M. Elaine Cress, PhD Professor Department of Kinesiology Institute of Gerontology

1. M. Elaine Cress, PhD Professor Department of Kinesiology Institute of Gerontology The University of Georgia South Carolina Aging Research Conference

2. 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

3. Physical Function Physical Health Physical Environment Psychosocial

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

5. The Disablement Model Functional Limitation Disability Pathology Impairment Nagi, 1976, 1991

6. The Disablement Model DEMAND Functional Limitation Disability Pathology Impairment CAPACITY Nagi, 1976, 1991

7. Zone of positive affect & adaptive behavior High Risk of more sedentary behavior negative affect and maladaptive behavior Maximum Comfort More modification strategies Higher risk of dependency Higher risk of injury, malnutrition, social isolation Maximum performance potential Physical Function Low Low High Environmental Press Adapted from Lawton & Nahemow, 1973

9. M. Elaine Cress, PhD

10. CS-PFP16 Threshold The average CS-PFP Threshold = 57 Cress & Meyer, 2003

11. High Function • No Difficulty • High Mobility • Pre-functional Limitation • Task Modification • Declines in Mobility • Low Function • Task Difficulty • Low Mobility 0 = Retire Comm., SF36 < 65 1 = Comm. Dweller, SF36  65 Cress & Meyer, 2003 Petrella & Cress, 2004

12. 45 20 CAMRA, LLC 2006 Cress & Meyer, 2003

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

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

15. 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 CAMRA, LLC 2006 Cress et al., MSSE, 2006

16. 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

17. 45 52 64 CAMRA, LLC 2006 Cress & Meyer, 2003

18. Parkinson’s Disease Schenkman, et al., Physical Therapy, 2008 60 year old man with Parkinson’s Disease Hoehn & Yahr Scale = 2 UPDRS – 41 4-month Endurance training 12 months home based exercise

19. Parkinson’s Disease CS-PFP total Schenkman, et al., Physical Therapy, 2008

20. Zone of positive affect & adaptive behavior High Physical Function Low Low High Environmental Press 70 66 49 Adapted from Lawton & Nahemow, 1973

21. 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