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The Effects of 12 Weeks of Step Aerobics Training on Functional Fitness of Elderly Women

Hallage, Tatiane1; Krause, Maressa P2; Haile, Luke2; Miculis, Cristiane P1; Nagle, Elizabeth F2; Reis, Rodrigo S1; Da Silva, Sergio G1

Journal of Strength and Conditioning Research: August 2010 - Volume 24 - Issue 8 - p 2261-2266
doi: 10.1519/JSC.0b013e3181ddacc6
Research Note
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Hallage, T, Krause, MP, Haile, L, Miculis, CP, Nagle, EF, Reis, RS, and Da Silva, SG. The effects of 12 weeks of step aerobics training on functional fitness of elderly women. J Strength Cond Res 24(8): 2261-2266, 2010-The purpose of this study was to determine the effects of 12 weeks of step aerobics (SA) training on the functional fitness of apparently healthy older women. Thirteen previously sedentary elderly women (mean age 63.14 years) participated in this study. Subjects performed 3 training sessions per week for 30-60 minutes per session. All measurements were assessed at baseline, after 12 weeks of training (posttest), and after 1 month of detraining. Assessments included the evaluation of body mass index (BMI), waist circumference (WC), strength of the upper (arm-curl [AC] test) and lower body (30-second chair-stand test [CS]), dynamic balance and agility (8 foot up and go [8 ft]), flexibility (chair sit-and-reach [CSR]), and cardiorespiratory fitness (6-minute walk test [6MW]). Step aerobics significantly improved all functional fitness components except for BMI. The 12 weeks of SA promoted a large effect size in the following measurements: WC (d = 1.6); CSR (d = 1.51); CS (d = 1.49); AC (d = 1.41); 8 ft (d = 1.32); and 6MW (d = 1.06) (p < 0.05). These results indicate that 12 weeks of SA had a positive effect on the functional fitness components of these older women. Furthermore, these findings were confirmed by the reverse effect observed after 1 month of detraining, except for upper body strength (AC test). In conclusion, 12 weeks of SA training can promote improvements in the functional fitness of apparently healthy older women. Therefore, SA can be considered an effective exercise modality to prevent the loss of functional fitness and its associated consequences.

1Laboratory of Sport and Exercise Research, Federal University of Parana, Curitiba, Brazil; and 2Center for Exercise and Health-Fitness Research Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania

Address correspondence to Tatiane Hallage, thallage@hotmail.com.

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Introduction

It is well known that the advancement of age increases the likelihood for functional limitation or loss, which can lead to more severe consequences such as physical disability (15,16,27,31). Therefore, effective strategies must be developed for the evaluation and prevention of functional fitness loss in older individuals. Exercise participation has been recognized as a preventive strategy across a wide range of health-related problems because of its proven beneficial effects on the physical, functional (3,6,26,29) and psychological well-being of older adults (3,29). However, there is insufficient evidence regarding the optimal mode of training to induce improvements in the functional fitness of older women (3,29).

Step aerobics (SA) has been considered a traditional and popular exercise mode among women since the 1980s. Step aerobics training involves stepping up and down on a single bench in choreographed, group-led movements to cadenced musical arrangements. The positive effects of SA training on body composition have been shown in young (21) and older adults (10). Step aerobics has improved lower body strength in older adults, which can be attributed to the repetitive action of stepping up and down on a bench (10,28). Step aerobics has improved upper body strength as well, because of its choreographies that involve dynamic movements of the arms (22). In addition, improvements in balance and agility have been shown in middle-aged and older adults because of the characteristic movements used in SA choreographies (11,28,30). Improvements in flexibility have been achieved by the range of motion required to perform the movements of SA choreographies and stretching exercises (29). Finally, because SA is considered a predominantly aerobic exercise modality, the majority of investigations have evaluated and shown its beneficial effect on cardiorespiratory fitness (CRF) (10,14,17,18).

Although there are many investigations that have confirmed the beneficial health outcomes associated with SA training in older adults (10,11,14,17,18,21,22,28,30). Those studies have not evaluated its effects on all functional fitness components at once. To our knowledge, no study has examined the effects of the same training program on all functional fitness components in older women. Therefore, the purpose of this study was to investigate the effects of SA training on all functional fitness components in apparently healthy older women.

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Methods

Experimental Approach to the Problem

This investigation employed a reverse, time-series design to determine the effects of 12 weeks of SA training, followed by 1 month of detraining, on functional fitness of apparently healthy and previously sedentary elderly women. The effects of SA on functional fitness tests (dependent variables) will be determined by comparisons between the performance on these tests at baseline and after 12 weeks of training (hereafter referred as posttest). The reverse effect of SA will be determined by comparisons between the performance on these same tests at posttest and after 1 month of detraining (hereafter referred as detraining). The detraining period began immediately after the 12 weeks of SA was completed. The functional fitness tests include evaluation of body composition, muscular strength, dynamic balance and agility, flexibility, and CRF, which have been previously validated (31).

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Subjects

Subjects were actively recruited in public places within approximately 3 km surrounding from the fitness center where the exercise sessions were performed. During the first appointment, a medical screening was performed to evaluate the history of cardiovascular, metabolic, or orthopedic disease and the presence of known neurological, musculoskeletal, or inflammatory disorders. The presence of disease or a known disorder was grounds for exclusion from the study. In addition, subjects were excluded from the investigation if they reported any limitation to perform basic and instrumental activities of daily living (ADLs) (20,24).

The sample was composed of 13 apparently healthy and previously sedentary women who attended the initial appointment and signed the informed consent defining their participation as voluntary. The mean age of the subjects was 63.14 years, and mean education was 10.7 years. The majority of the sample (77.0%) belonged to the middle socioeconomic class. During the study period, all subjects were instructed not to engage in any other regular physical activity and to maintain their current diet. After informing subjects of the testing and training procedures to be performed during the study, all subjects signed an informed consent form. The study protocol was approved by the Ethics Committee of the Universidade Federal do Paraná, the local equivalent of an Institutional Review Board.

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Procedures

The study period corresponded to the transition between the winter and spring seasons (August to November 2007). The 3 assessments periods (baseline, posttest, and detraining) were conducted at the Physiology Laboratory of the Exercise and Sport Research Center of the Universidade Federal do Paraná. Furthermore, the participants were instructed to refrain from eating 2 hours before the tests and to avoid any vigorous physical activity for the preceding 24 hours. During all evaluations, subjects wore standard sport wear (sport shoes, shorts, and T-shirt).

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Functional Fitness Battery

Functional fitness test procedures were followed in accordance with the protocols described previously by Rikli and Jones (31). Height was measured using a wall-mounted stadiometer (Sanny, standard model, Sao Paulo, Brazil). Weight was measured using a digital scale (Toledo, model 2096 PP; Sao Paulo, Brazil). Subsequently, body mass index (BMI, kg·m−2) was calculated. Waist circumference (WC) was measured using a tape measure, taken at the minimum circumference between the umbilicus and the xiphoid process.

The chair-stand (CS) test was used to assess lower body strength. After a demonstration by the test administrator, a practice trial of 2 repetitions was performed, followed by 2 30-second test trials. The score was the total number of stands executed correctly within 30 seconds. The best score of the 2 trials was used in the analysis. The CS test has strong test-retest reliability in older women (R = 0.92; 95% CI 0.87-0.95) and moderate criterion validity (r = 0.71) (31).

The arm-curl (AC) test was used to assess upper body strength. After a demonstration by the test administrator, a practice trial of 2 repetitions was performed, followed by 2 30-second test trials. The score was the total number of hand-weight curls performed through the full range of motion in 30 seconds using a 5-lb hand weight. The best score of the 2 trials was used in the analysis. The AC test has moderately strong test-retest reliability in older women (R = 0.80; 95% CI 0.67-0.89) and moderately strong criterion validity (r = 0.78) (31).

The 8-ft up-and-go (8-ft) test was used to assess agility and dynamic balance. After a demonstration by the test administer, 1 practice trial was performed followed by 2 test trials. The score used in the analysis was the shortest time to rise from a seated position, walk 0.31 m (8 ft), turn, and return to the seated position, measured to the nearest 1/10th second. The 8-ft test has a strong test-retest reliability in older women (R = 0.90; 95% CI 0.83-0.95) (31).

The chair sit-and-reach (CSR) test was used to assess lower body flexibility. After a demonstration by the tester, 2 practice trials were performed, followed by 2 test trials. The score used in the analysis was the best distance achieved between the extended fingers in the direction of the tip of the toe. The CSR test has a strong test-retest reliability in older women (R = 0.96; 95% CI 0.93-0.98), and strong criterion validity (r = 0.86) (31).

The 6-minute walk test (6MW) was used to assess CRF. After an explanation about the test procedures and a demonstration by a test administrator, groups of 5 participants were lined up and started the test one at a time with a 10-second interval between each other. The score used in the analysis was the total distance walked in 6 minutes along a 54.4-m rectangular course (18.0-m length × 9.2-m width), which was marked every 3.0 m. The 6MW test has strong test-retest reliability in older women (R = 0.91; 95% CI 0.84-0.95) and moderate criterion validity (r = 0.71) (31).

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Step Aerobics Training Program

Step aerobics training was performed using the low-impact version, in which 1 foot remains in contact with the floor or bench at all times, therefore, not allowing any hopping or jumping movements. The SA choreographies included patterns such as the conventional basic step; “V” step; “L” step; “A” step to both the right and left side; alternating step knee-lift sequences; alternating leg up, up, down, down patterns; and step kicks. Arm movements such as biceps curls and lateral raises at the shoulder level and above the head were incorporated simultaneously with the selected steps. The music cadence of all sessions was set between 120 and 126 foot strikes per minute.

The training protocol was designed in accordance with the guidelines recommended by the American College Sports Medicine (2). Step aerobics training consisted of 3 sessions per week, 30-60 minutes per session for 12 weeks conducted by the same previously trained instructor. The target intensity for all sessions was set at 50-70% heart rate (HR) reserve. At the beginning of the first exercise session, the resting HR of subjects was measured by a HR monitor (Polar Electro™, Oy, Finland). Heart rate was measured every 5 minutes of each session. In addition, subjects were instructed how to use the Borg 6-20 rate of perceived exertion (RPE) scale (5). A large copy of the RPE scale was displayed in front of the subjects throughout the session. Subjects were asked to rate their perceived exertion every 5 minutes during all exercise sessions (2).

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Statistical Analyses

The results are presented as mean and SD. The difference between the baseline and posttest measurement and the posttest and detraining was calculated as a percentage (%) for each dependent variable. Repeated-measures analysis of variance (ANOVA), with Bonferroni post hoc tests, was used to analyze the dependent variables over time-baseline, posttest, and detraining. Cohen's d was calculated to determine the effect size of the 12-week SA training on the functional fitness components using mean values from baseline and posttest. The level of significance was set a priori with p ≤ 0.05. All data analyses were completed using SPSS version 16.0 (SPSS Inc., Chicago, IL, USA).

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Results

The 12 weeks of SA training had a high attendance rate (mean rate of 85% and amplitude of 30.6). Changes in functional fitness components are shown in Table 1. Repeated-measures ANOVA determined a significant time main effect in the performance of all functional fitness tests and for WC measurement (p < 0.05). However, BMI did not change over time. Similarly, pairwise comparisons between the baseline and posttest indicated significant differences on the performance of all functional fitness tests and WC. The 12 weeks of SA training has a large effect size in the following measurements: WC (d = 1.6); CSR (d = 1.5); CS (d = 1.49); AC (d = 1.41); 8-ft up-and-go (d = 1.32); and the 6-minute walk (d = 1.06). These findings confirm that 12 weeks of SA training were effective to improve all functional fitness components, except BMI. Comparisons between the posttest and detraining indicate that the reverse effect of 12 weeks of SA occurred in the performance of all functional fitness tests (p < 0.05), except on the AC.

Table 1

Table 1

Figures 1 and 2 display the relative changes over time on the performance of the functional fitness tests. Figure 1 presents the differences between the baseline and posttest, whereas Figure 2 presents the differences between the posttest and detraining. In both figures, the significant change in CSR is not displayed because of its extreme difference compared to that of the other variables. The mean CSR increased 75.7% from baseline to posttest, and decreased 70.3% from posttest to detraining.

Figure 1

Figure 1

Figure 2

Figure 2

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Discussion

Our findings demonstrate that 12 weeks of SA promoted positive and large changes in the performance of all functional fitness tests. Although SA training did not alter BMI, it was effective in improving WC, which has been considered an indicator of central obesity in older women. Many studies have suggested that even small variations in the unit of WC can modify a health risk condition in older individuals and consequently improve their quality of life. Additionally, WC is strongly and directly associated with the risk for several chronic diseases, such as hypertension and type 2 diabetes, that contribute to the decline of functional fitness (13,37).

The loss of functional fitness has been associated with the decline of the ability to produce force (2,7). Hence, the maintenance of muscular strength is also crucial for older adults to maintain their capacity to independently perform ADLs (8). According to Hughes et al. (19), the decline of lower body strength in older individuals can vary from 14 to 16% per decade, indicating a stronger relevance for our findings. Step aerobics training was effective in improving lower body strength (CS) with an increase of 18.2 and 25.8% in upper body strength (AC).

A previous investigation found an increase in lower body strength (quadriceps strength) of 14% but did not find significant results in handgrip strength after 24 weeks of SA and walking training in older women (48-65 years) (10). DiBrezzo et al. (12) investigated the effect of a 10-week strength and balance training on older men and women (mean age of 74.9 years). The increase of lower body strength (CS test) was similar to our study (20%; p = 0.005); however, the increase of upper body strength (AC test) was lower than reported in this study (13%; p = 0.03). Additionally, Cao et al. (9) conducted a multicomponent training program, including pool walking, balance ball, and resistance exercises, with older women aged between 65 and 79 years, in which lower body strength (CS test) increased 13.5% (p = 0.001).

Balance and agility are other broadly studied neuromuscular components of functional fitness in older adults, because of their relation to the ability to perform ADLs (4). Dynamic balance and agility (8 ft), showed an improvement of 19% in our study. Similarly, Shigematsu et al. (32) demonstrated an increase in dynamic balance and agility of 20%, evaluated by a test involving walking around 2 cones, in older women after 12 weeks of aerobic dance training (p < 0.05).

The association of aging with significant losses of joint range of motion is enhanced by sedentary behavior, which is related to the deterioration of the functional ability to perform ADL (23). Flexibility significantly improved after the 12 weeks of SA training. The greatest relative effect was observed on trunk flexion (CSR), which increased 75%. Similarly, Alves et al. (1) reported effects of aquatic exercise on trunk flexion (CSR) after 12 weeks of training in older women (mean age of 78 years) with an increase of 93% (p = 0.001). The effect of both training programs on trunk flexion may be explained by the floor effect phenomenon, because the performance at baseline for the CSR corresponded to the lowest percentile according to the normative values recommended by Rikli and Jones (31).

Cardiorespiratory fitness is also considered to be a determinant factor of functional limitations (27,36). The maintenance of satisfactory levels of CRF may extend life expectancy free from functional limitations, altering the common trajectory of functional decline and postponing or even preventing disability (16,27,36). In the current study, CRF showed an increase of 9.4% after the SA training. Many studies that verified the effects of other aerobic modalities and functional exercises on CRF observed a wide range of improvements (1,33,35). For example, Alves et al. (1) verified an increase of 22% of CRF (6MW test) after 12 weeks of aquatic training with 53 women (mean age of 78 years). Takeshima et al. (33), found an increase of 16% of CRF (12MW test) after 12 weeks of walking training with 113 men and women (mean age of 73 years), whereas Toraman et al. (35) found an increase of 14% of CRF (6MW test) after 9 weeks of multicomponent exercise training with 42 men and women (60-86 years). Conversely, Lord et al. (25), who conducted a study with 508 men and women aged between 62 and 95 years, verified an increase of 4% (p < 0.05) in CRF after a multicomponent exercise program (walking, aerobic dance, strength and balance exercises). Therefore, it seems that the dose-response training effect on CRF of older individuals may be dependent of myriad factors, such as exercise modality, gender, age, initial fitness level, and specially exercise intensity.

Significant reductions on the performance of all functional fitness components were observed after 1 month of detraining with the exception of BMI and upper body muscular strength (AC). The reverse effect caused by the detraining period confirmed the effectiveness of SA training on the functional fitness components of older women. These results are similar to those observed by Toraman and Ayceman (34) who conducted a multicomponent training program (walking, calisthenics, and stretching) with 42 men and women (60-86 years). According to their results, after the second and fourth weeks of detraining, there were significant reductions in the performance of all functional tests, with subjects returning to the baseline condition. In the current study, although BMI did not differ significantly over time, the results of WC have a greater clinical relevance, as reported previously (13,37). After detraining, an attenuated decline of upper body strength (AC) was also observed. However, these changes did not show significant differences when compared with baseline values. These results could be explained by the fact that reductions in upper body strength tend to be at a lesser magnitude as compared to lower body strength (19). Being so, it is important to highlight the possibility that the reverse effect might be confirmed for this variable if a longer detraining period was used (>1 month).

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Practical Applications

The results of the present study demonstrated that 12 weeks of SA training reduced WC and increased the strength, balance, agility, flexibility, and CRF of older women. Therefore, it is suggested that SA training should be used as an effective strategy to promote improvements in the functional fitness of apparently healthy older women. Its low operational cost, easy applicability, high attendance rate, and the fact that it can be performed by many individuals of different fitness levels at the same time make this modality viable to be implemented in any community center.

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Acknowledgments

We would like to thank the participants for their excellent cooperation during the conduction of this study. No conflict of interests is verified among the authors. The results of the present study do not constitute endorsement of the product by the authors or the National Strength and Conditioning Association. No funding was received for this work from National Institutes of Health, Welcome Trust, Howard Hughes Medical Institute, or Others.

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Keywords:

physical function; exercise; aging

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