ABSTRACT
This study collected the questionnaire from the new participants who are middle-aged and elderly people in project of incentives led by local governments. This study focuses on the exercise group and non-exercise groups proportion of pefered incentives and the correlation of perfered incentives in these two groups. This study analyzed 9,590 middle-aged and elderly people who participated in a health promotion project with incentives and answered a questionnaire during the period of participation. The incentives were included 4 types: (1.) regional gift cards; (2.) national gift cards; (3.) rewards points that could be used at department stores and convenience stores nationwide, and (4.) donations. The result shows that both non-exercise and exercise groups preferred financial incentives over non-financial incentives. By type of monetary incentive, non-exercise group were more likely to prefer national gift certificates 1.39 times (OR: 1.39, 95%CI: 1.03-1.89); significantly more likely to prefer rewards point 1.44 times (OR: 1.44, 95%CI: 1.07-1.95) over non-monetary incentives compared to exercise group. Among the middle-aged and elderly people who participated in a health promotion program with incentives, the majority of two groups showed the preference that financial incentives over nonfinancial incentives. Comparing monetary incentives, both groups preferred local gift certificates than national gift certificates and rewards point.
ABSTRACT
In the present research, first we evaluated the association between urban area size and commuting modes with physical activity among working people. Then we investigated the longitudinal effects of urban area size and commuting modes on increased physical activity due to health guidance intervention. The subjects were 401 male employees (aged 46.3±7.8) of A corporation, and were split into two groups, metropolitan area group (N=235) and local area group (N=166), based on the population density of place of work. IPAQ-E was used for evaluation of walking environments, and physical activity was assessed using pedometers. The intervention consisted of an exercise-focused health guidance over the course of one year. The cross-sectional study admitted that in comparison with the local area group the metropolitan area group had more than physical activity (p<0.01). Not only the size of urban area but commuting modes were significantly related to the level of daily physical activity (p<0.001). In longitudinal study, regarding the effects of the intervention for the physical activity, the study showed the possibility that urban area size was not directly effective but traffic safety in residential area (p<0.05) and willingness to take a walk (p<0.01) were effective. The cross-sectional study suggested that the size of the urban area and commuting modes had independently an effect on the physical activity of working people. The longitudinal study, on the other hand, suggested that the size of the urban area and commuting modes may not any direct influence on the effects of physical activity intervention.
ABSTRACT
The purpose of this study was to clarify the change in symptoms, behavior, and feeling with acupuncture and the relationship between the changes and physical activity level in middle-aged and elderly people with musculoskeletal pain.<br> The Subjects were 55 (26 males and 29 females, aged 65.0±12.2 years) middle-aged and elderly people with musculoskeletal pain who have been treated with acupuncture. We investigated the change in their symptoms, behavior, and feeling (symptoms, frequency of other treatments, exercise, frequency of going out and taking trips, general feeling, confidence in physical fitness, and coping with the prospects for the symptoms) with acupuncture using an unsigned self-administered question naire. In addition, the health-related quality-of-life was evaluated with SF-8 and the physical activity level was assessed with the Short Version of the International Physical Activity Questionnaire.<br> The subjects mostly recognized that their symptoms, behavior, and feeling had a tendency to improve or remain unchanged with acupuncture. Evaluation of the relationship between the changes with acupuncture and walking physical activity showed that the subjects who felt their frequency of exercise or of going out or taking trips tended to increase with acupuncture treatment showed a significantly higher physical activity level than those who stated there was no change or a decreasing tendency (p<0.05). Similarly, the subjects whose assessment for the general feeling or coping with the prospects for symptoms was a tendency to irnprove with acupuncture showed a significantly higher physical activity level than those whose assessment was no change or deleterious change (p<0.05).<br> These results indicate that acupuncture might have a positive affect on their symptoms, behavior, and feeling, and also provide opportunities to increase walking physical activity in middle-aged and elderly people with skeletai and muscular disorders.
ABSTRACT
High-sensitivity C-reactive protein (CRP) is a novel risk factor for coronary artery disease. It is well known that body weight loss is effective in reducing serum CRP concentration ; however, the effect of exercise training on serum CRP concentration has not been fully elucidated. The purpose of this study was to examine the effect of a 24-week exercise training program on serum CRP concentration in 169 healthy middle-aged and elderly subjects (65.9±6.4 years). Each subject underwent baseline testing (peak oxygen uptake, daily physical activity, body weight, and serum CRP levels), and repeated these tests on completion of the training program. The subjects were classified into 2 groups based on initial CRP levels : normal<1.0 mg/L, n=139, and high≥1.0mg/L, n=30. On completion of the program, both daily physical activity and peak oxygen uptake increased significantly (+33.9±72.4%, p<0.0001, +5.4±14.7%, p=0.014, respectively). However, body weight did not change significantly. In addition, CRP levels of the entire group did not change significantly. However, CRP levels significantly decreased among the high baseline CRP group (from 1.82±0.81 mg/L to 0.98±0.59 mg/L, p<0.0001). It was concluded that serum CRP levels are reduced without body weight loss in response to exercise training in healthy middle-aged and elderly subjects with high initial CRP levels.
ABSTRACT
The purpose of this study was to investigate the effects of combined resistance training and aerobic training with protein intake after resistance training on body composition in obese middle-aged women. The subjects were 42 middle-aged women (age : 56.5±4.3 years, BMI : 26.6±2.3 kg/m<sup>2</sup>), who were classified into three supplementation groups: Protein group (PG), Isocalorie placebo group (IG), and Noncalorie placebo group (CG) by Double Blind Randomized Trial. The training program consisted of combined resistance training and aerobic training for 10 weeks, 5 times per week: twice a week in a university training room and 3 times per week at home. The subjects took the nutrient supplement immediately after each resistance training session. We measured body weight (Bw), body fat volume (Bf) by bioelectrical impedance analysis (BIA), and cross-sectional area (CSA) of muscle of the thigh extensor group (Te), flexor group (Tf), and psoas major (Pm) by magnetic resonance imaging (MRI) before and after the 10-week training period. Irrespective of group, Bw and Bf showed a significant decrease after the training period compared to before (p<0.001), and the CSA of Te muscle showed a significant increase after the training period (p<0.01). Moreover, the interaction of time×group was accepted in the CSA of Pm muscle (p<0.05), and the increase in muscle volume for PG was the highest increase among the three supplementation groups (p<0.05)(PG : 2.1±0.8 cm<sup>2</sup>, IG : 1.3±1.0 cm<sup>2</sup>, CG : 1.3±0.9 cm<sup>2</sup>). These results suggest that combined training in middle-aged obese women improves body composition, and resistance training with protein intake may increase the CSA of muscle of psoas major.
ABSTRACT
This study examined the effects of weight-bearing training on frail elderly whose level of care service is "care level 1" or "support required". Thirty-seven frail elderly (67-94 years old, mean age 82.8±6.8 years, men : N=8, 67-94 years, mean age 81.5±9.8 years, women : N=29, 69-92 years, mean age 83.1±5.8 years) participated in weight-bearing training including the use of a rubber band to improve physical function and lower limb muscle strength for eight weeks. Subjects were measured by a physical fitness test before and after the training. Ninety-two percent of the subjects completed the study. There was a significant improvement in knee extension maximum strength (1 RM)(p<0.01, n=32), functional reach (p<0.01, n=30), and sit-and-reach (p<0.01). There was a significant correlation between initial fitness level and improvement value (sit and reach : r=-0.362, p<0.05, n=33, functional reach : r=-0.563, p<0.01, n=31, stand up and sit down test : r=-0.729, p<0.01, n=31, stepping : r=-0.433, p<0.05, n=33, normal walking speed : r=-0.393, p<0.01, n=34). In conclusion, these results suggest that weight-bearing training may be a feasible and effective means of preventing muscle weakness and physical frailty for frail elderly. However, it is suggested that individual training programs need to be designed considering initial level of physical fitness.
ABSTRACT
The engaging>30 minutes of physical activity (PA) at 4-6 METs has been recommended for the prevention of cardiovascular disease. We determined whether relatively low intensity (i. e., 3-5 METs) PA inhibits the age-related central arterial stiffening, a risk of cardiovascular disease. In the cross-sectional study, the association between carotid arterial properties (via ultrasound system) and daily PA (via electric accelerometer) were studied in 172 normotensive people (41-82 yrs). People engaging>30 min/day of PA corresponding to 3-5 METs had a significantly lower beta-stiffness index than sedentary peers after adjusting for covariates (i. e., age and PA time at more than 6 METs). In the interventional study, beta-stiffness index of nine normotensive postmenopausal women was significantly decreased after the 12-week aerobic training (cycling at 80% of ventiratory threshold, ≈4 METs, 30 min/day, 5 days/week). These results suggest that the increase in daily PA at 3-5 METs inhibits the age-related carotid arterial stiffening.
ABSTRACT
Excess accumulation of visceral fat is reported to promote insulin resistance. However, it is not known whether or not insulin resistance improves without reducing visceral fat. Recent studies have reported, however, that exercise can improve insulin resistance. The aim of this study was to examine the effects of low-intensity exercise training on insulin resistance and visceral fat. Participants were 26 older adults, aged 63.9 ± 3.9 years, who were divided into two groups based on visceral fat area (VFA, cm<sup>2</sup>) measured by X-ray computed tomography. Eight men (153.4 ± 49.4 cm<sup>2</sup>) and 5 women (151.9 ± 45.5 cm<sup>2</sup>) were classified as having a VFA of 100 cm<sup>2</sup> or more (VFO group), and 6 men and 6 women as having less than 100 cm<sup>2</sup> (C group). After a 14-week exercise training program, VFA in women of the VFO group was significantly reduced (126.3 ± 40.0 cm<sup>2</sup>) ; though it did not reach 100 cm<sup>2</sup>. However, homeostasis model assessment (HOMA-IR), an index of insulin resistance, significantly improved from 4.6 ± 1.9 to 2.2 ± 1.1 among women in the VFO group. These data suggest that improvements in insulin resistance for women with relatively high VFA are weakly associated with exercise-induced reductions in VFA. Based on these results, the activation of skeletal muscle with physical activity has the possibility of being independently associated with an improvement in insulin resistance without a significant decrease of VFA.
ABSTRACT
In order to study the effect of muscle exercise on the medical expenditure of the elderly, a three-year exercise program focusing on muscle activity was performed by an intervention group. Individual yearly medical expenditures were collected by 20 participants of the exercise group aver aging 65.2 years of age and 23 control subjects averaging 68.4 years of age with National Health Insurance coverage. Yearly medical expenditures for the exercise group were significantly lower than those of the control group at one and two years after entry. The expenditures increased by 62.6% from 1997 to 1999 in the control group, whereas they increased by only 16.8% for the exer cise group. The results suggest the possibility of the effectiveness of muscle exercise on the reduction in medical expenditure among the elderly.
ABSTRACT
The purpose of this study was to evaluate the association between subjective usefulness of pedometer and step count, exercise adherence, and the possibility of a pedometer helping exercise adherence.<BR>The subjects were 106 community-dwelling citizens (mean age±SD, 66±5) who were put on an individual exercise program in addition to walking. The targeted step count was 8000 steps/day. Every subject wore a pedometer that registers 7 days of physical activity.<BR>The rate of adherence was 98.1%, and about 73% of subjects answered that using a pedometer is useful for physical activity. There was no difference in exercise habit at baseline between subjects answering useful or not useful.<BR>Only in the case of females, was step count and prevalence of targeted 8000 steps significantly higher in the group who felt a pedometer was useful than in the group who didn't feel it useful. However, in the group of males who felt the usefulness of a pedometer, step count significantly increased during the 3 months. In addition, the females who reached their targeted step count performed better in the 10 m hurdle walk and 6 min walk than those who could not reach the targeted step count.<BR>The awareness of self-health wellness, without the anxiety of physical fitness and adherence to exercise was higher in the subjects who felt a pedometer was useful than in the subjects who didn't.<BR>The subjects who felt a pedometer was useful achieved their targeted number of steps and increased walking ability and tended to adhere better to physical activity.<BR>It is suggested that a pedometer motivates adherence to physical activity and is useful for helping exercise adherence in the future. However, we need a randomized control trial for determining the relationship between exercise adherence and using a pedometer.
ABSTRACT
In order to establish a health promotion program for Taiyo Village in Ibaragi Prefecture, we initiated a research project at University of Tsukuba in 1996. The purpose of this research project are as follows : 1) Examine health promotion in the independent elderly, who make up the majority of the elderly population ; 2) Develop measures to prevent strokes, falls and fractures, which account for about half of the cases in which the elderly become bedridden ; 3) Establish a safe and effective exercise program according to scientifically proven health guidelines ; 4) Assess the efficacy of strength training, which has not been incorporated into most elderly exercise programs, in preventing the elderly from becoming bedridden due to falls and fractures ; 5) Develop a program that can be easily adapted by different municipalities ; and 6) Accumulate success stories at Taiyo Village and disseminate them throughout Japan. The results of this 7-year Taiyo Village project have yielded several important points: 1) Establishment of guidelines to improve life functions; 2) Development of an exercise program to improve and maintain functional ability for life ; and 3) Reduction in medical costs. The results of the present study suggest that when promoting the health of the elderly, it is important to not only study the efficacy of an exercise program, but to also establish a regional program that effectively utilizes research findings.
ABSTRACT
This study aimed to investigate the influence of aging on muscle thickness in lower limbs, with specific emphasis on the site- and gender-related differences. Subjects were a total of 191 healthy young and elderly persons of both genders : 51 young men (24.2±3.6 yrs), 45 young women (23.1±3.2yrs), 51 elderly males, and 44 elderly females. Lower leg anterior, and lower leg posterior muscle thickness was determined using a brightness mode ultrasonographic apparatus. At all sites except for the thigh posterior, the muscle thickness values were significantly greater in the young than in the elderly groups of both genders, even in terms of the ratio of muscle thickness to body mass<SUP>1/3</SUP> (Mt/Wt<SUP>1/3</SUP> ratio), calculated to normalize the morphological differences. The relative difference in muscle thickness between the two age groups was the greatest at the thigh anterior and the least at the thigh posterior in both genders. Between young men and women, the men showed significantly greater muscle thickness and Mt/Wt<SUP>1/3</SUP> ratio at every site than the women. Between the elderly groups, however, Mt/Wt<SUP>1/3</SUP> ratios at all sites, except for the thigh anterior, did not show significant gender-related differences. Relative differences in both muscle thickness and Mt/Wt<SUP>1/3</SUP> ratio between the young men and women were similar among the sites, but between the elderly groups the corresponding values at the thigh anterior were greater than at the other sites. These results indicate that 1) the influence of aging on muscle thickness differs between the muscle groups located in the anterior and posterior sited within the same segment, 2) for women, the age-related loss of muscle thickness at the thigh anterior is relatively greater as compared to those at the other sites of the lower limb.
ABSTRACT
Resistance exercise in the elderly and patients with a cardiovascular disorder has been thought to have a high cardiovascular risk, because it has the tendency to cause an excessive rise in blood pressure and induce serious arrhythmia. But recently, resistance exercise has been introduced into physical therapy because the safety of such exercise has been confirmed in subjects without a cardiovascular disorder.<BR>The purpose of this study was to investigate the safety of lower extremity resistance exercise in middle-aged or elderly subjects with hypertension and receiving medical treatment (n=24), and those without hypertension (n=40), by measuring cardiovascular response during resistance exercise of different loads (40% and 60% 1 RM), and usefulness of respiratory guidance during such exercise.<BR>As a result, there was no difference in diastolic blood pressure between those with and without hypertension ; but systolic blood pressure and rate pressure product both at rest and during exercise were significantly greater in patients with hypertension. However, neither group showed symptoms of angina, ischemic signs in ECG, or serious arrhythmia ; and there was no difference in the frequency of excessive rise in blood pressure between the groups (2 subjects with hypertension and 1 subject without hypertension) . Blood pressure during exercise was significantly lowered by respiratory guidance.<BR>These results show that it is important to measure blood pressure during exercise before resistance exercise training regardless of the presence of hypertension, although an excessive rise in blood pressure occurred in only a few subjects. Furthermore, it is important to exhale slowly and not hold one's breath during exercise.
ABSTRACT
The purpose of the present study was to investigate the effects of long-term exercise training on immune function in elderly individuals. This study was conducted on 27 sedentary subjects including 7 males and 20 females aged 66.1±4.2 yrs. (range of 60 to 77 yrs.) who participated in a 12-month exercise program. The subjects attended the exercise program 4.4 ± 1.7 times per month. Peripheral blood samples were taken prior to, and at 5 and 12 months during the exercise training program. Each lymphocyte subset (natural killer: NE, T, cytotoxic T: Tc, helper T: Th, memory-Th and NKT) count in the samples was measured using flow cytometry. Results indicated that NE and Tc cell counts were not significantly altered. Whereas, T and Th cell counts were significantly elevated after 12 months, and memory-Th and NET cell counts were significantly elevated after 5 and 12 months of exercise training. These results suggest that long-term exercise training may be a stimu lus to increase and or maintain immune function in elderly individuals.
ABSTRACT
The purpose of this study was to examine the relationship between housebound (defined as elderly who go outside less than once a week) and physical fitness test (6 items of grip strength, situps, trunk flexion, foot balance, 10 m hurdle walk, 6 min walk), fitness test score, Tokyo Metropolitan Institute of Gerontology (TMIG) index of competence (3 factors of instrumental self-maintenance, intellectual activity, and social role), and General Health Questionnaire (GHQ) (4 categories of somatic symptoms, anxietynsomnia, social dysfunction, severe depression), considering the differences among gender and age.<BR>The subjects were 296 community-dwelling elderly aged≥65 (mean age ; 75.5±4.9) . Of the subjects, 32% were male, and 57% were elderly aged≥75. Seventy-nine (27.2%) were housebound. The rate of housebound subjects with a full score for intellectual activity, social role on the TMIG sub-scales, 10m-hurdle walk and 6 minute walk was significantly worse than non-housebound subjects. The scores for social dysfunction and severe depression on the GHQ sub-scales for housebound were significantly higher than those for non-housebound ; and few housebound exercised more than 2 times per week or 30 minutes a day. The mental health of male housebound and housebound aged under 75 was the worst among all groups. On the other hand, female housebound and those aged≥75 had lower TMIG and physical fitness results. The characteristics of the housebound were different between genders. Among the housebound aged≥75, grip strength correlated with TMIG and GHQ-28 ; the 10 m hurdle walk correlated with severe depression, instrumental selfmaintenance and intellectual activity ; and the physical fitness score correlated with GHQ-28 after adjusted for age and gender.<BR>Physical fitness correlated with TMIG and GHQ among the housebound; and few housebound exercised in daily life. Improving grip strength and walking ability may reduce the number of housebound.
ABSTRACT
The influences of age on muscle architectural characteristics, i. e., muscle thickness, pennation angle, fascicle length, were studied in 121 men and 229 women aged 17 to 85 yrs. The subjects were divided into three age groups (younger : 17-39 yrs, middle-aged : 40-59 yrs, elderly : 60-85 yrs) for both genders. Muscle thickness and pennation angle of the vastus lateralis (VL), medial gastrocnemius (MG), and long head of triceps brachii (TB) muscles were measured using B-mode ultraso-nography, and fascicle length was estimated. In all age groups, men had significantly greater relative muscle thickness (to limb length) in VI, and TB than women, but not in MG. Relative muscle thickness of VL was significantly lower in elderly than in younger and middle-aged subjects. Ilowever, the corresponding differences in MG and TB were insignificant. The pennation angle of VL was significantly lower in elderly than in younger and middle-aged subjects, although there were no significant differences in pennation angles of MG and TB among the three groups. These results suggest that the decrease in thickness of vastus lateralis muscle with aging is significant, but not significant for medial gastrocnemius and triceps hrachii muscles.
ABSTRACT
This study was aimed to investigate the influences of age and gender on isometric muscle torque and explosive muscle power output with reference to muscle volume. A total of 177 healthy subjects of both genders were divided into four groups according to their age and gender : 46 young men (22.0±3.2yrs), 43 young women (22.7±3.3yrs), 46 elderly men (71.2±4.3yrs) and 42 elderly women (72.7±4.5 yrs) . The maximal voluntary isometric knee extension torque of the right leg (hip and knee angle at 90 degrees) and the power of bilateral leg extension in sitting position were mea sured. The ratios of both torque and power to muscle volume, estimated using ultrasonograph measurement, was calculated (torque/MV and power/MV respectively) . Torque was significantly less among the elderly than among the young for both genders, and among women than among the men for both age groups. Significant age-related differences were evident even in terms of torque/ MV, but the corresponding differences between men and women disappeared. On the other hand, power MV showed significant age- and gender-related differences, and the age-related difference was larger than that for torque MV. These results suggest that age- and gender-related differences in power are more noticeable than differences in torque and that these differences are not simply explained by differences in muscle volume.
ABSTRACT
The factors influencing ankle range of motion were investigated for 185 middle-aged and elderly subjects (116 women and 69 men, aged 48-86 years) . Each subject was seated with the right knee extended, and the ankle joint was passively dorsiflexed by a dynamometer with torque just tolerable for each subject, to measure the maximal dorsiflexion angle. During passive loading, elongation of muscle fibers in the gastrocnemius and Achilles tendon was determined in vivo by ultrasonography. There was a difference between women and men for the passive dorsiflexion angle (men smaller than women), which negatively correlated with muscle thickness of the posterior portion of the leg determined by ultrasonography. Both in women and men, the passive dorsiflexion angle negatively correlated with age, even after normalizing for maximal voluntary plantar flexion torque. Both elongation of muscle fibers and tendon was related to the passive dorsiflexion angle, and the ratio of tendon elongation to muscle fiber elongation positively correlated with the passive dorsiflexion angle. The active dorsiflexion angle, measured separately with the subject maximally dorsiflexing the ankle with no load, correlated with the passive dorsiflexion angle but not with age, and there was no gender difference. From the results it was suggested 1) that the mobility of the ankle joint is affected by elongation of both muscle fibers and tendon, but with the effect of the tendon being greater than that of muscle fibers, and 2) that muscle mass negatively affects passively-induced joint range of motion. Actively performed joint range of motion would be affected by elongation of the muscle-tendon corn plex and force-generating capability of the ankle. Gender difference in joint range of motion and the aging effect are related to these factors.
ABSTRACT
Arterial compliance progressively decreases with aging. This aging-induced reduction of arterial compliance causes an increase of systolic blood pressure (SBP), whereas regular exercise increases arterial compliance. We hypothesized that an increase in daily physical activity (DPA) produces a beneficial effect on systemic arterial compliance (SAC ; an index of central arterial compliance) and this phenomenon could decrease SBP in the elderly. We investigated the relationship among DPA, SAC, SBP, diastolic blood pressure (DBP), and some other risk factors for cardiovascular and/or cerebrovascular events (total cholesterol, HDL-cholesterol, and HOMA-R) cross-sectionally in 127 elderly persons (42 male, 85 female : aged 74±4 years) . The DPA was estimated by expended calories using an accelerometer. The SAC was calculated from a finger pulse pressure waveform recorded by using PORTAPRES ; and stroke volume obtained from the same pressure waveform based on the volume-clump method. The analyses demonstrated that SBP was directly and decreasingly affected by SAC, and that DPA had an increasing effect on SAC. Furthermore, SBP was directly and increasingly affected by DBP, and DBP was directly and decreasingly affected by both SAC and DPA. Therefore, it is considered that DPA may have suppressive effects on the rise of SBP through the indirect effects of changing SAC and DBP. These findings suggest that an increase in DPA could improve the age-induced reduction of arterial compliance and rise of SBP in elderly humans.
ABSTRACT
The ability to walk is just as important for the elderly as it is for young people. In fact, in the elderly, decreased mobility limits function in daily life and can lead to more serious situations (e.g., becoming bedridden) . The elderly population has increased over the last decade, and many researchers have studied the mobility of the elderly. However, the focus of most studies has been to facilitate recovery of bedridden individuals and prevent the elderly from becoming bedridden, and particularly to prevent fall-induced fractures, which often cause the elderly to become bedridden. However, about 70-80% of the elderly population do not require care, and it is necessary to conduct research on the maintenance of activities of daily living to make it possible for the elderly to work or volunteer. From this perspective, mobility is an important physical factor. Mobility is dependent on muscle activity and it has long been known that aging reduces muscle mass. Therefore, it is feasible to assume that reduced muscle mass leads to decreased ability to walk, and we have proven that there is a close correlation between the two. When presenting the idea of strength training to the elderly, it is appropriate to focus on the maintenance and improvement of mobility, not on the training itself. The results of our research can be summarized as follows:<BR>Muscle mass decreases with age, with the legs being affected to a greater degree than the arms. Moreover, muscle atrophy is dependent on weakening of muscle fibers, especially fast-twitch (Type II) fibers. Reduced lower limb muscle mass increases the risk of falling and can decrease walking ability to a degree that can affect daily living activities.<BR>In order to improve reduced muscle mass in aging, it is important to use an exercise program that is designed to strengthen fast-twitch fibers, which can be followed even by the elderly. Since walking therapy mostly mobilizes slow twitch fibers, it is not effective in preventing and improving muscle atrophy. It is important to have an exercise program that is designed to mobilize fast-twitch fibers.