Epidemiology of musculoskeletal injuries among sedentary and physically active adults

    Med. Sci. Sports Exerc.

    (2002)
  • C.S. Jones et al.

    Non-equipment exercise-related injuries among US women 65 and older: emergency department visits from 1994–2001

    J. Women Aging

    (2005)
  • H.K. Kuo et al.

    Exploring how peak leg power and usual gait speed are linked to late-life disability: data from the National Health and Nutrition Examination Survey (NHANES), 1999–2002

    Am. J. Phys. Med. Rehabil.

    (2006)
There are more references available in the full text version of this article.

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