Effects of exercise programs on depressive symptoms, quality of life, and self-esteem in older people: A systematic review of randomized controlled trials

The effect of proprioceptive neuromuscular facilitation techniques compared to general aerobic exercise on balance, fear of falling, and quality of life in older adults living in nursing homes: a randomized controlled trial

BACKGROUND

With aging, changes occur in various body systems, such as cardiovascular, respiratory, neuromusculoskeletal, and vestibular, leading to a decreased quality of life (QOL) and an increased fear of falling (FOF). Exercise and physical activity reduce the progression of aging complications. Therefore, we examined the effect of proprioceptive neuromuscular facilitation techniques compared to aerobic exercise on balance, fear of falling, and quality of life in older adults living in nursing homes.

METHODS

Fifty-two older adults aged over 60 (31 males, 21 females) living in nursing homes were included. After initial evaluation, individuals were randomly assigned to two treatment groups (PNF techniques and aerobic exercise). Both treatment groups received 12 treatment sessions over 4 weeks. Balance, fear of falling, and quality of life were assessed at baseline and after a 4-week intervention. Analysis of covariance (ANCOVA) and paired samples t-test were utilized to between and within-group changes of variables.

RESULTS

The results showed no significant differences in balance, fear of falling, and quality of life between groups after the intervention (P > 0.05). In the within-group comparison, only the PNF techniques group showed significant improvement in the Berg Balance Scale (BBS) after the intervention (P < 0.05).

CONCLUSION

The findings suggest that PNF techniques compared with aerobic exercise could not contribute to improved balance, fear of falling, and quality of life. Therefore, more clinical trial studies with a control group are needed to determine the exact effects of these techniques.

TRIAL REGISTRATION NUMBER (TRN) AND DATE OF REGISTRATION

The trial was registered at the ( https://www.irct.ir ), (IRCT20210505051181N4) on 9/2/2023.

Self-Esteem and Body Image in Older Women Practicing Taekwondo with Low Bone Density: A Randomized Clinical Trial

BACKGROUND

Physical exercise can take on a multivariate form, including combat sports, specifically Taekwondo, a Korean sport characterized by strikes involving the hands and feet. This sport has been gaining popularity worldwide in recent years and is being practiced by diverse populations, including the older women.

OBJECTIVE

This study aimed to investigate the effects of Taekwondo training on self-esteem and body image in older women with low bone mineral density (BMD).

METHODS

This is an experimental research with a two-group design, where assessments were conducted pre- and post during a 12-week intervention period. The sample consisted of 27 inexperienced older women in taekwondo practice, aged between 60 and 70 years, randomly distributed into the experimental group (n=14) and Control Group (n=13). BMD, self-esteem, and body image were assessed. For the evaluation of self-esteem, the Rosenberg Self-Esteem Scale (RSES) was utilized. For the evaluation of body images, the body image questionnaire was administered.

RESULTS

The results showed that the practice of taekwondo improved (p<0.001) body image in the variables, including physical condition, body skills, and health, while the variable appearance showed no difference (p=0.581).

CONCLUSION

The results of this experimental study indicate an improvement in the self-esteem and body image of older individuals practicing Taekwondo.

Adherence and Retention Rates to Home-Based Video Exercise Programs in Older Adults-Systematic Review and Meta-Analysis

Introduction: This systematic review and meta-analysis aimed to investigate adherence and retention rates to home-based video exercise programs and identify key factors associated with these rates in older adults to understand the effectiveness of home-based video exercise interventions. Methods: We searched PubMed, Web of Science, and Scopus for articles addressing adherence to and retention of home-based video exercise programs. The study was conducted following PRISMA recommendations. Results: A total of 26 articles, including 1,292 participants older than 65, were included in the final qualitative and quantitative syntheses. The weighted mean of the retention rate was 91.1, and of the attendance rate was 85.0, with low I2 = 3.5, not significant p = 0.409 heterogeneity. The generalized regression models showed a positive effect of session duration on the attendance rate (%), where the possible change from <20 min to >60 min duration could decrease the attendance rate (%) B = -24.390 (p <0.001). The delivery method had a significant effect, where the absence of live contact with the coach in web-based or DVD-delivered interventions could decrease the attendance rate (%) compared to the online sessions B = -11.482 (p = 0.010). The lockdown during the COVID-19 pandemic had a positive effect on both the attendance rate (%) B = 10.321 (p = 0.019) and retention rate (%) B = 9.577 (p = 0.032). Conclusions: This systematic review and meta-analysis indicate that supervised home-based video exercise programs lasting less than 60 min might be a suitable and sustainable exercise mode to keep older adults active, especially in times resembling feelings of confinement.

Multiple Trajectories and Predictors of Self-Esteem Change in Later Life: A Latent Growth Mixture Modeling Approach

Applying latent growth mixture modeling (GMM), this study delves into the examination of self-esteem trajectories in a sample of 5,597 older adults over a nine-year period. Four distinct patterns of self-esteem changes have emerged: low, decreasing, increasing, and high. Additionally, the study explores the relationships between each trajectory and various predictors encompassing demographic factors, socioeconomic status, health, and interpersonal relationships. The findings highlight the significance of these factors in predicting the likelihood of an individual following a specific self-esteem trajectory. Notably, maintaining employment, fostering satisfactory social relationships, and being free of frequent depressive feelings emerged as strong predictors for the stability and increase of high self-esteem. Intriguingly, an average or above-average income was unexpectedly associated with lower levels of self-esteem. The study emphasizes the contribution of GMM to advancing aging research.

The effects of combining visual-auditory stimuli with exercise on short-term affect improvement: a randomized controlled trial

ABSTRAC T

Prior research has explored the effects of engaging with real or virtual natural landscapes and listening to music during aerobic exercise on short-term affect, however, the specific differences in the improvement of short-term affect by different combinations of Virtual Reality (VR) and music rhythm require further investigation. The objective of this study is to investigate the effects of various combinations of VR and music on short-term mood, thereby providing a reference for future research on public fitness. This study recruited 132 valid participants (mean age 24.0 ± 0.9 years), with a gender distribution of 68 males and 64 females. Participants were randomly assigned to one of four groups: Visual-Music (V-M), Music-Visual (M-V), Visual-only (V), and Music-only (M). The exercise mode was 15 min of aerobic power cycling with 2 min of low-intensity power cycling intervals in the middle. After the exercise, the participants were asked to sit and then performed either a VR intervention or a music intervention for 15 min. The collected indicators included blood pressure, positive/negative affect, and heart rate variability indicators (RMSSD, SDNN, LF/HF). Data analysis included descriptive statistics, repeated measures ANOVA, and multifactor ANOVA. The effect of different VR and Music combined with exercise interventions on the improvement of short-term affect was analyzed based on the effect size (ɳp2) and combined with the significance p-value. Intra-group results showed that DBP, positive and negative affect, SDNN, RMSSD indicators in V-M group were significant differences (p < 0.05), while SBP, positive affect, negative affect, SDNN, RMSSD, LF/HF indicators in M-V group were significant differences (p < 0.05). Only SDNN and RMSSD indicators in M group had significant differences (p < 0.05), and only SBP and RMSSD indicators in V group had significant differences (p < 0.05). The results between groups showed that only SDNN and LH/HF groups had a significant difference (p < 0.05), other indicators had a trend of improvement or positive promotion to a certain extent, but the statistical difference was not significant (p > 0.05). Aerobic exercise with consistent intensity and the combined visual-auditory interventions (M-V and V-M) significantly improved blood pressure, and the short-term affect of physiological responses (LF/HF, SDNN, RMSSD), along with subjective affect measures, compared to other groups. These findings suggest that incorporating VR and music with exercise can effectively enhance short-term affect, recommending an integrated approach to aerobic exercise and relaxation through music and visual exposure to natural environments.

Living lab modelling as a pilot study assessing the potential psychological health benefits of forest environment for cancer survivors

OBJECTIVE

To evaluate the physiological and psychological changes in cancer survivors who engage in repeated forest therapy in a living environment.

METHODS

This study included stay-based forest therapy for female cancer survivors aged ≥40 years. The program was conducted in two cycles, each spanning 3 weeks and consisting of a 2-night, 3-day stay, followed by daily life integration. The cycles were repeated from July 2, 2022, to August 18, 2022. Participant assessment included standard physical health parameters and a questionnaire on general characteristics, lifestyle habits, stress levels, and health status.

RESULTS

Thirty-seven female cancer survivors participated in the forest healing program, 56.8% of whom had a history of breast cancer. The median body mass index (BMI) was 23.80 kg/m2 (range, 21.00-25.60). More than half of the patients reported mild-to-moderate fatigue, chronic pain, and mild-to-moderate depression (81%, 65%, and 73%, respectively). After two cycles of forest therapy, no significant differences were observed in terms of fatigue, pain, or BMI levels. However, significant improvements were found in quality of life measures, particularly the psychological quality of life (mean score 12.54 at baseline vs. 13.48 after cycle 2; P=0.007). Positive improvements were also observed in terms of stress (mean score 17.03 vs. 13.76; P=0.002) and depression (mean score 8.35 vs. 6.11; P=0.002) levels.

CONCLUSION

Our forest-healing program demonstrated that nature-based therapies improve the mental health and quality of life of female cancer survivors, suggesting the need for further research on nature-based interventions to better support cancer survivors.

The Effects of Various Types of Physical Exercise on Health Outcomes in Older Adults with Depression: A Systematic Review and Meta-Analysis of Controlled Trials

Methods

An electronic search of five databases was used to retrieve controlled studies investigating health-related outcomes associated with any type of PE, in adults over 65 years with depression. Where possible, data were analyzed in meta-analyses or else reported narratively. Results and Discussion. Fifteen studies were included in the review. All 15 studies had data available for meta-analysis, yet heterogeneity in exercise types and outcome measures limited synthesis. When data for all types of exercise were pooled together, significant improvements were found in depression (SMD = 0.52; CI = 0.07, 0.97; p = 0.02), physical health and function (SMD = 0.44, CI = 0.14, 0.74; p = 0.004), anxiety (SMD = 0.23; CI = 0.04, 0.42; p = 0.02), and self-efficacy (SMD = 0.97; CI = 0.32, 1.61; p = 0.003). When data were pooled according to exercise type, positive effects were demonstrated for aerobic exercise on depression (SMD = 0.49; CI = -0.16, 0.8; p = 0.003), tai chi/qigong on depression (SMD = 0.89; CI = -0.14, 1.63; p = 0.02), and self-efficacy (SMD = 6.70; CI = -0.90, 12.50; p = 0.02) and multicomponent exercise demonstrated positive effects on physical function (SMD = 0.49; CI = 0.12, 0.87; p = 0.009) and the physical health component of quality of life (SMD = 0.88; CI = 0.10, 1.65; p = 0.03). No health-related benefits were revealed from the combined findings of the two studies investigating strengthening exercises.

Conclusion

Lack of consistency regarding exercise types, dosage, and outcomes presents challenges in the evidence. In general, exercise is beneficial across a range of health-related variables. Multicomponent, aerobic, and tai chi forms of exercise appear most likely to reap benefits in depressed older adults; however, the type of benefit is determined by the type of exercise and should be considered when recommending a regime. This trial is registered with CRD42020173465.

Chronic exercise effects on overall depression severity and distinct depressive symptoms in older adults: A protocol of a systematic and meta-analytic review

INTRODUCTION

There is high evidence that chronic exercise benefits overall depression severity in older adults. However, late-life depression is characterized by considerable heterogeneity in clinical manifestation emphasizing the need for more individualized exercise intervention programs. Therefore, the objective of the proposed review is to investigate the effects of chronic exercise on overall depression severity and on different symptoms of depression in randomized controlled trials (RCTs) including older adults with a mean age of at least 60 years, and by considering the moderating effects of intervention characteristics and individual characteristics.

METHODS

This protocol is guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P). We will use the Population-Intervention-Comparator-Outcomes-Study design (PICOS) criteria for study inclusion and will search the following database sources for relevant RCTs: Web of Science, Academic Search Complete, CINAHL, APA Psycinfo, SPORTDiscuss, Cochrane. Two independent reviewers will conduct the study selection, data extraction, and quality assessment. Disagreement will be solved by a third reviewer. Primary outcome will be changes in overall depression severity and secondary outcomes will encompass changes in symptoms of depression as defined by the DSM-5, such as sleep quality, fatigue, anxiety, mood, apathy, changes in weight, information processing speed, and executive functions, from baseline until the end of the intervention and to any available intermediary measurement or follow up. Meta-analysis will be undertaken to synthesize the effects of chronic exercise on primary and secondary outcomes. Subgroup analysis will investigate the moderating effects of intervention characteristics (frequency, intensity, duration, type of exercise, cognitive demand, social interactions, exercise supervision, behavioral change techniques, compliance, study design, dropout-rate, type of control group) and individual characteristics (age, sex, education, functional capacity, global cognition, population) on primary and secondary outcomes. Additionally, we plan to assess quality of evidence and publication bias, and to carry out sensitivity analysis.

CONCLUSION

The results of the proposed review are anticipated to have a substantial impact on research and clinical practice. On the one hand, the review's conclusions could form the foundation for developing evidence-based recommendations for individualized exercise programs that alleviate depression in older adults. On the other hand, by revealing research gaps, the review results could encourage the formulation of research questions for further RCTs.

PROTOCOL REGISTRATION NUMBER

This protocol has been published in the Prospero repository (PROSPERO 2022 CRD42022361418, available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022361418).

Quality of life of patients with hip fracture was better during the COVID-19 period than before, an ancillary study from the HiFIT multicenter study

Background

The COVID-19 pandemic had a global impact on people life, notably because of lockdown periods. This could particularly affected patients suffering from hip fracture, who could have been more isolated during these periods. We aim at evaluating the impact of the COVID-19 period (including lockdown periods) on quality of life (QOL) in older adult patients 90 days after a surgery for a hip fracture.

Subject and methods

Ancillary study of the prospective randomized controlled HiFIT study. We compared the QOL measured at 90 days after a hip fracture surgery using the EuroQOL-5 dimensions 3 levels (EQ-5D), the Perceived Quality of life (PQOL) and the Instrumental Activities of Daily Living (IADL) in patients included in the Hifit study before and during the COVID-19 pandemic.

Results

The characteristics of the 161 patients included before and of the 213 included during the COVID period (including 122 (57%) during COVID with containment periods and 91 (43%) during COVID without containment periods) were similar (mean age 84 ± 10 years; 282 (75%) women). The majority (81%) of the patients alive at 90 days had returned to their previous place of residence in both periods. During the COVID period, EQ-5D showed better patient pain/discomfort and anxiety/depression levels. The PQOL happiness was not different, with around 81% of the patient being "happy" or "very happy" during the two periods and the IADL was also similar during the two periods. In the multivariate analysis odd ratios of having poorer outcomes were increased before COVID for pain/discomfort (OR 2.38, 95%CI [1.41-4.15], p = 0.001), anxiety (OR 1.89 [1.12-3.21], p = 0.017) and mobility (1.69 [1.02-2.86], p = 0.044).

Conclusion

Patient's quality of life measured using different scales was not altered during the COVID period compared to before COVID, 90 days after a hip fracture. Surprisingly, the Pain/Discomfort and Anxiety dimensions of the EQ-5D questionnaires were even better during the COVID period.Clinical trial registration:https://clinicaltrials.gov/ (NCT02972294).

Comparative impact of exercise-based interventions for postpartum depression: A Bayesian network meta-analysis

OBJECTIVE

The current study aimed to address and rank which exercise-based interventions are preferable to standard care/no therapy or another exercise intervention for postpartum depression (PPD) management and provide estimates for future definitive evidence.

METHODS

The authors systematically searched PubMed, Embase, the Web of Science, PsycInfo, and ClinicalTrails.gov for randomized controlled trials (RCTs) on exercise-based interventions for PPD from their inception to May 9, 2023. Included were RCTs of exercise-based interventions for PPD with at least 4 weeks' duration. The pooled effects of intervention comparisons were generated by the Bayesian random-effects model, and the quality of evidence was evaluated by the Grading of Recommendations, Assessment, Development, and Evaluations framework.

RESULTS

Twelve RCTs (1260 women; mean age, 20-35 years) comparing exercise-based interventions with usual care/no therapy were included. Exercise effectively treats depressive symptoms (standard mean difference [SMD], -0.81 [95% confidence interval (CI), -1.20 to -0.42], P < 0.001). Pram walking was significantly associated with a reduction of depressive symptoms during the postpartum period (SMD, -1.00 [95% CI, -2.60 to -0.10], P = 0.020), as well as yoga (SMD, -0.73 [95% CI, -1.84 to -0.43], P < 0.001) and supervised mixed exercise (SMD, -0.77 [95% CI, -1.67 to -0.01], P = 0.041) compared with usual care/no therapy. In indirect comparisons, pram walking (surface under the cumulative ranking curve, 58.9%) was better than yoga (SMD, -0.28 [95% CI, -1.86 to 1.22], P = 0.322) and supervised mixed exercise (SMD, -0.23 [95% CI, -1.59 to 1.12], P = 0.358). However, the difference was not statistically significant. The confidence in evidence was very low to moderate.

CONCLUSION

In women with PPD, all commonly prescribed physical exercises were effective alternative or complementary treatments. However, pram walking may perform better in improving the symptoms of PPD.

Physical activity and health-related quality of life in older adults: depression as a mediator

BACKGROUND

Physical activity(PA) is associated with health-related quality of life (HRQoL) among older adults, and both are associated with mood, such as depression. However, the indirect effects of PA on HRQoL in older adults have not been clearly established. This study explained how different types and intensities of PA were associated with HRQoL while considering the effects of depression in older adults.

METHODS

A cross-sectional study was conducted with 7,518 community-dwelling older adults aged 60 years and older. PA (leisure-time, household, and work-related), depression, and HRQoL were measured using the Physical Activity Scale for the Elderly (PASE), the 30-item Geriatric Depression Scale (GDS-30), and the 36-Item Short-Form Health Survey (SF-36), respectively. Information on age, gender, education, monthly income, activities of daily living, smoking, and alcohol drinking was also collected. Regression analysis was used to explore the relationship between PA, depression and HRQoL, and a mediation effect test process was used to verify the mediating mechanism of the depression on this relationship.

RESULTS

The study showed that after adjusting for a set of covariates, SF-36 Physical Component Summary (PCS) scores were negatively associated with depression (B = -2.046, 95% CI [2.584, -1.509]) and positively with PA (p < 0.001). Similarly, SF-36 Mental Component Summary (MCS) scores were negatively associated with depression (B = -11.657, 95% CI [-12.190, -11.124]). In mediation analyses, we found that depression partially mediated the relationship between different types and intensities PA and PCS (moderate leisure-time PA: B = 0.223, 95%CI [0.153,0.293], P < 0.001; vigorous leisure-time PA: B = 0.323, 95%CI [0.232,0.413], P < 0.001; moderate household PA: B = 0.092, 95%CI [0.045,0.139], P < 0.001; vigorous household PA: B = 0.137, 95%CI [0.085,0.190], P < 0.001; work-related PA: B = 0.193, 95%CI [0.658,0.190], P < 0.001) and MCS (moderate leisure-time PA: B = 1.243, 95%CI [1.008,1.479], P < 0.001; vigorous leisure-time PA: B = 1.800, 95%CI [1.585,2.015], P < 0.001; moderate household PA: B = 0.496, 95%CI [0.274,0.718], P < 0.001; vigorous household PA: B = 0.742, 95%CI [0.521,0.963], P < 0.001; work-related PA: B = 1.026, 95%CI [0.819,1.234], P < 0.001).

CONCLUSIONS

This study suggested that leisure-time, household, and work-related PA were negatively associated with depression, while positively affecting HRQoL in Chinese older adults. The relationships between different types and intensities of PA and HRQoL were mediated by depression. Interventions aimed at promoting purposeful exercise and different types of PA may have mental health benefits. It is recommended that geriatric health managers and healthcare planners prioritize interventions to help improve PA intensities, alleviate depressive symptoms to promote beneficial effects on HRQoL in older adults.

Physical Activity and Neuropsychological Functioning in Older Adults

Research has identified a positive relationship between physical activity and neuropsychological functioning across the lifespan. The present study further examined the relationship between physical activity, depression, anxiety, and cognitive functioning in community-dwelling older adults (ages 65-96) who completed an outpatient neuropsychological evaluation (N = 526). Psychometrically sound and validated measures were used to assess depression, anxiety, and cognitive functioning. Analyses of covariance (ANCOVA) were conducted to examine differences between individuals who reported regularly engaging in physical activity and those who did not, after adjusting for demographic variables (age, education, and gender). Results indicated that physical activity was associated with better scores on measures of depression, anxiety, and cognitive functioning. Effect sizes for total scores on all measures were large, but there was a sizeable range of effect sizes (from small to large) for various cognitive domains. Smallest effect sizes were observed for subtests measuring language skills and visuospatial abilities, whereas largest effect sizes were seen in processing speed and memory. Results suggest that engaging in physical activity may be a beneficial non-pharmacological intervention for older adults. These findings underscore the importance of integrating physical activity programs in community and healthcare settings to foster mental and cognitive health in older populations.

PROTOCOL: Non-pharmacological interventions for older people with a diagnosis of depression: An evidence and gap map

This is the protocol for an evidence and gap map. The objectives are as follows: To map available randomized control trials, economic evaluations, and systematic reviews that assess the effectiveness and cost-effectiveness of non-pharmacological interventions for older people with a diagnosis of depression and identify any existing gaps in the evidence that can inform future research.

Effectiveness of physical activity interventions for improving depression, anxiety and distress: an overview of systematic reviews

OBJECTIVE

To synthesise the evidence on the effects of physical activity on symptoms of depression, anxiety and psychological distress in adult populations.

DESIGN

Umbrella review.

DATA SOURCES

Twelve electronic databases were searched for eligible studies published from inception to 1 January 2022.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Systematic reviews with meta-analyses of randomised controlled trials designed to increase physical activity in an adult population and that assessed depression, anxiety or psychological distress were eligible. Study selection was undertaken in duplicate by two independent reviewers.

RESULTS

Ninety-seven reviews (1039 trials and 128 119 participants) were included. Populations included healthy adults, people with mental health disorders and people with various chronic diseases. Most reviews (n=77) had a critically low A MeaSurement Tool to Assess systematic Reviews score. Physical activity had medium effects on depression (median effect size=-0.43, IQR=-0.66 to -0.27), anxiety (median effect size=-0.42, IQR=-0.66 to -0.26) and psychological distress (effect size=-0.60, 95% CI -0.78 to -0.42), compared with usual care across all populations. The largest benefits were seen in people with depression, HIV and kidney disease, in pregnant and postpartum women, and in healthy individuals. Higher intensity physical activity was associated with greater improvements in symptoms. Effectiveness of physical activity interventions diminished with longer duration interventions.

CONCLUSION AND RELEVANCE

Physical activity is highly beneficial for improving symptoms of depression, anxiety and distress across a wide range of adult populations, including the general population, people with diagnosed mental health disorders and people with chronic disease. Physical activity should be a mainstay approach in the management of depression, anxiety and psychological distress.

PROSPERO REGISTRATION NUMBER

CRD42021292710.

Effects of Acute Exercise on Affect, Anxiety, and Self-Esteem in Poly-Substance Dependent Inpatients

INTRODUCTION

Negative affect and anxiety frequently precede the onset of drug use in those with substance use disorder (SUD). Low self-esteem may increase the risk of relapse. We examined the short-term effects of exercise on affect, anxiety, and self-esteem in inpatients with poly-SUD.

METHODS

This is a multicenter randomized control trial (RCT) with a crossover design. Thirty-eight inpatients (37.3 ± 6.4 years; 84% male) from three clinics participated in 45 min of soccer, circuit training, and control condition (psychoeducation) in a random order. Positive and negative affect (PANAS), state anxiety (single item), and self-esteem (Rosenberg SE-scale) were measured immediately before, immediately after, 1-h, 2-h, and 4-h post-exercise. Heart rate and ratings of perceived exertion were taken. Effects were assessed using linear mixed effects models.

RESULTS

Compared to the control condition, there were significant post-exercise improvements in positive affect (β = 2.99, CI = 0.39: 5.58), self-esteem (β = 1.84, CI = 0.49: 3.20), and anxiety (β = -0.69, CI = -1.34: -0.04) after circuit training (shown) and soccer. Effects persisted 4-h post-exercise. Reductions in negative affect were observed 2-h (circuit training: β = -3.39, CI = -6.35: -1.51) and 4-h (soccer: β = -3.71, CI = -6.03: -1.39) post-exercise, respectively.

CONCLUSION

Moderately strenuous exercise undertaken in naturalistic settings may improve mental health symptoms in poly-SUD inpatients for up to 4-h post-exercise.

Neuroticism and Stress in Older Adults: The Buffering Role of Self-Esteem

BACKGROUND

Chronic stress is associated with accelerated aging and poor health outcomes in older adults. According to the Transactional Model of Stress (TMS), distress is experienced when one perceives the stressor, or threat, to outweigh the ability to cope. The experience of distress is correlated with trait neuroticism, which is associated with greater perceptions of stress and stress reactivity, as well as a tendency to engage in maladaptive coping strategies. However, as individual personality traits do not act in isolation, this study aimed to investigate the moderating role of self-esteem in the relationship between neuroticism and distress using a TMS framework.

METHODS

A total of 201 healthy older adults (Mage = 68.65 years) completed questionnaires measuring self-esteem, neuroticism, perceived stress, and positive coping.

RESULTS

Greater neuroticism was significantly associated with less positive coping at low (b = -0.02, p < 0.001) and mean self-esteem levels (b = -0.01, p < 0.001), but not at high self-esteem levels (b = -0.01, p = 0.06). No moderating effect was found for perceived stress or overall distress.

CONCLUSION

The results support the association between trait neuroticism and indices of stress and suggest a potential buffering effect of self-esteem in moderating the negative association between neuroticism and positive coping.

Home-Based Exergame Program to Improve Physical Function, Fall Efficacy, Depression and Quality of Life in Community-Dwelling Older Adults: A Randomized Controlled Trial

This study aimed to investigate the effects of home-based exergame programs on physical function, fall efficacy, depression, and health-related quality of life in community-dwelling older adults. Fifty-seven participants aged 75 years or older were divided into control and experimental groups. The experimental group received a home-based exergame program that included balance and lower-extremity muscle strength for 8 weeks. The participants exercised at home for 50 min three times a week and were monitored through a video-conference application. Both groups received online education on musculoskeletal health once a week, whereas the control group did not exercise. Physical function was assessed using the one-leg standing test (OLST), Berg balance scale (BBS), functional reaching test (FRT), timed up-and-go test (TUGT), and five-times sit-to-stand (FTSTS). Fall efficacy was assessed using the modified falls efficacy scale (MFES). Depression was assessed using the geriatric depression scale (GDS). Health-related quality of life was assessed using a 36-item short-form health survey (SF-36). The experimental group showed an overall improvement in OLST, BBS, FRT, TUGT, and FTSTS (p < 0.05). MFES was significantly increased in the experimental group after the intervention (p < 0.05). The GDS significantly decreased in the experimental group after the intervention (p < 0.05). In SF-36, role limitations due to physical health, general health, and fatigue (energy and fatigue) items improved in the experimental group after intervention (p < 0.05). An 8-week home-based exergame program improved physical function, fall efficacy, depression, and health-related quality of life in older adults. The study was registered on ClinicalTrials.gov (NCT05802537).

Applying Gamification Principles and Therapeutic Movement Sequences to Design an Interactive Physical Activity Game: Development Study

BACKGROUND

Depression is a severe illness that has accelerated with the spread of COVID-19 and associated lockdowns. As a result, reported physical activity has substantially decreased, further increasing depressive symptoms.

OBJECTIVE

This study aims to explain the use of gamification principles to develop content for an interactive physical activity game for depression based on clinically proven depression diagnostic criteria.

METHODS

We discuss related work in this field, the game design framework, the users' depression severity, how we customize the contents accordingly, the gradual progression of the game to match exercise principles, and user flow optimization.

RESULTS

We provide a brief description of each of the games developed, including instructions on how to play and design aspects for flow, audio, and visual feedback methods. Exergames (interactive physical activity-based games) stimulate certain physical fitness factors such as improving reaction time, endurance, cardiovascular fitness, and flexibility. In addition, the game difficulty progresses based on various factors, such as the user's performance for successful completion, reaction time, movement speed, and stimulated larger joint range of motions. Cognitive aspects are included, as the user has to memorize particular movement sequences.

CONCLUSIONS

Mental health issues are linked to behavior and movement; therefore, future physical activity-based interactive games may provide excellent stimulation for inducing user flow, while physical activity can help train various physical fitness factors linked to depression.

Exercise for depression and depressive symptoms in older adults: an umbrella review of systematic reviews and Meta-analyses

OBJECTIVES

We aimed to gather and update the evidence on the impact of exercise on late-life depression.

METHOD

We conducted an umbrella review of meta-analyses of randomized controlled trials (RCTs) that assessed the effects of an exercise intervention for depression in older adults (e.g. 60+). Searches were conducted in Scopus, Web of Science, Embase, PubMed, BIREME, LILACS, SciELO, Cochrane Library for Systematic Reviews, and Opengray.eu. Methodological quality was assessed using A MeaSurement Tool to Assess Systematic Reviews (AMSTAR 2). Data analysis was performed with RStudio (version 4.0.2) and the generic inverse-variance method was used to pool the effect sizes from the included studies.

RESULTS

Twelve meta-analyses of 97 RCTs were included. The AMSTAR 2 rating was considered critically low in five studies, low in six studies, and high in one study. The effect size expressed by the standardized mean difference (SMD) varied between studies from -0.90 (95% CI = -1.51; -0.28) to -0.14 (95% CI = -0.36; 0.07) in favor of the exercise intervention. Pooling of the effect sizes produced a statistically significant moderate effect in which exercise was associated with lower levels of depression and depressive symptoms (OR = 2.24, 95% CI 1.77; 2.84).

CONCLUSION

Our findings suggest that exercise produces a moderate improvement in depression and depressive symptoms in older patients. We recommend providing physical activity for older adults.

KEY-POINTS

We investigated the effects of exercise interventions for depression in older adults.

Supplemental data for this article can be accessed online at https://doi.org/10.1080/13607863.2021.1951660.

Health effects and cost-effectiveness of a multilevel physical activity intervention in low-income older adults; results from the PEP4PA cluster randomized controlled trial

Background

Older adults are the least active population in the U.S. Low-income communities have fewer physical activity (PA) resources, contributing to less PA and increased chronic disease risk. This study assessed the effect of the multilevel, peer-led, Peer Empowerment Program 4 Physical Activity (PEP4PA) on moderate-to-vigorous PA (MVPA) and health outcomes, over 2 years of follow up.

Methods

In a cluster-randomized controlled trial, 12 senior or community centers serving low-income older adults were assigned to a PA intervention (n = 6) or usual programming (n = 6) condition. PEP4PA included self-monitoring, health coaching, group walks, social support, and community advocacy to improve walking conditions. The primary outcome was daily minutes of MVPA (7-day accelerometer). Secondary outcomes included Perceived Quality of Life (PQoL), 6-Minute Walk Test (6-MWT), blood pressure (BP), and depressive symptoms at baseline, 6, 12, 18 and 24 months. Mixed effects regression models estimated the effects on outcomes between groups over time and included random effects for repeated measures and center clustering. Effect modification by sex and income status was assessed. We calculated the incremental cost per daily minute of MVPA gained in the intervention group relative to the control group to assess cost effectiveness.

Results

We enrolled 476 older adults (50 + years). Participants were on average 71 years old, 76% female, 60% low income, and 38% identified as racial or ethnic minorities. Compared to the control group, intervention participants sustained roughly a 10 min/day increase in MVPA from baseline at all time points and increased mean PQoL scores from unsatisfied at baseline to satisfied at 12, 18 and 24 months. Males and higher-income groups had greater improvements in MVPA. No significant effects were observed for 6-MWT or depressive symptoms, and BP results were mixed. The incremental cost per minute MVPA gained per person was $0.25, $0.09, $0.06, and $0.05 at 6, 12, 18 and 24 months, respectively.

Conclusions

PEP4PA achieved increases in MVPA and PQoL in low-income older adults, over 2 years of follow up. The peer-led, community-based intervention provides a sustainable and cost-effective model to improve health behaviors in underserved, aging populations.

Trial registration

ClinicalTrials.gov (NCT02405325) March 20, 2015.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-022-01309-w.

Physical Activity and Sedentary Behavior of Residents in Assisted Living: A Preliminary Study

Low physical activity (PA) and high sedentary behavior (SB) place residents in assisted living at risk for physical decline, but little is known about factors that influence PA/SB in this setting. In the current cross-sectional study, we described objectively measured PA/SB (activPAL™) and examined the relationships between PA/SB and use of an assistive walking device, depression, sleep disturbance, pain, fatigue, social isolation, and the tendency to make social comparisons. Fifty-four residents from eight assisted living facilities participated. Mean time spent in PA was 252.9 (SD = 134.3) minutes/day. Mean time spent in SB was 660.8 (SD = 181.4) minutes/day. Depression predicted PA (R2 = 0.16). Residents using an assistive device spent significantly more time in SB (p = 0.02). Fatigue correlated with time in longer bouts of SB (r = 0.19, p = 0.04). The tendency to make social comparisons correlated with SB (r = 0.22, p = 0.04). Findings show residents in assisted living are inactive and further research is needed to fully understand factors that influence PA/SB. [Research in Gerontological Nursing, xx(x), xx-xx.].

COVID-19 lockdowns' effects on the quality of life, perceived health and well-being of healthy elderly individuals: A longitudinal comparison of pre-lockdown and lockdown states of well-being

PURPOSE

. The concept of lockdown in relation to COVID-19 is thought to have an indirect impact on the quality of life and well-being of the elderly due to its consequences on the physical, psychological, and cognitive health of individuals. However, previous published studies on this subject are limited in terms of methodological approach used, including the absence of pre-confinement status and the type of experimental design, which is often cross-sectional. The present study proposes a longitudinal design with pre-confinement measures. It assesses changes in quality of life, perceived health, and well-being by comparing the period before lockdown (T1 = December 2019), three months after the start of the first lockdown (T2 = June 2020), and during the second lockdown (T3 = January 2021) due to COVID-19.

MATERIALS AND METHODS

. This study is conducted with a group of 72 healthy elderly persons. They completed an electronic (online) survey assessing personal factors, activities, and participation as well as responding to the EuroQol-5D and Warwick-Edinburgh Mental Well-being Scale.

RESULTS

. A decrease in quality of life, perceived health and well-being was observed between T1 and T2 and between T1 and T3, but no difference was reported between the two lockdown periods. The variables associated with these changes included energy level, level of happiness, physical activity, change in medical condition, memory difficulties, level of perceived isolation and age.

CONCLUSION

. This study will help to target variables that may have a deleterious effect on older adults for consideration in future confinement settings and for preventive purposes.

Universal depression prevention: An umbrella review of meta-analyses

Depression is a disabling, highly prevalent, frequently chronic, and difficult-to-treat disorder with an immense cognitive, social, and economic burden. Given that many of the advances in other non-communicable disorders like cancer have been in prevention rather than treatment, the prevention of depression is currently an unmet public health priority. We sought to provide an overview of the meta-analytic literature through conducting a systematic umbrella review of universally delivered preventive interventions for depression. The search was conducted on March 18, 2021 utilising the following databases (all accessed through EBSCOHost); Allied and Complementary Medicine Database, CINAHL Complete, Global Health, Health Source: Nursing/Academic Edition, MEDLINE Complete and APA PsychArticles. The following search terms related to depression, prevention, and trial study design. Two authors independently screened articles and a third resolved discrepancies. Eligibility criteria sought to identify meta-analyses that investigated the prevention of depression (i.e., reduced incidence) through intervention studies that were universal, in that they were designed to be delivered to entire populations Six meta-analyses on psychological interventions, two school-based meta-analyses, and one eHealth meta-analysis were included in this umbrella review. Findings indicated that all identified studies were of good quality and one was of fair quality. One previous meta-review that examined physical activity to prevent depression was included in results, comprising eight meta-analyses. Preventive interventions have primarily and successfully utilized psychological therapeutic components, delivered at the school, community, and workplace settings. Both school- and eHealth-based interventions hold some utility for depression prevention. There is meta-analytic evidence that physical activity is efficacious for depression prevention. However, universal prevention is inconsistently defined. There is a pressing need for well-designed randomized controlled preventative interventions for depression before recommendations can be universally accepted with convincing level of evidence.

mHealth Apps for Musculoskeletal Rehabilitation: State of the Practice Review (Preprint)

Background

The number of mobile health (mHealth) apps released for musculoskeletal (MSK) injury treatment and self-management with home exercise programs (HEPs) has risen rapidly in recent years as digital health interventions are explored and researched in more detail. As this number grows, it is becoming increasingly difficult for users to navigate the market and select the most appropriate app for their use case. It is also unclear what features the developers of these apps are harnessing to support patient self-management and how they fit into clinical care pathways.

Objective

The objective of this study was to scope the current market of mHealth apps for MSK rehabilitation and to report on their features, claims, evidence base, and functionalities.

Methods

A cross-sectional study of apps for MSK rehabilitation was performed across the iTunes App Store and Google Play Store. Four search terms were used, namely, physiotherapy rehabilitation, physical therapy rehabilitation, rehabilitation exercise, and therapeutic exercise to identify apps, which were then cross-referenced against set selection criteria by 4 reviewers. Each reviewer, where possible, downloaded the app and accessed supplementary literature available on the product to assist in data extraction.

Results

A total of 1322 apps were identified. After applying the inclusion and exclusion criteria and removing duplicates, 144 apps were included in the study. Over half (n=81, 56.3%) of the included apps had been released within the past 3 years. Three quarters (n=107, 74.3%) of the apps made no reference to evidence supporting the design or efficacy of the app, with only 11.1% (n=16) providing direct citations to research. Most of the apps did utilize exercise pictures (n=138, 95.8%) or videos (n=97, 67.4%); however, comparatively few harnessed additional features to encourage engagement and support self-management, such as an adherence log (n=66, 45.8%), communication portal (n=32, 22.2%), patient-reported outcome capture (n=36, 25%), or direct feedback (n=57, 39.6%). Of note and concern, many of these apps prescribed generic exercises (n=93, 64.6%) in the absence of individualized input to the user, with few providing specific patient education (n=43, 34%) and safety advice or disclaimers (n=38, 26.4%).

Conclusions

The cohort of apps included in this study contained a large heterogeneity of features, so it is difficult for users to identify the most appropriate or effective app. Many apps are missing the opportunity to offer key features that could promote exercise adherence and encourage self-management in MSK rehabilitation. Furthermore, very few developers currently offering products on the market are providing evidence to support the design and efficacy of their technologies.

Can high-intensity interval training improve mental health outcomes in the general population and those with physical illnesses? A systematic review and meta-analysis

OBJECTIVE

High-intensity interval training (HIIT) is a safe and feasible form of exercise. The aim of this meta-analysis was to investigate the mental health effects of HIIT, in healthy populations and those with physical illnesses, and to compare the mental health effects to non-active controls and other forms of exercise.

DESIGN

Random effects meta-analyses were undertaken for randomised controlled trials (RCTs) comparing HIIT with non-active and/or active (exercise) control conditions for the following coprimary outcomes: mental well-being, symptoms of depression, anxiety and psychological stress. Positive and negative affect, distress and sleep outcomes were summarised narratively.

DATA SOURCES

Medline, PsycINFO, Embase and CENTRAL databases were searched from inception to 7 July 2020.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

RCTs that investigated HIIT in healthy populations and/or those with physical illnesses and reported change in mental well-being, depression, anxiety, psychological stress, positive/negative affect, distress and/or sleep quality.

RESULTS

Fifty-eight RCTs were retrieved. HIIT led to moderate improvements in mental well-being (standardised mean difference (SMD): 0.418; 95% CI: 0.135 to 0.701; n=12 studies), depression severity (SMD: -0.496; 95% CI: -0.973 to -0.020; n=10) and perceived stress (SMD: -0.474; 95% CI: -0.796 to -0.152; n=4) compared with non-active controls, and small improvements in mental well-being compared with active controls (SMD:0.229; 95% CI: 0.054 to 0.403; n=12). There was a suggestion that HIIT may improve sleep and psychological distress compared with non-active controls: however, these findings were based on a small number of RCTs.

CONCLUSION

These findings support the use of HIIT for mental health in the general population.

LEVEL OF EVIDENCE

The quality of evidence was moderate-to-high according to the Grading of Recommendations Assessment, Development and Evaluation) criteria.

PROSPERO REGISTRATION NUMBER

CRD42020182643.

Promoting physical activity and physical function in people with long-term conditions in primary care: the Function First realist synthesis with co-design

Background

As people age and accumulate long-term conditions, their physical activity and physical function declines, resulting in disability and loss of independence. Primary care is well placed to empower individuals and communities to reduce this decline; however, the best approach is uncertain.

Objectives

To develop a programme theory to explain the mechanisms through which interventions improve physical activity and physical function in people with long-term conditions in different primary care contexts, and to co-design a prototype intervention.

Data sources

Systematic literature searches of relevant databases with forwards and backwards citation tracking, grey literature searches and further purposive searches were conducted. Qualitative data were collected through workshops and interviews.

Design

Realist evidence synthesis and co-design for primary care service innovation.

Setting

Primary care in Wales and England.

Participants

Stakeholders included people with long-term conditions, primary care professionals, people working in relevant community roles and researchers.

Methods

The realist evidence synthesis combined evidence from varied sources of literature with the views, experiences and ideas of stakeholders. The resulting context, mechanism and outcome statements informed three co-design workshops and a knowledge mobilisation workshop for primary care service innovation.

Results

Five context, mechanism and outcome statements were developed. (1) Improving physical activity and function is not prioritised in primary care (context). If the practice team culture is aligned to the elements of physical literacy (mechanism), then physical activity promotion will become routine and embedded in usual care (outcome). (2) Physical activity promotion is inconsistent and unco-ordinated (context). If specific resources are allocated to physical activity promotion (in combination with a supportive practice culture) (mechanism), then this will improve opportunities to change behaviour (outcome). (3) People with long-term conditions have varying levels of physical function and physical activity, varying attitudes to physical activity and differing access to local resources that enable physical activity (context). If physical activity promotion is adapted to individual needs, preferences and local resources (mechanism), then this will facilitate a sustained improvement in physical activity (outcome). (4) Many primary care practice staff lack the knowledge and confidence to promote physical activity (context). If staff develop an improved sense of capability through education and training (mechanism), then they will increase their engagement with physical activity promotion (outcome). (5) If a programme is credible with patients and professionals (context), then trust and confidence in the programme will develop (mechanism) and more patients and professionals will engage with the programme (outcome). A prototype multicomponent intervention was developed. This consisted of resources to nurture a culture of physical literacy, materials to develop the role of a credible professional who can promote physical activity using a directory of local opportunities and resources to assist with individual behaviour change.

Limitations

Realist synthesis and co-design is about what works in which contexts, so these resources and practice implications will need to be modified for different primary care contexts.

Conclusions

We developed a programme theory to explain how physical activity could be promoted in primary care in people with long-term conditions, which informed a prototype intervention.

Future work

A future research programme could further develop the prototype multicomponent intervention and assess its acceptability in practice alongside existing schemes before it is tested in a feasibility study to inform a future randomised controlled trial.

Study registration

This study is registered as PROSPERO CRD42018103027.

Funding

This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 16. See the NIHR Journals Library website for further project information.

A systematic review of physical activity and quality of life and well-being

Maintaining or improving quality of life (QoL) and well-being is a universal goal across the lifespan. Being physically active has been suggested as one way to enhance QoL and well-being. In this systematic review, conducted in part for the 2018 U.S. Health and Human Services Physical Activity Guidelines for Americans Scientific Advisory Committee Report, we examined the relationship between physical activity (PA) and QoL and well-being experienced by the general population across the lifespan and by persons with psychiatric and neurologic conditions. Systematic reviews, meta-analyses, and pooled analyses from 2006 to 2018 were used for the evidence base. Strong evidence (predominantly from randomized controlled trials [RCTs]) demonstrated that, for adults aged 18-65 years and older adults (primarily 65 years and older), PA improves QoL and well-being when compared with minimal or no-treatment controls. Moderate evidence indicated that PA improves QoL and well-being in individuals with schizophrenia and Parkinson's disease, and limited evidence indicated that PA improves QoL and well-being for youth and for adults with major clinical depression or bipolar disorder. Insufficient evidence existed for individuals with dementia because of a small number of studies with mixed results. Future high-quality research designs should include RCTs involving longer interventions testing different modes and intensities of PA in diverse populations of healthy people and individuals with cognitive (e.g., dementia) and mental health conditions (e.g., schizophrenia) to precisely characterize the effects of different forms of PA on aspects of QoL and well-being.

A scoping review of physical activity interventions for older adults

BACKGROUND

To inform implementation and future research, this scoping review investigates the volume of evidence for physical activity interventions among adults aged 60+. Our research questions are: (1) what is the evidence regarding interventions designed to increase total physical activity in adults aged 60+ years, in accordance with three of the four strategic objectives of GAPPA (active societies, active environments, active people); (2) what is the current evidence regarding the effectiveness of physical activity programmes and services designed for older adults?; and (3) What are the evidence gaps requiring further research?

METHODS

We searched PEDro, MEDLINE, CINAHL and Cochrane from 1 January 2010 to 1 November 2020 for systematic reviews and meta-analyses of physical activity interventions in adults aged 60+. We identified interventions designed to: (1) increase physical activity; and (2) deliver physical activity programmes and services in home, community or outpatient settings. We extracted and coded data from eligible reviews according to our proposed framework informed by TIDieR, Prevention of Falls Network Europe (PROFANE), and WHO's International Classification of Functioning, Disability and Health (ICF). We classified the overall findings as positive, negative or inconclusive.

RESULTS

We identified 39 reviews of interventions to increase physical activity and 342 reviews of programmes/services for older adults. Interventions were predominantly structured exercise programmes, including balance strength/resistance training, and physical recreation, such as yoga and tai chi. There were few reviews of health promotion/coaching and health professional education/referral, and none of sport, workplace, sociocultural or environmental interventions. Fewer reported outcomes of total physical activity, social participation and quality of life/well-being. We noted insufficient coverage in diverse and disadvantaged samples and low-middle income countries.

CONCLUSIONS

There is a modest but growing volume of evidence regarding interventions designed to increase total physical activity in older adults, although more interventional studies with long term follow-up are needed, particularly for GAPPA 1. Active Societies and GAPPA 2. Active Environments. By comparison, there is abundant evidence for GAPPA 3. specific programmes and services, but coverage of sport and workplace interventions, and diverse samples and settings is lacking. Comprehensive reviews of individual studies are now needed as well as research targeting neglected outcomes, populations and settings.

Increased frequency of participation in civic associations and reduced depressive symptoms: Prospective study of older Japanese survivors of the Great Eastern Japan Earthquake

RATIONALE

Few studies have examined whether changes in participation in civic associations can mitigate depressive symptoms among older disaster survivors.

OBJECTIVES

We examined prospectively the association between changes in participation in civic associations and changes in depressive symptoms among older survivors of the 2011 Great Eastern Japan Earthquake.

METHODS

We analyzed questionnaire-based survey data on pre- and post-disaster participation in civic associations and depressive symptoms compiled for 3567 respondents aged 65 years and above. Changes in these symptoms were assessed using a 15-item Geriatric Depression Scale (GDS) as a continuous variable for 2010 and 2013. We investigated four types of civic associations: sports, hobby, voluntary groups, and senior citizens' clubs. Changes in participation were calculated by subtracting the participation frequency measured in 2010 from that measured in 2013. Applying 95% confidence intervals, we used linear regression models with imputation to estimate the age- and sex-adjusted and multivariate-adjusted standardized coefficients.

RESULTS

The survivors' GDS scores increased by 0.13 points on average between the pre-disaster and post-disaster periods. Average changes in the participation frequencies of respondents in each group were respectively +0.36 days/year, -5.63 days/year, +0.51 days/year, and -1.45 days/year. Increased frequencies of participation in the sports and hobby groups were inversely associated with changes in GDS scores (B = -0.003, Cohen's f² = 0.10, P = 0.01 and B = -0.002, Cohen's f² = 0.08, P = 0.04, respectively). The associations did not differ depending on the experience of housing damage caused by the disaster. In addition, we did not observe a significant association between changes in participation frequencies for voluntary groups or senior citizens' clubs and changes in GDS scores after multivariable adjustment.

CONCLUSIONS

Depressive symptoms of older adults post-disaster may be mitigated through increased frequency of participation in sports and hobby groups; yet, civic participation did not mitigate the adverse impact of disaster experiences on mental health.

Current Evidence of Measurement Properties of Physical Activity Questionnaires for Older Adults: An Updated Systematic Review

BACKGROUND

Questionnaires provide valuable information about physical activity (PA) behaviors in older adults. Until now, no firm recommendations for the most qualified questionnaires for older adults have been provided.

OBJECTIVES

This review is an update of a previous systematic review, published in 2010, and aims to summarize, appraise and compare the measurement properties of all available self-administered questionnaires assessing PA in older adults.

METHODS

We included the articles evaluated in the previous review and conducted a new search in PubMed, Embase, and SPORTDiscus from September 2008 to December 2019, using the following inclusion criteria (1) the purpose of the study was to evaluate at least one measurement property (reliability, measurement error, hypothesis testing for construct validity, responsiveness) of a self-administered questionnaire; (2) the questionnaire intended to measure PA; (3) the questionnaire covered at least one domain of PA; (4) the study was performed in the general, healthy population of older adults; (5) the mean age of the study population was > 55 years; and (6) the article was published in English. Based on the Quality Assessment of Physical Activity Questionnaires (QAPAQ) checklist, we evaluated the quality and results of the studies. The content validity of all included questionnaires was also evaluated using the reviewers' rating. The quality of the body of evidence was evaluated for the overall construct of each questionnaire (e.g., total PA), moderate-to-vigorous physical activity (MVPA) and walking using a modified Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach.

RESULTS

In total, 56 articles on 40 different questionnaires (14 from the previous review and 26 from the update) were included. Reliability was assessed for 22, measurement error for four and hypotheses testing for construct validity for 38 different questionnaires. Evidence for responsiveness was available for one questionnaire. For many questionnaires, only one measurement property was assessed in only a single study. Sufficient content validity was considered for 22 questionnaires. All questionnaires displayed large measurement errors. Only versions of two questionnaires showed both sufficient reliability and hypotheses testing for construct validity, namely the Physical Activity Scale for the Elderly (PASE; English version, Turkish version) for the assessment of total PA, and the Physical Activity and Sedentary Behavior Questionnaire (PASB-Q; English version) for the assessment of MVPA. The quality of evidence for these results ranged from very low to high.

CONCLUSIONS

Until more high-quality evidence is available, we recommend the PASE for measuring total PA and the PASB-Q for measuring MVPA in older adults. However, they are not equally qualified among different languages. Future studies on the most promising questionnaires should cover all relevant measurement properties. We recommend using and improving existing PA questionnaires-instead of developing new ones-and considering the strengths and weaknesses of each PA measurement instrument for a particular purpose.

Physical activity, physical self-perception and depression symptoms in patients with major depressive disorder: a mediation analysis

Physical inactivity is discussed as one of the most detrimental influences for lifestyle-related medical complications such as obesity, heart disease, hypertension, diabetes and premature mortality in in- and outpatients with major depressive disorder (MDD). In contrast, intervention studies indicate that moderate-to-vigorous-intensity physical activity (MVPA) might reduce complications and depression symptoms itself. Self-reported data on depression [Beck-Depression-Inventory-II (BDI-II)], general habitual well-being (FAHW), self-esteem and physical self-perception (FAHW, MSWS) were administrated in a cross-sectional study with 76 in- and outpatients with MDD. MVPA was documented using ActiGraph wGT3X + ® accelerometers and fitness was measured using cardiopulmonary exercise testing (CPET). Subgroups were built according to activity level (low PA defined as MVPA < 30 min/day, moderate PA defined as MVPA 30-45 min/day, high PA defined as MVPA > 45 min/day). Statistical analysis was performed using a Mann-Whitney U and Kruskal-Wallis test, Spearman correlation and mediation analysis. BDI-II scores and MVPA values of in- and outpatients were comparable, but fitness differed between the two groups. Analysis of the outpatient group showed a negative correlation between BDI-II and MVPA. No association of inpatient MVPA and psychopathology was found. General habitual well-being and self-esteem mediated the relationship between outpatient MVPA and BDI-II. The level of depression determined by the BDI-II score was significantly higher in the outpatient low- and moderate PA subgroups compared to outpatients with high PA. Fitness showed no association to depression symptoms or well-being. To ameliorate depressive symptoms of MDD outpatients, intervention strategies should promote habitual MVPA and exercise exceeding the duration recommended for general health (≥ 30 min/day). Further studies need to investigate sufficient MVPA strategies to impact MDD symptoms in inpatient settings. Exercise effects seem to be driven by changes of well-being rather than increased physical fitness.

Prevalence and associations of frailty in residents of Australian aged care facilities: findings from a retrospective cohort study

OBJECTIVES

Studies conducted among older people have shown that frailty is a common condition associated with an array of adverse outcomes. The aims of this study were to identify the prevalence and associations of frailty in older people residing in several aged care facilities located in Queensland, Australia.

METHODS

The database used for this study was drawn from the Aged Care Funding Instrument (ACFI) database of an Australian aged care provider, and contained data from ten aged care facilities in Queensland, Australia. A modification of an eFI originally developed by Clegg and colleagues and based on Rockwood's Frailty Index (FI) of cumulative deficits was used to identify frailty.

RESULTS

In total, 592 participants aged 75 years and over were included in the study (66.6% female). Median (IQR) age was 88.0 (9.0) years. Frailty prevalence among the sample was 43.6%, with 46.3% pre-frail and 10.1% not frail. In a multivariate logistic regression analysis incorporating three different models, frailty was significantly associated with three ACFI domains (Nutrition, Depression and Complex Health Care), along with facility size, consistently across two models. In the third model, frailty was also significantly associated with arthritis, diabetes, hypertension, osteoporosis and vision problems, along with male gender.

CONCLUSION

There is a need to develop frailty identification and management programs as part of standard care pathways for older adults residing in aged care facilities. Aged care facilities should consider regular frailty screening in residential aged care residents, along with interventions addressing specific issues such as dysphagia and depression.

Exercise interventions for the prevention of depression: a systematic review of meta-analyses

BACKGROUND

Exercise may be a promising target for depression interventions. However, evidence for a beneficial effect of exercise interventions on the prevention of depression differs substantially across different studies.

METHODS

A systematic search was performed up to July 2018 using PubMed, Embase, PsycINFO, and Cochrane. Articles were included if a meta-analysis of randomized controlled trials was performed that examined the effect of exercise interventions on the onset of depression or depressive symptoms in the general population. Meta-analyses focusing on treatment of diagnosed depression were excluded. Two authors independently screened the articles and graded the quality of included meta-analyses using AMSTAR 2.

RESULTS

Eight meta-analyses were included that showed little overlap in 134 included studies. All meta-analyses reported on depressive symptoms rather than onset of depression. Five of these were rated as moderate quality and three of low quality. Six meta-analyses found significant effects, and two found non-significant effects of exercise interventions in reducing depressive symptoms in children, adolescents, adults and the elderly (effect sizes ranging from - 0.10 to - 0.81). Scarce evidence did not allow to draw conclusions about the role of sex and characteristics of exercise on depression. However, some findings suggest that low intensity exercise was as effective as high intensity exercise. Heterogeneity among primary studies was high, likely caused by differences in study quality and exercise characteristics.

CONCLUSIONS

The evidence from this study suggests that exercise interventions have a beneficial effect on depressive symptoms in the general population across a wide age-range.

Social Support, Activities of Daily Living, and Depression among Older Japanese and Koreans Immigrants in the U.S

This study investigates the relationship between social support, activities of daily living (ADL), and depression among older Japanese and Koreans living in the U.S. Data were collected from 207 older Japanese and 210 older Koreans in various long-term care settings in Honolulu and Los Angeles. A hierarchical regression analysis indicated that social support was a significant factor of depressive symptoms in both groups and ADL was significantly associated with depressive symptoms among older Japanese. Based on our findings, we recommend means for social workers to address depression among older Japanese and Korean immigrants by improving social support and ADL.

The Effectiveness of Combining Visual Art Activities and Physical Exercise for Older Adults on Well-Being or Quality of Life and Mood: A Scoping Review

Visual art activities and physical exercise are both low-intensity and low-cost interventions. The present study aims to comprehensively describe published literature on the effectiveness of a combination of these interventions on well-being or quality of life (QoL) and mood of older adults. Embase, CINAHL, Ovid Medline (R), PsycINFO, and Web of Science databases were searched for studies published between 1990 and 2015 that evaluated interventions combining visual art therapy and exercise for people aged 50 years or older with at least one resultant well-being or QoL or mood outcome. We found 10 studies utilizing different combination programs and outcome measures, and most had small sample sizes. Seventy percent of the studies reported that combining both interventions was effective in improving well-being or QoL and mood in older adults. Future studies are, however, requisite to investigate whether in the respective population such a combination is more effective than either of the interventions alone.

Development of a clinical prediction model for the onset of functional decline in people aged 65-75 years: pooled analysis of four European cohort studies

BACKGROUND

Identifying those people at increased risk of early functional decline in activities of daily living (ADL) is essential for initiating preventive interventions. The aim of this study is to develop and validate a clinical prediction model for onset of functional decline in ADL in three years of follow-up in older people of 65-75 years old.

METHODS

Four population-based cohort studies were pooled for the analysis: ActiFE-ULM (Germany), ELSA (United Kingdom), InCHIANTI (Italy), LASA (Netherlands). Included participants were 65-75 years old at baseline and reported no limitations in functional ability in ADL at baseline. Functional decline was assessed with two items on basic ADL and three items on instrumental ADL. Participants who reported at least some limitations at three-year follow-up on any of the five items were classified as experiencing functional decline. Multiple logistic regression analysis was used to develop a prediction model, with subsequent bootstrapping for optimism-correction. We applied internal-external cross-validation by alternating the data from the four cohort studies to assess the discrimination and calibration across the cohorts.

RESULTS

Two thousand five hundred sixty community-dwelling people were included in the analyses (mean age 69.7 ± 3.0 years old, 47.4% female) of whom 572 (22.3%) reported functional decline at three-year follow-up. The final prediction model included 10 out of 22 predictors: age, handgrip strength, gait speed, five-repeated chair stands time (non-linear association), body mass index, cardiovascular disease, diabetes, chronic obstructive pulmonary disease, arthritis, and depressive symptoms. The optimism-corrected model showed good discrimination with a C statistic of 0.72. The calibration intercept was 0.06 and the calibration slope was 1.05. Internal-external cross-validation showed consistent performance of the model across the four cohorts.

CONCLUSIONS

Based on pooled cohort data analyses we were able to show that the onset of functional decline in ADL in three years in older people aged 65-75 years can be predicted by specific physical performance measures, age, body mass index, presence of depressive symptoms, and chronic conditions. The prediction model showed good discrimination and calibration, which remained stable across the four cohorts, supporting external validity of our findings.

A supervised exercise intervention fails to improve depressive symptoms and quality of life among sedentary older adults with HIV infection

Older people living with HIV (PLWH) experience multimorbidity that can negatively impact quality of life (QoL). Exercise can improve physical function, but effects on QoL are not well understood. 32 PLWH and 37 controls aged 50-75 completed 12-weeks of moderate-intensity exercise, then were randomized to moderate or high-intensity for 12 additional weeks. Depressive symptoms (CES-D scores) were significantly greater and QOL (SF-36 mental and physical summary scores) significantly lower among PLWH at baseline (all p < 0.05). PLWH had significantly greater worsening in CES-D scores compared to controls (3.4 [0.7, 6.0]; p = 0.01) between 13and 24 weeks. Mental QoL changed minimally, with no significant difference in changes by serostatus between weeks 0 and 12 or weeks 13 and 24 (p ≤ 0.22). Changes in physical function summary scores were similar by serostatus between 0 and 12 weeks (1.5 [-1.6, 4.6], p = 0.35), but declined significantly more among PLWH between 13 and 24 weeks (-4.1 [-7.2,-1], p = 0.01). Exercise intensity had no significant effect on changes in CES-D or SF-36 summary scores; high-intensity exercise was associated with greater improvements in vitality/fatigue (4.1 [0.8, 7.3], p = 0.02), compared to moderate-intensity. Exercise initiation failed to improve depressive symptoms or QoL among PLWH. Additional interventions may be needed to maximize these patient-reported outcomes among older PLWH initiating an exercise program.

The experience of motivation and adherence to group-based exercise of Norwegians aged 80 and more: a qualitative study

Background

Physical activity is crucial for public health; worldwide, across all age groups, exercise has been recognised as a factor that leads to improved health. However, many people do not engage in regular physical activity and hence miss the opportunity to achieve these significant physical and mental health benefits. With the benefits of exercise in mind, the aim of the present study is to describe the experiences of older people's motivation for participating in and adhering to a group-based exercise intervention in a local community setting.

Methods

A qualitative design was used in which semistructured interviews of three men and four women of an advanced age (81-92) were conducted; the participants described their experiences with their participation in and adherence to a long-term group exercise intervention programme in a community setting. Data were analysed using systematic text condensation and discussed in light of the salutogenetic theory.

Results

Four main themes emerged from the data collection: (1) Experience of health challenges: A meaningful starting point; (2) Adherence motivated by increased life-manageability; (3) Comprehensibility through skilled instruction and (4) Social and professional support enhancing motivation. The participants; who had experienced negative changes to their health and function, as well as to their life situation, chose to sign up for the exercise groups and continued to participate throughout the entire intervention. Attending group exercise sessions meant positive changes to physical, mental and social functions enhancing the participants' motivation to sustain their attendance and leading to positive behavioural changes that were important to their everyday lives.

Conclusion

Essential factors for these participants' decision to sign up for the exercise groups were the following: having important life areas connected to physical activity in their history and having belief in exercise as an effective way to restore function and coping; as well as having current experience of health challenges. Adherence to the group exercise was associated with better coping and the ability to fulfil roles and keep up with important life areas. Support from family, friends and professionals also contributed, both to the process of signing up, and adhering to this long-term intervention. The professionals' skills and the way the instructor tailored group instruction were emphasized as very important to the participants' adherence. Understanding of motivational factors for participation in and adherence to, exercise programmes is of great importance to older people, health professionals and society.

Relevant factors of depression in dementia modifiable by non-pharmacotherapy: a systematic review

Depression in dementia patients is associated with complications such as decreased activities of daily living and decreased quality of life. Because pharmacotherapeutic treatments for depression in dementia patients may have a poor risk-benefit ratio, effective non-pharmacotherapeutic interventions are favourable. However, the development of effective treatments requires the identification of depression-associated factors that can be modified by non-pharmacotherapeutic means in dementia patients. This systematic literature review aimed to identify modifiable factors related to depression and confirm that these factors can be improved by non-pharmacotherapeutic interventions. We searched PubMed, SpringerLink, the Web of Science, and the Cochrane Library for articles published between June 2007 and June 2017. We included studies that investigated causes of depression in dementia patients and excluded studies with unclear dementia diagnostic criteria or operational definitions. Of 9004 records screened, 6 studies were included. The participants included community-dwelling individuals and long-term care facility residents. The severity of dementia varied from mild to severe. After reviewing the studies, we identified five modifiable relevant factors in community-dwelling individuals: (i) pain; (ii) neuropsychiatric symptoms; (iii) cognitive decline; (iv) social isolation; and (v) quality of life. In long-term care facility residents, we identified neuropsychiatric symptoms and quality of life as relevant factors. Our results indicated that non-pharmacological interventions that improve these factors may improve symptoms of depression. A longitudinal study is recommended to clarify the mechanisms underlying depression symptoms and treatment in dementia patients. In addition, further investigation is needed to elucidate the ways in which differing dementia types and severity affect symptoms of depression.

Effects of a 10-week functional training programme on pain, mood state, depression, and sleep in healthy older adults

BACKGROUND

The purpose of this study was to analyze the effects of a 10-week functional training (FT) programme on pain, mood state, sleep, and depression in healthy older adults.

METHOD

A group of 38 older adults (32 women, 6 men) voluntarily participated in this study. Participants were randomly assigned to either the experimental group (n = 20; age: 75.44 ± 5.31 years) or the control group (n = 18: age: 76.35 ± 6.45 years). Pain, depression, mood state, and sleep were tested before and after FT.

RESULTS

After the treatment, the experimental group experienced significant improvements in geriatric depression (P < 0.001), vigour (P = 0.044), fatigue (P = 0.002), depression (P = 0.005), and hypersomnia (P = 0.014), whereas the control group experienced significant deterioration in geriatric depression (P = 0.003), pain (P < 0.001), vigour (P = 0.011), depression (P = 0.009), and hypersomnia (P = 0.018). In addition, the experimental group showed an iceberg profile of mood; the control group did not show this profile.

CONCLUSION

Ten-week FT improved mood state, depression, and sleep in healthy older adults. Therefore, FT exercises may be recommended for the prevention and treatment of insomnia, depression, and alterations in mood state.

Factors associated with body image dissatisfaction of the elderly who practice weight training

Abstract Introduction: The body image is a multidimensional construct of the internal and external representations of the corporal structures added to the physical appearance, which can be influenced by aging. The weight training can be an important exercise to help elderly to face all the changes arising from aging, being one of them the dissatisfaction with body image. Objective: This study aims at identifying the factors associated with body image dissatisfaction of the elderly who practice weight training. Methods: This is an observational cross-sectional study. The sample, chosen by convenience and intentionally, embraced 174 male and female elderly subjects who practice weight training at one of the 15 fitness centers drawn for the research that offered this modality of physical exercise in Maringá city, state of Paraná, Brazil. A questionnaire with sociodemographic and health profile questions was used, as well as the BSQ to assess body dissatisfaction. Data analysis was carried out by using a descriptive inferential statistical approach with the Chi-squared test, Fischer's exact test, and binary logistic regression, adopting a significance when p < 0.05. Results: The majority of the elderly showed no body dissatisfaction (82.2%). There was a significant association among the absence of body dissatisfaction and the following items: retirement (p = 0.031), current study (p = 0.035), self perception of health (p = 0.016), body self perception (p = 0.001), and practice time (p = 0.027). Conclusion: Based on the results obtained, it can be concluded that the sociodemographic factors are intervenient when considering body dissatisfaction of the elderly people who practice weight training.

What types of physical activities are effective in developing muscle and bone strength and balance?

The need to be fit, strong, fast and agile has been an evolutionary requirement since early history. In this paper we identify the effectiveness of different types of physical activity on muscle, bone and balance outcomes, and what types of physical activity contribute to the development and maintenance of these outcomes. We undertook a purposive search of PubMed, international evidence reviews of physical activity, and asked international experts to identify review level relevant literature on the effectiveness of muscle, bone and balance training and physical activity on health outcomes. We found consistent review level evidence that strength/resistance training as a single intervention or in combination with other activities, two/three occasions per week, were effective for muscular strength, with higher intensities of training producing greater gains. We found consistent review level evidence that strength training as a single intervention or in combination with high impact loading activities taken at least 3 times per week were effective for bone health. Physical activities with a high challenge to balance done in standing three times per week were beneficial for balance training and falls reduction. The current UK 2011 Chief Medical Officer's physical activity guidelines remain consistent with the most up to date review level evidence for muscle and balance health.

[Effect of a Physical activity program on self-esteem in subjects with chronic diseases. 'Pas a Pas' community intervention trial]

Objetivo

Evaluar la efectividad de un Programa de actividad física (AF) supervisado, con actividades socioculturales y de 9 meses de duración, sobre la autoestima y su asociación sobre el control de las enfermedades crónicas en adultos usuarios de atención primaria.

Diseño

Ensayo de intervención comunitaria, aleatorizado, controlado y multicéntrico.

Emplazamiento

Cuatro centros de atención primaria de Reus-Tarragona, España.

Participantes

Un total de 364 sujetos, aleatorizados al grupo control (GC = 104) y grupo intervención (GI = 260).

Intervención

Programa supervisado de caminatas de 120 min/semana con actividades socioculturales mensuales.

Mediciones principales

En los momentos basal y postintervención se valoró: AF (IPAQ-S), autoestima (escala de Rosenberg) e indicadores cardiovasculares: tabaquismo, presión arterial sistólica (PAS) y diastólica (PAD), colesterol LDL y HDL séricos, y glucosa sérica. Se registran características sociodemográficas y diagnósticos de enfermedades crónicas.

Resultados

El Programa incrementó la AF en el GI (p = 0,001), mientras que disminuyó en el GC (p = 0,002), y también la autoestima en el conjunto de participantes (1,28 puntos; p = 0,006) y en los grupos con diagnósticos de hipertensión (1,60 puntos; p = 0,005), dislipidemia (1,62 puntos; p = 0,012), exceso de peso (1,24 puntos; p = 0,011) o ansiedad/depresión (1,53 puntos; p = 0,045), valorados mediante modelos estadísticos multivariantes. El incremento de la autoestima durante la intervención disminuyó la PAS −0,5 mmHg (p = 0,030) en el grupo de hipertensos, independientemente de la PAS basal y del efecto de la intervención.

Conclusión

El Programa de AF realizado incrementó la AF y la autoestima en adultos usuarios de atención primaria. El incremento de la autoestima mejoró el control de la PAS en hipertensos.