Physical activity interventions targeting older adults. A critical review and recommendations

Evaluation of an exercise program incorporating an international cycling competition: a multimodal intervention model for physical, psychological, and social wellbeing in residential aged care

BACKGROUND

The transition into residential aged care is frequently associated with a reduction in physical activity, social engagement, and emotional wellbeing. Our aim was to evaluate the impact of a 26-day international cycling competition (Road Worlds Competition for Seniors), incorporating elements of exercise, audiovisual cycling footage, social engagement, and gamification, on the physical, psychological, and social well-being of aged care residents. We aimed to use findings to inform the development of a multi-modal intervention model to maximise wellbeing for older adults.

METHODS

Residents (N = 32) participated in a mixed-methods single-group intervention pilot study that compared pre-and post-competition measures for the following wellbeing domains; physical, psychological, and social. In addition, interviews were conducted with residents (n = 27) and staff (n = 6) to explore their experiences.

RESULTS

Measures identified significant improvements across multiple wellbeing domains, including functional fitness, depression, self-efficacy, and social network sizes. Findings from the interview data indicated that the multimodal components involved in the program delivery were valued by staff and residents who enjoyed the gamification, audiovisual cycling footage, social engagement, opportunities for reminiscence, and camaraderie between peers, staff, and volunteers.

CONCLUSIONS

Findings highlight a constellation of benefits across physical, psychological, and social domains of wellbeing and inform a model for innovative multidimensional programs in residential aged care. The benefits for residents with varying physical and cognitive abilities support the use of creative strategies that maximise inclusion and engagement for residents.

Psychosocial Outcomes Associated With Types and Intensities of Physical Activity in People With Spinal Cord Injury: The Mediating Role of Self-Efficacy and Functionality

BACKGROUND

Low rates of participation and quality of life (QoL) and high rates of psychological distress are common in spinal cord injury (SCI) population. Research has supported the mediating role of self-efficacy and functionality in improving psychosocial outcomes. Furthermore, evidence supports the impact of physical activity (PA) on psychosocial variables, but little is known about the types and intensities of PA. The objective of this study was to determine whether functionality and/or general self-efficacy (GSE) mediate the relationships between the various types of PA: (1) lifestyle and (2) leisure-time physical activity (LTPA); and various intensities of PA: (1) mild, (2) moderate, and (3) heavy PA with participation, psychological distress, and perception of QoL.

METHODS

The Physical Activity Recall Assessment for SCI, and measures of functionality, GSE, participation, psychological distress, and perception of QoL were administered to 159 participants. Path analysis was performed using Jeffrey's Amazing Statistics Program.

RESULTS

GSE significantly mediated, and functionality partially significantly mediated, the relationship between LTPA and psychosocial outcomes. GSE and functionality did not mediate the relationship between lifestyle activity and psychosocial outcomes.

CONCLUSIONS

It is recommended that people with SCI perform LTPA on a regular basis to achieve psychosocial benefits. These programs should be accompanied by strategies to improve GSE.

Indicators of Dietary Behavior and Physical Activity Change Associated with Metabolic Control of Obesity, Hypertension, and Type 2 Diabetes Mellitus in Mexican Adults: National Nutrition and Health Survey in Mexico, 2016

Introduction: Obesity (OB), type 2 diabetes mellitus (T2D), and hypertension (HTN) are health issues in Mexico linked to unhealthy behaviors. This study investigates the relationship between behavior change indicators and metabolic control in Mexican adults with OB, T2D, and HTN. Methods: We used data from the 2016 National Health and Nutrition Survey Midway (ENSANUT MC-2016), representing ∼59.5 million Mexican adults aged 20-59 with these conditions. We assessed behavior change indicators, including stages of change, self-efficacy, and perceptions of benefits and barriers. In addition, we conducted descriptive analyses and used statistical tests, such as Pearson's chi-squared test and logistic regression models, adjusted for multiple variables. Results: We found that adults in the action and maintenance stages of physical activity (PA) were four times more likely to have adequate HTN control than those in the precontemplation stage. Self-efficacy for PA was related to better control in T2D and HTN. Self-efficacy for reducing the consumption of sugary beverages was positively associated with control in OB and T2D. No significant association was observed with self-efficacy for consuming fruits and vegetables. Conclusion: Behavior-change indicators are significantly linked to metabolic control in adults with HTN. These results support the importance of these indicators in managing chronic diseases such as HTN and their potential use in public health strategies.

Origin and age group of the fastest amateur triathletes competing in 'Ironman Hawaii' between 2003 and 2019

Little is known about the prevalent nationalities among the best-placed athletes participating in "Ironman Hawaii." Moreover, the age at which athletes achieve their best performances remains unclear. The present study aimed to compare the prevalent nationalities among the athletes, their respective placement among the top five, and the performance difference between the different age groups in 'Ironman Hawaii' from 2003 to 2019. A total of 30 354 amateur triathletes were selected from the Obsessed Triathlete (OBSTRI) website. A "TOP 5" division filter was applied for further analysis, resulting in 1 851 athletes being included in this study. Among the male runners, Americans participated the most in Ironman events (39%), followed by Germans (10%). Among female runners, Americans participated the most (54%), followed by Australian runners (8%). Male Americans also featured most among the top five (30%), followed by Germans (16%). Female Americans were the most prevalent among the top five (47%), followed by Australian Americans (10%). There were no significant performance differences (p ​> ​0.05) between the 25-29 and 40-44 age groups for either sex. The 45-49 age group presented significantly worse performance than the 35-39 age group for both sexes (p ​< ​0.001). North Americans were the most performant and frequent participants in "Ironman Hawaii." The expected performance decline due to aging was observed after 45 years in both sexes.

Disability Among Older Adults in South-Eastern Nigeria

Disability is a common reason for the loss of independence. There is a dearth of data on older adults with disability in south-eastern Nigeria. Using a multistage sampling technique and disability indexes, we assessed 816 persons aged 65 years and above living with a disability. While respondents' experiences of abuse and property inheritance differ by gender, they have poor health status. Elevated risks of disability were associated with gender, increased age, education, smoking, alcohol use, and engagement in physical exercise. Findings suggest urgency in formulating and implementing ageing welfare policy in this African community undergoing demographic and social changes. While this is underway, we recommend a massive health promotion among older adults in this community. We also suggest the integration of courses on ageing in schools' curriculum since ageing is a life course phenomenon. This in the long run would provide ageing-friendly education that averts old age's deleterious effects.

Exploring Older Adults' Experiences of a Home-Based, Technology-Driven Balance Training Exercise Program Designed to Reduce Fall Risk: A Qualitative Research Study Within a Randomized Controlled Trial

BACKGROUND AND PURPOSE

With an aging population, falls have become an increasing public health concern. While face-to-face exercise programs have demonstrated efficacy in reducing falls, their effectiveness is hampered by low participation and adherence. Digital technologies are a novel and potentially effective method for delivering tailored fall prevention exercise programs to older adults. In addition, they may increase the reach, uptake, and sustainability of fall prevention programs. Therefore, understanding older adults' experiences of using technology-driven methods is essential. This study explored the user experience of StandingTall , a home-based fall prevention program delivered through a tablet computer.

METHODS

Fifty participants were recruited using purposive sampling, from a larger randomized controlled trial. Participants were selected to ensure maximum variability with respect to age, gender, experience with technology, and adherence to the program. Participants undertook a one-on-one structured interview. We followed an iterative approach to develop themes.

RESULTS AND DISCUSSION

Eight themes were identified. These fall under 2 categories: user experience and program design. Participants found StandingTall enjoyable, and while its flexible delivery facilitated exercise, some participants found the technology challenging. Some participants expressed frustration with technological literacy, but most demonstrated an ability to overcome these challenges, and learn a new skill. Older adults who engaged in a technology-driven fall prevention program found it enjoyable, with the flexibility provided by the online delivery central to this experience. While the overall experience was positive, participants expressed mixed feelings about key design features. The embedded behavior change strategies were not considered motivating by most participants. Furthermore, some older adults associated the illustrated characters with gender-based stereotypes and negative views of aging, which can impact on motivation and preventive behavior.

CONCLUSION

This study found digital technologies are an effective and enjoyable method for delivering a fall prevention program. This study highlights that older adults are interested in learning how to engage successfully with novel technologies.

A 12-week personalised physical activity and dietary protein intervention for older adults undergoing peritoneal dialysis: A feasibility study

This single-arm observational study explored the feasibility and efficacy of a 12-week personalised physical activity and dietary protein intervention programme for older adults undergoing peritoneal dialysis. Older adults undergoing peritoneal dialysis received eight individualised nutrition and physical activity advice sessions provided by trained nurses. Protein intake and physical activity were regarded as primary outcomes. All data were collected at baseline and at week 12. The enrolment rate was 78.4%. Twenty-nine patients participated in the study. Of these, 86.2% (25/29) completed the intervention. There was a significant increase in protein intake (t = -4.453, P< 0.001) and physical activity levels (Z = -2.929, P = 0.004). Of the participants, 56.0% achieved the targeted protein goal, and 41.4% met the physical activity goal. The timed up-and-go performance (t = 4.135, P = 0.001) increased after intervention. Trained nurses can successfully implement personalised diet and physical activity advice, and achieve promising patient outcomes.

Intervening on exercise and daylong movement for weight loss maintenance in older adults: A randomized, clinical trial

OBJECTIVE

This study aimed to determine the impact of dietary weight loss (WL) plus aerobic exercise (EX) and a "move more, more often" approach to activity promotion (SitLess; SL) on WL and maintenance.

METHODS

Low-active older adults (age 65-86 years) with obesity were randomized to WL+EX, WL+SL, or WL+EX+SL. Participants received a social-cognitive group-mediated behavioral WL program for 6 months, followed by a 12-month maintenance period. EX participants received guided walking exercise with the goal of walking 150 min/wk. SL attempted to achieve a step goal by moving frequently during the day. The primary outcome was body weight at 18 months, with secondary outcomes including weight regain from 6 to 18 months and objectively assessed physical activity and sedentary behavior at each time point.

RESULTS

All groups demonstrated significant WL over 6 months (p < 0.001), with no group differences. Groups that received SL improved total activity time (p ≤ 0.05), and those who received EX improved moderate-to-vigorous activity time (p = 0.003). Over the 12-month follow-up period, those who received WL+EX demonstrated greater weight regain (5.2 kg; 95% CI: 3.5-6.9) relative to WL+SL (2.4 kg; 95% CI: 0.8-4.0).

CONCLUSIONS

Pairing dietary WL with a recommendation to accumulate physical activity contributed to similar WL and less weight regain compared with traditional aerobic exercise.

Balance Enhancement in Older Adults: Is Functional-Task Training Better Than Resistance Training in Enhancing Balance in Older Adults?

Background and purpose

The effects of various exercise training programs on balance in older adults are well established. This study aimed to compare the effect of functional-task training with resistance training in improving balance performance in older adults.

Methods

A total of 100 community-dwelling older adults aged 65 years and above were randomly allocated into two groups: functional-task training (FTT) group and resistance training (RT) group. The FTT group (n = 50) performed functional task exercises and the RT group (n = 50) performed resistance exercises three times a week for 12 weeks. Balance was evaluated before and after the trial using the Berg Balance Scale (BBS) and the Timed Up and Go (TUG) test.

Results

A total of 87 subjects who completed the study were analyzed. Both the groups showed a significant change in BBS and TUG test (p < 0.05) from baseline to 12 weeks. However, post-intervention analysis between the groups showed a significant difference in both the BBS and TUG test (p < 0.05), i.e. improvement in the FTT group was better than the RE group at the end of training.

Conclusion

Both the FTT and RT were effective in improving balance. However, the improvement achieved by the FTT group was better than the RT group.

Caring as curing: Grandparenting and depressive symptoms in China

Research on grandparenting (i.e., caring for grandchildren) and mental health in Asian contexts has been limited, despite the rapid growth of older adults who take care of grandchildren. This study aims to investigate how grandparenting influences depressive symptoms in China. Using the China Health and Retirement Longitudinal Study (2011-2015, N = 4354), we conducted fixed effects regression models to examine the association between various types of grandparenting and depressive symptoms among older adults between the ages of 45 and 80. The results show that for grandparents, providing care to their grandchildren in skipped-generation households (i.e., grandparent-grandchildren families without adult children) is associated with a lower level of depressive symptoms compared to providing no care, after controlling for socioeconomic status, health behaviors, social support, and basic demographic characteristics. Other types of care (i.e., multigenerational household grandparenting, and part-time and full-time noncoresident grandparenting) are not significantly linked to caregiving grandparents' depressive symptoms. Overall, our findings suggest that sociocultural contexts need to be considered in explaining the different mental health implications of grandparenting.

The search for the ejecting chair: a mixed-methods analysis of tool use in a sedentary behavior intervention

Research is needed on interventions targeting sedentary behavior with appropriate behavior-change tools. The current study used convergent sequential mixed methods (QUAN + qual) to explore tool use during a edentary behavior intervention. Data came from a two-arm randomized sedentary behavior pilot intervention. Participants used a number of intervention tools (e.g., prompts and standing desks). Separate mixed-effects regression models explored associations between change in number of tools and frequency of tool use with two intervention targets: change in sitting time and number of sit-to-stand transitions overtime. Qualitative data explored participants' attitudes towards intervention tools. There was a significant relationship between change in total tool use and sitting time after adjusting for number of tools (β = -12.86, p = .02), demonstrating that a one-unit increase in tool use was associated with an almost 13 min reduction in sitting time. In contrast, there was a significant positive association between change in number of tools and sitting time after adjusting for frequency of tool use (β = 63.70, p = .001), indicating that increasing the number of tools without increasing frequency of tool use was associated with more sitting time. Twenty-four semistructured interviews were coded and a thematic analysis revealed four themes related to tool use: (a) prompts to disrupt behavior; (b) tools matching the goal; (c) tools for sit-to-stand were ineffective; and (d) tool use evolved over time. Participants who honed in on effective tools were more successful in reducing sitting time. Tools for participants to increase sit-to-stand transitions were largely ineffective. This study is registered at clincialtrials.gov. Identifier: NCT02544867.

Factors That Influence Walking Intervention Adherence for Older Adults Living in Retirement Communities

Walking interventions improve health outcomes among older adults. However, few clinical trials evaluate long-term behavior change adherence. The authors explored factors that influence walking adherence in older adults following their participation in a clinical trial. They conducted n = 7 focus groups with n = 23 participants enrolled in the parent study (ClinicalTrials.gov number: NCT03654807). The authors used content analysis to code data according to the social-ecological model. They found that supportive services (exercise classes) in retirement communities have multilevel impacts on adherence to walking activity. Residents from communities offering services continued walking because of increased confidence gained in the parent trial, while residents in communities without services were motivated by their functional improvements. Residents voiced frustration with retirement community physical activity programs that did not address the full spectrum of physical functioning. Findings support the need for retirement communities to account for various motivational factors in tailoring programs to promote increased physical activity for older adults.

Women's Health Initiative Strong and Healthy Pragmatic Physical Activity Intervention Trial for Cardiovascular Disease Prevention: Design and Baseline Characteristics

BACKGROUND

National guidelines promote physical activity to prevent cardiovascular disease (CVD), yet no randomized controlled trial has tested whether physical activity reduces CVD.

METHODS

The Women's Health Initiative (WHI) Strong and Healthy (WHISH) pragmatic trial used a randomized consent design to assign women for whom cardiovascular outcomes were available through WHI data collection (N = 18 985) or linkage to the Centers for Medicare and Medicaid Services (N30 346), to a physical activity intervention or "usual activity" comparison, stratified by ages 68-99 years (in tertiles), U.S. geographic region, and outcomes data source. Women assigned to the intervention could "opt out" after receiving initial physical activity materials. Intervention materials applied evidence-based behavioral science principles to promote current national recommendations for older Americans. The intervention was adapted to participant input regarding preferences, resources, barriers, and motivational drivers and was targeted for 3 categories of women at lower, middle, or higher levels of self-reported physical functioning and physical activity. Physical activity was assessed in both arms through annual questionnaires. The primary outcome is major cardiovascular events, specifically myocardial infarction, stroke, or CVD death; primary safety outcomes are hip fracture and non-CVD death. The trial is monitored annually by an independent Data Safety and Monitoring Board. Final analyses will be based on intention to treat in all randomized participants, regardless of intervention engagement.

RESULTS

The 49 331 randomized participants had a mean baseline age of 79.7 years; 84.3% were White, 9.2% Black, 3.3% Hispanic, 1.9% Asian/Pacific Islander, 0.3% Native American, and 1% were of unknown race/ethnicity. The mean baseline RAND-36 physical function score was 71.6 (± 25.2 SD). There were no differences between Intervention (N = 24 657) and Control (N = 24 674) at baseline for age, race/ethnicity, current smoking (2.5%), use of blood pressure or lipid-lowering medications, body mass index, physical function, physical activity, or prior CVD (10.1%).

CONCLUSION

The WHISH trial is rigorously testing whether a physical activity intervention reduces major CV events in a large, diverse cohort of older women. Clinical Trials Registration Number: NCT02425345.

A randomized controlled trial comparing community lifestyle interventions to improve adherence to diet and physical activity recommendations: the VitalUM study

Worldwide, adherence to national guidelines for physical activity (PA), and fruit and vegetable consumption is recommended to promote health and reduce the risk for (chronic) disease. This study reports on the effectiveness of various social-cognitive interventions to improve adherence to guidelines and the revealed adherence predictors. Participants (n = 1,629), aged 45-70 years, randomly selected and recruited in 2005-2006 from 23 Dutch general practices, were randomized (centralized stratified allocation) to four groups to receive a 12-month lifestyle intervention targeting guideline adherence for PA and fruit and vegetable consumption. Study groups received either four computer-tailored print communication (TPC) letters (n = 405), four telephone motivational interviewing (TMI) sessions (n = 407), a combined intervention (two TPC letters and two TMI sessions, n = 408), or no intervention (control group, n = 409). After the baseline assessment, all parties were aware of the treatment groups. Outcomes were measured with self-report postal questionnaires at baseline, 25, 47 and 73 weeks. For PA, all three interventions were associated with better guideline adherence than no intervention. Odds ratios for TPC, TMI and the combined intervention were 1.82 (95% CI 1.31; 2.54), 1.57 (95% CI 1.13; 2.18), and 2.08 (95% CI 1.50; 2.88), respectively. No pedometer effects were found. For fruit and vegetable consumption, TPC seemed superior to those in the other groups. Odd ratio for fruit and vegetable consumption were 1.78 (95% CI 1.32; 2.41) and 1.73 (95% CI 1.28; 2.33), respectively. For each behaviour, adherence was predicted by self-efficacy expectations, habit strength and stages of change, whereas sex, awareness and the number of action plans predicted guideline adherence for fruit and vegetable intake. The season predicted the guideline adherence for PA and fruit consumption. The odds ratios revealed were equivalent to modest effects sizes, although they were larger than those reported in systematic reviews. This study indicated that less resource intensive interventions might have the potential for a large public health impact when widely implemented. The strengths of this study were the participation of lower educated adults and evaluation of maintenance effects. (Trial NL1035, 2007-09-06).

Associations between exercising in a group and physical and cognitive functions in community-dwelling older adults: a cross-sectional study using data from the Kasama Study

[Purpose] To examine the associations of exercise habits, particularly exercising in a group, with physical and cognitive functions in community-dwelling older adults. [Participants and Methods] A total of 615 older adults participated in this cross-sectional study. We conducted three physical performance tests (grip strength, five times sit-to-stand, and 5-meter walk tests) and the Five-Cog test (attention, memory, visuospatial, language, and reasoning). We investigated exercise habits using questionnaires and classified the participants into three groups as follows: those who did not exercise (n=86), those who exercised alone (n=168), and those who exercised in a group (n=362). To clarify the associations of exercise habits with physical and cognitive functions, we used the analysis of covariance with adjustment for potential confounders. [Results] The participants who exercised in a group had better lower limb strength than those who exercised alone and better scores for all the variables than the non-exercisers. Furthermore, those who exercised in a group scored significantly higher on the attention, memory, visuospatial, and overall cognitive function tests than those who exercised alone. [Conclusion] Our results highlight the importance of the social aspects associated with exercising, such as the presence of exercise peers, to improve the physical and cognitive health of older adults.

Formative Evaluation of Consumer-Grade Activity Monitors Worn by Older Adults: Test-Retest Reliability and Criterion Validity of Step Counts

Background

To assess whether commercial-grade activity monitors are appropriate for measuring step counts in older adults, it is essential to evaluate their measurement properties in this population.

Objective

This study aimed to evaluate test-retest reliability and criterion validity of step counting in older adults with self-reported intact and limited mobility from 6 commercial-grade activity monitors: Fitbit Charge, Fitbit One, Garmin vívofit 2, Jawbone UP2, Misfit Shine, and New-Lifestyles NL-1000.

Methods

For test-retest reliability, participants completed two 100-step overground walks at a usual pace while wearing all monitors. We tested the effects of the activity monitor and mobility status on the absolute difference in step count error (%) and computed the standard error of measurement (SEM) between repeat trials. To assess criterion validity, participants completed two 400-meter overground walks at a usual pace while wearing all monitors. The first walk was continuous; the second walk incorporated interruptions to mimic the conditions of daily walking. Criterion step counts were from the researcher tally count. We estimated the effects of the activity monitor, mobility status, and walk interruptions on step count error (%). We also generated Bland-Altman plots and conducted equivalence tests.

Results

A total of 36 individuals participated (n=20 intact mobility and n=16 limited mobility; 19/36, 53% female) with a mean age of 71.4 (SD 4.7) years and BMI of 29.4 (SD 5.9) kg/m². Considering test-retest reliability, there was an effect of the activity monitor (P<.001). The Fitbit One (1.0%, 95% CI 0.6% to 1.3%), the New-Lifestyles NL-1000 (2.6%, 95% CI 1.3% to 3.9%), and the Garmin vívofit 2 (6.0%, 95 CI 3.2% to 8.8%) had the smallest mean absolute differences in step count errors. The SEM values ranged from 1.0% (Fitbit One) to 23.5% (Jawbone UP2). Regarding criterion validity, all monitors undercounted the steps. Step count error was affected by the activity monitor (P<.001) and walk interruptions (P=.02). Three monitors had small mean step count errors: Misfit Shine (−1.3%, 95% CI −19.5% to 16.8%), Fitbit One (−2.1%, 95% CI −6.1% to 2.0%), and New-Lifestyles NL-1000 (−4.3%, 95 CI −18.9% to 10.3%). Mean step count error was larger during interrupted walking than continuous walking (−5.5% vs −3.6%; P=.02). Bland-Altman plots illustrated nonsystematic bias and small limits of agreement for Fitbit One and Jawbone UP2. Mean step count error lay within an equivalence bound of ±5% for Fitbit One (P<.001) and Misfit Shine (P=.001).

Conclusions

Test-retest reliability and criterion validity of step counting varied across 6 consumer-grade activity monitors worn by older adults with self-reported intact and limited mobility. Walk interruptions increased the step count error for all monitors, whereas mobility status did not affect the step count error. The hip-worn Fitbit One was the only monitor with high test-retest reliability and criterion validity.

Evaluation of a Blended Physical Activity Intervention for Older Adults: Mixed Methods Study

BACKGROUND

Physical activity can prolong the ability of older adults to live independently. Home-based exercises can help achieve the recommended physical activity levels. A blended intervention was developed to support older adults in performing home-based exercises. A tablet and a personal coach were provided to facilitate the self-regulation of exercise behavior.

OBJECTIVE

In line with the Medical Research Council framework, this study aimed to carry out process evaluation of a blended intervention. The objectives were (1) to assess the long-term usability of the tablet adopted in the blended intervention and (2) to explore how the tablet, in conjunction with a personal coach, supported older adults in performing home-based exercises.

METHODS

The process evaluation was conducted with a mixed-methods approach. At baseline, older adults participating in the blended intervention were asked to fill out a questionnaire about their general experience with information and communication technology (ICT) devices and rate their own skill level. After 6 months, participants filled out the Usefulness, Satisfaction, and Ease of use (USE) questionnaire to assess the usefulness, satisfaction, and ease of use of the tablet. With a random selection of participants, in-depth interviews were held to explore how the tablet and coach supported the self-regulation. The interviews were double coded and analyzed with the directed content analysis method.

RESULTS

At baseline, 29% (65/224) of participants who started the intervention (mean age 72 years) filled out the ICT survey and 36% (37/103) of participants who used the tablet for 6 months (mean age 71 years) filled out the USE questionnaire. Furthermore, with 17% (18/103) of participants (mean age 73 years), follow-up interviews were held. The results of the baseline questionnaire showed that the large majority of participants already had experience with a tablet, used it regularly, and reported being skillful in operating ICT devices. After 6 months of use, the participants rated the usefulness, satisfaction, and ease of use of the tablet on average as 3.8, 4.2, and 4.1, respectively, on a 5-point scale. The analysis of the interviews showed that the participants felt that the tablet supported action planning, behavior execution, and self-monitoring. On the other hand, especially during the first few months, the personal coach added value during the goal setting, behavior execution, and evaluation phases of self-regulation.

CONCLUSIONS

The results of the process evaluation showed that older adults who participated in the study were positive about the blended intervention that was designed to support them in performing home-based exercises. Participants reported that the tablet helped them to perform the exercises better, more frequently, and safely. It supported them in various phases of self-regulation. The availability of a personal coach was nevertheless crucial. To support physical activity in older adults, a blended approach is promising.

Neighborhood Influences on Physical Activity Among Low-Income African American Adults With Type 2 Diabetes Mellitus

PURPOSE

The purpose of the study was to explore the influences of the neighborhood environment on physical activity (PA) among people living with type 2 diabetes mellitus (T2DM) in a community with limited resources.

METHODS

Participants were adults with T2DM and their family members or friends who help in the management of T2DM and who were living in a low-income African American (AA) community. Health care providers working in the neighborhood were also included. Using an emergent design, qualitative data were collected through 7 focus group discussions (N = 63) and 13 in-depth interviews. Verbatim transcriptions were analyzed via thematic coding to explore contextual factors that limit PA and meaning around neighborhood features that promote or discourage PA.

RESULTS

Levels of PA were strongly limited by neighborhood insecurity and a lack of recreational facilities in the neighborhood. People with T2DM and physical/mobility disabilities were more affected by the neighborhood environment than those without disabilities, particularly due to perceived safety concerns and social stigma. Despite socioeconomic inequalities within neighborhoods, participants showed resilience and made efforts to overcome social-environmental barriers to PA, applied various coping strategies, and received social support.

CONCLUSIONS

Results suggested that in an underserved neighborhood, individual barriers to physical activity were amplified by neighborhood-level factors such as crime, especially among individuals who have T2DM and disabilities. Socioeconomic inequalities should be addressed further to improve management of T2DM and its complications.

Open-Access Physical Activity Programs for Older Adults: A Pragmatic and Systematic Review

BACKGROUND AND OBJECTIVES

Open-access, community-based programs are recommended to assist older adults in meeting physical activity guidelines, but the characteristics, impact, and scalability of these programs is less understood. The Land-Grant University Cooperative Extension System, an organization providing education through county-based educators, functions as a delivery system for these programs. A systematic review was conducted to determine characteristics of effective older adult physical activity programs and the extent to which programs delivered in Extension employ these characteristics.

RESEARCH DESIGN AND METHODS

A systematic review of peer-reviewed and grey literature was conducted from August 2016 to February 2017. The review was limited to open-access (available to all), community-based physical activity interventions for older adults (≥65 years of age). The peer-reviewed literature search was conducted in PubMed and EBSCOhost; the grey literature search for Extension interventions was conducted through Extension websites, Land-Grant Impacts, and the Journal of Extension.

RESULTS

Sixteen peer-reviewed studies and 17 grey literature sources met inclusion criteria and were analyzed. Peer-reviewed and Extension programs were similar in their limited use of behavioral theories and group-based strategies. Compared to Extension programs, those in the peer-reviewed literature were more likely to use a combination of physical activity components and be delivered by trained professionals.

DISCUSSION AND IMPLICATIONS

The results indicate notable differences between peer-reviewed literature and Extension programs and present an opportunity for Extension programs to more effectively use evidence-based program characteristics, including behavioral theories and group dynamics, a combination of physical activity components, and educator/agent-trained delivery agents.

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.

Results of MyPlan 2.0 on Physical Activity in Older Belgian Adults: Randomized Controlled Trial

Background

The beneficial effects of physical activity (PA) for older adults are well known. However, few older adults reach the health guideline of 150 min per week of moderate-to-vigorous PA (MVPA). Electronic health (eHealth) interventions are effective in increasing PA levels in older adults in the short term but, rarely, intermediate-term effects after a period without the support of a website or an app have been examined. Furthermore, current theory-based interventions focus mainly on preintentional determinants, although postintentional determinants should also be included to increase the likelihood of successful behavior change.

Objective

This study aimed to investigate the effect of the theory-based eHealth intervention, MyPlan 2.0, focusing on pre- and postintentional determinants on both accelerometer-based and self-reported PA levels in older Belgian adults in the short and intermediate term.

Methods

This study was a randomized controlled trial with three data collection points: baseline (N=72), post (five weeks after baseline; N=65), and follow-up (three months after baseline; N=65). The study took place in Ghent, and older adults (aged ≥65 years) were recruited through a combination of random and convenience sampling. At all the time points, participants were visited by the research team. Self-reported domain-specific PA was assessed using the International Physical Activity Questionnaire, and accelerometers were used to objectively assess PA. Participants in the intervention group got access to the eHealth intervention, MyPlan 2.0, and used it independently for five consecutive weeks after baseline. MyPlan 2.0 was based on the self-regulatory theory and focused on both pre- and postintentional processes to increase PA. Multilevel mixed-models repeated measures analyses were performed in R (R Foundation for Statistical Computing).

Results

Significant (borderline) positive intervention effects were found for accelerometer-based MVPA (baseline−follow-up: intervention group +5 min per day and control group −5 min per day; P=.07) and for accelerometer-based total PA (baseline−post: intervention group +20 min per day and control group −24 min per day; P=.05). MyPlan 2.0 was also effective in increasing self-reported PA, mainly in the intermediate term. A positive intermediate-term intervention effect was found for leisure-time vigorous PA (P=.02), moderate household-related PA (P=.01), and moderate PA in the garden (P=.04). Negative intermediate-term intervention effects were found for leisure-time moderate PA (P=.01) and cycling for transport (P=.07).

Conclusions

The findings suggest that theory-based eHealth interventions focusing on pre- and postintentional determinants have the potential for behavior change in older adults. If future studies including larger samples and long-term follow-up can confirm and clarify these findings, researchers and practitioners should be encouraged to use a self-regulation perspective for eHealth intervention development.

Trial Registration

Clinicaltrials.gov NCT03194334; https://clinicaltrials.gov/ct2/show/NCT03783611.

Barriers and Motivators of Physical Activity Participation in Middle-aged and Older-adults - A Systematic Review

Identifying the difference in barriers and motivators between middle-age and older adults could contribute toward the development of age-specific health promotion interventions. The aim of this review was to synthesize the literature on barriers and motivators for physical activity in middle-aged (50-64 years) and older adults (65-70 years). The review examined qualitative and quantitative studies using the theoretical domain framework as the guiding theory. The search generated 9400 results from seven databases. A total of fifty-five articles meeting the inclusion criteria. Results indicate that barriers are comparable across the two age groups with environmental factors and resources being the most commonly identified barriers. In older adults, social influences, reinforcement and assistance in managing change were the most identified motivators. Middle-aged identified goals settings, believe that activity will be beneficial and social influences were most important. Findings can be used by professionals to encourage engagement with and adherence to physical activity.

A Group Dynamics-Based Exercise Intervention to Improve Physical Activity Maintenance in Breast Cancer Survivors

BACKGROUND

To maintain increases in physical activity (PA), interventions that implement group dynamics principles and strategies with the intent of enhancing group cohesion may be advantageous. This study examined group cohesion and PA following a group dynamics-based PA intervention among breast cancer survivors.

METHODS

The study was designed as a pilot randomized controlled trial comparing an 8-week group dynamics-based intervention with an individually supervised intervention. Group cohesion was measured by the Physical Activity Group Environment Questionnaire, and PA was measured at baseline, post-intervention, and 3-month follow-up using a self-report questionnaire and pedometer.

RESULTS

Group cohesion levels were high following the intervention and positively associated with PA at 3-month follow-up (ranger = .182-.555). At 3-month follow-up, 91.7% of participants in the group-dynamics-based intervention (n = 12) were classified as moderately active or greater, compared with 54.5% in the individually supervised intervention (n = 11).

CONCLUSIONS

These results suggest that, for breast cancer survivors, peer support and fostering group cohesion as part of an exercise program may help to support PA following the completion of a structured intervention. A larger trial with longer follow-up is needed to establish comparative efficacy for a group-dynamics-based exercise intervention to enhance long-term PA adherence in breast cancer survivors.

Gait training using a robotic hip exoskeleton improves metabolic gait efficiency in the elderly

Robotic exoskeletons are regarded as promising technologies for neurological gait rehabilitation but have been investigated comparatively little as training aides to facilitate active aging in the elderly. This study investigated the feasibility of an exoskeletal Active Pelvis Orthosis (APO) for cardiopulmonary gait training in the elderly. Ten healthy elderly volunteers exhibited a decreased (-26.6 ± 16.1%) Metabolic Cost of Transport (MCoT) during treadmill walking following a 4-week APO-assisted training program, while no significant changes were observed for a randomly assigned control group (n = 10) performing traditional self-paced overground walking. Moreover, robot-assisted locomotion was found to require 4.24 ± 2.57% less oxygen consumption than free treadmill walking at the same speed. These findings support the adoption of exoskeletal devices for the training of frail individuals, thus opening new possibilities for sustainable strategies for healthy aging.

A pedometer-based walking intervention in 45- to 75-year-olds, with and without practice nurse support: the PACE-UP three-arm cluster RCT

BACKGROUND

Guidelines recommend walking to increase moderate to vigorous physical activity (MVPA) for health benefits.

OBJECTIVES

To assess the effectiveness, cost-effectiveness and acceptability of a pedometer-based walking intervention in inactive adults, delivered postally or through dedicated practice nurse physical activity (PA) consultations.

DESIGN

Parallel three-arm trial, cluster randomised by household.

SETTING

Seven London-based general practices.

PARTICIPANTS

A total of 11,015 people without PA contraindications, aged 45-75 years, randomly selected from practices, were invited. A total of 6399 people were non-responders, and 548 people self-reporting achieving PA guidelines were excluded. A total of 1023 people from 922 households were randomised to usual care (n = 338), postal intervention (n = 339) or nurse support (n = 346). The recruitment rate was 10% (1023/10,467). A total of 956 participants (93%) provided outcome data.

INTERVENTIONS

Intervention groups received pedometers, 12-week walking programmes advising participants to gradually add '3000 steps in 30 minutes' most days weekly and PA diaries. The nurse group was offered three dedicated PA consultations.

MAIN OUTCOME MEASURES

The primary and main secondary outcomes were changes from baseline to 12 months in average daily step counts and time in MVPA (in ≥ 10-minute bouts), respectively, from 7-day accelerometry. Individual resource-use data informed the within-trial economic evaluation and the Markov model for simulating long-term cost-effectiveness. Qualitative evaluations assessed nurse and participant views. A 3-year follow-up was conducted.

RESULTS

Baseline average daily step count was 7479 [standard deviation (SD) 2671], average minutes per week in MVPA bouts was 94 minutes (SD 102 minutes) for those randomised. PA increased significantly at 12 months in both intervention groups compared with the control group, with no difference between interventions; additional steps per day were 642 steps [95% confidence interval (CI) 329 to 955 steps] for the postal group and 677 steps (95% CI 365 to 989 steps) for nurse support, and additional MVPA in bouts (minutes per week) was 33 minutes per week (95% CI 17 to 49 minutes per week) for the postal group and 35 minutes per week (95% CI 19 to 51 minutes per week) for nurse support. Intervention groups showed no increase in adverse events. Incremental cost per step was 19p and £3.61 per minute in a ≥ 10-minute MVPA bout for nurse support, whereas the postal group took more steps and cost less than the control group. The postal group had a 50% chance of being cost-effective at a £20,000 per quality-adjusted life-year (QALY) threshold within 1 year and had both lower costs [-£11M (95% CI -£12M to -£10M) per 100,000 population] and more QALYs [759 QALYs gained (95% CI 400 to 1247 QALYs)] than the nurse support and control groups in the long term. Participants and nurses found the interventions acceptable and enjoyable. Three-year follow-up data showed persistent intervention effects (nurse support plus postal vs. control) on steps per day [648 steps (95% CI 272 to 1024 steps)] and MVPA bouts [26 minutes per week (95% CI 8 to 44 minutes per week)].

LIMITATIONS

The 10% recruitment level, with lower levels in Asian and socioeconomically deprived participants, limits the generalisability of the findings. Assessors were unmasked to the group.

CONCLUSIONS

A primary care pedometer-based walking intervention in 45- to 75-year-olds increased 12-month step counts by around one-tenth, and time in MVPA bouts by around one-third, with similar effects for the nurse support and postal groups, and persistent 3-year effects. The postal intervention provides cost-effective, long-term quality-of-life benefits. A primary care pedometer intervention delivered by post could help address the public health physical inactivity challenge.

FUTURE WORK

Exploring different recruitment strategies to increase uptake. Integrating the Pedometer And Consultation Evaluation-UP (PACE-UP) trial with evolving PA monitoring technologies.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN98538934.

FUNDING

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 37. See the NIHR Journals Library website for further project information.

Identifying modifiable factors associated with health optimism in older adults

OBJECTIVE

Despite the documented importance of health optimism for enhancing health outcomes, very little work has been done to examine who experiences health optimism and under what conditions. The present study sought to identify modifiable factors associated with health optimism that could constitute the focus of future intervention efforts designed to promote health optimism among older people.

DESIGN

Participants were 453 (44% males) community-based Western Australians aged 60+ years (M = 70.39 years, SD = 6.06). Participants completed questionnaires to assess sociodemographic characteristics and provided information relating to physical and psychological health status.

RESULTS

Almost a quarter of participants (24%; n = 108) were classified as health optimists. Results from a multivariate regression analysis found quality of life, psychological well-being, and age to be directly and positively associated with health optimism. A subsequent path analytic model found depression (negatively) and self-efficacy (positively) to be indirectly associated with health optimism via both psychological well-being and quality of life.

CONCLUSION

These findings extend the limited evidence on health optimism in older adults by identifying various modifiable factors that may constitute potential areas of focus for future interventions designed to enhance health outcomes via the fostering of health optimism.

Psychological and social outcomes of sport participation for older adults: a systematic review

Sport participation is well known to promote health outcomes for children and adolescents. Nevertheless, there is insufficient evidence about the psychological and social outcomes of sport participation for older adults. This article provides the results of a systematic review of the psychological and social outcomes of sport participation for older adults. A systematic review of seven electronic databases was conducted and a total of 21 studies published that attended to psychological and/or social health benefits from sport participation of older adults (50 years old and over) were included. The outcomes of older adults’ sport participation included life satisfaction, depression, anxiety, stress, mood state, hedonistic values, socialisation, competition, and personal psychological outcomes such as personal empowerment, self-confidence, self-esteem and resistance to the negative view of ageing. Future studies are needed to conceptualise and operationalise the different levels of involvement of sport participation.

Supporting Older Adults in Exercising With a Tablet: A Usability Study

Background

For older adults, physical activity is vital for maintaining their health and ability to live independently. Home-based programs can help them achieve the recommended exercise frequency. An application for a tablet computer was developed to support older adults in following a personal training program. It featured goal setting, tailoring, progress tracking, and remote feedback.

Objective

In line with the Medical Research Council Framework, which prescribes thorough testing before evaluating the efficacy with a randomized controlled trial, the aim of this study was to assess the usability of a tablet-based app that was designed to support older adults in doing exercises at home.

Methods

A total of 15 older adults, age ranging from 69 to 99 years old, participated in a usability study that utilized a mixed-methods approach. In a laboratory setting, novice users were asked to complete a series of tasks while verbalizing their ongoing thoughts. The tasks ranged from looking up information about exercises and executing them to tailoring a weekly exercise schedule. Performance errors and time-on-task were calculated as proxies of effective and efficient usage. Overall satisfaction was assessed with a posttest interview. All responses were analyzed independently by 2 researchers.

Results

The participants spent 13-85 seconds time-on-task. Moreover, 79% (11/14)-100% (14/14) participants completed the basic tasks with either no help or after having received 1 hint. For expert tasks, they needed a few more hints. During the posttest interview, the participants made 3 times more positive remarks about the app than negative remarks.

Conclusions

The app that was developed to support older adults in doing exercises at home is usable by the target audience. First-time users were able to perform basic tasks in an effective and efficient manner. In general, they were satisfied with the app. Tasks that were associated with behavior execution and evaluation were performed with ease. Complex tasks such as tailoring a personal training schedule needed more effort. Learning effects, usefulness, and long-term satisfaction will be investigated through longitudinal follow-up studies.

Retention of osteocytic micromorphology by sclerostin antibody in a concurrent ovariectomy and functional disuse model

Prolonged mechanical unloading in bedridden patients and concurrent hormonal dysregulation represents the cause of one of the severest forms of osteoporosis, a condition for which there are very few efficacious interventions available to date. Sclerostin, a Wnt antagonist, acts as a negative regulator of bone formation. Sclerostin antibody (Scl-Ab)-mediated blockade of sclerostin can dramatically enhance bone formation and reduce bone resorption. This study was designed to investigate the therapeutic effect of the Scl-Ab on severe bone loss induced by concurrent mechanical unloading and estrogen deficiency in a hindlimb-suspended and ovariectomized rat model, and to study the cellular mechanisms underlying severe osteoporosis and Scl-Ab action. Unloading and ovariectomy resulted in severe loss of trabecular and cortical bone mass and strength; Scl-Ab can significantly counteract the deterioration of bone in unloaded and/or ovariectomized rats, with noticeably increased cortical bone formation. Scanning electron microscopy analysis revealed that unloading and ovariectomy lead to multiple morphological and structural abnormalities of osteocytes in cortical bone and the abnormalities were abolished by Scl-Ab administration. This study extends our previous conclusion that Scl-Ab represents a promising therapeutic approach for severe bone loss that occurs after being exposed to estrogen deficiency and prolonged mechanical unloading.

Tracking of sport and exercise types from midlife to old age: a 20-year cohort study of British men

Background

Previous physical activity (PA) tracking studies have examined the stability of overall PA and/or PA types, but few have investigated how specific types of sport/exercise track over the life course. The aim of this study was to determine how specific sports/exercises in midlife track and predict future sport/exercise and PA in men transitioning to old age.

Methods

Seven thousand seven hundred thirty-five men (aged 40–59 years) recruited in 1978–80 were followed up after 12, 16 and 20 years. At each wave men self-reported participation in sport/exercise. Frequent sport/exercise participants (> 1/month) reported the types of sport/exercise they engaged in. Men also reported total PA, health status, lifestyle behaviours and socio-demographic characteristics. Stability of each sport/exercise was assessed using kappa statistics and intraclass correlation coefficients. Logistic regression estimated the odds of participating in sport/exercise and being active at 20-year follow up according to specific types of sport/exercise in midlife.

Results

Three thousand three hundred eighty-four men with complete data at all waves were included in analyses. Tracking of specific sports/exercises ranged from fair to substantial, with golf being the most common and most stable. Bowls was the most frequently adopted. Odds of participating in sport/exercise and being active in old age varied according to sport/exercise types in midlife. Golf and bowls in midlife were the strongest predictors of sport/exercise participation in old age. Golf, cricket and running/jogging in midlife were among the strongest predictors of being active in old age. Compared to participating in just one sport/exercise in midlife, sampling multiple sports/exercises was more strongly associated with sport/exercise participation and being active in old age.

Conclusion

The stability of sport/exercise participation from midlife to old age varies by type. Specific sports/exercises in midlife may be more likely to predict future PA than others. However, participating in a range of sports/exercises may be optimal for preserving PA into old age.

Electronic supplementary material

The online version of this article (10.1186/s11556-018-0205-y) contains supplementary material, which is available to authorized users.

Effect of Hospitalizations on Physical Activity Patterns in Mobility-Limited Older Adults

OBJECTIVES

To evaluate the effect of hospitalizations on patterns of sedentary and physical activity time in mobility-limited older adults randomized to structured physical activity or health education.

DESIGN

Secondary analysis of investigator-blinded, parallel-group, randomized trial conducted at 8 U.S. centers between February 2010 and December 2013.

PARTICIPANTS

Sedentary men and women aged 70 to 89 at baseline who wore a hip-fitted accelerometer 7 consecutive days at baseline and 6, 12, and 24 months after randomization (N=1,341).

MEASUREMENTS

Participants were randomized to a physical activity (PA; n = 669) intervention that included aerobic, resistance, and flexibility training or to a health education (HE; n = 672) intervention that consisted of workshops on older adult health and light upper-extremity stretching. Accelerometer patterns were characterized as bouts of sedentary (<100 counts/min; ≥1, ≥10, ≥30, ≥60 minute lengths) and activity (≥100 counts/min; ≥1, ≥2, ≥5, ≥10 minute lengths) time. Each participant was categorized as having 0, 1 to 3, or 4 or more cumulative hospital days before each accelerometer assessment.

RESULTS

Hospitalization increased sedentary time similarly in both intervention groups (8 min/d for 1-3 cumulative hospital days and 16 min/d for ≥4 cumulative hospital days). Hospitalization was also associated with less physical activity time across all bouts of less than 10 minutes (≥1: -7 min/d for 1-3 cumulative hospital days, -16 min/d for ≥4 cumulative hospital days; ≥2: -5 min/d for 1-3 cumulative hospital days, -11 min/d for ≥4 cumulative hospital days; ≥5: -3 min/d for 1-3 cumulative hospital days, -4 min/d for ≥4 cumulative hospital days). There was no evidence of recovery to prehospitalization levels (time effect p >.41). PA participants had less sedentary time in bouts of less than 30 minutes than HE participants (-8 to -10 min/d) and more total activity (+3 to +6 min/d), although hospital-related changes were similar between the intervention groups (interaction effect p >.26).

CONCLUSION

Participating in a PA intervention before hospitalization had expected benefits, but participants remained susceptible to hospitalization's detrimental effects on their daily activity levels. There was no evidence of better activity recovery after hospitalization. J Am Geriatr Soc 67:261-268, 2019.

Associations Between Physical Function and Subjective Well-Being in Older Adults From Low- and Middle-Income Countries: Results From the Study on Global AGEing and Adult Health (SAGE)

BACKGROUND

Physical function is positively associated with subjective well-being in older adults from high-income nations. This study tests whether this association is evident in low- and middle-income countries.

METHODS

Data were drawn from the study on global AGEing and adult health, using nationally representative samples of individuals over 50 years old from China, Ghana, India, Mexico, Russia, and South Africa. Participant interviews measured well-being (quality of life, mood, and happiness) and physical function (grip strength, usual and rapid gait speed). Logistic regressions tested relations between physical function and well-being variables within each country.

RESULTS

Higher physical function measures exhibited moderate, yet significant, associations with increased odds of highly rated well-being (p < .05). However, higher gait speeds were unexpectedly associated with decreased odds of highly rated well-being (p < .05) in South Africa and Russia.

CONCLUSION

These results suggest that physical function is generally positively associated with perceived well-being in older individuals from lower income nations.

Does the intensity of daily walking matter for protecting against the development of a slow gait speed in people with or at high risk of knee osteoarthritis? An observational study

OBJECTIVE

Knee osteoarthritis (OA) is a risk factor for a decline in gait speed. Daily walking reduces the risk of developing slow gait speed and future persistent functional limitation. However, the protective role of walking intensity is unclear. We investigated the association of substituting time spent not walking, with walking at light and moderate-to-vigorous intensities for incident slow gait over 2-years, among people with or at high risk of knee OA.

METHOD

We used baseline and 2-year follow-up data from the Multicenter Osteoarthritis (MOST) study (n = 1731) and the Osteoarthritis Initiative (OAI, n = 1925). Daily walking intensity was objectively assessed using accelerometer-enabled devices, and classified as; not walking (<1 steps/min), very-light (1-49 steps/min), light (50-100 steps/min), and moderate-to-vigorous (>100 steps/min). We defined slow gait during a 20-m walk, as <1 m/s and <1.2 m/s. Isotemporal substitution evaluated time-substitution effects on incident slow gait outcomes at 2-years.

RESULTS

Replacing 20 min/day of not walking with walking at a moderate-to-vigorous intensity, demonstrated small to moderate reductions in the risk of developing a gait speed <1.0 m/s (Relative Risk [95% confidence interval (CI)]; MOST = 0.51 [0.27, 0.98], OAI = 0.21 [0.04, 0.98]), and <1.2 m/s (MOST = 0.73 [0.53, 1.00], OAI = 0.65 [0.36, 1.18]). However, only risk reductions for <1.0 m/s met statistical significance. Replacing not walking with very-light or light intensity walking was not associated with the risk of developing slow gait outcomes.

CONCLUSION

When possible, walking at a moderate-to-vigorous intensity (>100 steps/min) may be best recommended in order to reduce the risk of developing critical slow gait speed among people with, or at high risk of knee OA.

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.

Translating Behavior Change Principles Into a Blended Exercise Intervention for Older Adults: Design Study

Background

Physical activity can prevent or delay age-related impairments and prolong the ability of older adults to live independently. Community-based programs typically offer classes where older adults can exercise only once a week under the guidance of an instructor. The health benefits of such programs vary. Exercise frequency and the duration of the program play a key role in realizing effectiveness. An auxiliary home-based exercise program can provide older adults the opportunity to exercise more regularly over a prolonged period of time in the convenience of their own homes. Furthermore, mobile electronic devices can be used to motivate and remotely guide older adults to exercise in a safe manner. Such a blended intervention, where technology is combined with personal guidance, needs to incorporate behavior change principles to ensure effectiveness.

Objective

The aim of this study was to identify theory-based components of a blended intervention that supports older adults to exercise at home.

Methods

The Medical Research Council framework was used to develop the blended intervention. Insights from focus group, expert panels, and literature were combined into leading design considerations.

Results

A client-server system had been developed that combined a tablet app with a database in the cloud and a Web-based dashboard that can be used by a personal coach to remotely monitor and guide older adults. The app contains several components that facilitate behavior change—an interactive module for goal setting, the ability to draw up a personal training schedule from a library containing over 50 exercise videos, progress monitoring, and possibilities to receive remote feedback and guidance of a personal coach.

Conclusions

An evidence-based blended intervention was designed to promote physical activity among older adults. The underlying design choices were underpinned by behavior change techniques that are rooted in self-regulation. Key components of the tablet-supported intervention were a tailored program that accommodates individual needs, demonstrations of functional exercises, monitoring, and remote feedback. The blended approach combines the convenience of a home-based exercise program for older adults with the strengths of mobile health and personal guidance.

Isotemporal Substitution of Sedentary Behavior and Physical Activity on Function

The amount of time spent in sedentary behaviors (SB) progressively increases with age, while reducing time spent in light-intensity physical activity (LPA) and moderate- to vigorous-intensity physical activity (MVPA). These trajectories in PA and SB are linked to accelerated reductions in physical functioning.

PURPOSE

This study aimed to examine the association of substituting SB time with LPA and MVPA on physical function in older adults.

METHODS

Ninety-one older adults (mean age, 70.7 ± 10.2 yr) wore a hip-mounted accelerometer to measure SB, LPA, and MVPA time. Measures of physical function included a 400-m walk test (400W), the usual gait speed (UGS), the five times sit-to-stand (5xSTS) test, and the short physical performance battery (SPPB). Isotemporal substitution regression modeling was performed to assess the relationship of replacing the amount of time spent in one activity for another.

RESULTS

Replacing 30 min·d of SB with LPA was associated with a significant improvement in 400W (P = 0.0497), whereas MVPA resulted in a significant improvement (P < 0.01) in 400W, UGS, 5xSTS, and SPPB. Replacing 60 min·d of SB with 10 min·d of MVPA and 50 min·d of LPA was associated with significant improvements in the 400W, UGS, and 5xSTS (P < 0.05). Meanwhile, as little as 5 min·d of MVPA and 55 min·d of LPA were linked to a 78% increased odds of scoring with good function in the SPPB (P = 0.0247).

CONCLUSION

Replacing SB with LPA was linked to a significant improvement in the 400W, but not the other brief functional measures. Mixed doses of LPA and MVPA may add flexibility to interventions targeting reductions of SB in older adults for clinically relevant improvements in physical function.

Grandparenting and Self-Rated Health Among Older Korean Women

An increasing number of older Korean women have played an important role in taking care of their grandchildren to help their adult children. This study investigates the effects of grandparenting on older women' health in South Korea. Using the Korean Longitudinal Study of Aging ( N = 3,092), we estimated ordinal logistic regression models with lagged dependent variable to examine whether and how grandparenting type and transition and grandparenting intensity are associated with older women's self-rated health. Results show that grandmothers who provide long-term nonresidential grandparenting have better self-rated health than grandmothers who are not engaged in grandparenting. Grandmothers caring for grandchildren in skipped-generation households or multigenerational households do not suffer from a deficit in health. Grandparenting intensity is not associated with grandmothers' health. Our findings suggest that the implications of grandparenting for older women's health may differ in different social and cultural contexts.

Use of an Integrated Research-Practice Partnership to Improve Outcomes of a Community-Based Strength-Training Program for Older Adults: Reach and Effect of Lifelong Improvements through Fitness Together (LIFT)

Only 17% of older adults meet the recommendations for two days of full body strength training that is associated with improved functional fitness; reduced risk of falls; and reduced morbidity and mortality rates. Community-based interventions are recommended as they provide supportive infrastructure to reach older adults and impact strength training behaviors. Scalability and sustainability of these interventions is directly linked with setting-level buy-in. Adapting an intervention through an integrated research-practice partnership may improve individual and setting-level outcomes. The purpose of this study was to evaluate the initial reach and effect of a locally adapted, health educator-led strength-training intervention; Lifelong Improvements through Fitness Together (LIFT). LIFT was compared to an evidence-based exercise program, Stay Strong; Stay Healthy (SSSH). Intervention dose and mode were the same for LIFT and SSSH, but LIFT included behavioral change strategies. Older adult functional fitness was assessed before and after the 8-week strength training intervention. Health educators who delivered LIFT and SSSH were able to reach 80 and 33 participants, respectively. Participants in LIFT were able to significantly improve in all functional fitness measures whereas SSSH participants were only able to significantly improve in 5 of the 7 functional fitness measures. In conclusion, this study provides preliminary evidence that the locally adapted program reached more individuals and had improvements in functional fitness.

Cognitive Performance Does not Limit Physical Activity Participation in the Lifestyle Interventions and Independence for Elders Pilot Study (LIFE-P)

OBJECTIVES

We examined whether multiple domains of baseline cognitive performance were associated with prospective physical activity (PA) adherence in the Lifestyle Interventions and Independence for Elders Pilot study (LIFE-P).

DESIGN, SETTING, PARTICIPANTS

The LIFE-P study was a single-blind, multicenter, randomized controlled trial of a PA intervention compared to a successful aging educational intervention in sedentary, mobility-limited older adults.

INTERVENTION

A 12-month structured, moderate-intensity, multi-modal PA program that included walking, resistance training, and flexibility exercises. For the first 2 months (adoption), 3 center-based exercise sessions (40-60 min) / week were conducted. During the next 4 months (transition), center-based sessions were conducted 2 times / week. The subsequent maintenance phase consisted of optional once-to-twice-per-week center-based sessions and home-based PA.

MEASUREMENTS

Tests of executive and global cognitive functioning, working memory and psychomotor speed were administered at baseline. Median test scores were used to dichotomize participants into low or high cognitive performance groups.

RESULTS

52 mobility-limited older adults (age: 76.9 ±5 yrs) were randomized to the PA arm of LIFE-P. Compared to participants with high cognitive performance, participants with low performance had similar PA adherence rates (all P ≥ 0.34). Furthermore, weak and non-significant univariate relationships were elicited between all measures of cognition and overall PA adherence levels (r values ranged: -0.20 to 0.12, P ≥ 0.12).

CONCLUSION

These data suggest that cognitive performance does not limit long-term PA adherence in mobility-limited older adults. Additional studies in larger cohorts are warranted to verify these findings.

Sport Participation and Ageing: Evidence from Marathon Events

The purpose of this research is to study expectations regarding ageing (ERA) among individuals who participate in running events as well as to explore personality and demographic features as potential variables that influence ERA values. A quantitative questionnaire was selected as the predominant means of collecting the data and 196 successfully completed questionnaires were analyzed by means of the SPSS. Results indicate a positive correlation between ERA values and Change Seeker Index in our sample. Moreover gender and frequency of exercise found to have no significant effect on ERA score. Finally, ERA was examined among three generational cohorts and differences were noticed to physical subscale.

Effectiveness of a Timing and Coordination Group Exercise Program to Improve Mobility in Community-Dwelling Older Adults: A Randomized Clinical Trial

IMPORTANCE

Timing and coordination exercises may be an important addition to community-based health promotion exercise programs to improve walking in older adults.

OBJECTIVE

To compare the effectiveness of the On the Move group exercise program, which focuses on the timing and coordination of movement, with a seated strength, endurance, and flexibility program (usual care) at improving function, disability, and walking ability of older adults.

DESIGN, SETTING, AND PARTICIPANTS

Cluster-randomized, single-blind intervention trial. Thirty-two independent living facilities, senior apartment buildings, and senior community centers were randomized to On the Move (16 sites; 152 participants) or usual care (16 sites; 146 participants). Participants were 65 years or older, able to ambulate independently with a gait speed of at least 0.60 m/s, able to follow 2-step commands, and were medically stable.

INTERVENTIONS

Exercise classes were 50 minutes, twice a week for 12 weeks and had 10 or fewer participants per class. On the Move consisted of warm-up, timing and coordination (stepping and walking patterns), strengthening, and stretching exercises. The usual-care program consisted of warm-up, strength, endurance, and stretching exercises.

MAIN OUTCOMES AND MEASURES

The primary outcomes were self-report of function and disability (Late Life Function and Disability Instrument) and mobility (6-minute walk distance and gait speed) assessed by blinded individuals.

RESULTS

Participants (mean [SD] age, 80.0 [8.1] years) were mostly female (251 [84.2%]) and white (249 [83.6%]) and had a mean (SD) of 2.8 (1.4) chronic conditions. Intervention groups were similar on baseline characteristics. Postintervention, 142 (93.4%) participants in On the Move and 139 (95.2%) participants in usual care completed testing. On the Move had greater mean (SD) improvements than the usual-care group in gait speed (0.05 [0.13] vs -0.01 [0.11] m/s; adjusted difference = 0.05 [0.02] m/s; P = .002) and 6-minute walk distance (20.6 [57.1] vs 4.1 [55.6] m; adjusted difference = 16.7 [7.4] m; P = .03). Attendance was greater in the usual-care program compared with On the Move (95 [65.1%] vs 76 [50.0%] attended ≥20 classes; P = .03). There were no significant differences in any of the other primary or secondary outcomes.

CONCLUSIONS AND RELEVANCE

The On the Move group exercise program was more effective at improving mobility than a usual-care exercise program, despite lower attendance. Additional research examining the impact of the intervention on long-term disability outcomes is needed before recommending routine implementation into clinical practice.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT01986647.

Low physical activity as a key differentiating factor in the potential high-risk profile for depressive symptoms in older adults

BACKGROUND

The identification of potential high-risk groups for depression is of importance. The purpose of the present study was to identify high-risk profiles for depressive symptoms in older individuals, with a focus on functional performance.

METHODS

The population-based Healthy Ageing Initiative included 2,084 community-dwelling individuals (49% women) aged 70. Explorative cluster analysis was used to group participants according to functional performance level, using measures of basic mobility skills, gait variability, and grip strength. Intercluster differences in depressive symptoms (measured by the Geriatric Depression Scale [GDS]-15), physical activity (PA; measured objectively with the ActiGraph GT3X+), and a rich set of covariates were examined.

RESULTS

The cluster analysis yielded a seven-cluster solution. One potential high-risk cluster was identified, with overrepresentation of individuals with GDS scores >5 (15.1 vs. 2.7% expected; relative risk = 6.99, P < .001); the prevalence of depressive symptoms was significantly lower in the other clusters (all P < .01). The potential high-risk cluster had significant overrepresentations of obese individuals (39.7 vs. 17.4% expected) and those with type 2 diabetes (24.7 vs. 8.5% expected), and underrepresentation of individuals who fulfilled the World Health Organization's PA recommendations (15.6 vs. 59.1% expected; all P < .01), as well as low levels of functional performance.

CONCLUSIONS

The present study provided a potential high-risk profile for depressive symptoms among elderly community-dwelling individuals, which included low levels functional performance combined with low levels of PA. Including PA in medical screening of the elderly may aid in identification of potential high-risk individuals for depressive symptoms.

Healthier lifestyles after retirement in Europe? Evidence from SHARE

This paper investigates changes in health behaviours upon retirement, using data drawn from the Survey of Health Ageing and Retirement in Europe. By exploiting changes in eligibility rules for early and statutory retirement, we identify the causal effect of retiring from work on smoking, alcohol drinking, engagement in physical activity and visits to the general practitioner or specialist. We provide evidence about individual heterogeneous effects related to gender, education, net wealth, early-life conditions and job characteristics. Our main results--obtained using fixed-effect two-stage least squares--show that changes in health behaviours occur upon retirement and may be a key mechanism through which the latter affects health. In particular, the probability of not practicing any physical activity decreases significantly after retirement, and this effect is stronger for individuals with higher education. We also find that different frameworks of European health care systems (i.e. countries with or without a gate-keeping system to regulate the access to specialist services) matter in shaping individuals' health behaviours after retirement. Our findings provide important information for the design of policies aiming to promote healthy lifestyles in later life, by identifying those who are potential target individuals and which factors may affect their behaviour. Our results also suggest the importance of policies promoting healthy lifestyles well before the end of the working life in order to anticipate the benefits deriving from individuals' health investments.