Evaluation of CHAMPS, a physical activity promotion program for older adults

Understanding resilience: Lifestyle-based behavioral predictors of mental health and well-being in community-dwelling older adults during the COVID-19 pandemic

BACKGROUND

Changes in sleep, physical activity and mental health were observed in older adults during early stages of the COVID-19 pandemic. Here we describe effects of the COVID-19 pandemic on older adult mental health, wellbeing, and lifestyle behaviors and explore predictors of better mid-pandemic mental health and wellbeing.

METHODS

Participants in the Adult Changes in Thought study completed measures of lifestyle behaviors (e.g., sleep, physical activity) and mental health and wellbeing both pre-pandemic during regular study visits and mid-pandemic via a one-time survey. We used paired t-tests to compare differences in these measures pre- vs. mid-pandemic. Using multivariate linear regression, we further explored demographic, health, and lifestyle predictors of pandemic depressive symptoms, social support, and fatigue. We additionally qualitatively coded free text data from the mid-pandemic survey for related comments.

RESULTS

Participants (N = 896) reported significant changes in mental health and lifestyle behaviors at pre-pandemic vs. mid-pandemic measurements (p < 0.0001). Qualitative findings supported these behavioral and wellbeing changes. Being male, never smoking, and lower pre-pandemic computer time and sleep disturbance were significantly associated with lower pandemic depressive symptoms. Being partnered, female, never smoking, and lower pre-pandemic sleep disturbance were associated with higher pandemic social support. Pre-pandemic employment, more walking, less computer time, and less sleep disturbance were associated with less pandemic fatigue. Participant comments supported these quantitative findings, highlighting gender differences in pandemic mental health, changes in computer usage and physical activity during the pandemic, the value of spousal social support, and links between sleep disturbance and mental health and wellbeing. Qualitative findings also revealed additional factors, such as stresses from personal and family health situations and the country's concurrent political environment, that impacted mental health and wellbeing.

CONCLUSIONS

Several demographic, health, and lifestyle behaviors appeared to buffer the effects of the COVID-19 pandemic and may be key sources of resilience. Interventions and public health measures targeting men and unpartnered individuals could promote social support resilience, and intervening on modifiable behaviors like sleep quality, physical activity and sedentary activities like computer time may promote resilience to fatigue and depressive symptoms during future community stressor events. Further research into these relationships is warranted.

Lifestyle Empowerment for Alzheimer's Prevention Prescribed by Physicians: Methods and Adaptations to COVID-19

The health care system is insufficiently capitalizing on the benefits of physical exercise in America's aging population. Few tools exist to help clinicians incorporate physical activity into their clinical care, while barriers limit older adults from initiating and maintaining exercise programs. The Lifestyle Empowerment for Alzheimer's Prevention (LEAP! Rx) Program has been designed to support providers and participants in lifestyle change. LEAP! Rx uses two forms of participant enrollment: physician referrals through electronic health records and self-referrals to test the efficacy of delivering a community-based exercise and healthy lifestyle program to older adults. After referral into the program, participants are randomized to receive the LEAP! Rx Program or are placed in a standard-of-care group to receive the program later. The LEAP! Rx program consists of a personalized and structured exercise program, lifestyle education, and mobile health monitoring. This includes a 12-week Empowerment phase with coaching and supervised exercise training, followed by a 40-week Lifestyle phase with intermittent supervised exercise and coaching. Lifestyle education includes monthly, evidence-based classes on optimal aging. The evaluation of LEAP! Rx focuses on 1) the assessment of implementation and scalability of the LEAP!Rx Program for clinicians and patients 2) the effect of the LEAP! Rx Program on cardiorespiratory fitness, 3) the impact of the LEAP! Rx Program on secondary intervention outcome measures of chronic disease risk factors, including insulin resistance, body composition, and lipids. If successful, this study's findings could advance future healthcare practices, providing a new and practical approach to aging and chronic disease prevention.

The Quality of Life of Older Adults in Rural Eastern India and Its Influencing Factors: A Cross-Sectional Study

Aims This study aimed to assess the quality of life (QoL) of older adults in rural Odisha, India, exploring its multidimensional nature across physical, psychological, social, and environmental domains. The impact of depression and various sociodemographic factors on QoL was also investigated. Methods The research was conducted in the Tangi block of Khordha district, Odisha, encompassing 468 older adults. The World Health Organization Quality of Life Brief Version (WHOQOL-BREF) questionnaire, Geriatric Depression Scale (GDS-15), and sociodemographic questionnaire were used in data collection. Sampling employed a multistage approach, with statistical analysis utilizing Statistical Package for the Social Sciences (SPSS) version 20 (IBM SPSS Statistics, Armonk, NY), including t-tests for normally distributed data and the Mann-Whitney U test for non-normally distributed data. Results The QoL of older adults in rural Odisha showed variability, with physical and social domains exhibiting relatively positive scores compared to psychological and environmental domains. Depression significantly impacted all QoL dimensions, with the most profound effect observed in global QoL and global health. Sociodemographic factors such as employment, substance use, elder abuse, adverse life events, and poverty were identified as significant determinants of global QoL. Additionally, recreational activity, elder abuse, education, and employment significantly affected all QoL domains. Conclusions This study reveals the complex landscape of QoL of older adults in rural Odisha. The findings emphasize the need for comprehensive interventions targeting mental health, social support, and environmental conditions to enhance the overall well-being of this population. Policymakers and healthcare professionals should consider these multidimensional factors to develop effective strategies for improving the QoL of older adults in similar contexts.

Associations between social health factors, cognitive activity and neurostructural markers for brain health - A systematic literature review and meta-analysis

Social health factors (e.g., social activities or social support) and cognitive activity engagement have been associated with dementia risk, but their neural substrates have not been well established. This systematic review and meta-analysis summarizes the available evidence regarding the association between these factors and cerebral macro- and micro-structure. A comprehensive literature search was conducted in various databases, following predefined criteria. Heterogeneity, risk of publication bias and overall certainty of evidence were assessed using standardized scales and, whenever appropriate, random effects meta-analysis was conducted. Of 6715 identified articles, 43 were included. Overall, consistency of findings was low and methodological heterogeneity high for all outcomes. However, in some studies cognitive and social activities were positively associated with total brain, global and cortical grey matter and hippocampal volume as well as white matter microstructural integrity. Furthermore, structural social network characteristics (e.g., social network size) were associated with regional grey matter volumes, while functional social network characteristics (e.g., social support) were additionally associated with total brain volume. Meta-analyses revealed small but significant partial correlations between cognitive and social activities and hippocampal (three studies; n = 892; rz =0.07) and white matter hyperintensity volume (three studies; n = 2934; rz =-0.04). More prospective studies are needed to assess temporal associations.

What is the 'voltage drop' when an effective health promoting intervention for older adults-Choose to Move (Phase 3)-Is implemented at broad scale?

BACKGROUND

Choose to Move (CTM), an effective health-promoting intervention for older adults, was scaled-up across British Columbia, Canada. Adaptations that enable implementation at scale may lead to 'voltage drop'-diminished positive effects of the intervention. For CTM Phase 3 we assessed: i. implementation; ii. impact on physical activity, mobility, social isolation, loneliness and health-related quality of life (impact outcomes); iii. whether intervention effects were maintained; iv) voltage drop, compared with previous CTM phases.

METHODS

We conducted a type 2 hybrid effectiveness-implementation pre-post study of CTM; older adult participants (n = 1012; mean age 72.9, SD = 6.3 years; 80.6% female) were recruited by community delivery partners. We assessed CTM implementation indicators and impact outcomes via survey at 0 (baseline), 3 (mid-intervention), 6 (end-intervention) and 18 (12-month follow-up) months. We fitted mixed-effects models to describe change in impact outcomes in younger (60-74 years) and older (≥ 75 years) participants. We quantified voltage drop as percent of effect size (change from baseline to 3- and 6-months) retained in Phase 3 compared with Phases 1-2.

RESULTS

Adaptation did not compromise fidelity of CTM Phase 3 as program components were delivered as intended. PA increased during the first 3 months in younger (+1 days/week) and older (+0.9 days/week) participants (p<0.001), and was maintained at 6- and 18-months. In all participants, social isolation and loneliness decreased during the intervention, but increased during follow-up. Mobility improved during the intervention in younger participants only. Health-related quality of life according to EQ-5D-5L score did not change significantly in younger or older participants. However, EQ-5D-5L visual analog scale score increased during the intervention in younger participants (p<0.001), and this increase was maintained during follow-up. Across all outcomes, the median difference in effect size, or voltage drop, between Phase 3 and Phases 1-2 was 52.6%. However, declines in social isolation were almost two times greater in Phase 3, compared with Phases 1-2.

CONCLUSION

Benefits of health-promoting interventions-like CTM-can be retained when implemented at broad scale. Diminished social isolation in Phase 3 reflects how CTM was adapted to enhance opportunities for older adults to socially connect. Thus, although intervention effects may be reduced at scale-up, voltage drop is not inevitable.

Cognitive resilience depends on white matter connectivity: The Maastricht Study

INTRODUCTION

Differences in brain network connectivity may reflect the capability of the neurological substrate to compensate for brain damage and preserve cognitive function (cognitive reserve). We examined the associations between white matter connectivity, brain damage markers, and cognition in a population sample of middle-aged individuals.

METHODS

A total of 4759 participants from The Maastricht Study (mean age = 59.2, SD = 8.7, 50.2% male) underwent cognitive testing and diffusion magnetic resonance imaging (dMRI), from which brain volume, structural connectivity, and vascular damage were quantified. Multivariable linear regression was used to investigate whether connectivity modified the association between brain damage and cognition, adjusted for demographic and cardiometabolic risk factors.

RESULTS

More atrophic and vascular brain damage was associated with worse cognition scores. Increasing connectivity moderated the negative association between damage and cognition (χ² = 8.64, df = 3, p ≤ 0.001); individuals with high damage but strong connectivity showed normal cognition.

DISCUSSION

Findings support the reserve hypothesis by showing that brain connectivity is associated with cognitive resilience.

Community-Dwelling Older Adults and Physical Activity Recommendations: Patterns of Aerobic, Strengthening, and Balance Activities

Though it is known that most older adults do not meet the recommended physical activity (PA) guidelines, little is known regarding their participation in balance activities or the full guidelines. Therefore, we sought to describe PA patterns among 1,352 community-dwelling older adult participants of the Adult Changes in Thought study, a longitudinal cohort study exploring dementia-related risk factors. We used a modified version of the Community Healthy Activities Model Program for Seniors questionnaire to explore PA performed and classify participants as meeting or not meeting the full guidelines or any component of the guidelines. Logistic regression was used to identify factors associated with meeting PA guidelines. Despite performing 10 hr of weekly PA, only 11% of participants met the full guidelines. Older age, greater body mass index, needing assistance with instrumental daily activities, and heart disease were associated with decreased odds of meeting PA guidelines. These results can guide interventions that address PA among older adults.

Boxing vs Sensory Exercise for Parkinson's Disease: A Double-Blinded Randomized Controlled Trial

Background. Exercise is increasingly becoming recognized as an important adjunct to medications in the clinical management of Parkinson's disease (PD). Boxing and sensory exercise have shown immediate benefits, but whether they continue beyond program completion is unknown. This study aimed to investigate the effects of boxing and sensory training on motor symptoms of PD, and whether these benefits remain upon completion of the intervention. Methods. In this 20-week double-blinded randomized controlled trial, 40 participants with idiopathic PD were randomized into 2 treatment groups, (n = 20) boxing or (n = 20) sensory exercise. Participants completed 10 weeks of intervention. Motor symptoms were assessed at (week 0, 10, and 20) using the Unified Parkinson's Disease Rating Scale (UPDRS-III). Data were analyzed using SPSS, and repeated-measures ANOVA was conducted. Results. A significant interaction effect between groups and time were observed F(1, 39) = 4.566, P = .036, where the sensory group improved in comparison to the boxing group. Post hoc analysis revealed that in comparison to boxing, the effects of exercise did not wear off at washout (week 20) P < .006. Conclusion. Future rehabilitation research should incorporate similar measures to explore whether effects of exercise wear off post intervention.

Testing the effectiveness of community-engaged citizen science to promote physical activity, foster healthier neighborhood environments, and advance health equity in vulnerable communities: The Steps for Change randomized controlled trial design and methods

While low-income midlife and older adults are disproportionately affected by non-communicable diseases that can be alleviated by regular physical activity, few physical activity programs have been developed specifically with their needs in mind. Those programs that are available typically do not address the recognized local environmental factors that can impact physical activity. The specific aim of the Steps for Change cluster-randomized controlled trial is to compare systematically the initial (one-year) and sustained (two-year) multi-level impacts of an evidence-based person-level physical activity intervention (Active Living Every Day [ALED] and age-relevant health education information), versus the ALED program in combination with a novel neighborhood-level citizen science intervention called Our Voice. The study sample (N = 300) consists of insufficiently active adults ages 40 years and over living in or around affordable senior public housing settings. Major study assessments occur at baseline, 12, and 24 months. The primary outcome is 12-month change in walking, and secondary outcomes include other forms of physical activity, assessed via validated self-report measures supported by accelerometry, and physical function and well-being variables. Additional intervention impacts are assessed at 24 months. Potential mediators and moderators of intervention success will be explored to better determine which subgroups do best with which type of intervention. Here we present the study design and methods, including recruitment strategies and yields. TRIAL REGISTRATION: clinicaltrial.gov Identifier = NCT03041415.

Status Quo or Drop-Off: Do Older Adults Maintain Benefits From Choose to Move-A Scaled-Up Physical Activity Program-12 Months After Withdrawing the Intervention?

BACKGROUND

Choose to Move is one of few scaled-up health-promoting interventions for older adults. The authors evaluated whether Choose to Move participants maintained their intervention-related gains in physical activity (PA), mobility, and social connectedness 12 months after the intervention ended.

METHODS

The authors assessed PA, mobility, loneliness, social isolation, and muscle strength via questionnaire and objective measures in 235 older adults at 0 months (baseline), 6 months (end of intervention), and 18 months (12-months postintervention). The authors fitted linear mixed models to examine the change in each outcome from 6 to 18 months (primary objective) and 0 to 18 months (secondary objective) and reported by age group (60-74 and ≥75 y).

RESULTS

In younger participants, PA decreased between 6 and 18 months, but remained significantly higher than at baseline. Intervention-related benefits in loneliness, social isolation, mobility, and muscle strength were maintained between 6 and 18 months in the younger participants. Older participants maintained their intervention benefits in loneliness, mobility, and muscle strength. When compared with baseline values, PA levels in older participants were unchanged, whereas social isolation increased.

CONCLUSIONS

Older adults maintained some, but not all, health benefits of Choose to Move 12 months after the intervention ended. Long-term commitments are needed to deliver effective health-promoting interventions for older adults if benefits are to be maintained.

Pragmatic Evaluation of Older Adults' Physical Activity in Scale-Up Studies: Is the Single-Item Measure a Reasonable Option?

Convergent validity and responsiveness to change of the single-item physical activity measure were assessed in adults aged 60 years and older, at baseline (n = 205) and 6 months (n = 177) of a health promotion program, Choose to Move. Spearman correlations were used to examine associations between physical activity as measured by the single-item measure and the Community Health Activities Model Program for Seniors (CHAMPS) questionnaire at baseline and for 6-month change in all participants and for sex and age (60-74 years, and ≥75 years) subgroups. Effect size assessed responsiveness to change in physical activity for both tools. Baseline physical activity by the single-item measure correlated moderately with physical activity by the CHAMPS questionnaire in all participants and subgroups. Correlations were weaker for change in physical activity. Effect size for physical activity change was larger for the single-item measure than for the CHAMPS questionnaire. The single-item measure is a valid, pragmatic tool for use in intervention and scale-up studies with older adults.

Lifestyle exercise attenuates immunosenescence; flow cytometry analysis

Background

Interaction of physical activity and overall immune profile is very complex and depends on the intensity, duration and frequency of undertaken physical activity, the exposure to cytomegalovirus (CMV) infection and the age-related changes in the immune system. Daily physical activity, which particularly influences immunity, declines dramatically with age. Therefore, the aim of the study was to explain whether physical activity sustained throughout life can attenuate or reverse immunosenescence.

Methods

Ninety-nine older adults (60–90 years) were recruited for the study. According to the 6-min walk test (6WMT), the Åstrand-Ryhming bike test (VO₂max) and Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire, the individuals were classified as physically active (n = 34) and inactive (n = 20) groups. The analysis of T lymphocytes between active vs. inactive participants was performed using eight-parameter flow cytometry.

Results

Analysis of the baseline peripheral naïve and memory T lymphocytes showed a significant relationship of lifestyle exercise with the CD4/CD8 ratio. Above 50% of physically active participants demonstrated the CD4/CD8 ratio ≥ 1 or ≤ 2.5 contrary to the inactive group who showed the ratio < 1. The older adults with the result of 6WMT > 1.3 m/s and VO₂max > 35 mL/kg/min had a significantly higher CD4⁺CD45RA⁺ T lymphocyte percentage and also a higher ratio of CD4⁺CD45RA⁺/CD4⁺CD45RO⁺. Interestingly, in active older adults with IgG CMV⁺ (n = 30) the count of CD4⁺CD45RA⁺ T lymphocytes was higher than in the inactive group with IgG CMV⁺ (n = 20).

Conclusion

Based on the flow cytometry analysis, we concluded that lifestyle exercise could lead to rejuvenation of the immune system by increasing the percentage of naïve T lymphocytes or by reducing the tendency of the inverse CD4/CD8 ratio.

Circulating Mediators of Apoptosis and Inflammation in Aging; Physical Exercise Intervention

Sarcopenia is an age-related loss of skeletal muscle mass caused by many cellular mechanisms and also by lifestyle factors such as low daily physical activity. In addition, it has been shown that sarcopenia may be associated with inflammation and cognitive impairment in old age. Regular exercise is key in reducing inflammation and preventing sarcopenia and diseases related to cognitive impairment. The study was designed to assess the impact of exercise training on circulating apoptotic and inflammatory markers of sarcopenia in older adults. Eighty older adults aged 70.5 ± 5.8 years were randomized to the physically active group who participated in a 10-month Tai-Chi training session (TC, n = 40) and the control group who participated in health education sessions (HE, n = 40). Tai-Chi training caused a significant decrease in fat mass (FM) by 3.02 ± 3.99%, but an increase in appendicular skeletal muscle mass index (ASMI) by 1.76 ± 3.17% and gait speed by 9.07 ± 11.45%. Tai-Chi training elevated the plasma levels of C-reactive protein (CRP), tumor necrosis factor (TNFα), and tumor necrosis receptor factor II (TNFRII), and decreased caspases 8 and 9. Despite the increase in TNFα, apoptosis was not initiated, i.e., the cell-free DNA level did not change in the TC group. The study demonstrated that Tai-Chi training significantly reduced the symptoms of sarcopenia through the changes in body composition and physical performance, and improvements in cytokine-related mechanisms of apoptosis.

"It makes me feel not so alone": features of the Choose to Move physical activity intervention that reduce loneliness in older adults

BACKGROUND

Despite the well-known health benefits of physical activity (PA), older adults are the least active citizens. Older adults are also at risk for loneliness. Given that lonely individuals are at risk for accelerated loss of physical functioning and health with age, PA interventions that aim to enhance social connectedness may decrease loneliness and increase long-term PA participation. The objectives of this mixed-method study are to: (1) evaluate whether an evidence-based PA intervention (Choose to Move; CTM) influenced PA and loneliness differently among self-identified 'lonely' versus 'not lonely' older adults and (2) to describe factors within CTM components most likely to promote social connectedness/reduce loneliness.

METHODS

CTM is a flexible, scalable, community-based health promoting physical activity intervention for older adults. Two community delivery partner organizations delivered 56 CTM programs in 26 urban locations across British Columbia. We collected survey data from participants (n = 458 at baseline) at 0 (baseline), 3 (mid-intervention) and 6 (post-intervention) months. We conducted in depth interviews with a subset of older adults to understand how CTM facilitated or impeded their PA and social connectedness.

RESULTS

PA increased significantly from baseline to 3 months in lonely and not lonely participants. PA decreased significantly from 3 to 6 months in lonely participants; however, PA at 6 months remained significantly above baseline levels in both groups. Loneliness decreased significantly from baseline to 3 and 6 months in participants identifying as lonely at baseline. Factors within CTM components that promote social connectedness/reduce loneliness include: Activity coach characteristics/personality traits and approaches; opportunity to share information and experiences and learn from others; engagement with others who share similar/familiar experiences; increased opportunity for meaningful interaction; and accountability.

CONCLUSION

Health promoting interventions that focus on PA and social connectedness through group-based activities can effectively reduce social isolation and loneliness of older adults. Given the 'epidemic of loneliness' that plagues many countries currently, these kinds of interventions are timely and important. Research that further delineates mechanisms (e.g., sharing experiences vs. lectures), that modify the effect of an intervention on social connectedness outcomes for older adults engaged in community-based PA programs would be a welcome addition to the literature.

Physical activity is good for older adults-but is programme implementation being overlooked? A systematic review of intervention studies that reported frameworks or measures of implementation

OBJECTIVE

To examine older adult physical activity (PA) intervention studies that evaluated implementation and/or scale-up. Research question 1: What implementation and/or scale-up indicators (specific, observable and measurable characteristics that show the progress of implementation) were reported? Research question 2: What implementation and/or scale-up frameworks were reported? Research question 3: Did studies evaluate the relationship between implementation or scale-up of the intervention and individual level health/behaviour outcomes? If yes, how?

DESIGN

Systematic review.

DATA SOURCES

Publications from electronic databases and hand searches (2000 to December 2019).

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Any PA intervention studies with community-dwelling older adult participants (mean age ≥60 years). Required indicators: (a) Must report amount of PA as an outcome, with validated self-report or objective measures, and (b) Must have reported at least one implementation or scale-up framework and/or one implementation or scale-up indicator.

RESULTS

137 studies were included for research question 1, 11 for question 2 and 22 for question 3. 137 studies reported an implementation indicator: 14 unique indicators. None were specified as indicators for scale-up evaluation. 11 studies were guided by an implementation or scale-up framework. 22 studies described a relationship between an implementation indicator and an individual-level health outcome.

CONCLUSION

There is need for implementation research that extends beyond analysis at the individual level, includes clearly defined indicators and provides a guiding framework to support PA initiatives in older adults. Such implementation studies should evaluate factors in the broader context (eg,political, environmental) that influence scale-up.

PROSPERO REGISTRATION

CRD42018091839.

Feasibility of low-cost accelerometers in measuring functional recovery after major oncologic surgery

BACKGROUND AND OBJECTIVES

Low-cost consumer-based activity monitors (CAMs), such as the Fitbit, are popular for fitness and wellness tracking. Functional status is an excellent predictor of postoperative outcomes, yet objective measurements are resource-intensive. The aim of this study is to demonstrate the feasibility of using activity monitors during the perioperative period in patients undergoing major oncologic surgery.

METHODS

An institution review board proved that a prospective study was conducted. CAMs were worn throughout the perioperative period and accelerometer data were collected. Baseline and 21-days follow-up functional measures included short physical performance battery, Community Health Activities Model Program questionnaire, mobility assessment tool-short form, and 400 m walk.

RESULTS

A total of 19 of 22 (86%) patients who wore a CAM during the perioperative period had analyzable data. Compliance with wearing the device varied significantly: 100% preadmission, 19% in-hospital, and 82% postdischarge. Median daily steps decreased from preadmission to postdischarge (77% median reduction). Established resource-intensive measures of functional status did not perform well as measures of decreased functional status and activity when comparing baseline to 21-day postdischarge assessments.

CONCLUSIONS

Activity monitors are a feasible, low-cost measure of perioperative activity for patients undergoing major surgery, and may be useful in identifying patients vulnerable to postsurgical complications.

Use it or lose it: a qualitative study of the maintenance of physical activity in older adults

BACKGROUND

Lack of physical activity (PA) is a recognised global public health problem, which is increasing in prevalence with a detrimental impact on the pattern of disease worldwide. In the UK, older adults comprise the most sedentary group, with only 57% of males and 52% of females aged 65-74 years and 43% of males and 21% of females aged 75-84 years meeting PA recommendations. PA confers multiple health benefits including increased stamina, muscle, bone and joint strength, increased independence and reduced risk of falls in old age. Despite benefits experienced during time-limited PA programmes, increased PA is not always continued. This study aimed to provide a better understanding of PA maintenance behaviours in older people.

METHODS

Face to face semi-structured interviews were conducted with adults who completed one of two strength and balance exercise programmes as part of the ProAct65+ trial: group (FaME) and home based (OTAGO) exercises. Five GP practices in Nottingham and Derby were recruited and invited people aged 65 years and older who met eligibility criteria. Interviews were conducted in participants' homes. Interviews explored PA levels pre and post intervention, perceived health benefits, facilitators, barriers and use of technology for PA maintenance. The interviews were transcribed verbatim and analysed using framework analysis and the software NVivo10.

RESULTS

Fifteen participants from each intervention group were interviewed. The FaME group consisted of 10 females and 5 males, age range of 70-88 years. The OTAGO group consisted of 12 females and 3 males aged 72-95 years. Important themes identified were physical, social, psychological and environmental facilitators and barriers. These included increased physical autonomy, enjoyment, positive evaluation of the activity and physical benefits, importance of social interaction, positive feedback, development of behaviour considered normal or habitual, motivation and self-efficacy. Some participants used technologies not included in the original interventions, like pedometers and smart phones to motivate themselves.

CONCLUSIONS

A range of modifiable factors influence continued participation in PA at the end of exercise programmes. The findings from this study will inform the commissioning and quality improvement of future PA programmes and development of an intervention to enhance continuation of PA after exercise interventions in older adults.

Factors that influence implementation at scale of a community-based health promotion intervention for older adults

Background

Despite the many known benefits of physical activity (PA), relatively few older adults are active on a regular basis. Older adult PA interventions delivered in controlled settings showed promising results. However, to achieve population level health impact, programs must be effectively scaled-up, and few interventions have achieved this. To effectively scale-up it is essential to identify contextual factors that facilitate or impede implementation at scale. Our aim is to describe factors that influence implementation at scale of a health promotion intervention for older adults (Choose to Move). This implementation evaluation complements our previously published study that assessed the impact of Choose to Move on older adult health indicators.

Methods

To describe factors that influenced implementation our evaluation targeted five distinct levels across a socioecological continuum. Four members of our project team conducted semi-structured interviews by telephone with 1) leaders of delivery partner organizations (n = 13) 2) recreation managers (n = 6), recreation coordinators (n = 27), activity coaches (n = 36) and participants (n = 42) [August 2015 – April 2017]. Interviews were audio-recorded and professionally transcribed and data were analyzed using framework analysis.

Results

Partners agreed on the timeliness and need for scaled-up evidence-based health promotion programs for older adults. Choose to Move aligned with organizational priorities, visions and strategic directions and was deemed easy to deliver, flexible and adaptable. Partners also noted the critical role played by our project team as the support unit. However, partners noted availability of financial resources as a potential barrier to sustainability.

Conclusions

Even relatively simple evidence-based interventions can be challenging to scale-up and sustain. To ensure successful implementation it is essential to align with multilevel socioecological perspectives and assess the vast array of contextual factors that are at the core of better understanding successful implementation.

Social Engagement and Amyloid-β-Related Cognitive Decline in Cognitively Normal Older Adults

OBJECTIVE

Public health recommendations promote social engagement to reduce risk of cognitive decline and dementia. The objective of this study was to evaluate the longitudinal associations of social engagement and cognition in cognitively normal older adults with varying levels of neocortical amyloid-β, the Alzheimer's disease (AD) pathologic marker.

METHODS

Two hundred seventeen men and women, age 63-89 underwent assessments for social engagement and cognitive performance at baseline and 3 years later using the Community Healthy Activities Model Program for Seniors questionnaire and the Preclinical Alzheimer Cognitive Composite (PACC). Amyloid-β was measured using Pittsburgh compound B-PET. Multivariable regression models estimated main and interactive effects of baseline social engagement and amyloid-β on cognitive change. Reciprocal models estimated main and interactive effects of baseline cognitive performance and amyloid-β on change in social engagement.

RESULTS

Baseline social engagement was associated with PACC change as a modifier but not as a main effect. Lower baseline social engagement was associated with greater amyloid-β-related PACC decline, while higher baseline social engagement was associated with relative preservation of PACC scores (β = 0.05, p = 0.03). Reciprocally, lower baseline PACC score was associated with decline in social engagement score (β = 1.1, p = 0.02). This association was not modified by amyloid-β, and there was no direct association of amyloid-β with change in social engagement.

CONCLUSIONS

Low social engagement may be a marker of neurocognitive vulnerability in older adults who are cognitively normal but have evidence of AD pathophysiologic change. Understanding changes in social engagement in older adults may lead to earlier diagnosis of AD and advances in evidence-based prevention and treatment.

"The Social Side Is as Important as the Physical Side": Older Men's Experiences of Physical Activity

North American “hegemonic masculinity” values strength, autonomy, independence, and resilience among its ideals. As men age, their capacity is increasingly challenged and demands that they adapt to new physical and social realities. Although some reports on effective health-promoting programs for men are emerging, there is a need to better understand older men’s experiences with their mobility and physical activity. This is a photovoice study with men (N = 14) who were enrolled in a choice-based activity program for low active men. Based on in-depth interviews and analysis of over 800 photographs, three key themes emerged: the importance of social connectedness, supportive environments, and positive attitude toward the future. Findings are presented via a theoretical view of masculinities as socially constructed through relational behaviors and norms. Analyses provide insight into older men’s motivation to be physically active and highlight the need for programs and policies customized to promote physical activity of older men.

Men on the Move: A Randomized Controlled Feasibility Trial of a Scalable, Choice-Based, Physical Activity and Active Transportation Intervention for Older Men

We conducted Men on the Move, a 12-week randomized controlled feasibility trial of a scalable, choice-based, physical activity (PA) and active transportation intervention. Participants were community-dwelling men aged 60 years and older (n = 29 intervention [INT] and n = 29 waitlist control [CON]). Trained activity coaches delivered: (a) one-on-one participant consultations to develop personal action plans for PA and active transportation, (b) monthly group-based motivational meetings, (c) weekly telephone support, (d) complimentary recreation and transit passes, and (e) pedometers and diaries for self-monitoring. Men on the Move demonstrated high rates of recruitment, retention, and intervention adherence. INT chose a variety of group-based and individual PAs and destinations for their personal action plans. At 12 weeks, INT achieved more steps, moderate-vigorous PA, and energy expenditure than CON. INT was also more likely to take transit and meet national guideline levels of PA. At 24 weeks follow-up, INT benefits were sustained for moderate-vigorous PA and energy expenditure.

Association of screen time and physical activity with health-related quality of life in Iranian children and adolescents

Background

Health-related quality of life (HRQoL) is a multidimensional concept with significant effects and children and adolescence; while physical activity (PA) and screen time (ST) have been suggested as its probable predictors. Present study aims to investigate the association of PA, ST and their combination, with HRQoL in a nationally-representative sample of Iranian children and adolescents.

Methods

As for the estimated sample size, 25,000 students aged 6–18 years were selected via multi-stage cluster sampling from 30 provinces of Iran. Sociodemographic data was obtained by using the questionnaire of the World Health Organization-Global school based student health survey (GSHS). Persian Pediatric Quality of Life inventory (PedsQL) and Physical Activity Questionnaire for the pediatric age group (PAQ-A) were applied for evaluating HRQoL and PA, respectively. PA scores 1–1.9 and 2–5 were respectively considered as low and high PA. The average duration of time spent on watching TV and leisure time computer use were considered as ST behaviors. ST of less than 2 h was considered low.

Results

Out of 25,000 invited individuals, 23,043 students (mean age: 12.5) completed the study (response rate: 92.17%). In linear regression models, ST duration had significant inverse association with total QoL (β: − 0.49, p < 0.05). PA showed positive significant associations with HRQoL total score (β: 1.8, p < 0.05). Joint association of PA and ST revealed the strongest association of “high PA-low ST” category with total HRQoL (β: 2.2, p < 0.05); while “high PA-high ST” showed better total HRQoL score (β: 1.3) compared to “low PA-low ST” subgroup.

Conclusion

Both PA and ST are significantly and independently associated with HRQoL in Iranian children and adolescents; while the adverse effect of prolonged ST could be diminished by a high PA.

Functional status measures for the COPD patient: A practical categorization

The objective of this study is to review available functional status measures (FSMs) validated for use in the chronic obstructive pulmonary disease (COPD) population and categorizing the measures by their commonalities to formulate a framework that supports clinicians in the selection and application of FSMs. A literature review identifying valid and reliable measures of functional status for people with COPD was undertaken. Measures were thematically analyzed and categorized to develop a framework for clinical application. A variety of measures of activity levels exist, with 35 included in this review. Thematic categorization identified five categories of measures: daily activity, impact, surrogate, performance-based, and disability-based measures. The vast variety of FSMs available for clinicians to apply with people who have COPD may be overwhelming, and selection must be thoughtfully based on the nature of the population being studied/evaluated, and aims of evaluation being conducted, not simply as a standard measure used at the institution. Psychometric testing is a critical feature to a strong instrument and issues of reliability, validity, and responsiveness need to be understood prior to measurement use. Contextual nature of measures such as language used and activities measured is also important. A categorical framework to support clinicians in the selection and application of FSMs has been presented in this article.

Effect of a home-based exercise program on functional mobility and quality of life in elderly people: protocol of a single-blind, randomized controlled trial

Background

Elderly people have high rates of functional decline, which compromises independence, self-confidence, and quality of life (QoL). Physical exercise leads to significant improvements in strength, balance, functional mobility, and QoL, but there is still reduced access to this therapeutic strategy due to difficulties in locomotion to training centers or lack of adaptation to the exercise environment.

Methods/design

The purpose of this clinical trial will be to verify the effect of a progressive and semi-supervised, home-based exercise program on the functional mobility, and in the QoL of sedentary elderly people. This is a protocol of a consecutive, single-center, single-blind, and randomized controlled trial. The design, conduct, and report follows the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) guidelines. Sedentary elderly people will be enrolled, and randomly allocated into two groups. The intervention group will perform exercises in their own home and the control group will not perform exercises. The evaluations will occur at study enrollment and after 3 months of intervention, and will be performed using the functional mobility Timed Up & Go (TUG) test and sociodemographic and QoL questionnaires. In the statistical analysis, comparisons of mean and correlation analyses will be performed. The primary expected outcome is the improvement in functional mobility verified through the TUG test and the secondary outcome is the improvement in QoL verified by the WHOQOL-OLD.

Discussion

The lack of scientific evidence demonstrating the benefits of semi-supervised home exercise on functional mobility and QoL in elderly people represents an obstacle to the development of guidelines for clinical practice and for policy-makers. The World Health Organization highlighted the importance of musculoskeletal health programs for elderly people, and the exercise program described in this protocol was designed to be viable, easy to implement, and inexpensive, and could be performed at the home of elderly subjects after receiving only guidelines and follow-up via periodic visits. Based on these facts, we hope that this study will demonstrate that a well-structured, home-based exercise program can be effective in improving functional mobility and QoL of sedentary elderly people, even without constant supervision during exercise.

Trial registration

Registro Brasileiro de Ensaios Clínicos (ReBEC), Identifier: RBR-3cqzfy. Registered on 2 December 2016.

Electronic supplementary material

The online version of this article (10.1186/s13063-018-3061-1) contains supplementary material, which is available to authorized users.

Implementation of a co-designed physical activity program for older adults: positive impact when delivered at scale

Background

Despite known health benefits of physical activity (PA), older adults remain among the least physically active age group globally with 30–60% not meeting guidelines. In Canada, 87% do not meet recommended guidelines. To influence population health, interventions that are effective in small trials must be disseminated at scale. Despite evidence for efficacy, few PA interventions are scaled up to reach the wider community. In 2015, British Columbia (BC) Ministry of Health released a PA strategy where older adults were identified as a priority. In partnership with the Ministry, the Active Aging Research Team co-created a health promotion program called Choose to Move (CTM). CTM will be implemented in three phases at increasingly greater scale across BC. The objective of this study is to evaluate the effectiveness of CTM during Phase I (pilot) and Phase II (initial scale up) on PA, mobility, and social connectedness among older adults in BC, Canada.

Methods

We used a type 2 hybrid effectiveness-implementation study design, and herein focus on effectiveness. The implementation evaluation will be published as a companion paper elsewhere. Two community delivery partner organizations delivered 56 CTM programs in 26 large and small urban locations across BC. Outcome measurement occurred at 0 (baseline), 3 (mid-intervention) and 6 (post-intervention) months. We collected survey data from all participants (n = 458; province-wide) and also conducted a subset evaluation (n = 209).

Results

PA increased significantly during the active intervention phase (baseline-3 months) in younger (60–74 yrs.; + 1.6 days/week; p < 0.001) and older (≥75 yrs.; + 1.0 days/week; p < 0.001) participants. The increase was sustained at 6 months in younger participants only, who remained significantly more active than at baseline (+ 1.4 days/week; p < 0.001). Social exclusion indicators declined significantly in the younger group. Mobility and strength improved significantly at 3 months in the younger group, and in both groups at 6 months.

Conclusions

CTM adopted central tenets of implementation science that consider the complicated systems where interventions are delivered to improve public health. In this iteration of CTM we demonstrate that a partner-based health promotion intervention can be effectively implemented across settings to enhance PA, mobility and social connectedness in older adults.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-6210-2) contains supplementary material, which is available to authorized users.

Engagement in a Community Physical Activity Program and Its Effects Upon the Health-Related Quality of Life of Elderly People: A Cross-Sectional Study

BACKGROUND

Aging is related to an increase in the prevalence of noncommunicable diseases and impairments in health-related quality of life. Physical activity is a nonpharmacological intervention that is known to prevent and manage noncommunicable diseases and improve quality of life.

OBJECTIVES

To compare the quality of life, as measured by the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), of elderly participants and nonparticipants in a community physical activity program.

METHODS

One hundred elderly men and women (age > 60 years) who were either sedentary (sedentary [S] group; n = 50, 30 men) or physically active and attended a community physical activity program (physical activity [PA] group; n = 50, 30 men) took part in the study. All participants completed the SF-36 subscales to assess their quality of life.

RESULTS

The PA group reported higher values on the functioning capacity and general health perceptions subscales of the SF-36 when compared with the S group. Conversely, scores on the following SF-36 subscales did not differ between the groups: role limitations due to physical problems, pain, vitality, social functioning, role limitations due to emotional problems, and mental health. A ceiling effect was evident in both groups for all SF-36 subscales.

CONCLUSIONS

The SF-36 subscales were not sufficiently sensitive to detect differences between the S and PA groups (except for functioning capacity and general health perceptions), probably because of ceiling effects.

Protective effects of helmets on bicycle-related injuries in elderly individuals

OBJECTIVE

The increasing frequency of bicycle-related injuries is due to the growing elderly population and their increasing physical activity. This study aimed to compare the protective effects of helmets on bicycle-related injuries in elderly individuals compared with those in younger adults.

METHODS

Data from the Korean emergency department-based Injury In-depth Surveillance database from eight emergency departments during 2011-2016 were retrospectively analysed. The subjects sustained injuries while riding bicycles. Cases with unknown clinical outcomes were excluded. Covariates included mechanism, place and time of injury. The primary outcome was traumatic brain injury (TBI) incidence, and the secondary outcomes were in-hospital mortality and severe trauma. The effects of helmets on these outcomes were analysed and differences in effects were determined using logistic regression analysis. Subsequently, the differences in the effects of helmets use between age groups were examined by using interaction analysis RESULTS: Of 7181 adults, 1253 were aged >65 years. The injury incidents showed a bimodal pattern with peaks around ages 20 and 50 years. Meanwhile, the helmet-wearing rate showed a unimodal pattern with its peak at age 35-40 years; it decreased consistently with age. By multivariate analysis, helmet-wearing was associated with a reduced TBI incidence (OR 0.76; 95% CI 0.57 to 0.99) and severe trauma (OR 0.78; 95% CI 0.65 to 0.93). The effects of helmets increased in elderly individuals (TBI (p=0.022) and severe trauma (p=0.024)).

CONCLUSION

The protective effects of helmets on bicycle-related injuries are greater for elderly individuals, thus reducing TBI incidence.

Keeping active: maintenance of physical activity after exercise programmes for older adults

OBJECTIVES

To explore factors associated with maintenance of moderate-to-vigorous physical activity (MVPA) in community-dwelling adults aged ≥65 years after completing a 24-week exercise programme.

STUDY DESIGN

This is a cohort study nested within a randomised controlled trial evaluating group- and home-based exercise programmes for older people in England.

METHODS

MVPA levels and factors potentially associated with physical activity (PA) were self-reported at recruitment, 6, 12, 18 and 24 months after exercise programme. Multilevel logistic regression estimated odds ratios (ORs) for achieving target MVPA level (150 min/week) 6-24 months after exercise programmes ended.

RESULTS

Older people (OR per year increase: 0.89, 95% confidence interval [CI] 0.86, 0.93) and women (OR 0.47, 95% CI 0.33, 0.67) were less likely to achieve target MVPA. Those physically active at recruitment (OR 11.28, 95% CI 7.95, 16.01), with wider social networks (OR per unit increase in Lubben Social Network Scale: 1.06, 95% CI 1.03, 1.10) and performing more sit-to-stands in 30 s (OR for quartile 3 compared with quartile 1: 1.87, 95% CI 1.12, 3.10), were more likely to achieve target MVPA. Negative exercise expectations increased the odds of achieving target MVPA but only among the less active at recruitment (OR per unit increase in Outcome and Expectation for Exercise negative subscale: 1.90, 95% CI 1.39, 2.60). Associations did not differ significantly across the follow-up period.

CONCLUSION

A range of factors are associated with maintenance of PA 6-24 months after exercise programmes. Factors are not more strongly associated with shorter vs longer term PA maintenance. Commissioners and providers should consider targeting maintenance interventions to those least likely to maintain PA.

Comparing Class-Based and Home-Based Exercise for Older Adults With Chronic Health Conditions: 12-Month Follow-Up of a Randomized Clinical Trial

OBJECTIVE

To assess the maintenance of physical activity (PA) and health gains among participants in a class-based (CB) or home-based (HB) PA intervention over a 12-month study period.

METHODS

A total of 172 adults aged 50 years and older were randomly allocated to either a CB or an HB intervention, each involving an intensive 3-month phase with a 9-month follow-up period. Measures at baseline, 3, 6, and 12 months included self-reported PA and health, body mass index, waist circumference (WC), blood pressure, cardiovascular endurance (6-min walk test), physical function, and functional fitness (senior fitness test). Outcomes were analyzed using generalized estimating equations.

RESULTS

Maximum improvement was typically observed at 3 or 6 months followed by a modest diminution, with no differences between groups. For body mass index, waist circumference, 6-min walk test, and senior fitness test, there was progressive improvement through the study period. Greater improvement was seen in the CB group compared with the HB group on three items on the senior fitness test (lower body strength and endurance [29% vs. 21%, p < .01], lower body flexibility [2.8 cm vs. 0.4 cm, p < .05], and dynamic agility [14% vs. 7%, p < .05]).

CONCLUSION

The interventions were largely comparable; thus, availability, preferences, and cost may better guide program choice.

A systematic review and meta-analysis of structural magnetic resonance imaging studies investigating cognitive and social activity levels in older adults

Population aging has prompted considerable interest in identifying modifiable factors that may help protect the brain and its functions. Collectively, epidemiological studies show that leisure activities with high mental and social demands are linked with better cognition in old age. The extent to which socio-intellectual activities relate to the brain's structure is, however, not yet fully understood. This systematic review and meta-analysis summarizes magnetic resonance imaging studies that have investigated whether cognitive and social activities correlate with measures of gray and white matter volume, white matter microstructure and white matter lesions. Across eighteen included studies (total n = 8429), activity levels were associated with whole-brain white matter volume, white matter lesions and regional gray matter volume, although effect sizes were small. No associations were found for global gray matter volume and the evidence concerning white matter microstructure was inconclusive. While the causality of the reviewed associations needs to be established, our findings implicate socio-intellectual activity levels as promising targets for interventions aimed at promoting healthy brain aging.

Association between physical activity and health-related quality of life in elderly individuals with pre-diabetes in rural Hunan Province, China: a cross-sectional study

OBJECTIVES

There are few data on the relationship between health-related quality of life (HRQoL) and physical activity among elderly individuals with pre-diabetes. This study aimed to determine if differences existed in HRQoL between individuals with pre-diabetes who were physically active compared with those who were physically inactive in rural China.

DESIGN, SETTING AND PARTICIPANTS

A cross-sectional survey was conducted among the elderly (≧60 years) in rural communities in Yiyang City of China. Multistage cluster random sampling was carried out to select 42 areas, and interviews were conducted among 434 elderly individuals with pre-diabetes. Pre-diabetes was screened using an oral glucose tolerance test.

MAIN OUTCOME MEASURES

The Medical Outcomes Study 36-Item Short Form Health Survey questionnaire was used to measure HRQoL. Physical activity was assessed using the International Physical Activity Questionnaire. Multivariate analysis of covariance (MANCOVA) was used to test for differences in HRQoL between the physically active group and the inactive group.

RESULTS

A total of 434 individuals with pre-diabetes were included in this study. The physical component summary (PCS) score of HRQoL was 42.1±10.2 and the mental component summary score was 46.4±8.9. A median total physical activity of 524 metabolic equivalent-min/week was reported. A significant MANCOVA model (Wilks' λ=0.962, F(2,423)=8.44, P<0.001) indicated that elderly individuals with pre-diabetes who were physically active reported higher PCS scores (M_diff=5.2, P<0.001, effective size=0.47) compared with those physically inactive after adjusting for the following covariates: age, gender, marital status, education, smoking, chronic disease, body mass index and waist:hip ratio.

CONCLUSIONS

The HRQoL of elderly individuals with pre-diabetes is poor in rural China. These findings demonstrated that elderly individuals with pre-diabetes who were physically active had higher PCS scores than those who were physically inactive. Furthermore, these results support the rationale for developing a physical activity intervention for HRQoL of individuals with pre-diabetes.

TRIAL REGISTRATION NUMBER

ChiCTR-IOR-15007033; Results.

Discrepancies between crystallized and fluid ability are associated with frequency of social and physical engagement in community dwelling older adults

OBJECTIVE

Age differences have been noted in the discrepancies between crystallized and fluid ability (Gc-Gf). Larger Gc-Gf discrepancies have also been shown to be associated with Alzheimer's disease biomarkers and clinical severity. However, little is known regarding the relationship between Gc-Gf discrepancies in normal aging and functional outcomes. The aim of the present study was to examine this.

METHOD

Data from 104 adults (M_age = 71.70 years, SD = 9.016) were included in the present study. Measures from the NIH toolbox were used to form the discrepancy scores. Physical, cognitive, and social activities were identified using the Community Healthy Activities Model Program for Seniors activity questionnaire. Linear regression analyses, controlling for age, education, gender, health, and depressive symptoms, were used to examine the association between social, cognitive, and physical activities on Gc-Gf discrepancies.

RESULTS

Results showed that social and physical activity were significantly associated with greater discrepancies between crystallized and fluid ability, independent of covariates. There was no association between cognitive activity and Gc-Gf discrepancies.

CONCLUSIONS

Larger discrepancies between crystallized and fluid ability are related to frequency of social and physical activity. The findings support previous research that discrepancy scores may serve as a marker of cognitive decline. In more highly educated older individuals, Gc-Gf discrepancies may be a more accurate indicator of actual cognitive status.

Comparison of Dietary Quality Assessment Using Food Frequency Questionnaire and 24-hour-recalls in Older Men and Women

OBJECTIVES

To examine the agreement in nutrient intake and alternative healthy eating indices (AHEI) between a self-administered Food Frequency Questionnaire (FFQ) and 24-hour recall (24HR) measurements of diet by gender, among older adults.

MATERIAL AND METHODS

This is a cross-sectional observational study of 105 men and 99 women aged 65 and older living in urban and rural neighborhoods in Worcester County, Massachusetts, USA. Participants were queried on diet using both FFQ and 24HR. The healthy eating classification was compared between the two instruments by gender.

RESULTS

For men, the mean ± SD of AHEI total score was 48.2 ± 12.3 based on FFQ versus 34.7 ± 10.2 based on 24HR. For women, the mean ± SD was 47.9 ± 10.1 based on FFQ versus 36.1 ± 10.0 based on 24HR. Using 32 as the cutoff (40% of maximum AHEI score), 9% of men and 7% of women were classified as eating unhealthy based on the FFQ, versus 47% of men and 38% of women based on 24HR. Compared to women, men had larger 24HR to FFQ discrepancies in the nuts and vegetable protein subscore and white/red meat ratio, and smaller discrepancy in alcohol beverages subscore.

CONCLUSION

Agreements between FFQ and 24HR-based measures of diet quality were roughly comparable between men and women, though slightly better for women than men. Compared to 24HR, the FFQ tended to underestimate the proportions of older men and women classified as eating unhealthy and misclassified more men than women. Such limitations should be considered when the FFQ is used to study healthy eating in older age.

Racial Differences in Eating Patterns and Food Purchasing Behaviors among Urban Older Women

OBJECTIVE

To examine differences in diet and food purchasing behaviors between Black and White older women living in urban neighborhoods.

DESIGN

Cross-sectional observational study.

SETTING

Urban neighborhoods in Washington, DC, USA.

PARTICIPANTS

Community-dwelling White and Black women of age 65 and older.

MEASUREMENTS

Participants were queried on diet via 24-hour recalls, food purchasing habits, their use of neighborhood resources and local travel patterns. Frequency and location of self-reported food purchasing and consumption were compared by race.

RESULTS

In 2014 and 2015, 49 White and 44 Black older women were enrolled in the study. Compared to Whites, Blacks reported lower daily caloric intake (mean (SD) 1314 (404) vs. 1529 (448), p=0.02), with a higher percent of calories from protein and fat 1.8 (7.0), p=0.03), and a slightly higher polyunsaturated to saturated fat ratio (p=0.05). Blacks had substantially lower alternate healthy eating index (AHEI) (33.5 (10.2) vs. 43.9 (10.8) of 80 possible points, p<0.001), daily intake (grams) of total fiber (15.3 (8.1) vs. 22.9 (8.5), p<0.001), insoluble fiber (10.8 (6.9) vs. 15.9 (6.5), p<0.001), and soluble fiber (4.5 (2.0) vs. 6.9 (2.8), p<0.001). Blacks had lower intake of micronutrients, alcohol and caffeine. Blacks shopped for groceries less often (4.4 (3.0) vs. 6.2 (3.0) monthly; p=0.006) and spent a longer time traveling to stores (15.8 (9.1) vs. 11.5 (7.2) minutes per trip, p=0.02). A lower percent of Blacks walked to stores (14% vs. 40%, p=0.003) and a higher percent of Blacks rode in a car with someone else (33% vs. 6%, p<0.001).

CONCLUSIONS

In an urban setting, food consumption and purchasing behaviors differed substantially between older Black and White women, which should be further investigated and considered to promote healthy eating in older populations.

Gender and Age Differences in Levels, Types and Locations of Physical Activity among Older Adults Living in Car-Dependent Neighborhoods

BACKGROUND

A thorough understanding of gender differences in physical activity is critical to effective promotion of active living in older adults.

OBJECTIVES

To examine gender and age differences in levels, types and locations of physical activity.

DESIGN

Cross-sectional observation.

SETTING

Car-dependent urban and rural neighborhoods in Worcester County, Massachusetts, USA.

PARTICIPANTS

111 men and 103 women aged 65 years and older.

MEASUREMENTS

From 2012 to 2014, participants were queried on type, frequency and location of physical activity. Participants wore an accelerometer for 7 consecutive days.

RESULTS

Compared to women, men had a higher mean daily step count (mean (SD) 4385 (2122) men vs. 3671(1723) women, p=0.008). Men reported higher frequencies of any physical activity and moderate-to-vigorous physical activity, and a lower frequency of physical activity inside the home. Mean daily step counts and frequency of physical activity outside the home decreased progressively with age for both men and women. Women had a sharper decline in frequencies of self-reported physical activity. Men had a significant decrease in utilitarian walking, which women did not (p=0.07). Among participants who reported participation in any physical activity (n=190), more women indicated exercising indoors more often (59% vs. 44%, p=0.04). The three most commonly cited locations for physical activity away from home for both genders were streets or sidewalks, shopping malls, and membership-only facilities (e.g., YMCA or YWCA). The most common types of physical activity, performed at least once in a typical month, with over 40% of both genders reporting, included light housework, brisk walking, leisurely walking, and stretching.

CONCLUSION

Levels, types and location preferences of physical activity differed substantially by gender. Levels of physical activity decreased progressively with age, with greater decline among women. Consideration of these gender differences is necessary to improve the effectiveness of active living promotion programs among older adults.

Physical Activity Counseling Promotes Physical and Psychological Resilience in Older Veterans with Posttraumatic Stress Disorder

Individuals with posttraumatic stress disorder (PTSD) have elevated rates of morbidity, and a sedentary lifestyle can cause and aggravate the physical health needs of adults with PTSD. The primary aim of this paper was to explore the impact of physical activity (PA) counseling (vs. usual care) on physical and psychological outcomes among individuals with PTSD. A secondary aim was to compare these arm effects between those with and without PTSD.

METHODS

Older (>60 years) overweight veterans with impaired glucose tolerance were randomly assigned to an intervention or a usual care control arm. Of the 302 participants who underwent randomization, 67 (22%) had PTSD. Participants in the intervention arm received one in-person activity counseling session followed by regular PA telephone counseling over 12 months. Physical and psychological outcomes were assessed at baseline, 3, and 12 months.

RESULTS

Primary Aim (intervention vs. usual care among those with PTSD): PA increased on average from 80 minutes/week to 161 minutes/week among participants in the intervention arm (p=0.01). Large, clinically meaningful improvements in six-minute walk test and psychological health were observed over the course of the intervention (p<0.01). Secondary Aim (PTSD/No PTSD, intervention/usual care): participants with PTSD responded equally well to the intervention compared to participants without PTSD, though we observed significantly greater improvements in vitality and six-minute walk compared to participants without PTSD (p<0.05).

CONCLUSIONS

Given the epidemic of comorbid psychological illness and lifestyle-related disease among persons with PTSD, our findings support development and implementation of targeted PA interventions in this high-risk population.

Physical activity-related social control and social support in older adults: Cognitive and emotional pathways to physical activity

A survey of 217 older adults assessed physical activity-related positive and negative social control and emotional and informational support, using structural equation modeling to investigate mediational effects of emotional responses and behavioral intentions on physical activity. There were significant indirect effects of social control and social support on intentions as mediated by positive, but not negative, emotional responses, and significant indirect effects of emotional responses on physical activity as mediated by intentions. These findings help to identify the cognitive and emotional pathways by which social control and social support may promote or detract from physical activity in later life.

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.

Feasibility of a Memory Clinic-Based Physical Activity Prescription Program

BACKGROUND

Effective programs for promoting physical activity are needed for those with cognitive impairment.

OBJECTIVE

To test the feasibility of mobile Health (mHealth) technology-supported physical activity prescription from a tertiary care memory clinic.

METHODS

This feasibility study was designed as a 16-week randomized, crossover trial of a physical activity prescription: 8 weeks of intervention, 8 weeks of baseline or maintenance phase data collection. We recruited 2 cohorts: 21 individuals with Alzheimer-related cognitive impairment (mean age 72.3 (5.2), 9 females), and 9 individuals with normal cognition (mean age 69.6 (5.8), 8 females). We gave each cohort an mHealth accelerometer-based physical activity prescription to double number of steps taken. Our primary outcomes were feasibility and safety. Our secondary outcomes were change in weekly steps taken, Dementia Quality of Life Scale, Self-efficacy Scale, 6-minute Walk, and mini-Physical Performance Test.

RESULTS

Set-up and use of the device was not a barrier to participation. However, only 62% of participants with cognitive impairment completed the intervention. The cohort with cognitive impairment did not change their weekly step count above Week 1. All participants in the cohort with normal cognition were able to set up and use their device and increased their weekly step count above Week 1. There were no differences between Week 1 and Week 8 for any secondary measures in either cohort.

CONCLUSIONS

Setup and daily use of mHealth technology appears to be feasible for a person with cognitive impairment with the help of a partner, but increasing daily step counts over 8 weeks was not achieved. Future work needs to assess alternative activity prescription goals or additional support for patients and their partners.

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.

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.

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.

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.

Multicentre cluster randomised trial comparing a community group exercise programme and home-based exercise with usual care for people aged 65 years and over in primary care

BACKGROUND

Regular physical activity (PA) reduces the risk of falls and hip fractures, and mortality from all causes. However, PA levels are low in the older population and previous intervention studies have demonstrated only modest, short-term improvements.

OBJECTIVE

To evaluate the impact of two exercise promotion programmes on PA in people aged ≥ 65 years.

DESIGN

The ProAct65+ study was a pragmatic, three-arm parallel design, cluster randomised controlled trial of class-based exercise [Falls Management Exercise (FaME) programme], home-based exercise [Otago Exercise Programme (OEP)] and usual care among older people (aged ≥ 65 years) in primary care.

SETTING

Forty-three UK-based general practices in London and Nottingham/Derby.

PARTICIPANTS

A total of 1256 people ≥ 65 years were recruited through their general practices to take part in the trial.

INTERVENTIONS

The FaME programme and OEP. FaME included weekly classes plus home exercises for 24 weeks and encouraged walking. OEP included home exercises supported by peer mentors (PMs) for 24 weeks, and encouraged walking.

MAIN OUTCOME MEASURES

The primary outcome was the proportion that reported reaching the recommended PA target of 150 minutes of moderate to vigorous physical activity (MVPA) per week, 12 months after cessation of the intervention. Secondary outcomes included functional assessments of balance and falls risk, the incidence of falls, fear of falling, quality of life, social networks and self-efficacy. An economic evaluation including participant and NHS costs was embedded in the clinical trial.

RESULTS

In total, 20,507 patients from 43 general practices were invited to participate. Expressions of interest were received from 2752 (13%) and 1256 (6%) consented to join the trial; 387 were allocated to the FaME arm, 411 to the OEP arm and 458 to usual care. Primary outcome data were available at 12 months after the end of the intervention period for 830 (66%) of the study participants. The proportions reporting at least 150 minutes of MVPA per week rose between baseline and 12 months after the intervention from 40% to 49% in the FaME arm, from 41% to 43% in the OEP arm and from 37.5% to 38.0% in the usual-care arm. A significantly higher proportion in the FaME arm than in the usual-care arm reported at least 150 minutes of MVPA per week at 12 months after the intervention [adjusted odds ratio (AOR) 1.78, 95% confidence interval (CI) 1.11 to 2.87; p = 0.02]. There was no significant difference in MVPA between OEP and usual care (AOR 1.17, 95% CI 0.72 to 1.92; p = 0.52). Participants in the FaME arm added around 15 minutes of MVPA per day to their baseline physical activity level. In the 12 months after the close of the intervention phase, there was a statistically significant reduction in falls rate in the FaME arm compared with the usual-care arm (incidence rate ratio 0.74, 95% CI 0.55 to 0.99; p = 0.042). Scores on the Physical Activity Scale for the Elderly showed a small but statistically significant benefit for FaME compared with usual care, as did perceptions of benefits from exercise. Balance confidence was significantly improved at 12 months post intervention in both arms compared with the usual-care arm. There were no statistically significant differences between intervention arms and the usual-care arm in other secondary outcomes, including quality-adjusted life-years. FaME is more expensive than OEP delivered with PMs (£269 vs. £88 per participant in London; £218 vs. £117 in Nottingham). The cost per extra person exercising at, or above, target was £1919.64 in London and £1560.21 in Nottingham (mean £1739.93).

CONCLUSION

The FaME intervention increased self-reported PA levels among community-dwelling older adults 12 months after the intervention, and significantly reduced falls. Both the FaME and OEP interventions appeared to be safe, with no significant differences in adverse reactions between study arms.

TRIAL REGISTRATION

This trial is registered as ISRCTN43453770.

FUNDING

This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 18, No. 49. See the NIHR Journals Library website for further project information.

Effect of physical activity, social support, and skills training on late-life emotional health: a systematic literature review and implications for public health research

PURPOSE

Given that emotional health is a critical component of healthy aging, we undertook a systematic literature review to assess whether current interventions can positively affect older adults' emotional health.

METHODS

A national panel of health services and mental health researchers guided the review. Eligibility criteria included community-dwelling older adult (aged ≥ 50 years) samples, reproducible interventions, and emotional health outcomes, which included multiple domains and both positive (well-being) and illness-related (anxiety) dimensions. This review focused on three types of interventions - physical activity, social support, and skills training - given their public health significance and large number of studies identified. Panel members evaluated the strength of evidence (quality and effectiveness).

RESULTS

In all, 292 articles met inclusion criteria. These included 83 exercise/physical activity, 25 social support, and 40 skills training interventions. For evidence rating, these 148 interventions were categorized into 64 pairings by intervention type and emotional health outcome, e.g., strength training targeting loneliness or social support to address mood. 83% of these pairings were rated at least fair quality. Expert panelists found sufficient evidence of effectiveness only for skills training interventions with health outcomes of decreasing anxiety and improving quality of life and self-efficacy. Due to limitations in reviewed studies, many intervention-outcome pairings yielded insufficient evidence.

CONCLUSION

Skills training interventions improved several aspects of emotional health in community-dwelling older adults, while the effects for other outcomes and interventions lacked clear evidence. We discuss the implications and challenges in moving forward in this important area.

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.

Gender differences in physical activity patterns among older adults who fall

OBJECTIVE

This study describes gender differences in the level and pattern of physical activity in groups of older adults who were frequent fallers, intermittent fallers, or non-fallers.

METHODS

Interviews were conducted with adults aged 50 years and older (N=1834) at senior centers across Pennsylvania from 2010 to 2011. Self-reported falls and validated measures of physical activity were collected at baseline and at 6- and 12-month follow-up assessments.

RESULTS

Complete follow-up data were available for 1487 participants. Men who fell frequently decreased in recreational/leisure activity and household/yard work compared to the intermittent fallers and non-fallers. This association remained even when controlling for baseline health status. All women-regardless of fall group-engaged in similar levels of recreational/leisure activity and household/yard work over time. For both men and women, frequent fallers also showed a greater decrease in walking activities compared to intermittent fallers and non-fallers.

DISCUSSION

Frequent falling among older adults is associated with declines in common leisure, household, and walking activities. The effect of falling frequency on physical activity appears to affect men and women differently, generating the hypothesis that interventions to promote physical activity among fallers need to be gender specific.

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.