Relationship of exercise tolerance, exercise intensity, and physical performance in frail elderly individuals residing in a long-term care facility

Literature regarding the relationship between physiologic capacity and physical performance is limited and non-conclusive among the frail elderly. The purposes of this study were to examine the relationship of physiologic response to activity and physical performance using lower extremity activities, to describe performance capabilities, and to propose thresholds of performance in a sample of 78 frail older adults residing in long-term care facilities. Physiologic performance was evaluated using measures of heart rate during five minutes of walking and during a low level seated exercise test. Ratings of perceived exertion were determined following the exercise test. Physical performance was determined by timed chair rise and sit, challenged standing, 8-foot walk speed, and 5- minute walk distance. The subjects were tested in one session at the residential facility. All tests followed the same sequence with scheduled rest periods: challenged stands, walking speed test, five repetitions of chair rise and sit, rest break, 5-minute walk test, rest break, and seated step test. The subject's heart rate was monitored throughout and recorded during the last three minutes of the 5-minute walk and during the seated step test. The subject's heart rate was allowed to return to the resting rate between the test as indicated. Pearson product-moment correlation coefficients for heart rate measures and physical performance measures of walking speed demonstrated no relationship in the frail sample. Likewise, Spearman rank-order correlation analyses found no relationship between the ability to rise from a chair repeatedly and heart rate measures. Challenged stands also did not demonstrate a relationship to the recorded heart rate values in the frail sample. However, the 5-minute walk distance was found to have a fair relationship to walking speed (r = .35) for the frail sample. The 5-minute walk test and the physical performance measures exhibited fair to good relationships to each other and were safe, acceptable, and discriminative measures. The physical performance measures were objective, sensitive to different levels of physical capacity, and easily administered in spite of the frail status of the subjects. When combined, the walk speed, challenged stands, chair rise and sit, and the 5-minute walk distance were useful in describing the elderly in the sample. The heart rate data was easily obtained from the subjects, but was not as useful in determination of physical performance capabilities. Based on the data from the study, performance thresholds for the 5-minute walk was less than/equal to 380 feet, walking speed was less than/equal to .75 feet/second, challenged stands was inability to stand in tandem, and chair rise and sit was greater than/equal to 27.69 seconds to perform five repetitions.