Updating the evidence relating to physical activity intervention studies in older people

Impact of state of economic dependence and employment status on the self-perceived health of Indian elderly people across expenditure quintiles of households

Self-perceived health, a subjective assessment of health status, is influenced by state of economic independence and employment status after controlling for other demographic, social and health-related factors, particularly for elderly people as they tend to face discrimination in intra-household resource allocation. Being economically independent and employed increase the likelihood of elderly people rating their health as good/excellent compared to others and employment status came out as even more impactful. This study provides new insights by observing that across the expenditure quintile groups of the households, the importance of these variables varies as the bias in intra-household resource allocation against elderly people is supposed to increase with declining economic resources of the households. Economic independence improves the likelihood of rating one's health as good/excellent in the lowest expenditure quintile much more compared to those in the uppermost expenditure quintile. For employed too, the positive influence of employment status on self-perceived health of elderly people has been strictly increasing as we move down the expenditure quintiles of households.

Neurobiological evidence of longer-term physical activity interventions on mental health outcomes and cognition in young people: A systematic review of randomised controlled trials

OBJECTIVE

To investigate putative neurobiological mechanisms that link longer-term physical activity interventions to mental health and cognitive outcomes using randomised controlled trials in children, adolescents and young adults.

DATA SOURCES

A range of medical and psychological science electronic databases were searched (MEDLINE, EMBASE, Scopus, Web of Science, PsychINFO).

REVIEW METHODS

Original research studies were selected, data were extracted and quality was appraised.

RESULTS

Sixteen primary papers were included, ranging from healthy and community samples to subclinical and clinical populations across a variety of age ranges and using different neurobiological measures (e.g. magnetic resonance imaging, electroencephalography, cortisol, brain-derived neurotropic factor).

DISCUSSION

The majority of studies report improvement in mental health and cognition outcomes following longer-term physical activity interventions which coincide with neurobiological alterations, especially neuroimaging alterations in activation and electrophysiological parameters in frontal areas. Future research should include measures of pre-existing fitness and target those who would benefit the most from this type of intervention (e.g. those with a lower level of fitness and at risk for or with mental health problems).

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.

Physical Activity in Community Dwelling Older People: A Systematic Review of Reviews of Interventions and Context

BACKGROUND

The promotion and maintenance of higher physical activity (PA) levels in the older population is an imperative for cognitive and healthy ageing but it is unclear what approaches are best suited to achieve this for the increasing number of older people living in the community. Effective policies should be informed by robust, multi-disciplinary and multi-dimensional evidence, which not only seeks what works, but in 'what context? In addition to evidence on the efficacy and effectiveness of PA for maintaining cognitive health, social contexts such as 'how do we actually get older people to partake in PA?' and 'how do we sustain that activity long-term?' also need highlighting. This review is part of a comprehensive evidence synthesis of preventive interventions in older age, with a focus on healthy behaviours to identify evidence gaps and inform policy relating to ageing well and cognitive health. An overview of systematic reviews of PA was conducted to explore three topics: (1) PA efficacy or effectiveness for primary prevention of cognitive decline in 55+; (2) Interventions efficacious or effective for increasing PA uptake and maintenance in 55+; (3) barriers and facilitators to PA in 55+.

METHODS

Multiple databases were searched for studies in English from OECD countries between 2000 and 2016. Quality of included reviews in questions (1) and (2) were assessed using AMSTAR. Review protocols were registered on PROSPERO (CRD42014015554, 42014015584, CRD42014015557) and reviews follow PRISMA guideline.

FINDINGS

Overall, 40 systematic reviews were included. Question 1 (n = 14). 8,360 participants. Evidence suggests that PA confer mild positive effects on cognition in older adults with and without previous cognitive impairment. However, there is insufficient evidence of a dose-response relationship. Evidence on the effects of PA on delay of dementia onset is inconclusive. Question 2 (n = 17). 79,650 participants. Evidence supports the effectiveness of a variety of interventions, including group delivered, centre-based and cognitive approaches on short-term uptake of PA behaviour. Question 3 (n = 9). 22,413 participants. Barriers include health status, previous PA habits and experiences, and cultural sensitivity, while facilitators include enjoyable activities and convenient scheduling.

CONCLUSION

PA can offer small benefits to brain health, but evidence on how much activity is required to produce this effect is lacking. Evidence on the effectiveness of PA for preventing dementia and cognitive decline is lacking. Behavioural (walking, exercise) and cognitive (counselling and motivational interviews) interventions are effective for short-term uptake of physical activity in older people. In order to maintain long-term participation in PA, individualised interventions modelled using behavioural theories may be required. Public health messages should be aimed at promoting acceptable levels of PA above normal daily activities in older people. Policy and strategies aimed at increasing PA in older people should be encouraged while considering barriers and facilitators to behaviour change.

Relationships between the Active Aging Index and Disability-Free Life Expectancy: A Case Study in the Rajshahi District of Bangladesh

Life expectancy has increased considerably throughout the world. In Bangladesh, life expectancy has increased from about 53 years in 1975 to 69 years in 2010. However, it is unknown whether the increase in life expectancy is simultaneously accompanied by an increase in disability-free life expectancy (DFLE). The purpose of the study described in this article was to explore the relationship between life expectancy and DFLE in the Rajshahi District of Bangladesh by examining the relationships between the Active Aging Index (AAI) and DFLE. The study fi ndings suggest that urban, more-educated, elderly males are more active in all aspects of life and have longer DFLE. Females are found to outlive males but are more likely to live a greater part of their remaining life with disability. Positive correlations between the AAI and DFLE suggest that older adults could enjoy more DFLE by involving themselves in active aging activities.

Biodex Fall Risk Assessment in the Elderly With Ataxia: A New Age-Dependent Derived Index in Rehabilitation: An Observational Study

The aim of this study was to evaluate if the Biodex Fall Risk Assessment could provide an age-adjusted index useful for classifying patients at "risk of fall."This was a cohort study conducted on 61 chronic patients, in stable conditions, having a history of ataxia, difficulty in walking or loss of balance, and aged >64 years. These patients were coming from home to our Institute undergoing a period of in-hospital standard rehabilitation. Assessment of clinical parameters was performed at entry. Functional scales (Functional Independence Measure [FIM] for motor and cognitive function, Barthel G, Tinetti POMA), and the Biodex Fall Risk Index (FRI) were performed at entry and discharge. The Normalized FRI, obtained adjusting FRI to the reported maximum predictive FRI for the relevant age, identified 2 types of patients: those with a greater risk of fall than expected for that age, labeled Case 1 (Normalized FRI>1); and those with an equal or even lesser risk of fall than expected for that age, labeled Case 0 (Normalized FRI≤1).FRI, Normalized FRI as well as independent variables as age, sex, pathology group, FIM, BarthelG, were considered in a multiple regression analysis to predict the functional improvement (i.e., delta Tinetti Total score) after rehabilitation.Normalized FRI is useful in assessing patients at risk of falls both before and after rehabilitation. At admission, the Normalized FRI evidenced high fall risk in 46% of patients (Case 1) which decreased to 12% after rehabilitation, being greater than age-predicted in 7 patients (Case 1-1) despite the functional improvement observed after the rehabilitation treatment. Normalized FRI evidenced Case 1-1 patients as neurological, "very old" (86% in age-group 75-84 years), and with serious events at 18 to 24 months' follow-up. Normalized FRI, but not FRI, at admission was a predictor of improvement in Tinetti Total scores.The normalized FRI effectively indicated patients at higher risk of fall, in whom health deterioration, falls, or cognitive decline was later documented at follow-up. The normalized FRI could be a standardized measure for identifying frailer patients becoming a further criterium of discharge home and marker of fall risk at home.

Effects of strengthening and stretching exercise programmes on kinematics and kinetics of running in older adults: a randomised controlled trial

The aim of this study was to investigate the effects of strengthening and stretching exercises on running kinematics and kinetics in older runners. One hundred and five runners (55-75 years) were randomly assigned to either a strengthening (n = 36), flexibility (n = 34) or control (n = 35) group. Running kinematics and kinetics were obtained using an eight-camera system and an instrumented treadmill before and after the eight-week exercise protocol. Measures of strength and flexibility were also obtained using a dynamometer and inclinometer/goniometer. A time effect was observed for the excursion angles of the ankle sagittal (P = 0.004, d = 0.17) and thorax/pelvis transverse (P < 0.001, d = 0.20) plane. Similarly, a time effect was observed for knee transverse plane impulse (P = 0.013, d = 0.26) and ground reaction force propulsion (P = 0.042, d = -0.15). A time effect for hip adduction (P = 0.006, d = 0.69), ankle dorsiflexion (P = 0.002, d = 0.47) and hip internal rotation (P = 0.048, d = 0.30) flexibility, and hip extensor (P = 0.001, d = -0.48) and ankle plantar flexor (P = 0.01, d = 0.39) strength were also observed. However, these changes were irrespective of exercise group. The results of the present study indicate that an eight-week stretching or strengthening protocol, compared to controls, was not effective in altering age-related running biomechanics despite changes in ankle and trunk kinematics, knee kinetics and ground reaction forces along with alterations in muscle strength and flexibility were observed over time.

The Effectiveness of a Weight Maintenance Intervention for Adults with Intellectual Disabilities and Obesity: A Single Stranded Study

BACKGROUND

The evidence base for weight management programmes incorporating a weight loss and a weight maintenance phase for adults with intellectual disabilities (ID) is limited. This study describes the weight maintenance phase of a multicomponent weight management programme for adults with intellectual disability and obesity (TAKE 5).

MATERIALS AND METHODS

Thirty-one participants who had completed the 16 week TAKE five weight loss intervention (Phase I) were invited to participate in a 12 month weight maintenance intervention (Phase II). Content included recommendations of the National Weight Control Registry.

RESULTS

Twenty-eight participants completed Phase II with 50.4% maintaining their weight (mean weight change -0.5 kg, SD 2.2), 28.7% gaining weight (mean weight gain 5.4 kg, SD 2.2) and 21.6% losing weight (mean weight loss -8.0 kg, SD 3.0) at 12 months.

CONCLUSION

Further research is justified to investigate the efficacy of weight loss maintenance interventions in adults with intellectual disability and obesity, using controlled study designs.

Interventions to Increase Physical Activity Among Older Adults: A Meta-Analysis

PURPOSE OF THE STUDY

To determine the overall effectiveness of interventions designed to increase physical activity (PA) behavior among community-dwelling older adults.

DESIGN AND METHODS

Comprehensive literature searching identified eligible PA intervention studies among community-dwelling adults aged 65 and older, or sample mean age of 70. Diverse study characteristics were extracted and outcome data were duplicate coded. Overall mean effect sizes (ESs) were synthesized using a random-effects model. Heterogeneity of effects was analyzed using Q and I(2) statistics. Moderator analyses were conducted using meta-analytic analogues of ANOVA and regression for dichotomous and continuous moderators, respectively.

RESULTS

ESs were calculated from 13,829 primary study subjects. The overall mean ES for two-group posttest comparisons was 0.18 (95% CI 0.10-0.26, p < .001). This represents a difference of 620 steps/day or 73 min of PA/week between treatment and control groups. Significant moderators included the use of theory, how interventions were delivered, and cognitive plus behavioral-type intervention components. Non-significant moderators include the type of interventionist, delivery setting, and various measures of intervention dose.

IMPLICATIONS

PA interventions significantly improved PA behavior among community-dwelling older adults. Effective PA interventions may be efficiently delivered using already available resources and personnel. Future PA intervention research should be theoretically based, incorporate more diverse subjects, and compare intervention delivery methods.

Non-face-to-face physical activity interventions in older adults: a systematic review

Physical activity is effective in preventing chronic diseases, increasing quality of life and promoting general health in older adults, but most older adults are not sufficiently active to gain those benefits. A novel and economically viable way to promote physical activity in older adults is through non-face-to-face interventions. These are conducted with reduced or no in-person interaction between intervention provider and program participants. The aim of this review was to summarize the scientific literature on non-face-to-face physical activity interventions targeting healthy, community dwelling older adults (≥ 50 years). A systematic search in six databases was conducted by combining multiple key words of the three main search categories "physical activity", "media" and "older adults". The search was restricted to English language articles published between 1st January 2000 and 31st May 2013. Reference lists of relevant articles were screened for additional publications. Seventeen articles describing sixteen non-face-to-face physical activity interventions were included in the review. All studies were conducted in developed countries, and eleven were randomized controlled trials. Sample size ranged from 31 to 2503 participants, and 13 studies included 60% or more women. Interventions were most frequently delivered via print materials and phone (n=11), compared to internet (n=3) and other media (n=2). Every intervention was theoretically framed with the Social Cognitive Theory (n=10) and the Transtheoretical Model of Behavior Change (n=6) applied mostly. Individual tailoring was reported in 15 studies. Physical activity levels were self-assessed in all studies. Fourteen studies reported significant increase in physical activity. Eight out of nine studies conducted post-intervention follow-up analysis found that physical activity was maintained over a longer time. In the six studies where intervention dose was assessed the results varied considerably. One study reported that 98% of the sample read the respective intervention newsletters, whereas another study found that only 4% of its participants visited the intervention website more than once. From this review, non-face-to-face physical activity interventions effectively promote physical activity in older adults. Future research should target diverse older adult populations in multiple regions while also exploring the potential of emerging technologies.

Physical activity interventions among older adults: a literature review

Physical activity (PA) is important in the management of chronic illness among older adults worldwide. Researchers have conducted several intervention studies to increase PA behavior in this population. This review of the past 12 years of relevant PA intervention research among adults aged 60 years and older systematically summarized research findings, identified characteristics of successful interventions, and proposed areas of future research. There were 20 studies reviewed for this article, most employing a combination of cognitive-behavioral intervention design. Cognitive-based only and combination interventions were more successful in changing PA behavior; however, behavioral-based interventions demonstrated more long-term changes in PA behavior. Among theory-based interventions, self-efficacy was the most commonly operationalized construct. Findings from this review may inform future primary research to promote PA behavior among older adults, as well as gerontological clinical practice.

The 6-minute pegboard and ring test is correlated with upper extremity activity of daily living in chronic obstructive pulmonary disease

Background

Upper-extremity exercise is for pulmonary rehabilitation. The 6-minute pegboard and ring test (6PBRT) was developed to evaluate arm exercise capacity in patients with chronic obstructive pulmonary disease (COPD). The purpose of this study was to characterize the 6PBRT and evaluate its relationship with upper-extremity activities of daily living (ADLs) in COPD patients.

Methods

Twenty outpatients with mild to very severe COPD underwent the 6PBRT and spirometry, and their maximal inspiratory and expiratory pressures and grip strength were measured. For the 6PBRT, subjects were asked to move as many rings as possible in 6 minutes, and the score was the number of moved rings during the 6-minute period. Upper-extremity ADLs were evaluated with the upper extremity activities subdomain of the modified Pulmonary Functional Status and Dyspnea Questionnaire. Upper-extremity ADLs were also measured objectively by using a wrist accelerometer every day for 1 week.

Results

There was a positive correlation between 6PBRT score and inspiratory capacity (r = 0.71, P , 0.001), inspiratory capacity/total lung capacity predicted (r = 0.68, P , 0.01), and forced vial capacity (r = 0.57, P , 0.01). There was also a positive correlation between 6PBRT score and accelerometer count (r = 0.54, P , 0.05) and a negative correlation between 6PBRT score and arm activity score (ρ = −0.49, P , 0.05).

Conclusion

The 6PBRT may be a predictive test to maintain and improve upper-extremity ADL during pulmonary rehabilitation in patients with COPD.

Effectiveness of interventions to promote physical activity among socioeconomically disadvantaged women: a systematic review and meta-analysis

Physical activity is important for preventing weight gain and obesity, but women experiencing socioeconomic disadvantage are at high risk of inactivity. This study aimed to determine the effectiveness of interventions to increase physical activity among women experiencing disadvantage, and the intervention factors (i.e. physical activity measure, delivery mode, delivery channel, setting, duration, use of theory, behavioural techniques, participant age, risk of bias) associated with effectiveness. We conducted a meta-analysis of controlled trials using random-effects models and meta-regression. Seven databases were searched for trials among healthy women (18-64 years), which included a physical activity intervention, any control group, and statistical analyses of a physical activity outcome at baseline and post-intervention. Nineteen studies were included (n = 6,339). Because of substantial statistical heterogeneity (χ(2) = 53.61, df = 18, P < 0.0001, I(2) = 66%), an overall pooled effect is not reported. In subgroup analyses, between-group differences were evident for delivery mode, which modestly reduced heterogeneity (to 54%). Studies with a group delivery component had a standardized mean difference of 0.38 greater than either individual or community-based delivery. Programs with a group delivery mode significantly increase physical activity among women experiencing disadvantage, and group delivery should be considered an essential element of physical activity promotion programs targeting this population group.

Health-related factors associated with mode of travel to work

Active commuting (AC) to the workplace is a potential strategy for incorporating physical activity into daily life and is associated with health benefits. This study examined the association between health-related factors and mode of travel to the workplace. Methods. A volunteer convenience sample of employed adults completed an online survey regarding demographics, health-related factors, and the number of times/week walking, biking, driving, and using public transit to work (dichotomized as no walk/bike/drive/PT and walk/bike/drive/PT 1 + x/week). Logistic regression was used to predict the likelihood of each mode of transport and meeting PA recommendations from AC according to demographics and health-related factors. Results. The sample (n = 1175) was aged 43.5 ± 11.4 years and was primarily White (92.7%) and female (67.9%). Respondents reported walking (7.3%), biking (14.4%), taking public transit (20.3%), and driving (78.3%) to work at least one time/week. Among those reporting AC, 9.6% met PA recommendations from AC alone. Mode of travel to work was associated with several demographic and health-related factors, including age, number of chronic diseases, weight status, and AC beliefs. Discussion. Mode of transportation to the workplace and health-related factors such as disease or weight status should be considered in future interventions targeting AC.

Psychosocial and Environmental Correlates of Physical Activity Among Korean Older Adults

This study aimed to identify differences in individual, social, and physical environmental factors across the stages of physical activity and explore the effect of those variables on physical activity among older adults. Two hundred and ninety adults aged over 65 years were recruited from the Seodaemun district of Seoul. Standardized scales were used to measure physical activity, stage of change, self-efficacy, decisional balance, social support, and the physical environment. The results indicated that 70.7% of older adults engaged in regular physical activity. Based on the multivariate analysis of variance, only the psychological variables of self-efficacy and perceived benefits and the environmental variables of family support and the physical environment increased significantly across the stages of physical activity change. Based on the regression analysis, the most important predictors of physical activity in a descending order of significance were self-efficacy, perceived benefits, family support, and the physical environment. The total variance in physical activity explained by these variables was 40%.

A randomized controlled clinical trial of the Seattle Protocol for Activity in older adults

OBJECTIVES

To compare the efficacy of a physical activity program (Seattle Protocol for Activity (SPA)) for low-exercising older adults with that of an educational health promotion program (HP), combination treatment (SPA+HP), and routine medical care control conditions (RMC).

DESIGN

Single-blind, randomized controlled trial with two-by-two factorial design.

SETTING

Community centers in King County, Washington, from November 2001 to September 2004.

PARTICIPANTS

Two hundred seventy-three community-residing, cognitively intact older adults (mean age 79.2; 62% women).

INTERVENTIONS

SPA (in-class exercises with assistance setting weekly home exercise goals) and HP (information about age-appropriate topics relevant to enhancing health), with randomization to four conditions: SPA only (n=69), HP only (n=73), SPA+HP (n=67), and RMC control (n=64). Active-treatment participants attended nine group classes over 3 months followed by five booster sessions over 1 year.

MEASUREMENTS

Self-rated health (Medical Outcomes Study 36-item Short-Form Survey) and depression (Geriatric Depression Scale). Secondary ratings of physical performance, treatment adherence, and self-rated health and affective function were also collected.

RESULTS

At 3 months, participants in SPA exercised more and had significantly better self-reported health, strength, and general well-being (P<.05) than participants in HP or RMC. Over 18 months, SPA participants maintained health and physical function benefits and had continued to exercise more than non-SPA participants. SPA+HP was not significantly better than SPA alone. Better adherence was associated with better outcomes.

CONCLUSION

Older adults participating in low levels of regular exercise can establish and maintain a home-based exercise program that yields immediate and long-term physical and affective benefits.

Effectiveness of a home-based postal and telephone physical activity and nutrition pilot program for seniors

Objective. To evaluate the effectiveness of a 12-week home-based postal and telephone physical activity and nutrition pilot program for seniors. Methods. The program was delivered by mailed material and telephone calls. The main intervention consisted of a booklet tailored for seniors containing information on dietary guidelines, recommended physical activity levels, and goal setting. Dietary and walking activity outcomes were collected via a self-administered postal questionnaire pre- and postintervention and analysed using linear mixed regressions. Of the 270 seniors recruited, half were randomly selected for the program while others served as the control group. Results. The program elicited favourable responses. Postintervention walking for exercise/recreation showed an average gain of 27 minutes per week for the participants in contrast to an average drop of 5 minutes for the controls (P < .01). Little change was evident in errand walking for both groups. The intervention group (n = 114) demonstrated a significant increase in fibre intake (P < .01) but no reduction in fat intake (P > .05) compared to controls (n = 134). Conclusions. The participants became more aware of their health and wellbeing after the pilot program, which was successful in increasing time spent walking for recreation and improving fibre intake.

Prediction of foot clearance parameters as a precursor to forecasting the risk of tripping and falling

Tripping and falling is a serious health problem for older citizens due to the high medical costs incurred and the high mortality rates precipitated mostly by hip fractures that do not heal well. Current falls prevention technology encompasses a broad range of interventions; both passive (e.g., safer environments, hip protectors) and active (e.g., sensor-based fall detectors) which attempt to reduce the effects of tripping and falling. However the majority of these interventions minimizes the impact of falls and do not directly reduce the risk of falling. This paper investigates the prediction of gait parameters related to foot-to-ground clearance height during the leg swing phase which have been physically associated with tripping and falling risk in the elderly. The objective is to predict parameters of foot trajectory several walking cycles in advance so that anticipated low foot clearance could be addressed early with more volitional countermeasures, e.g., slowing down or stopping. In this primer study, foot kinematics was recorded with a highly accurate motion capture system for 10 healthy adults (25-32 years) and 11 older adults (65-82 years) with a history of falls who each performed treadmill walking for at least 10 min. Vertical foot displacement during the swing phase has three characteristic inflection points and we used these peak values and their normalized time as the target prediction values. These target variables were paired with features extracted from the corresponding foot acceleration signal (obtained through double differentiation). A generalized regression neural network (GRNN) was used to independently predict the gait variables over a prediction horizon (number of gait cycles ahead) of 1-10 gait cycles. It was found that the GRNN attained 0.32-1.10 cm prediction errors in the peak variables and 2-8% errors in the prediction of normalized peak times, with slightly better accuracies in the healthy group compared to elderly fallers. Prediction accuracy decreased linearly (best fit) at a slow rate with increasing prediction horizon ranging from 0.03 to 0.11 cm per step for peak displacement variables and 0.34 × 10(-3) - 1.81 × 10(-3)% per step for normalized peak time variables. Further time series analysis of the target gait variable revealed high autocorrelations in the faller group indicating the presence of cyclic patterns in elderly walking strategies compared to almost random walking patterns in the healthy group. The results are promising because the technique can be extended to portable sensor-based devices which measure foot accelerations to predict the onset of risky foot clearance, thus leading to a more effective falls prevention technology.

Maintaining physical activity among older adults: 24-month outcomes of the Keep Active Minnesota randomized controlled trial

OBJECTIVE

To evaluate the efficacy at 6-, 12-, and 24-month follow-up of Keep Active Minnesota (KAM), a telephone and mail-based intervention designed to promote physical activity (PA) maintenance among currently active adults age 50 to 70.

METHOD

Participants who reported having recently increased their MVPA to a minimum of 2d/wk, 30 min/bout, (N=1049) were recruited in 2004 and 2005 from one large managed care organization in Minnesota, and randomly assigned to either treatment (KAM; N=523), or Usual Care (UC; N=526) with PA assessed using the CHAMPS questionnaire, and expressed as kcal/wk energy expenditure.

RESULTS

We find a sustained, significant benefit of the intervention at 6, 12 and 24 months. kcal/wk expenditure in moderate or vigorous activities was higher at 6 (p<.03, Cohen's d(6m)=.16), 12 (p<.04, d(12 m)=.13) and 24 months (p<.01, d(24 m)=.16) for KAM participants, compared to UC participants.

CONCLUSIONS

The KAM telephone- and mail-based PA maintenance intervention was effective at maintaining PA in both the short-term (6 months) and longer-term (12 and 24 months) relative to usual care.

Health literacy and health seeking behavior among older men in a middle-income nation

Health literacy is a measure of the patient’s ability to read, comprehend and act on medical instructions. This research article examines health literacy and health-seeking behaviors among elderly men in Jamaica, in order to inform health policy. This is a descriptive cross-sectional study. A 133-item questionnaire was administered to a random sample of 2,000 men, 55 years and older, in St Catherine, Jamaica. In this study, 56.9% of urban and 44.5% of rural residents were health literate. Only 34.0% of participants purchased medications prescribed by the medical doctor and 19.8% were currently smoking. Despite the reported good self-related health status (74.4%) and high cognitive functionality (94.1%) of the older men, only 7.9% sought medical care outside of experiencing illnesses. Thirty-seven percent of rural participants sought medical care when they were ill compared with 31.9% of their urban counterparts. Thirty-four percent of the participants took the medication as prescribed by the medical doctor; 43% self-reported being diagnosed with cancers such as prostate and colorectal in the last 6 months, 9.6% with hypertension, 5.3% with heart disease, 5.3% with benign prostatic hyperplasia, 5.3% with diabetes mellitus, and 3.8% with kidney/bladder problems. Approximately 14% and 24% of the participants indicated that they were unaware of the signs and symptoms of hypertension and diabetes mellitus, respectively. The elderly men displayed low health literacy and poor health-seeking behavior. These findings can be used to guide the formulation of health policies and intervention programs for elderly men in Jamaica.

The effects of a 12-week walking program on community-dwelling older adults

Walking is a popular and easily accessible form of physical activity. However, walking instruction for older adults is based on the evidence gathered from younger populations. This study evaluated walking conditions, strength, balance, and subjective health status after a 12-week walking-training program in community-dwelling adults > 65-years-old. Participants walked 1,921 m (3,158.88 steps) in 26.69 min with a heart rate of 114 beats/min. An analysis of covariance to adjust for previous exercise habits, pretest strength, and subjective health status revealed significant differences in strength and in subjective physical and mental health status between experimental and control groups. This study identified the effects of the walking-training program on community-dwelling elderly adults without changing their previous physical activities.

A physical activity program to mobilize older people: a practical and sustainable approach

PURPOSE

Despite the documented benefits of physical activity, it remains difficult to motivate older adults to start and maintain regular physical activity. This study tested an innovative intervention for mobilizing older adults into a neighborhood-based walking program.

DESIGN AND METHODS

Researchers recruited a total of 260 healthy but insufficiently active adults aged 65 to 74 years and randomly selected from the Australian electoral roll from 30 Perth metropolitan neighborhoods. Social cognitive theory guided the design of the program. Researchers collected both qualitative and quantitative data to inform the development, together with ongoing process evaluation.

RESULTS

A total of 65% of participants completed the program. Their mean weekly walking time for recreation increased by about 100 min, and 80% of participants reported that they would continue to walk twice per week upon program completion.

IMPLICATIONS

This practical program is potentially effective and sustainable with respect to mobilizing physically inactive older people.

A new approach to physical activity maintenance: rationale, design, and baseline data from the Keep Active Minnesota Trial

Background

Since many individuals who initiate physical activity programs are highly likely to return to a sedentary lifestyle, innovative strategies to efforts to increase the number of physically active older adults who successfully maintain beneficial levels of PA for a substantial length of time are needed.

Methods/Design

The Keep Active Minnesota Trial is a randomized controlled trial of an interactive phone- and mail-based intervention to help 50–70 year old adults who have recently increased their physical activity level, maintain that activity level over a 24-month period in comparison to usual care. Baseline, 6, 12, and 24 month measurement occurred via phone surveys with kilocalories expended per week in total and moderate-to-vigorous physical activity (CHAMPS Questionnaire) as the primary outcome measures. Secondary outcomes include hypothesized mediators of physical activity change (e.g., physical activity enjoyment, self-efficacy, physical activity self-concept), body mass index, and depression. Seven day accelerometry data were collected on a sub-sample of participants at baseline and 24-month follow-up.

Discussion

The Keep Active Minnesota study offers an innovative approach to the perennial problem of physical activity relapse; by focusing explicitly on physical activity maintenance, the intervention holds considerable promise for modifying the typical relapse curve. Moreover, if shown to be efficacious, the use of phone- and mail-based intervention delivery offers potential for widespread dissemination.

Trial registration

ClinicalTrials.gov Identifier: NCT00283452.

Evaluation of the walkable neighborhoods for seniors project in Sacramento County

The Walkable Neighborhoods for Seniors project was implemented to foster the creation and promotion of safe and accessible neighborhood walking routes for seniors. This article describes a case study of the efforts put forth by a local task force jointly managed by the Sacramento County Department of Health Services and WALK Sacramento. To facilitate environmental and policy changes that would enable and encourage walking by older adults, these local lead agencies implemented several strategies including organizing a community task force with broad professional and civic representation, conducting environmental audits of selected walking routes, creating walking groups, and advocating for environmental and policy change. Evaluation processes yield information on successes, challenges, and lessons learned that could be applied to similar efforts undertaken by community organizations to improve the walkability of neighborhoods for older adults.

Maintaining physical activity among older adults: six-month outcomes of the Keep Active Minnesota randomized controlled trial

OBJECTIVE

We evaluate the 6-month efficacy of Keep Active Minnesota, a phone- and mail-based physical activity maintenance intervention designed for use with adults age 50 to 70 years who have increased their physical activity within the past year.

METHOD

Participants (N=1049) recruited in 2004 and 2005 from one large managed-care organization in Minnesota were randomly assigned to either treatment (N=523) or usual care (N=526) with physical activity assessed using the Community Healthy Activities Model Program for Seniors questionnaire, and expressed as kcal/week expenditures.

RESULTS

Total physical activity at baseline was similar for treatment and usual care participants (p<0.44) as was moderate/vigorous physical activity (p<0.21). Maintenance of physical activity was higher among treatment participants whose mean 6-month change in total kcal/week energy expenditure was -91, compared to -683 for usual care participants (p<0.002). Mean 6-month change in kcal/week expenditure in moderate or vigorous activities was -49 for treatment participants, compared to -612 for usual care participants (p<0.001).

CONCLUSIONS

This phone- and mail-based physical activity maintenance intervention is efficacious at maintaining physical activity at 6 months.

Efficacy of resistance and task-specific exercise in older adults who modify tasks of everyday life

BACKGROUND

The purpose of this study was to determine the efficacy of 10 weeks of resistance (RT), functional (FT), or functional plus resistance (FRT) training in older adults who modify tasks of everyday life and are at risk for subsequent disability.

METHODS

Thirty-two older adults (75.8 +/- 6.7 years) were tested following a control period and training. The primary outcome of the study was the number of task modifications and timed performance on eight tasks of daily life. Secondary outcomes included knee and elbow strength (extension and flexion), body composition, self-reported physical function, single-leg balance time, walking speed, and time to vacuum a carpet. The RT group performed progressive intensity training, and the FT group performed task-specific exercises 2 days per week. The FRT group performed 1 day of each training type.

RESULTS

No changes occurred in the control period. All three training groups reduced the need to modify tasks of everyday life (RT: 21%, FRT: 26%, and FT: 28%) and improved self-rated function and time to vacuum a carpet. Individuals who performed FT either 1 or 2 days per week also reduced their timed performance (RT: 2.5% [p = 0.48], FRT: 18.5%, and FT: 23%). Strength gains were primarily found in groups that performed RT either 1 or 2 days per week (RT and FRT). No significant changes occurred in walking speed, single-leg balance, or body composition.

CONCLUSION

The benefits of exercise are dependent on tasks performed during training. Exercise recommendations for low-functioning older adults should reflect task-specific exercise to prevent the onset of disability.

A snapshot of the prevalence of physical activity amongst older, community dwelling people in Victoria, Australia: patterns across the 'young-old' and 'old-old'

BACKGROUND

Physical activity has a range of health benefits for older people. The aim of this study was to determine physical activity prevalence and attitudes amongst respondents to a trial screening survey.

METHODS

A cross-sectional survey was conducted. Subjects were community dwelling older people aged > or = 65 years, recruited via general practices in Victoria, Australia. Participants completed a mailed screening tool containing the Geriatric Depression Scale, the Active Australia survey and the Physical Activity Readiness Questionnaire.

RESULTS

Of 330 participants, 20% were > or = 80 years. Activity levels were similar to those reported in population studies. The proportion of participants reporting physical activity was greatest for the walking category, but decreased across categories of physical activity intensity. The oldest-old were represented at all physical activity intensity levels. Over half reported exercising at levels that, according to national criteria are, 'sufficient to attain health benefit'. A greater proportion of participants aged 85 years and older were unaware of key physical activity messages, compared to participants aged less than 85 years.

CONCLUSION

Most population surveys do not provide details of older people across age categories. This survey provided information on the physical activity of people up to 91 years old. Physical activity promotion strategies should be tailored according to the individual's needs. A better understanding of the determinants of physical activity behaviour amongst older sub-groups is needed to tailor and target physical activity promotion strategies and programs to maximise physical activity related health outcomes for older people.

Exploring the feasibility of a community-based strength training program for older people with depressive symptoms and its impact on depressive symptoms

Background

Depression is a disabling, prevalent condition. Physical activity programs may assist depression management in older people, ameliorate co-morbid conditions and reduce the need for antidepressants. The UPLIFT pilot study assessed the feasibility of older depressed people attending a community-based progressive resistance training (PRT) program. The study also aimed to determine whether PRT improves depressive status in older depressed patients.

Methods

A randomised controlled trial was conducted. People aged ≥ 65 years with depressive symptoms were recruited via general practices. Following baseline assessment, subjects were randomly allocated to attend a local PRT program three times per week for 10 weeks or a brief advice control group. Follow-up assessment of depressive status, physical and psychological health, functional and quality of life status occurred post intervention and at six months.

Results

Three hundred and forty six people responded to the study invitation, of whom 22% had depressive symptoms (Geriatric Depression Scale, GDS-30 score ≥ 11). Thirty two people entered the trial. There were no significant group differences on the GDS at follow-up. At six months there was a trend for the PRT intervention group to have lower GDS scores than the comparison group, but this finding did not reach significance (p = 0.08). More of the PRT group (57%) had a reduction in depressive symptoms post program, compared to 44% of the control group. It was not possible to discern which specific components of the program influenced its impact, but in post hoc analyses, improvement in depressive status appeared to be associated with the number of exercise sessions completed (r = -0.8, p < 0.01).

Conclusion

The UPLIFT pilot study confirmed that older people with depression can be successfully recruited to a community based PRT program. The program can be offered by existing community-based facilities, enabling its ongoing implementation for the potential benefit of other older people.

Long-term married couples' health promotion behaviors: identifying factors that impact decision-making

Knowledge about health promotion behaviors and their determinants in older individuals is scant. Even less is known about persons in long-term marriages, although a growing interdependence in health decision-making has been suggested. The purpose of this study was to identify determinants of health promotion activities in older adults who were in long-term marriages. Pender's Health Promotion Model and a proposed re-conceptualization of Pender's interpersonal influences were used to guide selection of study variables. Perceived barriers and perceived self-efficacy, two behavior-specific cognitions, and relationship quality and social support, proposed interpersonal influences, were hypothesized to predict participation in health promotion behaviors. A convenience sample of 80 individuals in long-term marriages was recruited. Regression analysis identified four predictor variables as explaining 31% of the participation in health promotion behaviors: relationship quality, perceived barriers, perceived self-efficacy, and social support. Implications for nursing practice and for further research are discussed.

Receipt of exercise counseling by older women

OBJECTIVES

To compare the national prevalence of reported receipt of clinician exercise counseling across four age groups of women (50-64, 65-74, 75-84, and > or =85) and to determine whether age or health are barriers to reported receipt of exercise counseling.

DESIGN

2000 National Health Interview Survey (NHIS).

SETTING

United States.

PARTICIPANTS

Six thousand three hundred eighty-five women aged 50 and older who responded to the 2000 NHIS, representing an estimated 34.5 million noninstitutionalized women nationally.

MEASUREMENTS

Exercise counseling, disease burden, functional dependency, and physical inactivity were assessed by questionnaire.

RESULTS

Of the 6,385 women, 52.2% were aged 50 to 64, 24.8% were aged 65 to 74, 18.0% were age 75 to 84, and 5.1% were aged 85 and older. Overall, 28.3% reported that a clinician had recommended that they begin or continue to perform any type of exercise or physical activity during the previous year: 31.4% of women aged 50 to 64, 29.2% of women aged 65 to 74, 21.6% of women aged 75 to 84, and 14.4% of women aged 85 and older. Women aged 75 to 84 (adjusted odds ratio (AOR)=0.8, 95% confidence interval (CI)=0.6-1.0) and women aged 85 and older (AOR=0.6, 95% CI=0.4-0.9) were substantially less likely to report clinician counseling about exercise, before and after adjustment. Further adjustment for illness burden and functional dependency did not attenuate the effect of receipt of exercise counseling.

CONCLUSION

Reported receipt of exercise counseling by older women is low nationally. Despite known benefits of late-life exercise, women aged 75 and older are less likely to report receiving exercise counseling from their clinicians than women aged 50 to 64. Interventions should be aimed at increasing clinician counseling about exercise, especially to older women.

The physical inactivity matrix: lessons from the classification of physical inactivity interventions

Physical inactivity (PI), a leading modifiable cause of disease and injury, is endemic in industrialised nations. Although considerable research has been undertaken in this field, we lack a system to synthesise the research literature to inform policy and identify research needs. The aims of this study were to (1) develop a system to classify physical inactivity intervention studies, (2) examine the distribution of PI interventions published in the peer-reviewed health literature using the system, and (3) consider implications for future research. We developed the Physical Inactivity Matrix (PIM), with 12 intervention points, created by the intersection of two dimensions: the intervention target (individual, physical environment and social/cultural environment) and the activity focus (transport, work/school, leisure and consumer). A formal search of the health research literature identified 529 eligible studies and each was classified into one of the 12 cells of the PIM. Most studies were categorised as: individual-leisure (68%), individual-work/school (12%) or social/cultural environment-leisure (13%). Only 4% targeted the physical environment. The findings of this initial application of the PIM support the call for greater investment in policies, interventions and research that focus on the relationship between the environment and PI, and transportation in particular. There would be merit in establishing the inter-rater reliability of the PIM and applying it to a wider variety of studies, including those published in the transportation and urban planning literatures. The PIM could be a useful tool for monitoring trends in research directions and funding levels over time and across countries.