Over the past two decades, a strong movement toward objective research (i.e., evidence-based medicine) has emerged in the fields of exercise science and physical education. It is now well-recognized that randomized, controlled trials (RCTs), when appropriately designed, represent the gold standard in medical studies and are usually considered of greatest evidentiary value for assessing the efficacy of interventions. RCTs are particularly effective for evaluation of drugs, devices, and procedures. In order to improve quality of reporting of RCTs, the consolidated standards of reporting trials (CONSORT) statement was developed in 1996 and use of the CONSORT statement has improved the reporting quality of RCTs over the past several years. However, RCTs are often not practical or not ethical for evaluating many public health interventions. Having a control group (no exercise, no diet, and/or no lifestyle modification) in intervention-based studies using unhealthy humans is definitely undesirable. There are viable options that should be used. For example, a trial having three groups (e.g., 1-day per week exercise group, 3-day per week exercise group, and 5-day per week exercise group) would be of more value for people with lifestyle-related diseases than having one group that does nothing. With these in mind, a paradigm shift in terms of designing health-related intervention studies for the fields of exercise science and physical education is proposed in this article.

The purpose of this study was to investigate activity fitness of daily living of elderly women in Korea. The subjects were 253 elderly women ranging in age from 65 to 84 years. Twenty items related to the activity fitness of daily living were measured. The Pearson's correlation coefficients between the performance test items and age were significant (P<0.05) and the score of all items remarkably decreased with advancing age. In order to extract activity fitness of daily living, the principal component analysis was applied to the 20×20 correlation matrix. The first principal component was interpreted as fundamental activity fitness (FAF) of daily living. The results of the comparison clearly indicated that the 75-79 and 80-84 age groups were inferior in FAF of daily living. Furthermore, in order to analyze the factorial structure of these elderly women, extracted factors were rotated with normal varimax criterion. The activity fitness (AF) of daily living were categorized to 7 factors : muscular strength and movement of the whole body, flexibility, balance, coordination of upper limbs, agility of upper and lower limbs, endurance, and reaction time. Results of the comparison of AF factors showed that a decline with advancing age was significant for muscular strength and movement of the whole body. The prediction equations of FAF were developed using multiple regression analyses. Results indicated that 8 selected items from 7 factors were significant predictors of the dependent variable FAF. Equally clarified was that 3 of our 8 items could be excluded, while still yielding comparable precision in predicting FAF. On the basis of all our analyses and considering the practicability of the measurement, we recommend the equation FAFS=1.504 X₁-0.838 X₂-0.489 X₃-0.363 X₄-0.686 X₅+68.71, with an R=0.850; where FAFS=fundamental activity fitness score, X₁=arm curl, X₂ walking around two chairs in a figure 8, X₃=one foot tapping in a sitting position, X₄=sit and reach, X₅ carrying beans using chopsticks, which can predict FAF with high precision in elderly Korean women.

This study was conducted to determine the effect of exercise training in water (water exercise) in sedentary obese women. Twenty-three women, aged 23-58 years (mean±SD 41.7±11.7), partici pated in this study. Any volunteer with diagnosed disease or taking prescribed medication that might influence the outcome of this study was excluded from participation. The women were allocated either to the exercise group (n =15, weight =65.2±12.3 kg, %body fat=39.2±7.0%) or the control group (n = 8, 62.4±8.3 kg, 34.0±2.4%), respectively. The exercise program consisted of dynamic movements for 60 minutes per session, three days per week for 16 weeks. The exercise intensity was set at approximately 65% of the age-related maximal heart rate. The attendance rate on the program was 89.2±3.0%. The body mass and %body fat of the exercise group decreased significantly by 4.7±1.9 kg (P<0.05) and 3.6±2.4% (P<0.01), respectively, compared with the preexercise values. Significant improvements in their aerobic capacity, trunk flexibility and vertical jump (P<0.05) were also observed. Their energy intake and the amount of other daily physical activity remained essentially unchanged throughout the study. No significant changes in any of the parameters measured occurred, in the control group. These findings indicate that water exercise improved the body composition and physical fitness of obese women.

Although body mass is known to be related to bone mass, defined as bone mineral density (BMD) and bone mineral content (BMC), little is known about the effects of body mass reduction programs on bone mass. This study assessed bone mass changes in response to four body mass reduction programs that utilized diet and/or exercise. Ninety-four obese or overweight women (age 49.3±7.1 years, body mass 68.5±7.7 kg) were randomly assigned 4 groups (2 intervention forms × 2 trials) : diet in trial 1 (D₁, n=27), diet plus exercise in trial 1 (DE₁, n=28), diet in trial 2 (D₂, n=21), and diet plus exercise in trial 2 (DE₂, n=18) . Body mass, body mass index (BMI), absolute and relative (%fat) fat mass, lean mass, BMC, and BMD were measured by dual energy X-ray absorptiometry before and after the 3-month intervention program. Body mass loss was similar in DI (-9.7%) and D₂ (-11.6%), and in DE₁ (-13.8%) and DE₂ (-12.2%) . However, BMC loss was different (P<0.05) between trial 1 and trial 2 for each intervention form (D₁: -3.2% vs D₂ ; -0.9%, DE₁: -4.5% vs DE₂: -0.8%) . With this in mind, multiple regression analyses were applied, with either change in BMC or BMD as the dependent variable, and other physical characteristics measured before and after the intervention program as independent variables. Results indicated that multiple correlation coefficients were statistically significant (R=0.61 with BMC, R=0.49 with BMD) . BMI after the intervention program and change in body mass were identified as the significant contributors to the change in BMC, while change in %fat and age were identified as the significant contributors to the change in BMD. These results suggest that, during body mass reduction, (1) physical characteristics are the significant contributors to changes in BMC and BMD and (2) exercise may not prevent the loss of bone mass.

The purpose of this study was to examine the validity of physical performance tests (test battery) for assessing functional fitness required for activities of daily life in older persons with chronic disease. This test battery consisted of 4 items: arm curl, walking around two cones, moving beans with chopsticks, and functional reach. Seventy-one persons (aged 66.7±7.8 yr) with either hemiplegia, Parkinson's disease (PD), or chronic obstructive pulmonary disease (COPD) served as subjects. There were significant differences among standard test scores in each rate of progression of the disease in all hemiplegia groups (Stages III, IV, V), and COPD groups (Stages 1, 2, 3) (Kruskal-Wallis'H=22.3 and 7.3, respectively) . In PD groups, there was no significant difference between standard scores in Stages II and III (Mann-Whitney's U=4.0) . However, the rank order correlation coefficient between the ranking in standard test score and the ranking in physical independence assessed by a medical doctor and a public health nurse was significant (ρ=0.57, P<0.05) . All tests were safely applied for all subjects. These results suggest that our test battery may be applicable to a majority of older persons with various chronic diseases. Furthermore, the variability of standard test scores was greater than the clinical subjective ratings by Stage, which suggests that such a classification may provide a better description of disease progress/functional fitness.

Pulmonary rehabilitation is a common therapy for improving both exercise tolerance and quality of life (QoL) in patients with chronic obstructive pulmonary disease (COPD) . Although exercise is an important rehabilitation strategy, walking, treadmill use, bicycling and respiratory muscle training can be monotonous. A comprehensive exercise program that includes recreational activities may be a more effective means to decrease the occurrence of dyspnea during daily activities and improve QoL in patients with COPD. The purpose of this study was to investigate the effects of our exercise therapy, including recreational activities and respiratory muscle training, on dyspnea and health related QoL (HRQL) in COPD patients. Thirty-eight male patients with COPD were randomly assigned to a control (C) (70.1±6.4yr) (n=12) . pulmonary rehabilitation (PR) (70.3±8.3yr) (n= 16), or exercise (EX) (68.7±4.6yr) (n=10) group. The following evaluations were performed at baseline and at 8 weeks: (1) cycle ergometer test ; (2) 6-min walking distance : (3) physical fitness (4) pulmonary function ; (5) dyspnea : and (6) HRQoL (SF-36) . The C group showed no significant changes in physical fitness, pulmonary function, dyspnea, and HRQoL scores throughout the observation period. There was a significant (P<0.05) improvement in 6-min walking distance. physical fit-ness, maximum rnspiratory pressure (MIP), and HRQoL for the PR group. The EX group demons-trated a significant (P<0.05) improvement in physical fitness, maximum expiratory pressure (MEP), dyspnea, and HRQoL. Moreover, the degree of improvement in each variable was greater for EX than for PR. There were significant (P<0.05) correlations between MIP and FEV_1.0 (r=0.65), and between MEP and FEV_1.0 (r=0.43) . Based on these results, it appears that our comprehensive exercise program, including recreational activities and respiratory muscle training, improves physical fitness, pulmonary function, dyspnea, and quality of life in COPD patients.

The purpose of this study was to implement a community-based exercise program for postdischarge stroke survivors in the public health center. The subjects were fourteen male stroke survivors with chronic upper and lower limb paresis (63.0±5.9 years) . The study design was quasiexperimental, with each subject serving as his own control. All subjects have to meet following inclusion criteria: (1) first stroke resulting in hemiplegia, (2) at least 6 months post-stroke, (3) able to walk independently, and (4) free from grave aphasia, apraxia, agnosia, or disequilibrium. A 25-week (2 deek) training program consisted of a warm-up, lower and upper extremity muscle strengthening, recreational activities, walking training, and a cool down. The duration of this program is approximately 70 minutes a day. The outcome measure was the 12 functional fitness test items and questionnaire in activities parallel to daily living. Significant improvements (P<0.05) were found for handgrip strength, knee extension strength, tandem balance, standing and sitting, and timed up and go in the treatment period. However, the scores in activities parallel to daily living were not significant. These results suggest that they may attain significant functional improvements in response to implementation of a community-based exercise program. In conclusion, post-discharge stroke survivors can improve their functional fitness status by participating in a community-based exercise program.