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Home versus center based physical activity programs in older adults.

N L Ashworth1, K E Chad, E L Harrison

  • 1Physical Medicine & Rehabilitation, University of Alberta, Glenrose Rehabilitation Hospital, 10230-111 Avenue, Edmonton, Alberta, Canada, T5G 0B7. ashworth@cha.ab.ca

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Center-based exercise programs show short-term benefits for peripheral vascular disease, but home-based programs boast superior long-term adherence in older adults. Evidence for chronic obstructive pulmonary disease is conflicting.

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Area of Science:

  • Gerontology
  • Exercise Physiology
  • Public Health

Background:

  • Physical inactivity is a major preventable cause of death and disease.
  • Exercise programs can treat conditions like cardiovascular disease, osteoarthritis, and COPD.
  • Programs vary from home-based to supervised center-based interventions.

Purpose of the Study:

  • To compare the effectiveness of home-based versus center-based physical activity programs for older adults.
  • To evaluate health outcomes in older adults participating in different exercise program settings.

Main Methods:

  • Systematic review of randomized and quasi-randomized controlled trials.
  • Searched multiple databases including CENTRAL, MEDLINE, EMBASE, CINAHL, Health Star, Dissertation Abstracts, Sport Discus, and Science Citation Index.
  • Included studies of adults aged 50+ with cardiovascular risk factors, cardiovascular disease, COPD, or osteoarthritis, excluding cardiac/post-operative programs within one year.

Main Results:

  • Six trials (372 participants) were included; five medium quality, one poor.
  • Center-based programs improved walking distance and pain-free time in peripheral vascular disease short-term, but with potential bias.
  • Home-based programs demonstrated significantly higher long-term adherence (68% vs. 36%) in sedentary older adults; no differences in treadmill performance or risk factors.
  • Conflicting evidence exists for chronic obstructive pulmonary disease (COPD) effectiveness.
  • No studies addressed osteoarthritis, cost, or healthcare utilization.

Conclusions:

  • Center-based programs offer short-term advantages for peripheral vascular disease, though potential bias exists.
  • Home-based programs show superior long-term exercise adherence.
  • Evidence for chronic obstructive pulmonary disease (COPD) is inconclusive regarding program effectiveness.
  • Further research is needed, particularly for osteoarthritis and cost-effectiveness.