m. elaine cress, phd professor department of kinesiology institute of gerontology

M. Elaine Cress, PhDProfessor

Department of KinesiologyInstitute of Gerontology

The University of Georgia

South Carolina Aging Research Conference

Objectives• Establish the theoretical basis for functional

assessment• Describe the Continuous Scale Physical Functional

Performance (CS-PFP) Test and the psychometric properties CS-PFP

• Present CS-PFP Normative data • Provide data on interventions to increase functional

capacity • Posit some future directions function

FUNCTION

Psychosocial

Physical Environment

PhysicalHealth

Physical Function

Kaplan, G. In: Public Health and Aging Eds Hickey, T, Speers, MA, Prohaska, TR, 1997 p. 39

The Disablement Model

Nagi, 1976, 1991

Pathology ImpairmentFunctional Limitation Disability

The Disablement Model

Nagi, 1976, 1991

Pathology ImpairmentFunctional Limitation Disability

DEMANDDEMAND

CAPACITYCAPACITY

Phy

sica

l Fun

ctio

n

Low

High

Environmental PressLow High

More modificationstrategiesHigher risk of dependencyHigher risk of injury, malnutrition,social isolation

Risk of more sedentary behavior negative affect and maladaptive behavior

Max

imum

Com

fort

Max

imum

perfo

rman

ce

poten

tial

Zone of positiveaffect & adaptive behavior

Adapted from Lawton & Nahemow, 1973

M. Elaine Cress, PhD

VO2peak

mLkg-1min-1

(95% CI)

Strength

Nm/[kgm-1] (95% CI)

Threshold 20.13

(17.33, 22.92)

2.5 (1.91, 3.11)

CS-PFP Threshold

55.30 (47.8, 56.2)

58.05 (47.7, 58.6)

CS-PFP16 Threshold

The average CS-PFP Threshold = 57

Cress & Meyer, 2003

Pre-functional Limitation

•Task Modification

•Declines in Mobility

High Function

•No Difficulty

•High Mobility

Low Function

•Task Difficulty

•Low Mobility

0 = Retire Comm., SF36 < 651 = Comm. Dweller, SF36 65

Cress & Meyer, 2003Petrella & Cress, 2004

CAMRA, LLC 2006

4520

Cress & Meyer, 2003

Men: CS-PFP Normative dataN= 342 Min, Mean, Max

Women: CS-PFP Normative dataN= 559 Min, Mean, Max

CAMRA, LLC 2006

Congestive Heart Failure• Age – 62 11.4 year old men and women (n=61)• Comorbidity

– Class II CHF – 44%

– Class III CHF – 56%

• Beck Depression Inventory 21 8

6MWT CS-PFP10 Class II 401 92 44.3 14 Class III 276 116 31.2 15

Cress et al., MSSE, 2006

Public Housing Residents walking intervention

• Age – 71.5 8.1 n=26• Income – 80% < $20,000• African American 34%• CS-PFP10

– Total - 49.2 11.9– increase 9.8 CS-PFP units– Effect size .75

Moore et al., J. Geriatric PT, in press

CAMRA, LLC 2006

45

Cress & Meyer, 2003

52 64

Parkinson’s Disease

• 60 year old man with Parkinson’s Disease

• Hoehn & Yahr Scale = 2

• UPDRS – 41

• 4-month Endurance training

• 12 months home based exercise

Schenkman, et al., Physical Therapy, 2008

Parkinson’s Disease

Schenkman, et al., Physical Therapy, 2008

CS

-PF

P to

tal

Phy

sica

l Fun

ctio

n

Low

High

Environmental PressLow High

Zone of positiveaffect & adaptive behavior

Adapted from Lawton & Nahemow, 1973

49

7066

Summary

• Performance-based measures provide valuable information on the impact of aging or disease on physical function

• Functional performance provides information on physical reserve

• Future directions: Performance based linkages between function, environment and quality of life