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Flexibility of Older Adults Aged 55–86 Years and the Influence of Physical Activity

Flexibility of Older Adults Aged 55–86 Years and the Influence of Physical Activity Hindawi Publishing Corporation Journal of Aging Research Volume 2013, Article ID 743843, 8 pages http://dx.doi.org/10.1155/2013/743843 Clinical Study Flexibility of Older Adults Aged 55–86 Years and the Influence of Physical Activity 1,2 2 Liza Stathokostas, Matthew W. McDonald, 1,2 1,2 Robert M. D. Little, and Donald H. Paterson Canadian Centre for Activity and Aging, Faculty of Health Sciences, 3M Centre 2225, eTh University of Western Ontario, London, ON, Canada N6A 3K7 School of Kinesiology, Faculty of Health Sciences, 3M Centre 2225, eTh University of Western Ontario, London, ON,CanadaN6A 3K7 Correspondence should be addressed to Liza Stathokostas; lstatho2@uwo.ca Received 21 February 2013; Revised 8 May 2013; Accepted 2 June 2013 Academic Editor: Astrid E. Fletcher Copyright © 2013 Liza Stathokostas et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Cross-sectional age-related differences in flexibility of older adu lts aged 55–86 years of varying activity levels were examined. Shoulder abduction and hip flexion flexibility measurements were obtained from 436 individuals (205 men, 71±9 years; 231 women, 72±8 years). Total physical activity was assessed using the Minnesota Leisure-Time Physical Activity Questionnaire. Shoulder abduction showed a significant decline averaging 5 degrees/de cade in men and 6 degrees/decade in women. Piecewise linear regression showed an accelerated decline in men starting at the age of 71 years of 0.80 degrees/year, whereas in women the onset of decline (0.74 degrees/year) was 63 years. Men and women showed a significant decline in hip flexion (men: 6 degrees/decade; women: 7 degrees/decade). Piecewise linear regression revealed a rate of decline of 1.16 degrees/year beginning at 71 years in men and in women a single linear decline of 0.66 degrees/year. Multiple regression analysis showed that age and physical activity accounted for only 9% of the variance in hip flexion in women and 10% in men, with age but not physical activity remaining significant. Similarly for shoulder abduction, age was significant but not physi cal activity, in a model that described 8% of the variance for both sexes. 1. Introduction to support the recommendation of the inclusion of a flex- ibility component to older adult exercise programs, many As indicated in a recent systematic review by our group older adult activity programs place a considerable emphasis [1], there is conflicting information regarding both the rela- on flexibility. eTh present study attempts to add additional tionship between flexibility training interventions and func- insight to this area by presenting the relationship between tional outcomes and the relationship between improved declines in flexibility across age and functional outcomes in flexibility and daily functioning; health benefits have not yet a large sample of individuals representing the older adult age been established. The comparison of studies in this area to range. Joint flexibility may decrease across the age span [ 2– provideaprescription of theflexibility is complicatedbythe 4], which has the potential to aeff ct normal daily functioning. variety of limb ranges of motion studied, testing procedures Upper body flexibility is known to be important for activities utilized, and methods of assessing physical activity levels. such as getting dressed and reaching for objects, while Furthermore, this component of physical health has been lower body flexibility is important for maintaining normal somewhat neglected or forgotten in the current literature walking patterns and for activities involving bending and despite the lack of evidence for recommendations of the reaching [5]. While the loss in flexibility with age has been amount and type of flexibility needed for health in older attributable, in part, to decreased activity [5], the literature adults. Further, despite this lack of a synthesis of the literature describing the influence of physical activity on flexibility and 2 Journal of Aging Research theaging processissurprisinglylimited.Thepurpose of the and1.02% peryearinfemales foreachyearbeyondthe present study was to examine the cross-sectional age-related age of 55, corresponding to the rate of decline in self-paced differences in flexibility in a large sample of independently walking as measured in the sample of the present study (age living adults aged 55–86 years with varying activity levels. 55 to 85 years). us, Th the “intensity codes” for the vigor with eTh recent systematic literature review identiefi d the lack which older adults participated in a particular activity were of an established relationship between improved flexibility age-adjusted. According to the MLTPAQ scoring system, and daily functioning and health benefits [ 1]. As such, a physical activity was characterized by total energy expendi- secondary purpose of the present study was to describe any ture (in MET/minutes/day) and also examined for energy relationships of physical activity levels and of functional expenditure in activities characterized as light, moderate, or outcomes (specifically walking), with flexibility measures. heavy intensity. 2. Methods 2.2.4. Muscle Strength. The design of the leg dynamometer and the procedures followed for measuring plantar flexion 2.1. Sample Selection, Recruitment, and Participation. The strength have been previously reported [9]. Subjects were municipal tax assessment list, containing names of house- seated on a bench with the thigh locked in a horizontal posi- holders and residents in the city of London, Ontario (2011, tion and knee flexed at 85 degrees in the leg dynamometer. population 366,151), provided the sampling frame. Those The dominant leg was clamped down and the subject was living in institutions, defined as nursing homes or chronic asked to push-off, that is, to attempt to raise their heel off care facilities, were not eligible. A stratified random sample the ground. eTh force generated against the clamp bar was was drawn from the population. The strata were defined recorded with a strain gauge calibrated with standard weights. by gender and six five-year age groups, starting with age Three trials were done. Maximal grip strength (of three of 55,and thesamplingratewas settoselect35men and trials) of the dominant hand was measured using a handgrip womenineachstratum.Thosesampled were sent aletter dynamometer with interchangeable casings to accommodate inviting their participation, and a follow-up call to recruit hand size. and screen the respondents was made. Exclusion criteria were those who responded no to the question of their ability to walk an 80 meter course. u Th s, the target population the 2.2.5. Normal and Fast Walking. As a measure of lower body noninstitutionalized population aged 55–85 years who self- function, walking speed (time/meters) and step length were reported the ability to walk 80 meters. eTh university’s human assessed by having subjects walk an 80-meter course at their research review board approved the study, and each subject normal and fast self-selected speeds [8]. signed informed consent. 2.2.6. Self-Rated Health and Life Satisfaction. Self-rated 2.2. Measurements health and life satisfaction were assessed using a question- naire containing modified questions from the Nottingham 2.2.1. Anthropometric. Body height, mass, skinfold thickness Health Profile [ 10], as were self-reported walking difficulty (four sites: biceps, triceps, subscapular, and suprailiac), and and difficulty with stairs, by rating degree of difficulty on a waist and hip girth were measured. Body mass index was vfi e-point scale. calculated. 2.3. Analysis. Data analyses were performed with the Statisti- 2.2.2. Joint Flexibility. Hip flexion was assessed using a cal Package for the Social Sciences (SPSS 19.0, Ireland, 2010). Leighton flexometer fastened to the hip, with the range of All descriptive data are presented as mean± SD. Frequency motion determined by bending backward as far as possible distributions were examined for categorical variables. Ranges and then forward as far as possible [6]. Shoulder abduction of motion of the hip and shoulder joints across age were wasmeasuredasthe rangeofmotionofthe righthandfrom analyzed by both linear regression and piecewise linear the side of the leg, upward and outward in an arc [6]. regression with a 2-segment model (Sigma Plot 12.0, Chicago, Illinois, USA); these ts fi produced similar 𝑅 values. Age 2.2.3. Physical Activity. The Minnesota Leisure-Time Phys- and physical activity were entered into a multiple regression ical Activity Questionnaire (MLTPAQ) was used to assess analysis to determine associations with shoulder and hip self-reported physical activity levels [7]. The questionnaire flexibility. Further, expanded univariate logistic regression was administered with the aid of a research assistant. For the was performed to identify other variables associated with present data in older adults, the intensity codes (metabolic determining flexibility. Lastly, stepwise linear regression, rate scores) for different activities, developed for middle- allowing for entry and removal at the 0.10 level of signica fi nce, aged subjects, were reduced in proportion to the age-related was used to examine the relationship of flexibility with physi- slowing of self-paced walking speed, to acknowledge that cal (self-rated health, self-reported arthritis, body mass index, older adults would pursue these activities at a slower absolute and upper and lower body strength), functional (walking and pace. Specifically, the codes were decreased 8.9% for males stair climbing difficulty, step length, and walking speed), and and 4.6% for females from middle age to 55 years [8]. The codes were then decreased a further 0.61% per year in males psychosocial (self-rated health, life satisfaction) variables. Journal of Aging Research 3 200 200 180 180 160 160 140 140 120 120 100 100 80 80 50 55 60 65 70 75 80 85 90 50 60 70 80 90 Age (years) Age (years) (a) (b) Figure 1: (a) Age analysis for shoulder flexibility in men. Piecewise linear regression s-segment model shows breaking at the age of 71 years. 2 2 Rate of decline prior to age 71 is−0.20 degrees per year and−0.80 degrees per year aeft r the age of 71 years. ( 𝑅 of fit 𝑅 = 0.09). (b) Age analysis for shoulder flexibility in women. Piecewise linear regression s-segment model shows breaking at the age of 63 years. Rate of change 2 2 prior to age 63 is 0.38 degrees per year and−0.74 degrees per year aeft r the age of 63 years. ( 𝑅 of fit 𝑅 =0.09). 3. Results Table 1: Subject characteristics. Total sample Men Women 3.1. Response Rate. eTh recruitment process resulted in 1451 (𝑛=436 ) (𝑛=205 ) (𝑛=231 ) individuals contacted; 696 were eligible, and 441 (63.4%) participated and is detailed by Koval et al. [11]. Participants Age (years) 71± 8.6 70.4± 8.8 71.4± 8.4 were more likely to be widowed and less likely to be married, BMI 26± 3.9 26.3± 3.1 25.8± 4.4 more likely to have had a white-collar job, and had some Mass (kg) 71± 12.9 78.2± 10.5 64.5± 11.4 postsecondary education. Physical activity level 406± 201 386± 182 423± 215 (MET/minutes/day) 3.2. Descriptionofthe Sample. Flexibility measurements were Shoulder abduction 138± 15 138± 16 138± 15 obtained from a total of 436 community-dwelling individuals (degrees,𝑛=431 ) (𝑛=202 ) (𝑛=231 ) (205 men, mean age 70.4 ± 8.8 years; 231 women, mean Hip flexion 102± 18 114± 18 109± 19 age71.4±8.4 years). Subject characteristics are presented (degrees,𝑛=402 ) (𝑛=183 ) (𝑛=219 ) in Table 1. Self-rated health among the group indicated that BMI: body mass index, 𝑃<0.05 . 11% of the sample considered their health to be “excellent” and 54% rated their health as “good.” Almost half of the with those 71 years old, whereas in women the onset of decline sample was fully retired (49%) and 11% were employed full was 63 years and declined across age at a rate of 0.74 degrees time. Seven percent of the sample reported being not “very per year (Figures 1(a) and 1(b)). satisfied” with life. Sixty-three reported being “quite satisfied” and30% reported being“very satisefi d.”Themarital status of the sample indicated that 56% were married. Based on self- 3.3.2. Hip Flexion. The women had significantly higher hip reported physical activity levels, the calculated total energy flexion of 114 degrees versus the men, with 102 degrees. expenditure in leisure time physical activity would indicate However, both showed a similarly significant age-related that the present sample was, on average, very active, but decline in hip flexion (men: 6 degrees per decade; women: encompassed a wide range of activity levels. 7 degrees per decade). Piecewise linear regression revealed a rate of decline of 1.16 degrees per year, across age, beginning at 71 years in men (Figure 2(a)). In women, the decrease across 3.3. Flexibility and Differences by Age theage span of thesamplewas asinglelineardecline of 0.66 degrees per year (Figure 2(b)). 3.3.1. Shoulder Abduction. The mean range of motion of shoulder flexibility was 138 degrees in our sample, with no difference between men and women. Shoulder abduction 3.4. Relationship of Age and Physical Activity with Flexibil- showed a significant decline across age, averaging 5 degrees ity. Both upper and lower body flexibility measures were per decade in men and 6 degrees per decade in women. From normally distributed. Age was signica fi nt ( 𝑃 < 0.01 ), but piecewise linear regression, an accelerated decline of 0.80 the contribution of physical activity was not (females:𝑃= degrees per year was observed in the sample of men starting 0.14;males: 𝑃 = 0.57 ), when included in a regression Shoulder flexibility (degrees) Shoulder flexibility (degrees) 4 Journal of Aging Research 160 160 140 140 120 120 100 100 80 80 60 60 40 40 50 60 70 80 90 50 60 70 80 90 Age (years) Age (years) (a) (b) Figure 2: (a) Age analysis for hip flexion in men. Piecewise linear regression s-segment model shows breaking at the age of 71 years. The rate 2 2 of decline prior to 71 years is−0.19 degrees per year and−1.16 degrees per year thereaeft r. ( 𝑅 of fit 𝑅 =0.11). (b) Age analysis for hip flexion in women. Piecewise linear regression s-segment model shows breaking at the age of 86 years. The rate of decline prior to 86 years is −0.66 2 2 degrees per year and−2.67 degrees per year thereaeft r. ( 𝑅 of fit 𝑅 =0.08). model that described 9% of the variance for both males and was associated with all walking speeds; however, none of females in the decline in shoulder abduction. The regression the associations were maintained when adjustment was made model accounted for only 7% of the variance (in both for age. men and women) in the change in hip flexion. Again, age Self-rated health and life satisfaction were not associated showed a significant contribution ( 𝑃 < 0.01 ); however, the with either upper (𝑃 = 0.18 ; 𝑃 = 0.32 )orlower body contribution of physical activity to lower body flexibility was flexibility ( 𝑃=0.09 ;𝑃=0.30 ). not significant for either males ( 𝑃 = 0.71 ) or females (𝑃= 0.42). 4. Discussion This study provides descriptive data on the age-related differ- 3.5. Variables Associated with Flexibility. Neither total phys- ences (across the age range of 55–85 years) in flexibility in a ical activity nor the components of light-, moderate-, and large cross-sectional sample of male and female community- heavy-intensity physical activity were significantly related to dwelling older adults. It also provides an examination of flexibility of the hip or shoulder at the univariate level (Tables theroleofphysicalactivityinthe changestoupper and 2(a) and 2(b)). Age was significant and explained 8% and 7% lower body flexibility with aging and a determination of of variance in shoulder and hip flexibility, respectively. the relationship of flexibility with functional outcomes in For upper body flexibility, age, BMI, plantar flexor older adults. Our sample demonstrated a mean upper body strength, and handgrip strength were entered into the flexibility of 138 degrees and a mean lower body flexibility of stepwise linear regression (Table 3(a)). Regression analysis 109 degrees. Bassey et al. [12] reported shoulder abduction yielded a model including age, BMI, and plantar flexion values of 125 degrees for men and 119 for women in a strength that resulted in 10.5% of the variance in upper body similar large sample (𝑛=894 ) of community-dwelling adults flexibility being accounted for by those variables. over the age of 65 years. These values are lower than those Age, sex, BMI, and hand grip strength were entered into reported for the present study’s sample; however, it should a regression model for lower body flexibility, accounting for be noted that the shoulder abduction measure was slightly 19.6% of the variance in hip flexibility ( Table 3(b)). different, and a large proportion of the sample in Bassey’s study reported having a functional disability. 3.6. Association with Function, Self-Rated Health, and Life With respect to sex differences, the majority of the Satisfaction. eTh re was no association between upper body literature indicates that women have greater flexibility at all flexibility and the “functional measures” of self-reported ages [4, 13–18]. Our results were in agreement for lower body difficulty in walking or climbing stairs. Step length was flexibility, although there was no significant difference based associated with upper body flexibility but not when adjust- on sex for upper body flexibility. This is in contrast to Bassey ment was made for age. Normal, fast, and very fast walking et al. [12], who reported significantly lower shoulder abduc- speeds were associated with upper body flexibility, but only tion flexibility for females in their sample. Doriot and Wang very fast walking speed (𝑃 = 0.001 ) was still associated [19] did not nd fi consistent sex differences among their 26 when adjustment was made for age. Lower body flexibility measures of joint range of motion. Similarly, Walker et al. [20] Hip flexibility (degrees) Hip flexibility (degrees) Journal of Aging Research 5 Table 2: (a) Univariate associations with shoulder flexibility. (b) Table 3: (a) Shoulder flexibility regression model. (b) Hip flexibility Univariate associations with hip flexibility. regression model. (a) (a) Mean (SD) 𝑟𝑃 value Parameter 𝑅 SE 𝑃 value estimate Sex: −0.017 0.722 Age 0.083 −0.486 0.091 <0.001 males = 205; females = 231 0.009 0.187 0.001 Age (years) 71± 8.6 −0.290 <0.001 BMI −0.647 Plantar flexion 405.8± 201.0 0.029 0.547 ∗ Total physical activity 0.039 0.006 0.002 0.045 strength 186.1± 82.6 0.057 0.235 Light activity 2 ∗ Cumulative𝑅 =0.117, BMI: body mass index, significance set at = 𝑃< 115.1± 91.1 0.030 0.530 Moderate activity 0.05. Heavy activity 104.6± 141.3 −0.012 0.810 (b) 26± 3.9 −0.094 0.052 BMI 2 Parameter 𝑅 SE 𝑃 value 56.0± 20.5 0.013 0.825 Sumofskinfolds estimate 879.5± 322.9 0.197 <0.001 Plantar flexion strength ∗ 0.066 0.117 <0.001 Age −0.571 Handgrip strength 292.1± 112.7 0.126 <0.001 ∗ 0.117 2.721 <0.001 Sex—female 18.8 Arthritis: −0.022 0.752 BMI 0.09 −1.014 0.265 <0.001 no =107;yes =108 Handgrip ∗ 0.029 0.013 0.018 BMI: body mass index; self-reported arthritis data available for 215 sub- 0.031 strength jects. 2 ∗ Cumulative𝑅 =0.235, BMI: body mass index, significance set at = 𝑃< (b) 0.05,sex:male=0; female =1. Mean (SD) 𝑟𝑃 value Sex: 0.341 <0.001 males = 205; females = 231 Comparative rates of decline are not readily available in the 71± 8.6 −0.256 <0.001 Age (years) literature, but rates of 1.5 degrees per year have been reported 405.8± 201.0 0.027 0.586 Total physical activity for lower back flexion, and the greatest decline appears to occur with trunk extension [21]. 186.1± 82.6 0.039 0.435 Light activity Whereas differences in flexibility by sex may occur, the Moderate activity 115.1± 91.1 −0.010 0.839 rate of change with age has been reported to be similar in both 104.6± 141.3 0.022 0.658 Heavy activity men and women [22, 23], and our results concur. In contrast, 26± 3.9 −0.131 0.009 BMI McCulloch [14] showed little decline in sit-and-reach scores 56.0± 20.5 0.080 0.187 Sumofskinfolds in women versus men, who showed a dramatic decline in age Plantar flexion strength 879.5± 322.9 0.055 0.279 groups of 65 to 75 years, citing differences in the decline in work activity of men over the older adult age range. 292.1± 112.7 −0.113 0.029 Hand grip strength This study provides a description of potential critical peri- Arthritis: −0.107 0.132 ods of decline in flexibility across the older adult age range. no =107;yes =108 At the age of 71 years, it appears that both upper and lower BMI: body mass index; self-reported arthritis data available for 215 sub- body flexibility show an accelerated decline in males, whereas jects. in females, only upper body flexibility shows a change in the rate of decline, with lower body showing a steady rate of found no differences in ranges of motion of the shoulder, change. James and Parker [22] reported decreases in active elbow, hip, or knee joints, between older men and women. and passive motion in lower limb joints during the period of These varying results are likely due to different population 70 to 92 years, with the decline becoming more pronounced samples, joints studied, and customary use of the joints. during the ninth decade. While not significant, Charkravarty The rate of decline in flexibility with age will vary and Webley [15] reported a greater decline in range of motion depending on the body part measured, the training status in a group over the age of 75 years versus a group of 65–74 of the sample, and population being studied. In our sample years, adding support to the trend for an accelerated decline of relatively healthy community-dwelling older adults, the in flexibility in the oldest old. eTh present sample had an rate of decline in our measure of upper body flexibility age range including up to 86 years, and the piecewise linear (shoulder abduction) was 0.5 degrees per year in males and regression did suggest that an accelerated decline would 0.6 degrees per year in females. Declines in hip flexion of 0.6 occur in the oldest women. degrees per year in males and 0.7 degrees per year in females Whereas age may be associated with a decline in flexibil- were documented. A 1% decline per year (approximately 1.2 ity, older adults still maintain the ability to improve flexibility degrees per year, or nearly double the rate found in the with general exercise training programs [24–27]and with present study) in shoulder abduction range of motion of flexibility-specicfi training, as reviewed by Stathokostas et al. older men and women was reported by Bassey et al. [12]. [1]. In addition, the difference in rate of change in flexibility 6 Journal of Aging Research across joints has been attributed to chronic use of those joints, A factor to consider in range-of-motion declines is the loss for example, those used in activities of daily living. As such, of compliance in connective tissue with aging. This loss can one purpose of the present study was to determine if age- lead to decreased range of motion and therefore mobility related losses in flexibility were associated with in physical limitations. For example, it was shown by Vandervoort et al. activity levels. Our results showed no relationship between [32] that a loss of flexibility in the ankle joint aeff cts walking self-reported physical activity levels and upper or lower body mechanics. It might have been expected that our measure of flexibility.Walkeretal. [ 20] also reported no differences in lower body flexibility would be associated with our walking the ranges of motion in the shoulder, elbow, hip, or knee measures, as representatives of function; however this was joints, in a sample of 60 older men and women classified not the case. This may be due to the lack of contribution into high and low physical activity categories based on self- of hip flexion to gait. Nevertheless, self-reported difficulty report. Also, similar results were found by Miotto et al. [28] with stair climbing also failed to show an association in when comparing the hamstring flexibility in a sample of the present population. Previously, our laboratory identiefi d active versus sedentary adults with a mean age of 68 years; shoulder flexibility as one determinant of independence no difference was observed. Bassey et al. [ 12]studied the when comparing a group of independently living older adults association between shoulder abduction and self-reported versus those in rest or nursing homes [33]. Tainaka et al. customary use of the shoulder and found an association; [34] showed that ankle dorsi-flexion range of motion was however, it should be noted that the effect was not significant a significant physical tfi ness factor in predicting six-year in womeninmultipleregression(replaced by eoff rtscore), incidence of disability. es Th e studies might suggest that the and the effect of customary use was greater in those with roles of flexibility and function with aging are population- a disability. This nding fi may suggest that a more closely- dependent and may not be as influential in younger or matched flexibility and activity-specific measurement is more healthy subgroups of older adults, based on epidemiological reflective of the role of physical activity in the change in data. Nevertheless, based on the reference values indicating flexibility with age. Nevertheless, in a smaller sample of that shoulder abduction range of motion of 120 degrees and 30 older women, Rikli and Busch [29]found asignicfi ant hip flexion values of 30–50 degrees (for most hip-related difference for trunk and shoulder flexibility in active versus functional activities) are considered lower-end thresholds inactive women, where active was considered as vigorous associated with functional loss [35], we would consider our activity for at least 30 minutes, three days per week. This study sample of healthy community-dwelling older adults to be reported a significant age-by-activity interaction for shoulder high functioning. Based on the present data for shoulder flexibility, but not for trunk flexion. Voorrips et al. [ 30], in a abduction, using the “reference” that a value of<120 degrees sample of 50 women with a mean age of 72 years, reported was related to functional loss, the conclusion would be that, significantly better flexion at the hip and spine in women among our community-dwelling, disability-free sample the who self-reported high activity levels (several hours per week probability of the age-related decline in flexibility falling in aerobic-type exercises). A vfi e-year longitudinal study by to below the reference values was very low—less than∼10 Lan et al. [31] demonstrated that baseline and follow-up subjects beyond age 75 years fell below this “functional thoracolumbar flexibility values were higher in older adults threshold” and the average for the 85 year old was close to 130 participating in a Chinese conditioning program of repeated degrees. For the hip flexibility measure of the present study, motions and postures with range of motion warm-up versus a we are not aware of data to establish a functional threshold; sedentary control group. Further, while both groups showed however from the present data where hip flexion was not an age-related decline over the vfi e years, the control group related to functional outcomes, the hip flexion was above 70 had a larger decline in flexibility, supporting a positive role of degrees and the average for the 85 year old was∼100 degrees. physical activity in attenuating the decline in flexibility with An individual’s quality of life includes their sense of age. u Th s, our results suggest that the age-related declines in well-being, which depends on how they feel about their flexibility of disability-free independently living older adults health and their level of satisfaction with life. In order to are not influenced by their overall level of daily physical address the broader issue of how physical tfi ness attributes activity (although specific stretching exercises can still alter can contribute to health in older adults, the relationship the flexibility levels of older adults). between these health indicators and flexibility was examined. The present study also examined whether shoulder or hip Self-rated health and life satisfaction were not associated flexibility was related to “functional” outcomes, specifically with either upper or lower body flexibility in the present walking speeds or self-reported mobility dicffi ulty. Normal sample of independent older adults. In contrast, Bassey et al. step length and normal, fast, and very fast walking speeds [12] reported an association of life satisfaction and social were associated with shoulder abduction; however, only for engagement with shoulder range of motion in a large sample very fast walking speed was the association consistently of older men and women. However, the difference between maintained when adjustments were made for age. Our results studies, as mentioned earlier, is that the sample of Bassey et al. did not provide evidence that the change in lower body flex- [10] reported a high rate of disability, including shoulder- ibility(hipflexion)impactedfunctioning with age. Normal, specicfi disability and arthritis. In our sample, no relationship fast, and very fast walking speeds were associated with hip between arthritis and flexibility was indicated. In support of flexion, but as with shoulder abduction, the relationship was the decline in flexibility playing a role in quality of life of not sustained when adjustment for age was made. There older adults, Fabre et al. [36] reported a significant association was no association with self-reported difficulty in walking. between upper body flexibility and health-related quality of Journal of Aging Research 7 life in nonagenarians. This sample was community dwelling, [3] H. Nonaka, K. Mita, M. Watakabe et al., “Age-related changes in the interactive mobility of the hip and knee joints: a geometrical with 45% of the sample reporting orthopedic conditions analysis,” Gait and Posture,vol.15, no.3,pp. 236–243, 2002. and 43% reporting at least one chronic condition. u Th s, [4] M. Shields, M. S. Tremblay, M. Laviolette, C. L. Craig, I. Janssen, although further research is required to understand the role and S. C. 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Cherry et al., “Age-related deteri- 6, pp. 919–923, 1984. orationinflexibilityisassociatedwithhealth-relatedquality of life in nonagenarians,” Journal of Geriatric Physical Therapy ,vol. [21] D. K. Einkauf, M. L. Gohdes, G. M. Jensen, and M. J. Jewell, 30,no. 1, pp.16–22,2007. “Changes in spinal mobility with increasing age in women,” Physical Therapy ,vol.67, no.3,pp. 370–375, 1987. [22] B. James and A. W. Parker, “Active and passive mobility of lower limb joints in elderly men and women,” The American Journal of Physical Medicine and Rehabilitation,vol.68, no.4,pp. 162–167, [23] R. E. Rikli and C. J. Jones, “Functional tfi ness normative scores for community-residing older adults, ages 60–94,” Journal of Aging and Physical Activity,vol.7,no. 2, pp.162–181,1999. [24] S. Morini, A. Bassi, C. Cerulli, A. Marinozzi, and M. Ripani, “Hip and knee joints flexibility in young and elderly people: eeff ctofphysicalactivityinthe elderly,” Biology of Sport,vol. 21,no. 1, pp.25–37,2004. [25] J. E. Misner,B.H.Massey, M. Bemben,S.Going,and J. Patrick, “Long-term effects of exercise on the range of motion of aging women,” JournalofOrthopaedic andSportsPhysicalTherapy , vol. 16,no. 1, pp.37–42,1992. [26] M. C. Morey, P. A. Cowper, J. R. Feussner et al., “Two-year trends in physical performance following supervised exercise among community-dwelling older veterans,” Journal of the American Geriatrics Society,vol.39, no.10, pp.986–992,1991. [27] C. L. Hubley-Kozey,J.C.Wall, andD.B.Hogan,“Eeff cts of a general exercise program on passive hip, knee, and ankle range of motion of older women,” Topics in Geriatric Rehabilitation, vol. 10, no. 3, pp. 33–44, 1995. [28] J. M. Miotto,W.J.Chodzko-Zajko,J.L.Reich,and M. M. Supler, “Reliability and validity of the fullerton functional tfi ness test: an independent replication study,” Journal of Aging and Physical Activity,vol.7,no. 4, pp.339–353,1999. [29] R. Rikli and S. 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Flexibility of Older Adults Aged 55–86 Years and the Influence of Physical Activity

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Copyright © 2013 Liza Stathokostas et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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10.1155/2013/743843
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Hindawi Publishing Corporation Journal of Aging Research Volume 2013, Article ID 743843, 8 pages http://dx.doi.org/10.1155/2013/743843 Clinical Study Flexibility of Older Adults Aged 55–86 Years and the Influence of Physical Activity 1,2 2 Liza Stathokostas, Matthew W. McDonald, 1,2 1,2 Robert M. D. Little, and Donald H. Paterson Canadian Centre for Activity and Aging, Faculty of Health Sciences, 3M Centre 2225, eTh University of Western Ontario, London, ON, Canada N6A 3K7 School of Kinesiology, Faculty of Health Sciences, 3M Centre 2225, eTh University of Western Ontario, London, ON,CanadaN6A 3K7 Correspondence should be addressed to Liza Stathokostas; lstatho2@uwo.ca Received 21 February 2013; Revised 8 May 2013; Accepted 2 June 2013 Academic Editor: Astrid E. Fletcher Copyright © 2013 Liza Stathokostas et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Cross-sectional age-related differences in flexibility of older adu lts aged 55–86 years of varying activity levels were examined. Shoulder abduction and hip flexion flexibility measurements were obtained from 436 individuals (205 men, 71±9 years; 231 women, 72±8 years). Total physical activity was assessed using the Minnesota Leisure-Time Physical Activity Questionnaire. Shoulder abduction showed a significant decline averaging 5 degrees/de cade in men and 6 degrees/decade in women. Piecewise linear regression showed an accelerated decline in men starting at the age of 71 years of 0.80 degrees/year, whereas in women the onset of decline (0.74 degrees/year) was 63 years. Men and women showed a significant decline in hip flexion (men: 6 degrees/decade; women: 7 degrees/decade). Piecewise linear regression revealed a rate of decline of 1.16 degrees/year beginning at 71 years in men and in women a single linear decline of 0.66 degrees/year. Multiple regression analysis showed that age and physical activity accounted for only 9% of the variance in hip flexion in women and 10% in men, with age but not physical activity remaining significant. Similarly for shoulder abduction, age was significant but not physi cal activity, in a model that described 8% of the variance for both sexes. 1. Introduction to support the recommendation of the inclusion of a flex- ibility component to older adult exercise programs, many As indicated in a recent systematic review by our group older adult activity programs place a considerable emphasis [1], there is conflicting information regarding both the rela- on flexibility. eTh present study attempts to add additional tionship between flexibility training interventions and func- insight to this area by presenting the relationship between tional outcomes and the relationship between improved declines in flexibility across age and functional outcomes in flexibility and daily functioning; health benefits have not yet a large sample of individuals representing the older adult age been established. The comparison of studies in this area to range. Joint flexibility may decrease across the age span [ 2– provideaprescription of theflexibility is complicatedbythe 4], which has the potential to aeff ct normal daily functioning. variety of limb ranges of motion studied, testing procedures Upper body flexibility is known to be important for activities utilized, and methods of assessing physical activity levels. such as getting dressed and reaching for objects, while Furthermore, this component of physical health has been lower body flexibility is important for maintaining normal somewhat neglected or forgotten in the current literature walking patterns and for activities involving bending and despite the lack of evidence for recommendations of the reaching [5]. While the loss in flexibility with age has been amount and type of flexibility needed for health in older attributable, in part, to decreased activity [5], the literature adults. Further, despite this lack of a synthesis of the literature describing the influence of physical activity on flexibility and 2 Journal of Aging Research theaging processissurprisinglylimited.Thepurpose of the and1.02% peryearinfemales foreachyearbeyondthe present study was to examine the cross-sectional age-related age of 55, corresponding to the rate of decline in self-paced differences in flexibility in a large sample of independently walking as measured in the sample of the present study (age living adults aged 55–86 years with varying activity levels. 55 to 85 years). us, Th the “intensity codes” for the vigor with eTh recent systematic literature review identiefi d the lack which older adults participated in a particular activity were of an established relationship between improved flexibility age-adjusted. According to the MLTPAQ scoring system, and daily functioning and health benefits [ 1]. As such, a physical activity was characterized by total energy expendi- secondary purpose of the present study was to describe any ture (in MET/minutes/day) and also examined for energy relationships of physical activity levels and of functional expenditure in activities characterized as light, moderate, or outcomes (specifically walking), with flexibility measures. heavy intensity. 2. Methods 2.2.4. Muscle Strength. The design of the leg dynamometer and the procedures followed for measuring plantar flexion 2.1. Sample Selection, Recruitment, and Participation. The strength have been previously reported [9]. Subjects were municipal tax assessment list, containing names of house- seated on a bench with the thigh locked in a horizontal posi- holders and residents in the city of London, Ontario (2011, tion and knee flexed at 85 degrees in the leg dynamometer. population 366,151), provided the sampling frame. Those The dominant leg was clamped down and the subject was living in institutions, defined as nursing homes or chronic asked to push-off, that is, to attempt to raise their heel off care facilities, were not eligible. A stratified random sample the ground. eTh force generated against the clamp bar was was drawn from the population. The strata were defined recorded with a strain gauge calibrated with standard weights. by gender and six five-year age groups, starting with age Three trials were done. Maximal grip strength (of three of 55,and thesamplingratewas settoselect35men and trials) of the dominant hand was measured using a handgrip womenineachstratum.Thosesampled were sent aletter dynamometer with interchangeable casings to accommodate inviting their participation, and a follow-up call to recruit hand size. and screen the respondents was made. Exclusion criteria were those who responded no to the question of their ability to walk an 80 meter course. u Th s, the target population the 2.2.5. Normal and Fast Walking. As a measure of lower body noninstitutionalized population aged 55–85 years who self- function, walking speed (time/meters) and step length were reported the ability to walk 80 meters. eTh university’s human assessed by having subjects walk an 80-meter course at their research review board approved the study, and each subject normal and fast self-selected speeds [8]. signed informed consent. 2.2.6. Self-Rated Health and Life Satisfaction. Self-rated 2.2. Measurements health and life satisfaction were assessed using a question- naire containing modified questions from the Nottingham 2.2.1. Anthropometric. Body height, mass, skinfold thickness Health Profile [ 10], as were self-reported walking difficulty (four sites: biceps, triceps, subscapular, and suprailiac), and and difficulty with stairs, by rating degree of difficulty on a waist and hip girth were measured. Body mass index was vfi e-point scale. calculated. 2.3. Analysis. Data analyses were performed with the Statisti- 2.2.2. Joint Flexibility. Hip flexion was assessed using a cal Package for the Social Sciences (SPSS 19.0, Ireland, 2010). Leighton flexometer fastened to the hip, with the range of All descriptive data are presented as mean± SD. Frequency motion determined by bending backward as far as possible distributions were examined for categorical variables. Ranges and then forward as far as possible [6]. Shoulder abduction of motion of the hip and shoulder joints across age were wasmeasuredasthe rangeofmotionofthe righthandfrom analyzed by both linear regression and piecewise linear the side of the leg, upward and outward in an arc [6]. regression with a 2-segment model (Sigma Plot 12.0, Chicago, Illinois, USA); these ts fi produced similar 𝑅 values. Age 2.2.3. Physical Activity. The Minnesota Leisure-Time Phys- and physical activity were entered into a multiple regression ical Activity Questionnaire (MLTPAQ) was used to assess analysis to determine associations with shoulder and hip self-reported physical activity levels [7]. The questionnaire flexibility. Further, expanded univariate logistic regression was administered with the aid of a research assistant. For the was performed to identify other variables associated with present data in older adults, the intensity codes (metabolic determining flexibility. Lastly, stepwise linear regression, rate scores) for different activities, developed for middle- allowing for entry and removal at the 0.10 level of signica fi nce, aged subjects, were reduced in proportion to the age-related was used to examine the relationship of flexibility with physi- slowing of self-paced walking speed, to acknowledge that cal (self-rated health, self-reported arthritis, body mass index, older adults would pursue these activities at a slower absolute and upper and lower body strength), functional (walking and pace. Specifically, the codes were decreased 8.9% for males stair climbing difficulty, step length, and walking speed), and and 4.6% for females from middle age to 55 years [8]. The codes were then decreased a further 0.61% per year in males psychosocial (self-rated health, life satisfaction) variables. Journal of Aging Research 3 200 200 180 180 160 160 140 140 120 120 100 100 80 80 50 55 60 65 70 75 80 85 90 50 60 70 80 90 Age (years) Age (years) (a) (b) Figure 1: (a) Age analysis for shoulder flexibility in men. Piecewise linear regression s-segment model shows breaking at the age of 71 years. 2 2 Rate of decline prior to age 71 is−0.20 degrees per year and−0.80 degrees per year aeft r the age of 71 years. ( 𝑅 of fit 𝑅 = 0.09). (b) Age analysis for shoulder flexibility in women. Piecewise linear regression s-segment model shows breaking at the age of 63 years. Rate of change 2 2 prior to age 63 is 0.38 degrees per year and−0.74 degrees per year aeft r the age of 63 years. ( 𝑅 of fit 𝑅 =0.09). 3. Results Table 1: Subject characteristics. Total sample Men Women 3.1. Response Rate. eTh recruitment process resulted in 1451 (𝑛=436 ) (𝑛=205 ) (𝑛=231 ) individuals contacted; 696 were eligible, and 441 (63.4%) participated and is detailed by Koval et al. [11]. Participants Age (years) 71± 8.6 70.4± 8.8 71.4± 8.4 were more likely to be widowed and less likely to be married, BMI 26± 3.9 26.3± 3.1 25.8± 4.4 more likely to have had a white-collar job, and had some Mass (kg) 71± 12.9 78.2± 10.5 64.5± 11.4 postsecondary education. Physical activity level 406± 201 386± 182 423± 215 (MET/minutes/day) 3.2. Descriptionofthe Sample. Flexibility measurements were Shoulder abduction 138± 15 138± 16 138± 15 obtained from a total of 436 community-dwelling individuals (degrees,𝑛=431 ) (𝑛=202 ) (𝑛=231 ) (205 men, mean age 70.4 ± 8.8 years; 231 women, mean Hip flexion 102± 18 114± 18 109± 19 age71.4±8.4 years). Subject characteristics are presented (degrees,𝑛=402 ) (𝑛=183 ) (𝑛=219 ) in Table 1. Self-rated health among the group indicated that BMI: body mass index, 𝑃<0.05 . 11% of the sample considered their health to be “excellent” and 54% rated their health as “good.” Almost half of the with those 71 years old, whereas in women the onset of decline sample was fully retired (49%) and 11% were employed full was 63 years and declined across age at a rate of 0.74 degrees time. Seven percent of the sample reported being not “very per year (Figures 1(a) and 1(b)). satisfied” with life. Sixty-three reported being “quite satisfied” and30% reported being“very satisefi d.”Themarital status of the sample indicated that 56% were married. Based on self- 3.3.2. Hip Flexion. The women had significantly higher hip reported physical activity levels, the calculated total energy flexion of 114 degrees versus the men, with 102 degrees. expenditure in leisure time physical activity would indicate However, both showed a similarly significant age-related that the present sample was, on average, very active, but decline in hip flexion (men: 6 degrees per decade; women: encompassed a wide range of activity levels. 7 degrees per decade). Piecewise linear regression revealed a rate of decline of 1.16 degrees per year, across age, beginning at 71 years in men (Figure 2(a)). In women, the decrease across 3.3. Flexibility and Differences by Age theage span of thesamplewas asinglelineardecline of 0.66 degrees per year (Figure 2(b)). 3.3.1. Shoulder Abduction. The mean range of motion of shoulder flexibility was 138 degrees in our sample, with no difference between men and women. Shoulder abduction 3.4. Relationship of Age and Physical Activity with Flexibil- showed a significant decline across age, averaging 5 degrees ity. Both upper and lower body flexibility measures were per decade in men and 6 degrees per decade in women. From normally distributed. Age was signica fi nt ( 𝑃 < 0.01 ), but piecewise linear regression, an accelerated decline of 0.80 the contribution of physical activity was not (females:𝑃= degrees per year was observed in the sample of men starting 0.14;males: 𝑃 = 0.57 ), when included in a regression Shoulder flexibility (degrees) Shoulder flexibility (degrees) 4 Journal of Aging Research 160 160 140 140 120 120 100 100 80 80 60 60 40 40 50 60 70 80 90 50 60 70 80 90 Age (years) Age (years) (a) (b) Figure 2: (a) Age analysis for hip flexion in men. Piecewise linear regression s-segment model shows breaking at the age of 71 years. The rate 2 2 of decline prior to 71 years is−0.19 degrees per year and−1.16 degrees per year thereaeft r. ( 𝑅 of fit 𝑅 =0.11). (b) Age analysis for hip flexion in women. Piecewise linear regression s-segment model shows breaking at the age of 86 years. The rate of decline prior to 86 years is −0.66 2 2 degrees per year and−2.67 degrees per year thereaeft r. ( 𝑅 of fit 𝑅 =0.08). model that described 9% of the variance for both males and was associated with all walking speeds; however, none of females in the decline in shoulder abduction. The regression the associations were maintained when adjustment was made model accounted for only 7% of the variance (in both for age. men and women) in the change in hip flexion. Again, age Self-rated health and life satisfaction were not associated showed a significant contribution ( 𝑃 < 0.01 ); however, the with either upper (𝑃 = 0.18 ; 𝑃 = 0.32 )orlower body contribution of physical activity to lower body flexibility was flexibility ( 𝑃=0.09 ;𝑃=0.30 ). not significant for either males ( 𝑃 = 0.71 ) or females (𝑃= 0.42). 4. Discussion This study provides descriptive data on the age-related differ- 3.5. Variables Associated with Flexibility. Neither total phys- ences (across the age range of 55–85 years) in flexibility in a ical activity nor the components of light-, moderate-, and large cross-sectional sample of male and female community- heavy-intensity physical activity were significantly related to dwelling older adults. It also provides an examination of flexibility of the hip or shoulder at the univariate level (Tables theroleofphysicalactivityinthe changestoupper and 2(a) and 2(b)). Age was significant and explained 8% and 7% lower body flexibility with aging and a determination of of variance in shoulder and hip flexibility, respectively. the relationship of flexibility with functional outcomes in For upper body flexibility, age, BMI, plantar flexor older adults. Our sample demonstrated a mean upper body strength, and handgrip strength were entered into the flexibility of 138 degrees and a mean lower body flexibility of stepwise linear regression (Table 3(a)). Regression analysis 109 degrees. Bassey et al. [12] reported shoulder abduction yielded a model including age, BMI, and plantar flexion values of 125 degrees for men and 119 for women in a strength that resulted in 10.5% of the variance in upper body similar large sample (𝑛=894 ) of community-dwelling adults flexibility being accounted for by those variables. over the age of 65 years. These values are lower than those Age, sex, BMI, and hand grip strength were entered into reported for the present study’s sample; however, it should a regression model for lower body flexibility, accounting for be noted that the shoulder abduction measure was slightly 19.6% of the variance in hip flexibility ( Table 3(b)). different, and a large proportion of the sample in Bassey’s study reported having a functional disability. 3.6. Association with Function, Self-Rated Health, and Life With respect to sex differences, the majority of the Satisfaction. eTh re was no association between upper body literature indicates that women have greater flexibility at all flexibility and the “functional measures” of self-reported ages [4, 13–18]. Our results were in agreement for lower body difficulty in walking or climbing stairs. Step length was flexibility, although there was no significant difference based associated with upper body flexibility but not when adjust- on sex for upper body flexibility. This is in contrast to Bassey ment was made for age. Normal, fast, and very fast walking et al. [12], who reported significantly lower shoulder abduc- speeds were associated with upper body flexibility, but only tion flexibility for females in their sample. Doriot and Wang very fast walking speed (𝑃 = 0.001 ) was still associated [19] did not nd fi consistent sex differences among their 26 when adjustment was made for age. Lower body flexibility measures of joint range of motion. Similarly, Walker et al. [20] Hip flexibility (degrees) Hip flexibility (degrees) Journal of Aging Research 5 Table 2: (a) Univariate associations with shoulder flexibility. (b) Table 3: (a) Shoulder flexibility regression model. (b) Hip flexibility Univariate associations with hip flexibility. regression model. (a) (a) Mean (SD) 𝑟𝑃 value Parameter 𝑅 SE 𝑃 value estimate Sex: −0.017 0.722 Age 0.083 −0.486 0.091 <0.001 males = 205; females = 231 0.009 0.187 0.001 Age (years) 71± 8.6 −0.290 <0.001 BMI −0.647 Plantar flexion 405.8± 201.0 0.029 0.547 ∗ Total physical activity 0.039 0.006 0.002 0.045 strength 186.1± 82.6 0.057 0.235 Light activity 2 ∗ Cumulative𝑅 =0.117, BMI: body mass index, significance set at = 𝑃< 115.1± 91.1 0.030 0.530 Moderate activity 0.05. Heavy activity 104.6± 141.3 −0.012 0.810 (b) 26± 3.9 −0.094 0.052 BMI 2 Parameter 𝑅 SE 𝑃 value 56.0± 20.5 0.013 0.825 Sumofskinfolds estimate 879.5± 322.9 0.197 <0.001 Plantar flexion strength ∗ 0.066 0.117 <0.001 Age −0.571 Handgrip strength 292.1± 112.7 0.126 <0.001 ∗ 0.117 2.721 <0.001 Sex—female 18.8 Arthritis: −0.022 0.752 BMI 0.09 −1.014 0.265 <0.001 no =107;yes =108 Handgrip ∗ 0.029 0.013 0.018 BMI: body mass index; self-reported arthritis data available for 215 sub- 0.031 strength jects. 2 ∗ Cumulative𝑅 =0.235, BMI: body mass index, significance set at = 𝑃< (b) 0.05,sex:male=0; female =1. Mean (SD) 𝑟𝑃 value Sex: 0.341 <0.001 males = 205; females = 231 Comparative rates of decline are not readily available in the 71± 8.6 −0.256 <0.001 Age (years) literature, but rates of 1.5 degrees per year have been reported 405.8± 201.0 0.027 0.586 Total physical activity for lower back flexion, and the greatest decline appears to occur with trunk extension [21]. 186.1± 82.6 0.039 0.435 Light activity Whereas differences in flexibility by sex may occur, the Moderate activity 115.1± 91.1 −0.010 0.839 rate of change with age has been reported to be similar in both 104.6± 141.3 0.022 0.658 Heavy activity men and women [22, 23], and our results concur. In contrast, 26± 3.9 −0.131 0.009 BMI McCulloch [14] showed little decline in sit-and-reach scores 56.0± 20.5 0.080 0.187 Sumofskinfolds in women versus men, who showed a dramatic decline in age Plantar flexion strength 879.5± 322.9 0.055 0.279 groups of 65 to 75 years, citing differences in the decline in work activity of men over the older adult age range. 292.1± 112.7 −0.113 0.029 Hand grip strength This study provides a description of potential critical peri- Arthritis: −0.107 0.132 ods of decline in flexibility across the older adult age range. no =107;yes =108 At the age of 71 years, it appears that both upper and lower BMI: body mass index; self-reported arthritis data available for 215 sub- body flexibility show an accelerated decline in males, whereas jects. in females, only upper body flexibility shows a change in the rate of decline, with lower body showing a steady rate of found no differences in ranges of motion of the shoulder, change. James and Parker [22] reported decreases in active elbow, hip, or knee joints, between older men and women. and passive motion in lower limb joints during the period of These varying results are likely due to different population 70 to 92 years, with the decline becoming more pronounced samples, joints studied, and customary use of the joints. during the ninth decade. While not significant, Charkravarty The rate of decline in flexibility with age will vary and Webley [15] reported a greater decline in range of motion depending on the body part measured, the training status in a group over the age of 75 years versus a group of 65–74 of the sample, and population being studied. In our sample years, adding support to the trend for an accelerated decline of relatively healthy community-dwelling older adults, the in flexibility in the oldest old. eTh present sample had an rate of decline in our measure of upper body flexibility age range including up to 86 years, and the piecewise linear (shoulder abduction) was 0.5 degrees per year in males and regression did suggest that an accelerated decline would 0.6 degrees per year in females. Declines in hip flexion of 0.6 occur in the oldest women. degrees per year in males and 0.7 degrees per year in females Whereas age may be associated with a decline in flexibil- were documented. A 1% decline per year (approximately 1.2 ity, older adults still maintain the ability to improve flexibility degrees per year, or nearly double the rate found in the with general exercise training programs [24–27]and with present study) in shoulder abduction range of motion of flexibility-specicfi training, as reviewed by Stathokostas et al. older men and women was reported by Bassey et al. [12]. [1]. In addition, the difference in rate of change in flexibility 6 Journal of Aging Research across joints has been attributed to chronic use of those joints, A factor to consider in range-of-motion declines is the loss for example, those used in activities of daily living. As such, of compliance in connective tissue with aging. This loss can one purpose of the present study was to determine if age- lead to decreased range of motion and therefore mobility related losses in flexibility were associated with in physical limitations. For example, it was shown by Vandervoort et al. activity levels. Our results showed no relationship between [32] that a loss of flexibility in the ankle joint aeff cts walking self-reported physical activity levels and upper or lower body mechanics. It might have been expected that our measure of flexibility.Walkeretal. [ 20] also reported no differences in lower body flexibility would be associated with our walking the ranges of motion in the shoulder, elbow, hip, or knee measures, as representatives of function; however this was joints, in a sample of 60 older men and women classified not the case. This may be due to the lack of contribution into high and low physical activity categories based on self- of hip flexion to gait. Nevertheless, self-reported difficulty report. Also, similar results were found by Miotto et al. [28] with stair climbing also failed to show an association in when comparing the hamstring flexibility in a sample of the present population. Previously, our laboratory identiefi d active versus sedentary adults with a mean age of 68 years; shoulder flexibility as one determinant of independence no difference was observed. Bassey et al. [ 12]studied the when comparing a group of independently living older adults association between shoulder abduction and self-reported versus those in rest or nursing homes [33]. Tainaka et al. customary use of the shoulder and found an association; [34] showed that ankle dorsi-flexion range of motion was however, it should be noted that the effect was not significant a significant physical tfi ness factor in predicting six-year in womeninmultipleregression(replaced by eoff rtscore), incidence of disability. es Th e studies might suggest that the and the effect of customary use was greater in those with roles of flexibility and function with aging are population- a disability. This nding fi may suggest that a more closely- dependent and may not be as influential in younger or matched flexibility and activity-specific measurement is more healthy subgroups of older adults, based on epidemiological reflective of the role of physical activity in the change in data. Nevertheless, based on the reference values indicating flexibility with age. Nevertheless, in a smaller sample of that shoulder abduction range of motion of 120 degrees and 30 older women, Rikli and Busch [29]found asignicfi ant hip flexion values of 30–50 degrees (for most hip-related difference for trunk and shoulder flexibility in active versus functional activities) are considered lower-end thresholds inactive women, where active was considered as vigorous associated with functional loss [35], we would consider our activity for at least 30 minutes, three days per week. This study sample of healthy community-dwelling older adults to be reported a significant age-by-activity interaction for shoulder high functioning. Based on the present data for shoulder flexibility, but not for trunk flexion. Voorrips et al. [ 30], in a abduction, using the “reference” that a value of<120 degrees sample of 50 women with a mean age of 72 years, reported was related to functional loss, the conclusion would be that, significantly better flexion at the hip and spine in women among our community-dwelling, disability-free sample the who self-reported high activity levels (several hours per week probability of the age-related decline in flexibility falling in aerobic-type exercises). A vfi e-year longitudinal study by to below the reference values was very low—less than∼10 Lan et al. [31] demonstrated that baseline and follow-up subjects beyond age 75 years fell below this “functional thoracolumbar flexibility values were higher in older adults threshold” and the average for the 85 year old was close to 130 participating in a Chinese conditioning program of repeated degrees. For the hip flexibility measure of the present study, motions and postures with range of motion warm-up versus a we are not aware of data to establish a functional threshold; sedentary control group. Further, while both groups showed however from the present data where hip flexion was not an age-related decline over the vfi e years, the control group related to functional outcomes, the hip flexion was above 70 had a larger decline in flexibility, supporting a positive role of degrees and the average for the 85 year old was∼100 degrees. physical activity in attenuating the decline in flexibility with An individual’s quality of life includes their sense of age. u Th s, our results suggest that the age-related declines in well-being, which depends on how they feel about their flexibility of disability-free independently living older adults health and their level of satisfaction with life. In order to are not influenced by their overall level of daily physical address the broader issue of how physical tfi ness attributes activity (although specific stretching exercises can still alter can contribute to health in older adults, the relationship the flexibility levels of older adults). between these health indicators and flexibility was examined. The present study also examined whether shoulder or hip Self-rated health and life satisfaction were not associated flexibility was related to “functional” outcomes, specifically with either upper or lower body flexibility in the present walking speeds or self-reported mobility dicffi ulty. Normal sample of independent older adults. In contrast, Bassey et al. step length and normal, fast, and very fast walking speeds [12] reported an association of life satisfaction and social were associated with shoulder abduction; however, only for engagement with shoulder range of motion in a large sample very fast walking speed was the association consistently of older men and women. However, the difference between maintained when adjustments were made for age. Our results studies, as mentioned earlier, is that the sample of Bassey et al. did not provide evidence that the change in lower body flex- [10] reported a high rate of disability, including shoulder- ibility(hipflexion)impactedfunctioning with age. Normal, specicfi disability and arthritis. In our sample, no relationship fast, and very fast walking speeds were associated with hip between arthritis and flexibility was indicated. In support of flexion, but as with shoulder abduction, the relationship was the decline in flexibility playing a role in quality of life of not sustained when adjustment for age was made. There older adults, Fabre et al. [36] reported a significant association was no association with self-reported difficulty in walking. between upper body flexibility and health-related quality of Journal of Aging Research 7 life in nonagenarians. This sample was community dwelling, [3] H. Nonaka, K. Mita, M. Watakabe et al., “Age-related changes in the interactive mobility of the hip and knee joints: a geometrical with 45% of the sample reporting orthopedic conditions analysis,” Gait and Posture,vol.15, no.3,pp. 236–243, 2002. and 43% reporting at least one chronic condition. u Th s, [4] M. Shields, M. S. Tremblay, M. Laviolette, C. L. Craig, I. Janssen, although further research is required to understand the role and S. C. 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