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Effect of Functional Exercise Training
Research documenting initial strength gains attributable
to neural adaptations suggests that functional improvements,
which are partially measured by strength gains, may also occur
after a short course of functional exercise training. Identifying
early improvements in functional fitness is important as it may
motivate older adults to persist with a functional exercise program
to maintain fitness.
The purpose of this study was to determine if there were
significant improvements in functional fitness levels in older adults
after 4 weeks of participation in a functional exercise program.
METHODS
Approach to the Problem
This study tested the hypothesis that performing a short course
of functional exercise training would result in improved functional
fitness in older adults. The independent variable was exercise type.
The experimental group performed functional exercises, while the
control group performed traditional exercises. All subjects were
regular exercisers, so the control group simply continued with their
usual routines. Functional fitness scores were measured before and
after a 4-week training period to assess changes in both groups.
Subjects
The subject population consisted of 24 volunteer men and
women aged between 58 and 78 years. The subjects were randomly
assigned to 1 of 2 groups: a functional exercise group (experimental:
n = 12) and a traditional exercise group (control: n = 12). All
subjects were actively participating, with physician approval and
referral, in the La Crosse Exercise and Health Program (LEHP)
at the University of Wisconsin-La Crosse (UWL). Subjects had a
variety of cardiac, metabolic, and orthopedic conditions; however,
subjects were excluded if they had conditions precluding them from
performing the functional exercises prescribed in this study (eg,
marked balance deficits affecting gait, extreme obesity, and inability
to perform 12 minutes of continuous activity). Subjects were
recruited by flyers distributed to members of the LEHP. Interested
individuals were interviewed to determine their availability and
suitability for the study and to confirm their medical history. Each
subject provided informed consent prior to participation. The
protocol was approved by the Institutional Review Board for the
Protection of Human Subjects at UWL.
Procedures
Functional fitness levels were assessed for all subjects before
and after the 4-week training period. Testing was conducted
using the Fullerton Functional Fitness Test for Older Adults
(FFT) developed by Rikli and Jones. 2,18 The FFT consists of the
following 6 components: 30-second chair stand for lower body
strength, bicep curls for upper body strength, 6-minute walk
for cardiovascular endurance, chair sit-and-reach for hamstring
flexibility, back scratch for shoulder flexibility, and 8-foot up-andgo
for balance and agility.
The experimental group participated in functional exercise
sessions 3 days per week for 4 consecutive weeks. Subjects were
required to attend at least 10 sessions to be retained in the study.
Each session consisted of a 5-minute warm-up, a circuit of 12
functional exercises, and a 10-minute cool-down. Each functional
exercise was performed for 1 minute, and the entire circuit was
completed 3 times. Subjects were instructed to exercise at a moderate
intensity level (11-14 using the Borg Rating of Perceived Exertion
Scale 19 ). Resistance, repetitions, and speed were progressed based
on the ability and comfort level of each subject, while maintaining
a moderate intensity level. The subjects in the control group were
instructed to continue with their usual physical activities during
the 4-week study period.
Functional Exercise Circuit
The functional exercise circuit is a modified version of the circuit
developed by Whitehurst et al 12 consisting of 12 exercises, which
were each performed for 1 minute, with 15-second transitions
between each exercise. Resistance was added as tolerated, using
various levels of sand-filled milk jugs to approximate weights of
common household items (one-half to 10 pounds). As the exercises
became easier to perform, the level of difficulty was increased by
adding weight or making modifications to the exercise, to achieve
and maintain moderate intensity. It is important to note that
although the exercises were generally similar to those used in the
FFT, they were not identical. This should reduce concerns related
to the specificity of testing and training overlap.
Unilateral balance. Subjects stood on each leg for 30 seconds,
while using the upper extremities for support by holding on to
the back of a chair. The spine was kept in a neutral position,
the abdominals were held tight, and subjects were instructed to
avoid knee hyperextension. The level of difficulty was increased
by removing upper extremity support, flexing the hips so that the
thighs were parallel to the floor, adding head rotations and arm
motions, or closing both eyes.
Golfer’s lift. Subjects stood on 1 leg, with the knee straight
but not hyperextended. They then flexed forward at the hip and
reached toward the floor, while extending the nonweightbearing
leg behind the body. They then returned to upright position. The
spine was kept in a neutral position and the abdominals were held
tight throughout the movement. Repetitions were performed for
30 seconds on 1 leg and then on the other. An increased level of
difficulty was achieved by adding small weights in the hands.
Squat with arms forward. Standing in place, subjects squatted
slowly up and down for 60 seconds. The arms were kept slightly
forward, the knees were kept behind the toes, and the abdominals
were held tight throughout the movement. An increased level of
difficulty was achieved by deepening the squat, extending the arms
out to be parallel to the floor, or holding a weight in front of the
body with both hands.
Wall push-ups. Subjects faced the wall with their feet a
comfortable distance away from the base of the wall. The feet and
hands were shoulder width apart, and the body was aligned with
a neutral spine. Subjects were instructed to slowly lean toward
the wall and then push away. Repetitions were performed for 1
minute. Intensity was increased by performing knee push-ups or
full push-ups on the floor.
Lateral squats. Subjects stepped sideways and squatted, while
keeping their trunk aligned, and then returned to an upright
position. This motion was then repeated to the opposite side,
alternating sides for 1 minute. The level of difficulty was increased
Gundersen Lutheran Medical Journal • Volume 5, Number 1, July 2008 5