An evaluation of three self-report physical activity instruments for older adults

Aerobic Activity in the Healthy Elderly Is Associated with Larger Plasticity in Memory Related Brain Structures and Lower Systemic Inflammation

Cognitive abilities decline over the time course of our life, a process, which may be mediated by brain atrophy and enhanced inflammatory processes. Lifestyle factors, such as regular physical activities have been shown to counteract those noxious processes and are assumed to delay or possibly even prevent pathological states, such as dementing disorders. Whereas the impact of lifestyle and immunological factors and their interactions on cognitive aging have been frequently studied, their effects on neural parameters as brain activation and functional connectivity are less well studied. Therefore, we investigated 32 healthy elderly individuals (60.4 ± 5.0 SD; range 52–71 years) with low or high level of self-reported aerobic physical activity at the time of testing. A higher compared to a lower level in aerobic physical activity was associated with an increased encoding related functional connectivity in an episodic memory network comprising mPFC, thalamus, hippocampus precuneus, and insula. Moreover, encoding related functional connectivity of this network was associated with decreased systemic inflammation, as measured by systemic levels of interleukin 6.

Validation of the self-report EXERNET questionnaire for measuring physical activity and sedentary behavior in elderly

This study aims to examine the validity and reliability of the Elderly EXERNET Physical Activity Questionnaire (EEPAQ) in a sample of Spanish elderly population. A sample of 73 elderly successfully completed the EEPAQ and wore an accelerometer over 7 consecutive days. Test-retest reliability of the EEPAQ was assessed by having the participants answer the EEPAQ twice within 14 days. Criterion validity was assessed for the questionnaire against the accelerometer, as the gold standard. Results indicated that EEPAQ had adequate reliability measured by Intraclass correlation coefficient (ICC) (walking ICC=0.88; sitting ICC=0.68; household activities ICC=0.97), and good validity against the accelerometer. Walking had a significant (p<0.05) correlation with countsmin^-1 (r=0.56) and moderate to vigorous physical activity (MVPA) (r=0.51), as well as a negative significant (p<0.01) correlation with sedentary minutes (r=-0.33). Sitting time was positively correlated (r=0.57; p<0.01) with sedentary time and negatively correlated with the countsmin^-1 and MVPA. EEPAQ seems to be a valid and reliable tool to measure physical activity (PA) in a population of elderly living in Spain.

Efficacy of brief behavioral counselling by allied health professionals to promote physical activity in people with peripheral arterial disease (BIPP): study protocol for a multi-center randomized controlled trial

Background

Physical activity is recommended for people with peripheral arterial disease (PAD), and can improve walking capacity and quality of life; and reduce pain, requirement for surgery and cardiovascular events. This trial will assess the efficacy of a brief behavioral counselling intervention delivered by allied health professionals to improve physical activity in people with PAD.

Methods

This is a multi-center randomised controlled trial in four cities across Australia. Participants (N = 200) will be recruited from specialist vascular clinics, general practitioners and research databases and randomised to either the control or intervention group. Both groups will receive usual medical care, a written PAD management information sheet including advice to walk, and four individualised contacts from a protocol-trained allied health professional over 3 months (weeks 1, 2, 6, 12). The control group will receive four 15-min telephone calls with general discussion about PAD symptoms and health and wellbeing. The intervention group will receive behavioral counselling via two 1-h face-to-face sessions and two 15-min telephone calls. The counselling is based on the 5A framework and will promote interval walking for 3 × 40 min/week. Assessments will be conducted at baseline, and 4, 12 and 24 months by staff blinded to participant allocation. Objectively assessed outcomes include physical activity (primary), sedentary behavior, lower limb body function, walking capacity, cardiorespiratory fitness, event-based claudication index, vascular interventions, clinical events, cardiovascular function, circulating markers, and anthropometric measures. Self-reported outcomes include physical activity and sedentary behavior, walking ability, pain severity, and health-related quality of life. Data will be analysed using an intention-to-treat approach. An economic evaluation will assess whether embedding the intervention into routine care would likely be value for money. A cost-effectiveness analysis will estimate change in cost per change in activity indicators due to the intervention, and a cost-utility analysis will assess change in cost per quality-adjusted life year. A full uncertainty analysis will be undertaken, including a value of information analysis, to evaluate the economic case for further research.

Discussion

This trial will evaluate the efficacy and cost-effectiveness of a brief behavioral counselling intervention for a common cardiovascular disease with significant burden.

Trial registration

ACTRN 12614000592640 Australian New Zealand Clinical Trials Registry. Registration Date 4 June 2014.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3801-7) contains supplementary material, which is available to authorized users.

Cognitive change is more positively associated with an active lifestyle than with training interventions in older adults at risk of dementia: a controlled interventional clinical trial

BACKGROUND

While observational studies show that an active lifestyle including cognitive, physical, and social activities is associated with a reduced risk of cognitive decline and dementia, experimental evidence from corresponding training interventions is more inconsistent with less pronounced effects. The aim of this study was to evaluate and compare training- and lifestyle-related changes in cognition. This is the first study investigating these associations within the same time period and sample.

METHODS

Fifty-four older adults at risk of dementia were assigned to 10 weeks of physical training, cognitive training, or a matched wait-list control condition. Lifestyle was operationalized as the variety of self-reported cognitive, physical, and social activities before study participation. Cognitive performance was assessed with an extensive test battery prior to and after the intervention period as well as at a 3-month follow-up. Composite cognition measures were obtained by means of a principal component analysis. Training- and lifestyle-related changes in cognition were analyzed using linear mixed effects models. The strength of their association was compared with paired t-tests.

RESULTS

Neither training intervention improved global cognition in comparison to the control group (p = .08). In contrast, self-reported lifestyle was positively associated with benefits in global cognition (p < .001) and specifically in memory (p < .001). Moreover, the association of an active lifestyle with cognitive change was significantly stronger than the benefits of the training interventions with respect to global cognition (ps < .001) and memory (ps < .001).

CONCLUSIONS

The associations of an active lifestyle with cognitive change over time in a dementia risk group were stronger than the effects of short-term, specific training interventions. An active lifestyle may differ from training interventions in dosage and variety of activities as well as intrinsic motivation and enjoyment. These factors might be crucial for designing novel interventions, which are more efficient than currently available training interventions.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier NCT01061489 . Registered February 2, 2010.

Physical activity measurement- a primer for health promotion

As the importance of physical activity is recognised in health promotion, the task of measuring it becomes a central research and practice challenge. Measurement of physical activity is important to policy makers interested in population surveillance, as well as to practitioners interested in programme evaluation and research. This review outlines 'best practice' in physical activity measurement, and provides an inventory of established physical activity and related measures for use in health promotion programme evaluation, research and surveillance at the national and local level.

Sensorimotor Peripheral Nerve Function and Physical Activity in Older Men

We determined whether sensorimotor peripheral nerve (PN) function was associated with physical activity (PA) in older men. The Osteoporotic Fractures in Men Study Pittsburgh, PA, site (n = 328, age 78.8 ± 4.7 years) conducted PN testing, including: peroneal motor and sural sensory nerve conduction (latencies, amplitudes: CMAP and SNAP for motor and sensory amplitude, respectively), 1.4g/10g monofilament (dorsum of the great toe), and neuropathy symptoms. ANOVA and multivariate linear regression modeled PN associations with PA (Physical Activity Scale for the Elderly [PASE] and SenseWear Armband). After multivariable adjustment, better motor latency was associated with higher PASE scores (160.5 ± 4.8 vs. 135.6 ± 6.7, p < .01). Those without versus with neuropathy symptoms had higher PASE scores (157.6 ± 5.3 vs. 132.9 ± 7.1, p < .01). Better versus worse SNAP was associated with slightly more daily vigorous activity (9.5 ± 0.8 vs. 7.3 ± 0.7, p = .05). Other PN measures were not associated with PA. Certain PN measures were associated with lower PA, suggesting a potential pathway for disability.

Psychometric evaluation of a self-reported physical activity questionnarie used in the pilot phase of the AZAR Cohort Study

Background: The purpose of this study was to assess the psychometric properties of a self-reported physical activity (PA) questionnaire based on data from the pilot phase of the AZAR Cohort Study.

Methods: In this cross-sectional study, all 35-70 years old people living in Khameneh, a city in East Azarbaijan, Iran were invited to take part in the pilot phase of the AZAR Cohort Study. A total of 952 people completed the self-reported PA questionnaire and the International Physical Activity Questionnaire (IPAQ). Construct validity was evaluated by exploratory and confirmatory factor analyses (EFA and CFA). Spearman’s correlation coefficient between the scores of the two instruments was used to examine the concurrent validity. Reliability was measured using intraclass correlation coefficient (ICC) and Cronbach’s alpha coefficient.

Results: In EFA applying principal component analysis with varimax rotation, four factors were identified including recreational leisure time (variance = 52.73%), sedentary leisure time (variance = 38.68%), household/gardening work (variance = 38.66%), and occupation work (variance = 12.67%). The extracted factors were also supported by the CFA (CFI = 0.98, GFI =0.936, RMSEA=0.057). The results indicated moderate concurrent validity (ρ = 0.62, P < 0.001). ICC and Cronbach’s alpha were 0.59 and 0.7, respectively.

Conclusion: These results showed acceptable and moderate psychometric properties for the self-reported PA questionnaire to assess PA in this population-based study.

Husbands' and Wives' Physical Activity and Depressive Symptoms: Longitudinal Findings from the Cardiovascular Health Study

BACKGROUND

When examining older adults' health behaviors and psychological health, it is important to consider the social context.

PURPOSE

The purpose of this study was to examine in older adult marriages whether each spouse's physical activity predicted changes in their own (actor effects) and their partner's (partner effects) depressive symptoms. Gender differences were also examined.

METHOD

Each spouse within 1260 married couples (at baseline) in the Cardiovascular Health Study completed self-report measures at wave 1 (1989-1990), wave 3 (1992-1993), and wave 7 (1996-1997). Dyadic path analyses were performed.

RESULTS

Husbands' physical activity significantly predicted own decreased depressive symptoms (actor effect). For both spouses, own physical activity did not significantly predict the spouse's depressive symptoms (partner effects). However, husbands' physical activity and depressive symptoms predicted wives' physical activity and depressive symptoms (partner effects), respectively. Depressive symptoms did not predict physical activity.

CONCLUSION

Findings suggest that husbands' physical activity is particularly influential for older married couples' psychological health.

Association between leg strength and muscle cross-sectional area of the quadriceps femoris with the physical activity level in octogenarians

INTRODUCTION

Aging is a complex physiological process whose main feature is the progressive loss of functionality, which may be delayed or attenuated by improving physical fitness. 

OBJECTIVE

To determine the association between leg strength and the muscle cross-sectional area of the quadriceps femoris in relation to physical activity level in the elderly. 

MATERIALS AND METHODS

Thirty-two functionally autonomous people over 80 years (men: 82.80±2.09 years; women: 83.77±4.09 years) participated in this study. The Barthel Index, the Yale Physical Activity Survey and the Chair Stand Test were the instruments used. 

RESULTS

There were significant differences between sexes in muscle area (p<0.001) in the Chair Stand Test (p=0.028) and the walk index (p=0.029), with higher values in men. The muscle area and the Chair Stand Test correlated significantly with the walk index (r=0.445, p<0.005, and r=0.522, p<0.001, respectively) and the total weekly activity index (r=0.430, p<0.005, and r=0.519, p<0.001, respectively). In the multiple linear regression models for the total weekly activity index, muscle area and the Chair Stand Test, only the latter behaved as a predictor variable. 

CONCLUSIONS

Muscle strength and muscle mass of quadriceps showed a significant association with the physical activity level in older people. Leg muscle strength was useful to reveal muscle mass and physical activity level in older people, which is relevant as a clinical practice indicator.

Loss of follow-up and associated factors in patients enrolled in the HIV/AIDS program of the Hospital Universitario San Ignacio, Colombia, 2012-2013

INTRODUCTION

Regular long-term clinical follow-up is an important component of HIV care. 

OBJECTIVE

To describe the reasons for follow-up loss among patients enrolled in the HIV/AIDS program of a university hospital. 

MATERIALS AND METHODS

A nested case-control study was carried out on a retrospective cohort between January 1st, 2012 and July 31st, 2013. 

RESULTS

A group of 45 patients was selected; the incidence density rate of patients lost to follow-up was 17.7 per 100 patient/years. The following variables were significantly linked to follow-up loss in the bivariate analysis: Unemployment (p=0.000); alcohol consumption (p=0.004); number of years of evolution of the disease (p=0.032); gender (p=0.027), and mean age of 34 years (p=0.000). When logistic regression was adjusted for the probability of follow-up loss the significant variables were: Mean age of 34 years (p=0.019, 95% CI: 0.871-0.976); female (p=0.017, 95% CI: 1.903-31.83); alcohol consumption (p=0.028, 95% CI: 0.040-0.830), and unemployment (p=0.001, 95% CI: 4.696-464.692). 

CONCLUSIONS

HIV/AIDS programs need to establish follow-up systems and means to trace any losses in order to establish strategies to improve patient retention and, thus, their long-term quality of life.

Reliability of Physical Activity Measures During Free-Living Activities in People After Total Knee Arthroplasty

BACKGROUND

Few instruments that measure physical activity (PA) can accurately quantify PA performed at light and moderate intensities, which is particularly relevant in older adults. The evidence of their reliability in free-living conditions is limited.

OBJECTIVE

The study objectives were: (1) to determine the test-retest reliability of the Actigraph (ACT), SenseWear Armband (SWA), and Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire in assessing free-living PA at light and moderate intensities in people after total knee arthroplasty; (2) to compare the reliability of the 3 instruments relative to each other; and (3) to determine the reliability of commonly used monitoring time frames (24 hours, waking hours, and 10 hours from awakening).

DESIGN

A one-group, repeated-measures design was used.

METHODS

Participants wore the activity monitors for 2 weeks, and the CHAMPS questionnaire was completed at the end of each week. Test-retest reliability was determined by using the intraclass correlation coefficient (ICC [2,k]) to compare PA measures from one week with those from the other week.

RESULTS

Data from 28 participants who reported similar PA during the 2 weeks were included in the analysis. The mean age of these participants was 69 years (SD=8), and 75% of them were women. Reliability ranged from moderate to excellent for the ACT (ICC=.75-.86) and was excellent for the SWA (ICC=.93-.95) and the CHAMPS questionnaire (ICC=.86-.92). The 95% confidence intervals (95% CI) of the ICCs from the SWA were the only ones within the excellent reliability range (.85-.98). The CHAMPS questionnaire showed systematic bias, with less PA being reported in week 2. The reliability of PA measures in the waking-hour time frame was comparable to that in the 24-hour time frame and reflected most PA performed during this period.

LIMITATIONS

Reliability may be lower for time intervals longer than 1 week.

CONCLUSIONS

All PA measures showed good reliability. The reliability of the ACT was lower than those of the SWA and the CHAMPS questionnaire. The SWA provided more precise reliability estimates. Wearing PA monitors during waking hours provided sufficiently reliable measures and can reduce the burden on people wearing them.

Cross-Cultural Adaptation of the CHAMPS Questionnaire in French Canadians with COPD

Physical activity is difficult to measure in individuals with COPD. The Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire demonstrated strong clinometric properties when used with the elderly and with those affected by chronic disease. Study objectives were to translate, culturally adapt the CHAMPS into French, and reexamine its test-retest reliability and construct validity in French and English Canadians with COPD. This paper presents the cross-cultural adaptation of the CHAMPS; results of its clinometric testing will be described in another article. The CHAMPS examines the degree of physical activity performed in a typical week through two summary scales, caloric expenditure and activity frequency. The CHAMPS was only in English; thus, a cross-cultural adaptation was needed to translate the CHAMPS into French for use in French Canadians with COPD. Cross-cultural adaptation consisted of forward and back translation, with expert review at each stage of translation: minor inconsistencies were uncovered and rectified. Five French participants with COPD completed the finalized Canadian French CHAMPS and participated in cognitive debriefing; no problematic items were identified. A structured and stepwise, cross-cultural adaptation process produced the Canadian French CHAMPS, with items of equivalent meaning to the English version, for use in French Canadians with COPD.

Cognitively Engaging Activity Is Associated with Greater Cortical and Subcortical Volumes

As the population ages and dementia becomes a growing healthcare concern, it is increasingly important to identify targets for intervention to delay or attenuate cognitive decline. Research has shown that the most successful interventions aim at altering lifestyle factors. Thus, this study examined how involvement in physical, cognitive, and social activity is related to brain structure in older adults. Sixty-five adults (mean age = 71.4 years, standard deviation = 8.9) received the Community Healthy Activities Model Program for Seniors (CHAMPS), a questionnaire that polls everyday activities in which older adults may be involved, and also underwent structural magnetic resonance imaging. Stepwise regression with backward selection was used to predict weekly time spent in either social, cognitive, light physical, or heavy physical activity from the volume of one of the cortical or subcortical regions of interest (corrected by intracranial volume) as well as age, education, and gender as control variables. Regressions revealed that more time spent in cognitive activity was associated with greater volumes of all brain regions studied: total cortex (β = 0.289, p = 0.014), frontal (β = 0.276, p = 0.019), parietal (β = 0.305, p = 0.009), temporal (β = 0.275, p = 0.020), and occipital (β = 0.256, p = 0.030) lobes, and thalamus (β = 0.310, p = 0.010), caudate (β = 0.233, p = 0.049), hippocampus (β = 0.286, p = 0.017), and amygdala (β = 0.336, p = 0.004). These effects remained even after accounting for the positive association between cognitive activity and education. No other activity variable was associated with brain volumes. Results indicate that time spent in cognitively engaging activity is associated with greater cortical and subcortical brain volume. Findings suggest that interventions aimed at increasing levels of cognitive activity may delay cognitive consequences of aging and decrease the risk of developing dementia.

Group Versus Individual Physical Therapy for Veterans With Knee Osteoarthritis: Randomized Clinical Trial

BACKGROUND

Efficient approaches are needed for delivering nonpharmacological interventions for management of knee osteoarthritis (OA).

OBJECTIVE

This trial compared group-based versus individual physical therapy interventions for management of knee OA.

DESIGN AND METHODS

Three hundred twenty patients with knee OA at the VA Medical Center in Durham, North Carolina, (mean age=60 years, 88% male, 58% nonwhite) were randomly assigned to receive either the group intervention (group physical therapy; six 1-hour sessions, typically 8 participants per group) or the individual intervention (individual physical therapy; two 1-hour sessions). Both programs included instruction in home exercise, joint protection techniques, and individual physical therapist evaluation. The primary outcome measure was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC; range=0-96, higher scores indicate worse symptoms), measured at baseline, 12 weeks, and 24 weeks. The secondary outcome measure was the Short Physical Performance Battery (SPPB; range=0-12, higher scores indicate better performance), measured at baseline and 12 weeks. Linear mixed models assessed the difference in WOMAC scores between arms.

RESULTS

At 12 weeks, WOMAC scores were 2.7 points lower in the group physical therapy arm compared with the individual physical therapy arm (95% confidence interval [CI]=-5.9, 0.5; P=.10), indicating no between-group difference. At 24 weeks, WOMAC scores were 1.3 points lower in the group physical therapy arm compared with the individual physical therapy arm (95% CI=-4.6, 2.0; P=.44), indicating no significant between-group difference. At 12 weeks, SPPB scores were 0.1 points lower in the group physical therapy arm compared with the individual physical therapy arm (95% CI=-0.5, 0.2; P=.53), indicating no difference between groups.

LIMITATIONS

This study was conducted in one VA medical center. Outcome assessors were blinded, but participants and physical therapists were not blinded.

CONCLUSIONS

Group physical therapy was not more effective than individual physical therapy for primary and secondary study outcomes. Either group physical therapy or individual physical therapy may be a reasonable delivery model for health care systems to consider.

Clinically meaningful changes in functional performance resulting from self-directed interventions in individuals with arthritis

OBJECTIVES

To examine the clinical meaningfulness of changes observed in functional performance from two self-directed interventions targeting adults with arthritis.

STUDY DESIGN

Randomized controlled trial.

METHODS

Participants (n = 312) were randomized to a 12-week self-directed exercise or nutrition intervention. Objective measures of functional performance (6-minute walk, seated reach, grip strength, 30-second chair stand, gait speed, balance) were obtained at baseline, 12 weeks, and nine months. Minimally (≥0.20 standard deviation) and substantially (≥0.50) meaningful changes in functional performance were examined. Changes in the percent 'impaired' and at risk for losing independence using established standards, and associations between physical activity and impairment/risk status were also examined. Group × Time interactions were not significant; therefore groups were combined in all analyses.

RESULTS

Minimally (31-71%) and substantially (13-54%) meaningful changes in function were shown. There was a significant decrease in the percentage of participants 'impaired' on the 30-second chair stand (both time points) and gait speed (nine months). The percentage of participants at risk for losing independence significantly decreased for the 30-second chair stand (both time points) and the 6-minute walk (nine months). Those engaging in ≥2 h of leisure-time physical activity were significantly less likely to be impaired on the 6-minute walk, 30-second chair stand, and gait speed at 12 weeks, and the 6-minute walk at nine months.

CONCLUSIONS

Interventions that can slow functional declines, and ideally result in clinically meaningful improvements in functional performance among adults with arthritis are needed. Meaningful improvements in various indicators of functional performance can result from self-directed exercise and nutrition programs. These types of programs have the potential for wide-spread dissemination, and thus broad reach.

A Combined Patient and Provider Intervention for Management of Osteoarthritis in Veterans: A Randomized Clinical Trial

BACKGROUND

Management of osteoarthritis requires both medical and behavioral strategies, but some recommended therapies are underused.

OBJECTIVE

To examine the effectiveness of a combined patient and provider intervention for improving osteoarthritis outcomes.

DESIGN

Cluster randomized clinical trial with assignment to osteoarthritis intervention and usual care groups. (ClinicalTrials.gov: NCT01130740).

SETTING

Department of Veterans Affairs Medical Center in Durham, North Carolina.

PARTICIPANTS

30 providers (clusters) and 300 outpatients with symptomatic hip or knee osteoarthritis.

INTERVENTION

The telephone-based patient intervention focused on weight management, physical activity, and cognitive behavioral pain management. The provider intervention involved delivery of patient-specific osteoarthritis treatment recommendations to primary care providers through the electronic medical record.

MEASUREMENTS

The primary outcome was total score on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at 12 months. Secondary outcomes were WOMAC function and pain subscale scores, physical performance (Short Physical Performance Battery), and depressive symptoms (Patient Health Questionnaire-8). Linear mixed models that were adjusted for clustering of providers assessed between-group differences in improvement in outcomes.

RESULTS

At 12 months, WOMAC scores were 4.1 points lower (indicating improvement) in the osteoarthritis intervention group versus usual care (95% CI, -7.2 to -1.1 points; P = 0.009). WOMAC function subscale scores were 3.3 points lower in the intervention group (CI, -5.7 to -1.0 points; P = 0.005). WOMAC pain subscale scores (P = 0.126), physical performance, and depressive symptoms did not differ between groups. Although more patients in the osteoarthritis intervention group received provider referral for recommended osteoarthritis treatments, the numbers who received them did not differ.

LIMITATION

The study was conducted in a single Veterans Affairs medical center.

CONCLUSION

The combined patient and provider intervention resulted in modest improvement in self-reported physical function in patients with hip and knee osteoarthritis.

PRIMARY FUNDING SOURCE

Department of Veterans Affairs, Health Services Research and Development Service.

Moderate-intensity physical activity is independently associated with lower-extremity muscle power in older women

Skeletal muscle power is a salient determinant of physical function in older adults, but its relationship with habitual physical activity has not been well-characterized. The aim of this study was to examine the association between moderate-intensity physical activity and lower-extremity muscle power in community-dwelling older women. Older women (n = 96, mean age = 73.9 ± 5.6 years, mean body mass index = 26.5 ± 4.7 kg/m(2)) underwent assessments for body composition via dual-energy X-ray absorptiometry and lower-extremity muscle power (watts) using the Nottingham power rig. The Community Health Activities Model Program for Seniors questionnaire was used to estimate weekly caloric expenditure in moderate-intensity physical activity (kcals/wk). Linear regression indicated that moderate-intensity physical activity was independently related to muscle power (standardized β = 0.20, p = .03), and this relationship remained following adjustment for covariates. Analysis of covariance revealed that women in the highest tertile of volume of physical activity had significantly greater muscle power than those with the lowest volume (199.0 vs. 170.7 watts, p < .05). Moderate-intensity physical activity was independently associated with lower-extremity muscle power in older women. Future intervention trials should determine if increasing habitual physical activity is associated with improvements in lower-extremity muscle power in older women.

Skeletal muscle TLR4 and TACE are associated with body fat percentage in older adults

Elevated skeletal muscle expression of toll-like receptor 4 (TLR4) has been linked to increased inflammation in clinical populations. TNFα converting enzyme (TACE), which cleaves membrane-bound TNFα (mTNFα) to its soluble (sTNFα) and more bioactive form, has been linked to chronic disease. In contrast, higher physical activity level is associated with decreased chronic disease risk and inflammation. The purpose of the present study was to examine the relationship between physical activity and skeletal muscle TLR4, TACE, and TNFα in older adults. In 26 older adults (age = 68 ± 4 years, body mass index = 26 ± 3 kg·m(-2)), self-reported physical activity (kcal·week(-1)), estimated maximal oxygen consumption, and body composition (air plethysmography) were measured. TLR4, TACE, mTNFα, and sTNFα were measured in skeletal muscle biopsies (vastus lateralis) using western blot analyses. Pearson product-moment correlations were run between variables. Significance was set at p < 0.05. Skeletal muscle TACE was directly associated with sTNFα (r = 0.53, p < 0.01). Linear regression modeling showed that mTNFα and TACE expression were predictive of sTNFα expression. No correlations were observed between physical activity and TLR4, TACE, or sTNFα. Percent body fat was directly associated with skeletal muscle TLR4 (r = 0.52, p < 0.01) and TACE (r = 0.50, p < 0.01), whereas fasting blood glucose was directly associated with TACE and sTNFα. In conclusion, we found that percent body fat was directly associated with TLR4 and TACE expression in skeletal muscle of older adults. These findings suggest that elevated skeletal muscle expression of TLR4 and TACE may contribute to the augmented inflammation and chronic disease risk observed with increased adiposity.

Association of complementary and alternative medicine use with symptoms and physical functional performance among adults with arthritis

BACKGROUND

Research shows high prevalence of complementary and alternative medicine (CAM) use in individuals with arthritis. Little is known about CAM use and objectively measured physical functional performance.

OBJECTIVE

The main objective was to determine if CAM use was associated with self-reported symptoms and physical functional performance in adults with arthritis. The secondary objectives were to describe the perceived helpfulness and correlates of CAM use.

METHODS

We analyzed cross-sectional data from a self-administered questionnaire and objectively measured physical functional performance prior to randomization to a self-paced exercise program or control condition (n = 401). We used the Fisher's exact test, analysis of variance, and general linear models to examine the association of CAM use with socio-demographic characteristics, symptoms and functional performance. Logistic regression computed the odds of perceiving CAM as helpful by level of use.

RESULTS

Most respondents had used CAM (76%). Dietary supplements were the most-used (53.1%). Female gender and college education predicted greater number of modalities used. Compared to non-users, use of any CAM was associated with greater fatigue and lower grip strength; relaxation techniques with lower walk distance and gait speed; dietary change with greater pain and stiffness and lower walk distance; and yoga with lower pain and stiffness, greater walk distance, chair stands, seated reach and gait, but lower grip strength. Perceived help was positively associated with the number of modalities used.

CONCLUSIONS

Associations between CAM and symptoms or functional performance were mixed. Only yoga showed positive associations; however, yoga practitioners were more physically active overall than non-practitioners.

Prevalence and Predictors of Pre-Diabetes and Diabetes among Adults 18 Years or Older in Florida: A Multinomial Logistic Modeling Approach

BACKGROUND

Individuals with pre-diabetes and diabetes have increased risks of developing macro-vascular complications including heart disease and stroke; which are the leading causes of death globally. The objective of this study was to estimate the prevalence of pre-diabetes and diabetes, and to investigate their predictors among adults ≥18 years in Florida.

METHODS

Data covering the time period January-December 2013, were obtained from Florida's Behavioral Risk Factor Surveillance System (BRFSS). Survey design of the study was declared using SVYSET statement of STATA 13.1. Descriptive analyses were performed to estimate the prevalence of pre-diabetes and diabetes. Predictors of pre-diabetes and diabetes were investigated using multinomial logistic regression model. Model goodness-of-fit was evaluated using both the multinomial goodness-of-fit test proposed by Fagerland, Hosmer, and Bofin, as well as, the Hosmer-Lemeshow's goodness of fit test.

RESULTS

There were approximately 2,983 (7.3%) and 5,189 (12.1%) adults in Florida diagnosed with pre-diabetes and diabetes, respectively. Over half of the study respondents were white, married and over the age of 45 years while 36.4% reported being physically inactive, overweight (36.4%) or obese (26.4%), hypertensive (34.6%), hypercholesteremic (40.3%), and 26% were arthritic. Based on the final multivariable multinomial model, only being overweight (Relative Risk Ratio [RRR] = 1.85, 95% Confidence Interval [95% CI] = 1.41, 2.42), obese (RRR = 3.41, 95% CI = 2.61, 4.45), hypertensive (RRR = 1.69, 95% CI = 1.33, 2.15), hypercholesterolemic (RRR = 1.94, 95% CI = 1.55, 2.43), and arthritic (RRR = 1.24, 95% CI = 1.00, 1.55) had significant associations with pre-diabetes. However, more predictors had significant associations with diabetes and the strengths of associations tended to be higher than for the association with pre-diabetes. For instance, the relative risk ratios for the association between diabetes and being overweight (RRR = 2.00, 95% CI = 1.55, 2.57), or obese (RRR = 4.04, 95% CI = 3.22, 5.07), hypertensive (RRR = 2.66, 95% CI = 2.08, 3.41), hypercholesterolemic (RRR = 1.98, 95% CI = 1.61, 2.45) and arthritic (RRR = 1.28, 95% CI = 1.04, 1.58) were all further away from the null than their associations with pre-diabetes. Moreover, a number of variables such as age, income level, sex, and level of physical activity had significant association with diabetes but not pre-diabetes. The risk of diabetes increased with increasing age, lower income, in males, and with physical inactivity. Insufficient physical activity had no significant association with the risk of diabetes or pre-diabetes.

CONCLUSIONS

There is evidence of differences in the strength of association of the predictors across levels of diabetes status (pre-diabetes and diabetes) among adults ≥18 years in Florida. It is important to monitor populations at high risk for pre-diabetes and diabetes, so as to help guide health programming decisions and resource allocations to control the condition.

Group trajectory analysis helps to identify older cancer survivors who benefit from distance-based lifestyle interventions

BACKGROUND

The number of older cancer survivors is increasing as more adults survive to older ages. The objectives of this study were to examine trajectories of physical activity (PA) and physical function (PF) over a 2-year lifestyle counseling study and to identify characteristics of the trajectory groups.

METHODS

This was a secondary analysis of Reach Out to Enhance Wellness, a randomized controlled trial of home-based lifestyle counseling. The 641 participants were older (≥65 years), overweight (body mass index [BMI], 25 to <40 kg/m(2)), long-term community-dwelling survivors (>5 years) of breast, prostate, and colorectal cancer from Canada, the United Kingdom, and the United States (21 states) who had been randomly assigned to an immediate intervention or a 12-month-wait-listed control arm. The main outcome measures were PA and PF trajectory group membership.

RESULTS

Three PA groups and 5 PF trajectory groups were observed. The baseline BMI (P < .001) and self-efficacy for performing strength (P < .0001) and endurance exercises (P < .0002) were the strongest predictors of achieving the highest amount of PA and the most favorable functional trajectory over 2 years. Individuals with low baseline self-efficacy, no PA, and a Short Form 36 PF subscale score < 65 did not benefit from the intervention.

CONCLUSIONS

This study identified characteristics of survivors who benefited from home-based interventions and suggested alternative approaches for survivors requiring more structured and intensive interventions to promote behavioral changes.

Asymmetry in leg extension power impacts physical function in community-dwelling older women

OBJECTIVE

The aim of this study was to examine the association between asymmetry in leg extension power (LP) and lower-extremity physical function (LEF) in community-dwelling older women.

METHODS

Older women (n = 94, 74.0 ± 5.5 y) were assessed for unilateral LP (watts) using the Nottingham power rig, and absolute and relative (%ASYM) differences in LP between the dominant and nondominant legs were calculated. LEF was assessed via the 6-minute walk, 8-foot up-and-go and 30-second chair stand, and a composite measure of LEF was calculated by summing z scores of each test. In addition, body composition was measured via dual-energy x-ray absorptiometry and moderate-intensity physical activity was assessed via questionnaire.

RESULTS

The absolute difference in LP between the dominant and nondominant legs was 10.2 ± 9.0 watts, which translated to a %ASYM of 11.3% ± 10.5% (P < 0.01). %ASYM had bivariate associations with all individual measures of LEF (r range = -0.22 to -0.34, all P < 0.05). Using multivariate linear regression, %ASYM was an independent predictor of a composite LEF z score (standardized β= -0.18, P < 0.05) after adjustment for age, comorbidities, physical activity, relative adiposity, and total leg power. Analysis of covariance indicated that women with low asymmetry had a significantly better LEF z score than those with high asymmetry (0.60 vs -0.13, P = 0.04).

CONCLUSIONS

These findings indicate that a greater magnitude of asymmetry in LP is associated with poorer LEF in older women. Research is needed to determine whether interventions that correct asymmetries in lower-body muscle power confer functional benefits in older women.

Cognitive behavioral therapy and tai chi reverse cellular and genomic markers of inflammation in late-life insomnia: a randomized controlled trial

BACKGROUND

Sleep disturbance is associated with activation of systemic and cellular inflammation, as well as proinflammatory transcriptional profiles in circulating leukocytes. Whether treatments that target insomnia-related complaints might reverse these markers of inflammation in older adults with insomnia is not known.

METHODS

In this randomized trial, 123 older adults with insomnia were randomly assigned to cognitive-behavioral therapy for insomnia (CBT-I), tai chi chih (TCC), or sleep seminar education active control condition for 2-hour sessions weekly over 4 months with follow-up at 7 and 16 months. We measured C-reactive protein (CRP) at baseline and months 4 and 16; toll-like receptor-4 activated monocyte production of proinflammatory cytokines at baseline and months 2, 4, 7, and 16; and genome-wide transcriptional profiling at baseline and month 4.

RESULTS

As compared with sleep seminar education active control condition, CBT-I reduced levels of CRP (months 4 and 16, ps < .05), monocyte production of proinflammatory cytokines (month 2 only, p < .05), and proinflammatory gene expression (month 4, p < .01). TCC marginally reduced CRP (month 4, p = .06) and significantly reduced monocyte production of proinflammatory cytokines (months 2, 4, 7, and 16; all ps < .05) and proinflammatory gene expression (month 4, p < .001). In CBT-I and TCC, TELiS promoter-based bioinformatics analyses indicated reduced activity of nuclear factor-κB and AP-1.

CONCLUSIONS

Among older adults with insomnia, CBT-I reduced systemic inflammation, TCC reduced cellular inflammatory responses, and both treatments reduced expression of genes encoding proinflammatory mediators. The findings provide an evidence-based molecular framework to understand the potential salutary effects of insomnia treatment on inflammation, with implications for inflammatory disease risk.

Accelerometer-measured physical activity among older adults in urban India: Results of a study on global AGEing and adult health substudy

OBJECTIVES

Accelerometry provides researchers with a powerful tool to measure physical activity in population-based studies, yet this technology has been underutilized in cross-cultural studies of older adults. The present study was conducted among older adults in an urban setting in India with the following three objectives: (1) to compare average activity levels obtained through different durations of monitoring (1, 3, and 7 days); (2) to document differences in physical activity patterns by sex and age; and (3) to evaluate links between measures of physical activity and anthropometrics, as well as between activity parameters and measures of household size, work status, and social cohesion.

METHODS

The present study uses data from a physical activity substudy of the World Health Organization's Study on global AGEing and adult health (SAGE-PA). This study of 200 older adults (49-90 years old; 72 males, 128 females) in urban India combines 7 continuous days of ActiGraph GT3X accelerometry with anthropometric and sociodemographic data.

RESULTS

Results reveal overall low activity levels, with significantly lower activity energy expenditure (AEE) among females (P < 0.05). No significant differences were documented in activity level by monitoring duration. Age was negatively correlated with AEE in men (P < 0.01) and women (P < 0.001). AEE was positively correlated with BMI in men (P < 0.01) and women (P < 0.05). Finally, women who were more socially integrated had greater AEE (P < 0.01).

CONCLUSIONS

This study illustrates the utility of accelerometry for quantifying activity levels in aging populations in non-Western nations. Am. J. Hum. Biol. 28:412-420, 2016. © 2015 Wiley Periodicals, Inc.

Sex-specific relationships of physical activity, body composition, and muscle quality with lower-extremity physical function in older men and women

OBJECTIVE

This study aims to determine the sex-specific relationships of physical activity, body composition, and muscle quality with lower-extremity physical function in older men and women.

METHODS

Seventy-nine community-dwelling men (n = 39; mean [SD] age, 76.1 [6.2] y; mean [SD] body mass index, 27.3 [3.8] kg/m(2)) and women (n = 40; mean [SD] age, 75.8 [5.5] y; mean [SD] body mass index, 27.0 [3.8] kg/m(2)) were assessed for physical activity via questionnaire, body composition via dual-energy x-ray absorptiometry scanning, leg extension power using the Nottingham power rig, and muscle quality (W/kg; the ratio of leg extension power [W] to lower-body mineral-free lean mass [kg]). A composite measure of physical function was obtained by summing Z scores from the 6-minute walk, 8-ft up-and-go test, and 30-second chair-stand test.

RESULTS

As expected, men had significantly greater levels of physical activity, lower adiposity, greater lean mass, higher leg extension power, and greater muscle quality compared with women (all P < 0.05). In linear regression analyses, muscle quality and physical activity were the strongest predictors of lower-extremity physical function in men and independently explained 42% and 29% of the variance, respectively. In women, muscle quality (16%) and percent body fat (12%) were independent predictors after adjustment for covariates.

CONCLUSIONS

Muscle quality is the strongest predictor of lower-extremity physical function in men and women, but sex impacts the importance of physical activity and adiposity. These findings suggest that older men and women may benefit from different intervention strategies for preventing physical disability and also highlight the importance of weight management for older women to preserve physical function.

Patterns of Physical Activity Among Older Adults in New York City: A Latent Class Approach

INTRODUCTION

Little research to date has explored typologies of physical activity among older adults. An understanding of physical activity patterns may help to both determine the health benefits of different types of activity and target interventions to increase activity levels in older adults. This analysis, conducted in 2014, used a latent class analysis approach to characterize patterns of physical activity in a cohort of older adults.

METHODS

A total of 3,497 men and women aged 65-75 years living in New York City completed the Physical Activity Scale for the Elderly (PASE) in 2011. PASE scale items were used to classify subjects into latent classes. Multinomial regression was then used to relate individual and neighborhood characteristics to class membership.

RESULTS

Five latent classes were identified: "least active," "walkers," "domestic/gardening," "athletic," and "domestic/gardening athletic." Individual-level predictors, including more education, higher income, and better self-reported health, were associated with membership in the more-active classes, particularly the athletic classes. Residential characteristics, including living in single-family housing and living in the lower-density boroughs of New York City, were predictive of membership in one of the domestic/gardening classes. Class membership was associated with BMI even after controlling for total PASE score.

CONCLUSIONS

This study suggests that individual and neighborhood characteristics are associated with distinct physical activity patterns in a group of older urban adults. These patterns are associated with body habitus independent of overall activity.

Instrument for evaluation of sedentary lifestyle in patients with high blood pressure

OBJECTIVE

this article describes the diagnostic accuracy of the International Physical Activity Questionnaire to identify the nursing diagnosis of sedentary lifestyle.

METHOD

a diagnostic accuracy study was developed with 240 individuals with established high blood pressure. The analysis of diagnostic accuracy was based on measures of sensitivity, specificity, predictive values, likelihood ratios, efficiency, diagnostic odds ratio, Youden index, and area under the receiver-operating characteristic curve.

RESULTS

statistical differences between genders were observed for activities of moderate intensity and for total physical activity. Age was negatively correlated with activities of moderate intensity and total physical activity.

CONCLUSION

the analysis of area under the receiver-operating characteristic curve for moderate intensity activities, walking, and total physical activity showed that the International Physical Activity Questionnaire present moderate capacity to correctly classify individuals with and without sedentary lifestyle.

Physical activity mediates the relationship between program participation and improved mental health in older adults

OBJECTIVES

There is an implicit assumption that increased physical activity (PA) levels are responsible for the mental health benefits resulting from participation in PA programs. Other factors associated with participation may in fact be responsible. The purpose of this study was to examine whether changes in PA mediated the effects of two PA programs (Active Choices [AC] and Active Living Every Day [ALED]) on mental health outcomes.

STUDY DESIGN

Secondary data analyses of quasi-experimental study.

METHODS

A sub-sample of older adults who participated in AC (n = 744) and ALED (n = 853) were included in the current analyses. MacKinnon's product of coefficients was used to test change in PA as a mediator of the relationship between program dose and change in mental health outcomes (depressive symptoms, stress, and number of days with poor mental health).

RESULTS

Change in PA explained 19% (AC) and 13% (ALED) of the absolute effects of program dose on depressive symptoms, 18% (AC) and 14% (ALED) of the effects on stress, and 37% (ALED) of the effects on days with poor mental health.

CONCLUSIONS

Mounting evidence from both epidemiological studies and controlled trials suggests that PA can improve mental health. This study adds that increasing PA levels may improve mental health in older adults in 'real-world' settings.

Adoption and maintenance of gym-based strength training in the community setting in adults with excess weight or type 2 diabetes: a randomized controlled trial

Background

Participant adoption and maintenance is a major challenge in strength training (ST) programs in the community-setting. In adults who were overweight or with type 2 diabetes (T2DM), the aim of this study was to compare the effectiveness of a standard ST program (SST) to an enhanced program (EST) on the adoption and maintenance of ST and cardio-metabolic risk factors and muscle strength.

Methods

A 12-month cluster-randomized controlled trial consisting of a 6-month adoption phase followed by a 6-month maintenance phase. In 2008–2009, men and women aged 40–75 years (n = 318) with T2DM (n = 117) or a BMI >25 (n = 201) who had not participated in ST previously were randomized into either a SST or an EST program (which included additional motivationally-tailored behavioral counselling). Adoption and maintenance were defined as undertaking ≥ 3 weekly gym-based exercise sessions during the first 6-months and from 6–12 months respectively and were assessed using a modified version of the CHAMPS (Community Healthy Activity Models Program for Seniors) instrument.

Results

Relative to the SST group, the adjusted odds ratio (OR) of adopting ST for all participants in the EST group was 3.3 (95 % CI 1.2 to 9.4). In stratified analyses including only those with T2DM, relative to the SST group, the adjusted OR of adopting ST in the EST group was 8.2 (95 % CI 1.5–45.5). No significant between-group differences were observed for maintenance of ST in either pooled or stratified analyses. In those with T2DM, there was a significant reduction in HbA1c in the EST compared to SST group during the adoption phase (net difference, -0.13 % [-0.26 to -0.01]), which persisted after 12-months (-0.17 % [-0.3 to -0.05]).

Conclusions

A behaviorally-focused community-based EST intervention was more effective than a SST program for the adoption of ST in adults with excess weight or T2DM and led to greater improvements in glycemic control in those with T2DM.

Trial registration

Registered at ACTRN12611000695909 (Date registered 7/7/2011).

Exercise, sedentary pastimes, and cognitive performance in healthy older adults

BACKGROUND

Moderately vigorous physical activity (MVPA) provides a protective affect against cognitive decline and cardiovascular risk factors. Less is known about sedentary pastimes or non exercise physical activity (NEPA) and cognitive performance.

METHOD

125 healthy adults 65 or older with no clinical evidence of cognitive impairment were enrolled. The CogState computerized neurocognitive battery was administered. Leisure activities were measured using the Community Health Activity Program for Seniors (CHAMPS).

RESULTS

Sedentary pastimes were associated with executive dysfunction (P = 0.01); MVPA with high memory scores (P = 0.05) and NEPA with improved working memory (P = 0.05). Only sedentary pastimes and executive dysfunction retained significance after correction for multiple comparisons. Smoking and alcohol confounded the association of memory with sedentary pastimes and MVPA.

CONCLUSIONS

Study highlights: negative impact of sedentary pastimes on executive function, need for additional investigation of sedentary behavior, NEPA, the impact of addictions upon activity in late life.

Intake of antioxidants and subsequent decline in physical function in a racially/ethnically diverse population

OBJECTIVES

Oxidative stress is considered a risk factor for physical function (PF) decline with aging. The objective of this study was to examine the relationship between antioxidant intake and change in PF over a 5-year period.

DESIGN, SETTING, PARTICIPANTS

The Boston Area Community Health (BACH) Survey is a population-based longitudinal study including 5,502 racially/ethnically diverse and randomly selected participants aged 30-79 years.

MEASUREMENTS

In total, 2828 persons aged 30-79 years completed the validated Block Food Frequency Questionnaire (FFQ) and participated in the follow-up study. Change in PF from baseline (2002-2005) to follow-up (2006-2010) was assessed using the validated SF-12 questionnaire. Linear models were used to examine the association between energy-adjusted quartiles of vitamins C, E and carotenoids and change in PF.

RESULTS

A low intake (first quartile) of vitamin E was associated with a greater decline in PF compared with the highest quartile, with a mean difference in change in PF of -1.73 (95%CI:-3.31,-0.15). Notably, this mean difference was clinically meaningful as it was equivalent to the effect estimate we found for participants who were approximately 15 years apart in age in our cohort, as 1 year increase in age was associated with a mean difference in change in PF of -0.11 (95%CI:-0.16,-0.06). PF decline was not significantly different in the lowest compared with the highest quartile of vitamin C (mean difference=-1.29, 95%CI:-2.61, 0.03) or carotenoids (mean difference=-0.62, 95%CI:-2.22,0.99).

CONCLUSIONS

Low intake of vitamin E was significantly associated with decline in PF with aging. These results are clinically meaningful, extend previous findings that oxidative stress contributes to PF decline, and may inform the development of future prevention strategies aimed at reducing this clinical and public health problem.

English language proficiency and physical activity among Mexican-origin women in South Texas and South Carolina

OBJECTIVES

To examine the relationship between English language proficiency (ELP), physical activity, and physical activity-related psychosocial measures (i.e., exercise self-efficacy, exercise social support, perceptions of environmental supports) among Mexican-origin women in South Carolina and Texas.

DESIGN

Adjusted robust regression and interaction modeling to evaluate baseline questionnaire data on self-reported ELP with CHAMPS leisure-time moderate-to-vigorous physical activity (MVPA), accelerometry data, Physical Activity Self-Efficacy, Physical Activity Social Support, and Environmental Support for Physical Activity in 118 Mexican-origin women.

RESULTS

The adjusted regression revealed a significant association between ELP and perceived physical activity self-efficacy (β = 234.2, p = .004), but not with physical activity social support. In South Carolina, CHAMPS leisure-time MVPA (411.4 versus 114.3 minutes, p < .05) was significantly different between women in the high ELP quartile and those in the very low quartile. Among high ELP Mexican-origin women, participants in Texas reported significantly higher MVPA measured by accelerometry (p = .042) than those in South Carolina.

CONCLUSION

Our findings indicate that ELP was associated with physical activity and that contextual factors may also play a role.

Daily stressors, past depression, and metabolic responses to high-fat meals: a novel path to obesity

BACKGROUND

Depression and stress promote obesity. This study addressed the impact of daily stressors and a history of major depressive disorder (MDD) on obesity-related metabolic responses to high-fat meals.

METHODS

This double-blind, randomized, crossover study included serial assessments of resting energy expenditure (REE), fat and carbohydrate oxidation, triglycerides, cortisol, insulin, and glucose before and after two high-fat meals. During two separate 9.5-hour admissions, 58 healthy women (38 breast cancer survivors and 20 demographically similar control subjects), mean age 53.1 years, received either a high saturated fat meal or a high oleic sunflower oil meal. Prior day stressors were assessed by the Daily Inventory of Stressful Events.

RESULTS

Greater numbers of stressors were associated with lower postmeal REE (p = .008), lower fat oxidation (p = .04), and higher insulin (p = .01), with nonsignificant effects for cortisol and glucose. Women with prior MDD had higher cortisol (p = .008) and higher fat oxidation (p = .004), without significant effects for REE, insulin, and glucose. Women with a depression history who also had more stressors had a higher peak triglyceride response than other participants (p = .01). The only difference between meals was higher postprandial glucose following sunflower oil compared with saturated fat (p = .03).

CONCLUSIONS

The cumulative 6-hour difference between one prior day stressor and no stressors translates into 435 kJ, a difference that could add almost 11 pounds per year. These findings illustrate how stress and depression alter metabolic responses to high-fat meals in ways that promote obesity.

Psychosocial mediators of two community-based physical activity programs

BACKGROUND

Previous findings are inconclusive regarding the mediators of physical activity behavior change.

PURPOSE

To test self-efficacy and social support as mediators of Active Choices, a telephone-delivered physical activity intervention, and Active Living Every Day, a group-based physical activity intervention, implemented with midlife and older adults in community settings.

METHODS

MacKinnon's product of coefficients was used to examine social support and self-efficacy as mediators of change in physical activity. The proportion of the total effect mediated was calculated. Each model controlled for age, gender, race (white vs. non-white), body mass index (BMI), and education (high school graduate or less vs. at least some college).

RESULTS

Increases in self-efficacy mediated increases in physical activity among Active Choices (n = 709) and Active Living Every Day (n = 849) participants. For Active Living Every Day, increases in social support also mediated increases in physical activity in single mediator models.

CONCLUSIONS

Increasing self-efficacy and social support may help increase physical activity levels in older adults.

Validity of self-reported fitness across black and white race, gender, and health literacy subgroups

PURPOSE

To compare concurrent criterion validity of the Self-Reported Fitness (SRFit) Survey, a new fitness measure, between black and white race, gender, and health literacy groups.

DESIGN

Cross-sectional.

SETTING

Midwest urban primary care center and commercial fitness center.

SUBJECTS

One hundred one black, white, male, and female primary care patients aged ≥40 years.

MEASURES

Measures included demographics, the Rapid Estimate of Adult Literacy in Medicine, the SRFit Survey, and the Rikli and Jones Senior Fitness Test battery of physical tests. The BodPod determined percentage of body fat. Body mass index was calculated.

ANALYSIS

Concurrent validity was assessed using Pearson and Spearman rank order correlations between corresponding physical tests and SRFit survey items.

RESULTS

Correlations between physical tests and SRFit items ranged from r = .52 to .76 (ρ = .41-.85) in males, r = .40 to .79 (ρ = .33-.80) in females, r = .45 to .79 (ρ = .53-.82) in blacks, and r = .49 to .77 (ρ = .33-.82) in whites. Correlations were r = .58 (ρ = .58) to r = .77 (ρ = .79) in persons with low health literacy and r = .50 to .79 (ρ = .39-.85) among persons with moderate to high health literacy.

CONCLUSION

SRFit shows similar concurrent validity across race, gender, and health literacy subgroups.

Light-intensity activity attenuates functional decline in older cancer survivors

While moderate- to vigorous-intensity physical activities (MVPA) confer the greatest health benefits, evidence suggests that light-intensity activities are also beneficial, particularly for older adults and individuals with moderate to severe comorbidities.

PURPOSE

To examine cross-sectional and longitudinal associations between light-intensity activity and physical function in older cancer survivors at increased risk for age- and treatment-related comorbidities, including accelerated functional decline.

METHODS

The analysis included data from 641 breast, prostate, and colorectal cancer survivors (54% female) age 65 yr and older who participated in a 1-yr home-based diet and exercise intervention designed to reduce the rate of physical function decline. ANCOVA was used to compare means of physical function across levels of PA intensity (low-light [LLPA]: 1.5-2.0 METs; high-light [HLPA]: 2.1-2.9 METs; MVPA: ≥3.0 METs).

RESULTS

In cross-sectional analyses, increasing tertiles of light-intensity activity were associated with higher scores for all three measures of physical function (all P values <0.005), after adjusting for age, sex, body mass index, comorbidity, symptoms, and MVPA. Associations were stronger for HLPA than for LLPA. Compared with survivors who had decreased MVPA or maintained stable MVPA and HLPA at the postintervention follow-up, those who had increased HLPA, but had decreased MVPA or maintained stable MVPA, reported higher physical function scores (LS means [95% confidence interval]: SF-36 Physical Function Subscale: -5.58 [-7.96 to -3.20] vs -2.54 [-5.83 to 0.75], P = 0.14; Basic Lower Extremity Function: -2.00 [-3.45 to -0.55] vs 0.28 [-1.72 to 2.28], P = 0.07; Advanced Lower Extremity Function: -2.58 [-4.00 to -1.15] vs 0.44 [-1.52 to 2.40], P = 0.01).

CONCLUSIONS

Our findings suggest that increasing light-intensity activities, especially HLPA, may be a viable approach to reducing the rate of physical function decline in individuals who are unable or reluctant to initiate or maintain adequate levels of moderate-intensity activities.

Innovative Research Design Exploring the Effects of Physical Activity and Genetics on Cognitive Performance in Community-Based Older Adults

Physical activity is predictive of better cognitive performance and lower risk of Alzheimer's disease (AD). The apolipoprotein E gene (APOE) is a susceptibility gene for AD with the e4 allele being associated with a greater risk of AD. Cross-sectional and prospective research shows that physical activity is predictive of better cognitive performance for those at greater genetic risk for AD. However, the moderating role of APOE on the effects of a physical activity intervention on cognitive performance has not been examined. The purpose of this manuscript is to justify the need for such research and to describe the design, methods, and recruitment tactics used in the conductance of a study designed to provide insight as to the extent to which cognitive benefits resulting from an 8-month physical activity program are differentiated by APOE e4 status. The effectiveness of the recruitment strategies and the feasibility of recruiting APOE e4 carriers are discussed.

Reproducibility and validity of the physical activity scale for the elderly (PASE) questionnaire in patients after total hip arthroplasty

BACKGROUND

The assessment of physical activity is of concern in patients after total hip arthroplasty (THA). However, so far, no questionnaire has demonstrated adequate reproducibility and validity for assessing physical activity in these patients.

OBJECTIVE

The aim of this study was to evaluate the reproducibility and validity of the Physical Activity Scale for the Elderly (PASE) questionnaire in patients after THA.

DESIGN

This was a measurement study.

METHODS

Fifty patients who had undergone THA (25 women, 25 men), with an average age of 68 years, were evaluated. Of these patients, 25 were assessed between 2 and 7 months after surgery (THAearly), and another 25 were assessed between 7 and 12 months after surgery (THAlate). Reproducibility of the PASE questionnaire was evaluated by administering the questionnaire on 2 different occasions. Construct validity of the PASE questionnaire was assessed by comparing the physical activity level reported by patients with that objectively recorded by a body-mounted accelerometer. Reproducibility was investigated with intraclass correlation coefficients (ICC [2,1]) for reliability and standard errors of measurement (SEM) for agreement. Validity was investigated with Pearson correlation coefficients (r).

RESULTS

The ICC (2,1) for the PASE total score was .77 (95% confidence interval [95% CI]=.63, .86); the SEM was 23.0% (95% CI=19.2, 28.7). Validity correlation for the PASE total score was .38 (95% CI=.12, .60). No significant differences were found between THAearly and THAlate groups for reliability, agreement, and validity outcomes.

LIMITATIONS

Reproducibility of the PASE questionnaire may have been underestimated because the physical activity of patients was compared between 2 consecutive but different weeks. Reliability and validity analyses were underpowered.

CONCLUSIONS

Further study with a larger sample size is necessary to obtain precise reliability and validity estimates. Nevertheless, inadequate agreement calls into question the PASE questionnaire's ability to assess the physical activity level of patients after THA surgery.

The steps to health randomized trial for arthritis: a self-directed exercise versus nutrition control program

BACKGROUND

Despite the established benefits of exercise for adults with arthritis, participation is low. Safe, evidence-based, self-directed programs, which have the potential for high reach at a low cost, are needed.

PURPOSE

To test a 12-week, self-directed, multicomponent exercise program for adults with arthritis.

DESIGN

Randomized controlled trial. Data were collected from 2010 to 2012. Data were analyzed in 2013 and 2014.

SETTING/PARTICIPANTS

Adults with arthritis (N=401, aged 56.3 [10.7] years, 85.8% women, 63.8% white, 35.2% African American, BMI of 33.0 [8.2]) completed measures at a university research center and participated in a self-directed exercise intervention (First Step to Active Health(®)) or nutrition control program (Steps to Healthy Eating).

INTERVENTION

Intervention participants received a self-directed multicomponent exercise program and returned self-monitoring logs for 12 weeks.

MAIN OUTCOME MEASURES

Self-reported physical activity, functional performance measures, and disease-specific outcomes (arthritis symptoms and self-efficacy) assessed at baseline, 12 weeks, and 9 months.

RESULTS

Participants in the exercise condition showed greater increases in physical activity than those in the nutrition control group (p=0.01). Significant improvements, irrespective of condition, were seen in lower body strength, functional exercise capacity, lower body flexibility, pain, fatigue, stiffness, and arthritis management self-efficacy (p values<0.0001). More adverse events occurred in the exercise than nutrition control condition, but only one was severe and most were expected with increased physical activity.

CONCLUSIONS

The exercise program improves physical activity, and both programs improve functional and psychosocial outcomes. Potential reasons for improvements in the nutrition control condition are discussed. These interventions have the potential for large-scale dissemination. This study is registered at Clinicaltrials.gov NCT01172327.

Variables explaining health-related quality of life in community-dwelling older adults

BACKGROUND AND PURPOSE

Although health-related quality of life (HRQL) has been linked to numerous factors in older adults, limited or conflicting studies have investigated variables explaining HRQL in healthy, community-dwelling older adults. The purpose of this study was to determine whether physical activity, gait speed, balance, strength, endurance, and flexibility were associated with HRQL in healthy, community-dwelling older adults.

METHODS

Participants of this cross-sectional, correlational research design study included residents of a senior living community, aged 60 years and older who were independent in at least unlimited household ambulation. These residents participated in tests of physical activity, gait speed, balance, strength, endurance, flexibility, and HRQL (Medical Outcomes Study Short-Form Health Survey, SF-36). The physical (PCS) and mental (MCS) component summary scores of the SF-36 were calculated.

RESULTS

Data were collected on 84 participants (mean [SD] age = 78.6 (5.9) years, 54.8% women). Significant correlations were found between the PCS and fast gait speed (FGS) (r = 0.43; p < .001), the Fullerton Advanced Balance Scale (r = 0.44; p < .001), 8-ft up-and-go (r = -0.34; p = .002), and chair stand (r = 0.37; P = .001). Only body mass index (BMI) (r = 0.30; p = .007) was significantly correlated with MCS. Forward stepwise linear regression analyses were conducted, controlling for age, sex, and BMI, to identify factors associated with the PCS and MCS. In the model using PCS as the dependent variable, FGS accounted for 26% of the variance (R2 change) in PCS over and above age, sex, and BMI (R2 change = 0.03); for the full model, F = 5.37, p = .001. In the regression analysis using MCS as the dependent variable, only the 8-ft up-and-go was retained (R2 change = 0.06) over and above age, sex, and BMI (R2 change = 0.16); for the full model, F = 3.71, p = .01.

DISCUSSION

Fast gait speed, balance, and lower body strength were associated with the PCS of the SF-36; however, FGS was the only variable that uniquely contributed to the variance in the PCS. Body mass index was associated with the MCS; however, only balance uniquely contributed to the variance in the MCS. Physical activity was not associated with the PCS or MCS.

CONCLUSIONS

The results of this study support the assessment of FGS in community-dwelling older adults to gain insight into physical health status. Interventions directed toward FGS, balance, and BMI may contribute to optimum HRQL in this population.