Effects of a 5-year exercise-centered health-promoting programme on mortality and ADL impairment in the elderly

Objective: the effects of regular exercise over 5 years on mortality and ADL impairment were evaluated in elderly people. Design: intervention study. Setting: Tsuru City Yamanashi prefecture, Japan. Methods: the subjects of this study were 245 elderly people living at home. Of these individuals, 155 (56 males aged 76.5+/-4.2 years at the baseline level; 99 females aged 76.2+/-4.8 years) who voluntarily participated in our original health-promoting programme were regarded as an intervention group. The remaining 90 (29 males aged 77.6+/-5.2 years at the baseline level; 61 females aged 77.3+/-5.1 years) were regarded as a control group. The programme was a 5-year intervention consisting of collective sessions given six times a year every 2 months. The intervention was a combination of an exercise programme based on theories of exercise physiology and a support programme based on health education theories. The relative risks of death and ADL impairment adjusted for age, presence or absence of cardiovascular or musculo-skeletal disorders, and functional fitness level at the baseline were calculated using logistic regression analysis. Results: the rates of participant compliance per year were 67.7% in the first year of the intervention period and gradually decreased thereafter to 43.9% in the last year. Amongst female subjects the percentage of those who exercised habitually at the end of the study period was the same as that in the baseline in the intervention group but was significantly lower at the end of the study in the control group (chi(2)=10.576, P<0.01). The relative risk of death in the intervention group was 1.0 (95% CI 0.22-4.51) amongst the males and 0.16 (95% CI 0.03-0.81) amongst the females. Relative risk of ADL impairment was 0.22 (95% CI 0.03-1.42) amongst the males and 0.36 (95% CI 0.13-1.02) amongst the females. Conclusion: These findings suggest that the improved mortality and state of independence in the female portion of the intervention group occurred as a result of increased physical exercise levels in daily fife. However, validation of our results must await research that employs a randomized control trial to avoid various biases and confounding factors between the intervention and the control groups.