Mobility Matters

A physical therapy study combining strength training and speed training gives the frail elderly a new lease on life

By John Koloen

Before she became part of a new UTMB study called the Strong Elders Project Pilot last October, ninety-four-year-old Doris Ruyle wasn’t leaving the house. In March, after twelve weeks of exercise, she took an ocean cruise. Seventy-six-year-old Anne Kusnerik says, “My husband noticed I had some problems walking, and I wasn’t getting up like I should.” After the exercise regimen, she adds, “I can do more and I’m a lot better than I was.”

Just getting in and out of a car and walking were a trial for eighty-four-year-old Mary Healey before she started the project. “Now, she can walk by herself and gets in and out of a car much easier,” says her daughter, Jeanette Astry.

Participating in the Strong Elders Project Pilot turned out to be a life-changing decision, not only for Ruyle, Kusnerik, and Healey, but also for a number of other older individuals who came to the UTMB Alumni Field House last October to take part in a study that potentially may benefit not just themselves but also untold millions who aren’t growing old comfortably.

As the study seems to show, exercise isn’t just for the young and healthy. It’s also good for the frail elderly—defined for purposes of this study as those older people who have walking problems. (Other academics often use a different definition, classifying frail elders as those people who are at risk for placement into a nursing home because they’re losing so much function.)

Elizabeth Protas, professor and chair of Physical Therapy at UTMB, directs this study and says preliminary findings show that the frail elderly may nearly double their endurance and gait—or walking speed—through exercise.

“The focus in our research is to take someone who is already weak and walking slowly or having poor endurance and then see whether we can reverse that decline, improve their walking, improve their endurance, and improve their function,” she says.

“We could hardly believe the results ourselves because the exercise participants’ walking really improved up to normal speeds and endurance for people their age,” Protas explains.

Physical therapist Sandrine Tissier works with Strong Elders Project Pilot study participants, who dutifully appear at the UTMB Alumni Field House three times a week for twelve weeks. The workout, which starts at nine-thirty in the morning, lasts until about eleven. Tissier cheerfully fills the air with encouraging words as two women who volunteered to be in the study talk during a break about why they are participating.

“My husband got me to come,” says Kusnerik, a Galveston resident. Ruyle learned about the project from a letter she received from UTMB late last summer. Intrigued by what she read, she shared it with her daughter, Sandy Paul. Ruyle, who will be ninety-five in June, lives with her daughter on the northern edge of Texas City. “My mother asked me what I thought about it,” Paul says. “She told me she’d very much like to participate. I thought it was a good idea, too. I want to keep her up and going as long as possible.”

Her daughter chauffeurs Healey in from Friendswood, about an hour away from UTMB. Healey says she hated the program at first, but it didn’t take her long to learn to love it. “In the beginning she leaned heavily on physical therapist Tissier, and now she can walk by herself,” her daughter says. Healey says her daughter and her family have “been very supportive” and “wanted me to keep coming because they could see how much it was helping me.”

In addition to chairing the Department of Physical Therapy in the School of Allied Health Sciences, Protas is a senior fellow in the Sealy Center on Aging and a senior scientist in the Center for Rehabilitation Sciences. Her areas of interest include geriatrics, the rehabilitation of adults with stroke, Parkinson’s disease, and spinal cord injury. She has been a faculty member at UTMB since 2002.

“The focus in our research is to take someone who is already weak and walking slowly or having poor endurance and then see whether we can reverse that decline, improve their walking, improve their endurance, and improve their function.”

The pilot study, which is funded by a thirty thousand dollar “seed grant” from the Center for Rehabilitation Sciences, was launched in October 2004 with twenty volunteer study subjects. Participants, ranging in age from seventy to ninety-four, exercised three days a week for twelve weeks at the UTMB Alumni Field House. The simple exercises included stair-stepping, standing up from a sitting position, stair-climbing, knee-bends, and walking on a treadmill. To prevent falls when using the treadmill, the participants wore a harness called a “treadabout.”

“The speed training using treadmills is different from what you’d usually do with elders,” Protas continues. “It’s really how you would train a young track athlete. Our innovation is combining the strength training with the speed training and, perhaps in the future, with dietary supplements.” The supplements, administered in capsule form, are a combination of essential amino acids including most of the essential ones—histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine, and valine.

Protas divided the volunteers into two groups—frail older persons who exercised and a control group of older individuals who did not have a walking impairment and did not exercise. The non-exercisers took essential amino acid supplements, which had to be especially formulated and cost the study three thousand dollars per person. Those who exercised did not take supplements in this study. “The supplements really shouldn’t give us much change in function,” Protas says. “But for people who are very frail, one of the problems is that they just don’t have enough muscle mass to get stronger. We think that the supplements will help build the muscle tissue, and then the strengthening will be more effective.” And, in fact, the group taking supplements did show increased muscle mass and strength, Protas observes. (This part of the study, she notes, was conducted by UTMB researchers Elisabet Børsheim and Robert Wolfe of the muscle metabolism unit at the Shriners Hospital for Children–Galveston.)

“Loss of mobility not caused by disease occurs because of the lack of physical activity,” Protas says. Only
12 percent of people aged seventy-five and older engage in leisure-time physical activity for thirty minutes a day, Protas adds. Nearly two-thirds report no leisure-time physical activity.

Protas would like to see physical therapists and exercise physiologists work with the elderly.

“It’s easy to train the young athlete, but a lot of people don’t want to train the grandmas. A lot of people need some expert advice before they start exercising.”

The next step is to secure funding for a larger study. Protas plans to submit a proposal to the National Institutes of Health to extend the trials to three groups of mobility-impaired elders—those who would perform only exercises, those who would take supplements without exercising, and those who would combine exercise with supplements. She envisions this phase of the study continuing for four to five years at a cost of one hundred sventy-five thousand dollars to two hundred thousand dollars annually.

“It’s really important to show that you can do this in a larger group. In a small study, you can select people carefully who are highly motivated,” Protas says. “A larger group makes it easier to determine whether in the general population of elders something like this will be useful.”