Predictors of physical activity in community-dwelling elderly white women

TLR/NLRP3 inflammasome signaling pathways as a main target in frailty, cachexia and sarcopenia

Mobility disability is a common condition affecting older adults, making walking and the performance of activities of daily living difficult. Frailty, cachexia and sarcopenia are related conditions that occur with advancing age and are characterized by a decline in muscle mass, strength, and functionality that negatively impacts health. Chronic low-grade inflammation is a significant factor in the onset and progression of these conditions. The toll-like receptors (TLRs) and the NLRP3 inflammasome are the pathways of signaling that regulate inflammation. These pathways can potentially be targeted therapeutically for frailty, cachexia and sarcopenia as research has shown that dysregulation of the TLR/NLRP3 inflammasome signaling pathways is linked to these conditions. Activation of TLRs with pathogen-associated molecular patterns (PAMPs or DAMPs) results in chronic inflammation and tissue damage by releasing pro-inflammatory cytokines. Additionally, NLRP3 inflammasome activation enhances the inflammatory response by promoting the production and release of interleukins (ILs), thus exacerbating the underlying inflammatory mechanisms. These pathways are activated in the advancement of disease in frail and sarcopenic individuals. Targeting these pathways may offer therapeutic options to reduce frailty, improve musculoskeletal resilience and prevent or reverse cachexia-associated muscle wasting. Modulating TLR/NLRP3 inflammasome pathways may also hold promise in slowing down the progression of sarcopenia, preserving muscle mass and enhancing overall functional ability in elderly people. The aim of this review is to investigate the signaling pathways of the TLR/NLRP3 inflammasome as a main target in frailty, cachexia and sarcopenia.

Predictors of Physical Activity One Year After Moderate to Severe Traumatic Brain Injury

OBJECTIVES

To identify predictors of moderate to vigorous physical activity (MVPA) at 12-months post-moderate-severe traumatic brain injury (TBI).

SETTING

Four inpatient rehabilitation centers.

PARTICIPANTS

Individuals enrolled in the TBI Model Systems with moderate to severe TBI, admitted to inpatient rehabilitation, and able to ambulate without physical assistance from another person.

DESIGN

Prospective longitudinal cohort study. MVPA was measured by having participants wear an ActiGraph GT3X on their wrist for 7 consecutive days.

MAIN ANALYSES

We used multivariate regression to predict minutes per week of MVPA at 12 months after TBI. Three classes of predictors were entered hierarchically-demographic and clinical variables (age, sex, body mass index, education, TBI severity, neighborhood walkability score, and self-reported preinjury physical activity [PA] level), baseline TBI-related comorbid conditions (eg, measures of sleep, pain, mood, fatigue, and cognition), and intention to exercise and exercise self-efficacy assessed approximately 1 week after discharge from inpatient rehabilitation.

RESULTS

180 participants (ages 17.7-90.3 years) were enrolled, and 102 provided at least 5 days of valid accelerometer data at 12 months. At 12 months, participants recorded an average of 703 (587) minutes per week of MVPA. In univariate and multivariate analyses, age was the only significant predictor of 12-month MVPA ( r = -0.52). A sharp decline in MVPA was observed in the tertile of participants who were over the age of 61.

CONCLUSIONS

Older adults with TBI are at elevated risk of being physically inactive. Assuming PA may enhance health after TBI, older adults are a logical target for prevention or early intervention studies. Studies with longer outcomes are needed to understand the trajectory of PA levels after TBI.

The Association between Changes in Built Environment and Changes in Walking among Older Women in Portland, Oregon

Some cross-sectional evidence suggests that the objectively measured built environment can encourage walking among older adults. We examined the associations between objectively measured built environment with change in self-reported walking among older women by using data from the Study of Osteoporotic Fractures (SOF). We evaluated the longitudinal associations between built environment characteristics and walking among 1253 older women (median age = 71 years) in Portland, Oregon using generalized estimating equation models. Built environment characteristics included baseline values and longitudinal changes in distance to the closest bus stop, light rail station, commercial area, and park. A difference of 1 km in the baseline distance to the closest bus stop was associated with a 12% decrease in the total number of blocks walked per week during follow-up (e^β = 0.88, 95% CI: 0.78, 0.99). Our study provided limited support for an association between neighborhood transportation and changes in walking among older women. Future studies should consider examining both objective measures and perceptions of the built environment.

The impact of different step rate threshold methods on physical activity intensity in older adults

BACKGROUND

Older adults benefit most from engaging in higher-intensity physical activity, which is often determined using step rate thresholds. Fixed step rate thresholds that correspond to moderate (MPA) and vigorous-intensity physical activity (VPA) have been developed for heuristic activity promotion. The activPAL monitor uses step rate thresholds to determine activity intensity. Stepping thresholds may also vary based on body mass index (BMI) or aerobic fitness level in older adults. Despite the various thresholds used in the literature, it is unclear whether they produce similar outcomes.

RESEARCH QUESTION

How does time spent in physical activity intensities compare between different step rate thresholds in older adults?

METHODS

Thirty-eight participants (24♀; 67 ± 4 years; BMI: 26.6 ± 4.4 kg/m²) wore an activPAL monitor 24-hr/day for up to 7-d (total: 205-d). Aerobic fitness (V̇O₂max: 23 ± 8 ml/kg/min) was determined via indirect calorimetry during a maximal, graded cycling test. Time spent in each intensity category (light-physical-activity [LPA], MPA, VPA) was determined using the fixed (MPA/VPA) 100/130, 110/130, and activPAL step rate thresholds (74/212), as well as BMI-adjusted absolute (108.5 ± 2.5/134.0 ± 4.8) and BMI-adjusted relative (40%/60% V̇O₂max; 111.4 ± 14.7/132.0 ± 19.0) cut-offs. Times spent in each intensity category were compared between methods.

RESULTS

The activPAL and 100/130 thresholds yielded less LPA and more MPA than all other methods. The activPAL had no time spent in VPA at all. The BMI-adjusted absolute and relative thresholds produced statistically equivalent time in LPA and MPA (via equivalence testing), but not VPA. No two methods yielded similar time spent in LPA, MPA, or VPA.

SIGNIFICANCE

The choice of step rate threshold has a major impact on physical activity intensity outcomes in older adults. Inherently, strategies that adjust for older adults' body size and/or aerobic fitness level provide a more individualized data processing strategy than fixed thresholds that assume the same threshold for all older adults.

Age score for assessing motor function in Chinese community-dwelling older women

The study aimed to develop a physical fitness age score to assess motor function in community-dwelling elderly women and verify its validity. Principal component analysis was employed to build a physical fitness age score based on motor function variables. Validation test showed that the physical fitness age in the exercised older women was significantly lower than their chronological age, while no significant difference was observed between the physical fitness age and the chronological age in the normal elderly. The findings suggest that physical fitness age score is a valid approach to evaluate motor function in Chinese community-dwelling elderly women.

The Practice of Vigorous Physical Activity Is Related to a Higher Educational Level and Income in Older Women

Few studies have shown evidence about the factors that can determine physical practice in women over 60 years of age due to educational, economic, social, or health inequalities. Its knowledge could help to understand the determinants that encourage the practice of physical activity and the improvement of health in women over 60. Therefore, the aim of this research was to evaluate the level of studies, income, and the usefulness of social and health services in physically active older women according to the level of activity they practice. The IPAQ (International Physical Activity Questionnaire) and CUBRECAVI (subjective health scale) scales have been applied to a sample of 257 women between 61 and 93 years old (M = 69.44, SD = 4.61). The results have shown that those with vigorous physical activity are related to higher levels of education (p < 0.001) and income (p = 0.004). Furthermore, being dissatisfied with social and health services is associated with low levels of physical activity (p = 0.005). Older women who perform physical activity regularly are associated with high levels in some of the socio-environmental aspects of quality of life. High physical activity is related to a higher educational level and income. Socio-environmental factors generate social inequalities and modulate the lifestyles of older women.

Sex-Specific Associations Between Bone-Loading Score and Adiposity Markers in Middle-Aged and Older Adults

The authors examined sex-specific relationships between fat mass index (FMI), android/gynoid (A/G) fat ratio, relative skeletal muscle mass index, and Bone-Specific Physical Activity Questionnaire derived bone-loading scores (BLSs) in middle-aged and older adults (men, n = 27; women, n = 33; age = 55-75 years). The FMI, A/G fat ratio, and relative skeletal muscle mass index were estimated by dual-energy X-ray absorptiometry. The Bone-Specific Physical Activity Questionnaire was used to assess: (a) BLSpast (age 1 until 12 months before the study visit), (b) BLScurrent (last 12 months), and (c) BLStotal (average of [a] and [b]) scores. Separate multiple linear regression analysis of (a) age, FMI, and relative skeletal muscle mass index and (b) age, height, and A/G fat ratio versus BLS revealed that FMI and A/G fat ratio were negatively associated with BLSpast and BLStotal (p < .05) in women only. Adiposity and, specifically, central adiposity is negatively related to bone-loading physical activity in middle-aged and older women.

Age-Related Changes in Concentric and Eccentric Isokinetic Peak Torque of the Trunk Muscles in Healthy Older Versus Younger Men

This study investigated age-related changes in trunk muscle function in healthy men and the moderating effect of physical activity. Twelve older (67.3 ± 6.0 years) and 12 younger (24.7 ± 3.1 years) men performed isokinetic trunk flexion and extension tests across a range of angular velocities (15°/s-180°/s) and contractile modes (concentric and eccentric). For concentric trunk extension, mixed-effects analysis of covariance revealed a significant interaction between Angular velocity × Age group (p = .026) controlling for physical activity. Follow-up univariate analysis of covariance revealed that the younger group produced significantly greater peak torque for all concentric extension conditions. Eccentric trunk strength was somewhat preserved in the older group. Age-related changes in trunk strength were independent of physical activity. The normal loss of trunk muscle strength in older age is muscle- and contractile-mode specific. These findings provide guidance for effective intervention strategies to offset adverse health outcomes related to trunk strength loss in older adults.

Types of leisure time physical activities (LTPA) of community-dwelling persons who have been screened positive for dementia

Background

To (a) describe the pattern of leisure time physical activities (LTPA) in community-dwelling persons who have been screened positive for dementia and (b) determine the health-related and sociodemographic factors associated with LTPA.

Methods

Data of the general practitioner-based, randomized, controlled intervention trial, DelpHi-MV (Dementia: life- and person-centered help in Mecklenburg-Western Pomerania) were used. Patients aged 70 years or older, who lived at home and had a DemTect< 9 were informed about the study by their General practitioners and invited to participate. Data from 436 participants with complete baseline data were used. Standardized, computer-assisted assessments were made during face-to-face interviews at the participants’ homes.

Results

Two hundred thirty-eight patients (54.6%) carried out LTPA (men 58.4%, women 51.8%). Physically active patients mentioned one to two different activities; diversity of LTPA was higher for men than for women. The most-frequently mentioned types of activity were gardening (35.3%), cycling (24.1%) and mobility training (12.4%); there was only a statistically significant difference between men and women in cycling, χ²(1) = 21.47, p < .001. The odds of LTPA increased with increasing quality of life (OR = 2.41), lower impairments in activities of daily living (OR = 0.85), and living in a rural environment (OR = 2.02).

Conclusions

Our findings suggest that people who have been screened positive for dementia living in a rural area are more likely to be active than people living in an urban area. Following studies should investigate whether this difference has an effect on the progression of dementia.

Trial registration

ClinicalTrial.gov Identifier NCT01401582.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02201-1.

Walking for hypertension

BACKGROUND

Increased physical activity has been recommended as an important lifestyle modification for the prevention and control of hypertension. Walking is a low-cost form of physical activity and one which most people can do. Studies testing the effect of walking on blood pressure have revealed inconsistent findings.

OBJECTIVES

To determine the effect of walking as a physical activity intervention on blood pressure and heart rate.

SEARCH METHODS

We searched the following databases up to March 2020: the Cochrane Hypertension Specialised Register, CENTRAL (2020, Issue 2), Ovid MEDLINE, Ovid Embase, CINAHL, PsycINFO, SPORTDiscus, PEDro, the WHO International Clinical Trials Registry Platform, and ClinicalTrials.gov. We also searched the following Chinese databases up to May 2020: Index to Taiwan Periodical Literature System; National Digital Library of Theses and Dissertation in Taiwan; China National Knowledge Infrastructure (CNKI) Journals, Theses & Dissertations; and Wanfang Medical Online. We contacted authors of relevant papers regarding further published and unpublished work. The searches had no language restrictions.

SELECTION CRITERIA

Randomised controlled trials of participants, aged 16 years and over, which evaluated the effects of a walking intervention compared to non-intervention control on blood pressure and heart rate were included.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane. Where data were not available in the published reports, we contacted authors. Pooled results for blood pressure and heart rate were presented as mean differences (MDs) between groups with 95% confidence intervals (CIs). We undertook subgroup analyses for age and sex. We undertook sensitivity analyses to assess the effect of sample size on our findings.

MAIN RESULTS

A total of 73 trials met our inclusion criteria. These 73 trials included 5763 participants and were undertaken in 22 countries. Participants were aged from 16 to 84 years and there were approximately 1.5 times as many females as males. The characteristics of walking interventions in the included studies were as follows: the majority of walking interventions was at home/community (n = 50) but supervised (n = 36 out of 47 reported the information of supervision); the average intervention length was 15 weeks, average walking time per week was 153 minutes and the majority of walking intensity was moderate. Many studies were at risk of selection bias and performance bias. Primary outcome We found moderate-certainty evidence suggesting that walking reduces systolic blood pressure (SBP) (MD -4.11 mmHg, 95% CI -5.22 to -3.01; 73 studies, n = 5060). We found moderate-certainty evidence suggesting that walking reduces SBP in participants aged 40 years and under (MD -4.41 mmHg, 95% CI -6.17 to -2.65; 14 studies, n = 491), and low-certainty evidence that walking reduces SBP in participants aged 41 to 60 years (MD -3.79 mmHg, 95% CI -5.64 to -1.94, P < 0.001; 35 studies, n = 1959), and those aged 60 years of over (MD -4.30 mmHg, 95% CI -6.17 to -2.44, 24 studies, n = 2610). We also found low certainty-evidence suggesting that walking reduces SBP in both females (MD -5.65 mmHg, 95% CI -7.89 to -3.41; 22 studies, n = 1149) and males (MD -4.64 mmHg, 95% CI -8.69 to -0.59; 6 studies, n = 203). Secondary outcomes We found low-certainty evidence suggesting that walking reduces diastolic blood pressure (DBP) (MD -1.79 mmHg, 95% CI -2.51 to -1.07; 69 studies, n = 4711) and heart rate (MD -2.76 beats per minute (bpm), 95% CI -4.57 to -0.95; 26 studies, n = 1747). We found moderate-certainty evidence suggesting that walking reduces DBP for participants aged 40 years and under (MD -3.01 mmHg, 95% CI -4.44 to -1.58; 14 studies, n = 491) and low-certainty evidence suggesting that walking reduces DBP for participants aged 41 to 60 years (MD -1.74 mmHg, 95% CI -2.95 to -0.52; 32 studies, n = 1730) and those aged 60 years and over (MD -1.33 mmHg, 95% CI -2.40 to -0.26; 23 studies, n = 2490). We found moderate-certainty evidence that suggests walking reduces DBP for males (MD -2.54 mmHg, 95% CI -4.84 to -0.24; 6 studies, n = 203) and low-certainty evidence that walking reduces DBP for females (MD -2.69 mmHg, 95% CI -4.16 to -1.23; 20 studies, n = 1000). Only 21 included studies reported adverse events. Of these 21 studies, 16 reported no adverse events, the remaining five studies reported eight adverse events, with knee injury being reported five times.

AUTHORS' CONCLUSIONS

Moderate-certainty evidence suggests that walking probably reduces SBP. Moderate- or low-certainty evidence suggests that walking may reduce SBP for all ages and both sexes. Low-certainty evidence suggests that walking may reduce DBP and heart rate. Moderate- and low-certainty evidence suggests walking may reduce DBP and heart rate for all ages and both sexes.

Family Orchards and Health-Related Quality of Life in the Elderly. A Protocol for a Study in Las Hurdes (Spain) Based on an Ethnographic Approach

Demographic evolution is resulting on an aged population increment in Spain. This growth has been more relevant in rural areas, where the population has traditionally lived under hard socio-economic conditions and leveraging the natural resources such as food from family orchards to survive. Studies that have investigated the possibilities and uses of these traditional family orchards today in relation to health-related quality of life in the elderly are scarce. Based on a previous ethnography, this mixed research aims to describe a protocol that will evaluate the effects of the use of traditional family orchards as a daily resource on fitness and quality of life of the elderly population in Las Hurdes (Spain). Body composition, fitness, mental health, health-related quality of life, and activity-related behaviors of participants will be assessed. The outcomes of this study might enable us to design further tailored physical exercise-based interventions using family orchards as an adequate resource to improve the health-related quality of life and fitness of the elderly in rural areas. In addition, the study detailed here might also be applied to other similar rural areas in Spain and worldwide.

Age-related degeneration of lumbar muscle morphology in healthy younger versus older men

AIM

The aim of this study was to evaluate age-related changes in lumbar paravertebral muscle (LPM) morphology in healthy younger and older adult men.

METHODS

T2-weighted axial MRI of the lumbar spine were obtained for 12 healthy older (67.3 ± 6.0 years) and younger (24.7 ± 3.1 years) men. Normalised muscle volume (NMV) and muscle fat infiltrate (MFI) were determined bilaterally for the psoas (PS), quadratus lumborum (QL), erector spinae (ES) and multifidus (MF). MANOVA was used to compare NMV and MFI between age groups. Follow-up ANOVA compared NMV and MFI for each muscle between age groups, with physical activity (PA) as a covariate. Stepwise regression was used to explore the association between muscle morphology.

RESULTS

NMV of the ES and QL were significantly lower in the older group (OG) (p = 0.040 and p < 0.001, respectively). MFI across all muscles was significantly greater in the OG (p < 0.001). PA did not moderate the relationship between aging and muscle degeneration. Non-dominant handgrip strength was associated with NMV (p = 0.003).

CONCLUSIONS

Age-related atrophy is muscle specific in the lumbar spine; changes in lumbar musculature is independent of PA, handgrip strength may reflect morphological changes in the postural muscles with age. This study supports establishing effective targeted exercise interventions in the lumbar musculature.

Association between Health Indicators and Health-Related Quality of Life according to Physical Activity of Older Women

The purpose of this study was to compare sociodemographic factors, health factors and nutritional status according to the physical activity of older women, and to analyze the factors affecting their quality of life. The subjects of this study were 5661 older women aged 60 or older who participated in the Korean National Health and Nutrition Survey (KNHANES) from 2008 to 2013. The socioeconomic factors, subjective health status and disease status, lifestyle and dietary quality, and life quality were compared among two groups (active group and inactive group). The inactive group had significantly higher rates of obesity and unemployment, comorbidities, numbers without spouses, experiencing stress, poor subjective health status, depression or suicidal thoughts, and also higher rates of skipping meals. The life quality index and dietary quality was also significantly lower in the inactive group, and subjects experienced significantly higher pain or discomfort and problems in mobility and the usual activities. The results of multivariate analysis after adjusting for age in groups engaging in physical activities showed the life quality index to increase in accordance with the diet quality, economic income, and education level. It was confirmed that life quality was significantly low if the participant showed a poor subjective health evaluation, obese with many diseases, spouseless, and experienced high levels of stress. Considering the rapid aging and high life expectancy of women, regular physical activity is very important for maintaining health and improving the life quality of older women, and it is believed that comprehensive attention and management of lifestyle and diet quality are necessary.

Effects of a Person-Centered Nursing Intervention for Frailty among Prefrail Community-Dwelling Older Adults

This study examined the effects of a person-centered nursing intervention program for frailty (PNIF) targeting community-dwelling prefrail older people in South Korea. The study participants were 40 community-dwelling older adults (≥65 years) who were classified as prefrail on the Cardiovascular Health Study (CHS) frailty index. The intervention group (n = 20) received group intervention sessions two days/week for twelve weeks and the control group (n = 20) attended lectures about frailty prevention one day/week for four weeks. The evaluation instruments included the CHS Frailty Index, a JAMAR® hydraulic hand dynamometer, the Short Physical Performance Battery (SPPB), the Korean version of the Community Healthy Activities Model Program for Seniors Questionnaire (K-CHAMPS), the Mini Nutritional Assessment (MNA), the Geriatric Depression Scale Short Form-Korea Version (GDSSF-K), the ENRICHD Social Support Instrument (ESSI), and the Goal Attainment Scale (GAS). Significant differences were found in the CHS Frailty Index (p < 0.001), left-hand grip strength (p = 0.022), right-hand grip strength (p = 0.009), SPPB (p = 0.007), K-CHAMPS (p = 0.009), MNA (p = 0.018), and GDSSF-K (p = 0.001) between the two groups after 12 weeks. No significant between-group differences in ESSI scores were observed. The PNIF effectively improved grip strength, physical function, physical activity, and nutritional status, reduced depression, and prevented frailty among community-dwelling older adults.

Factors associated with change in self-reported physical activity in the very old: The Newcastle 85+ study

BACKGROUND

Higher physical activity (PA) has been linked to better health and functioning. Trajectories of PA and associated factors have been studied in older adults aged ≥65, but less is known about influences on PA change in the very old (aged ≥85).

OBJECTIVE

To investigate factors associated with self-reported PA and PA change over time in very old adults.

METHODS

845 participants in the Newcastle 85+ Study were followed for health and functioning at 1.5-, 3-, and 5-year follow-up (wave 2 to 4). PA scores (range 0-18) and PA levels (low (PA scores 0-1), medium (2-6) and high (7-18)) were determined using a purpose-designed PA questionnaire. We used linear mixed models (LMM) to investigate factors associated with 5-year change in PA scores.

RESULTS

Overall, men had higher mean PA scores than women (up to 2.27 points). The highest proportion of participants (42-48%) had medium levels of PA across the waves. Although most experienced decline-stability in moderate and increases in high PA levels were also observed. The fully adjusted LMM revealed a curvilinear annual decline in PA scores of 0.52 (0.13) (β (SE), p<0.001), which decelerated by 0.07 (0.02) points (p<0.01) over time. The factors associated with low PA scores at baseline were female gender, higher waist-hip ratio, and no alcohol intake. Better self-rated and cognitive health and having fewer diseases were associated with higher PA scores. None were associated with the rate of change in PA over time.

CONCLUSION

We observed a curvilinear trend and deceleration in PA scores decline in the very old. Men and those in better health and who drank alcohol were more physically active at baseline. None of the factors were associated with the rate of PA decline. Investigating those who maintain or increase levels of PA may inform interventions for at risk groups with PA decline.

Factors Associated with Participation of Community-Dwelling Older Adults in a Home-Based Falls Prevention Program

This observational study was conducted to determine which factors are associated with frequent participation in a home-based exercise program. The effects of frequent participation on health-related outcomes over time are investigated, as well. Community-dwelling adults aged ≥65 years participated in a twelve-week home-based exercise program. The program consisted of an instruction book with exercises that were performed individually at home. Frequent participation was classified as performing exercises of the instruction book daily or a few days a week during the study period. A logistic regression analysis was performed to determine the association between factors (i.e., demographic and health-related characteristics) and frequent participation. Furthermore, to investigate the effects of frequent participation on health-related outcomes, generalized linear and logistic regression models were built. A total of 238 participants (mean age 81.1 years (SD ± 6.7), 71% female) were included in the study. Frequent participation during the study period was indicated by fifty-two percent of participants. Analyses showed that a higher degree of pain (OR: 1.02, 95% CI: 1.⁻1.04) was associated with frequent participation. In addition, the effect of frequent participation over time was a significant improvement in current health perceptions (B: 4.46, SE: 1.99).

Health, psychological, social and environmental mediators between socio-economic inequalities and participation in exercise among elderly Japanese

This study examined which of the identified health, psychological, social and environmental mediators could most effectively explain the socio-economic status (SES)-based differences in participation in exercise among elderly Japanese. The candidates for mediators were composed based on the socio-ecological model. A representative sample of people 65 years and older living in two areas with different residential SES in Tokyo, Japan produced 739 effective participants. The intensity of exercise was evaluated based on whether the participants exercise for 30 minutes or longer twice a week, or for 20 minutes or longer three times a week. SES was evaluated by education and income. Mediators were assessed through four dimensions: (a) health, (b) psychological status, (c) social relations and (d) environmental context. As a result, SES's indirect effect through the mediators was evaluated using a multiple mediator model. The influence of both education and income on exercise was mediated by self-efficacy for exercise and social support for exercise. Self-efficacy for exercise had the strongest effect, while social support for exercise explained more of the income differences affecting participation in exercise than it did regarding educational differences. Self-efficacy for exercise may have the strongest effect as a mediator, which would explain the differences in participation in exercise among elderly Japanese based on education and income.

Stay active for life: physical activity across life stages

Purpose

This paper concerns participation of Poles aged 15+ years in leisure time and transport-related physical activity (PA) with a special focus on the life stages. The purpose of the paper was to analyze types of exercises, current and future behavior concerning PA, availability of sport and recreation facilities, and factors having the strongest relation with undertaking PA at a sufficient level according to pro-health recommendations of World Health Organization (WHO).

Patients and methods

A survey was carried out on the representative sample (n=2,000). Respondents were classified in accordance to their life stages with a two-step cluster analysis. Relationships between meeting the dose of PA required for health recommendations and a membership in groups of life stages were evaluated using log-linear analysis. The strength of this relationship was expressed by the odds ratio. In order to capture relationships between meeting WHO recommendations and a set of explanatory variables, a predictive model was built.

Results

Life stages and various related events have a significant relation with a decrease of PA. Among groups of a particular risk, there are professionally active and unemployed people aged 50–64 years without children as well as retirees aged 65+ years who do not meet WHO recommendations (45.3; 50.4% and 47.6%). The unemployed and retirees more frequently (p<0.0001) do not or cannot practice sport and do not think that a change of their situation is expected soon. However, 35% of professionally active people aged 50–64 years without children and 18.2% of unemployed people declare that they are currently not active but if they had the possibility, they would start practicing sport.

Conclusion

Campaigns promoting PA should be targeted at groups of a particular risk. Any attempts of increasing PA or changing tendencies of its decrease should consider life conditions of these persons, as well as their needs, motivations, and barriers.

Patient-Related Factors Associated with Adherence to Recommendations Made by a Fracture Liaison Service: A Mixed-Method Prospective Study

A Fracture Liaison Service (FLS) has been calculated to be a cost-effective model of care for patients with fragility fracture (FF). Cost-effectiveness can be achieved when adherence to bone health recommendations from FLS staff is high. This prospective study combined participants’ telephone longitudinal survey data (intervention group, n = 354) and interviews with 16 individuals from FLS in three health regions of the province of Quebec (Canada). Participants were recruited between January 2013 and April 2015. Regression models were fit to examine the relationship between participant-related factors and adherence at 12 months to osteoporosis medication, vitamin D supplementation, and participation in physical activity. Participants acknowledging FF as a consequence of osteoporosis were more likely to adhere to medication (odds ratio (OR) 2.5; p = 0.001) and vitamin D supplementation (OR 2.3; p = 0.01). Paradoxically, the same participants were less prone to engage in physical activity (OR 0.5, p = 0.01). Qualitative interviews suggested that feedback from FLS coordinators helped participants understand the underlying cause of their FF. This study highlighted the key roles of FLS staff in helping patients to recognize FF as a sign of underlying bone disease and encouraging adherence to care recommendations.

Influence of Socioeconomic Status and Perceived Barriers on Physical Activity Among Taiwanese Middle-Aged and Older Women

BACKGROUND

Physical activity (PA) is associated with cardiovascular health in general populations, particularly in women. Middle-aged and older women are at high risk of less engagement in PA for unknown and complicated reasons.

OBJECTIVES

The aim of this study was to investigate whether PA was positively associated with socioeconomic status and psychosocial correlates of PA (self-efficacy and perceived benefits) but inversely correlated with perceived barriers in women (age >40 years).

METHODS

A cross-sectional survey of 326 community-dwelling women was conducted. Data on socioeconomic status, PA, and its psychosocial correlates (ie, perceived benefits/barriers and self-efficacy) were collected using self-report questionnaires. Analyses were performed by multiple linear regressions.

RESULTS

Monthly income (β = .35, P = .015), employment status (β = .32, P < .001), and perceived barriers to PA (β = -.19, P = .008) were significantly associated with PA. More highly educated women participated in more (β = .13, P = .033) vigorous PA, women with fewer perceived barriers participated in more (β = -.14, P = .047) moderate-intensity PA, and employed women participated in more (β = .35, P < .001) walking. Significantly higher scores of perceived barriers, including "no trainer," "feeling exhausted," "lack of motivation," and "lack of guidance," were identified in women with low PA compared with those with moderate PA.

CONCLUSION

Socioeconomic status and perceived barriers are associated with PA and its intensity level. Some specific barriers provide insights into the key factors that contribute to low PA in middle-aged and older women. These findings can be considered in future interventions to design PA promotion programs for this population to protect against cardiovascular diseases.

Investigating the associations between productive housework activities, sleep hours and self-reported health among elderly men and women in western industrialised countries

BACKGROUND

After retirement, elderly men and women allocate more time to housework activities, compared to working-age adults. Nonetheless, sleep constitutes the lengthiest time use activity among the elderly, but there has not been any study on the associations between time spent on housework activities, sleep duration and self-reported health among the older population. This study not only examined individual associations between self-reported health and both housework activities and sleep duration, but it also explored self-reported health by the interaction effect between housework activities and sleep duration separately for men and women.

METHODS

Pooled data from the Multinational Time Use Study (MTUS) on 15,333 men and 20,907 women from Germany, Italy, Spain, UK, France, the Netherlands and the US were analysed. Multiple binary logistic regression models were used to examine the associations between three broad categories of housework activities ((1) cooking, cleaning and shopping, (2) gardening and maintenance; (3) childcare) and health. We further investigated the extent to which total housework hours and sleep duration were associated with self-reported health for men and women separately.

RESULTS

We found a positive association between time devoted to housework activities, total housework and health status among elderly men and women. Compared to those who spent 1 to 3 h on total productive housework, elderly people who spent >3 to 6 h/day had higher odds of reporting good health (OR = 1.25; 95% CI = 1.14-1.37 among men and OR = 1.10; 95% CI = 1.01-1.20 among women). Both short (<7 h) and long (>8 h) sleep duration were negatively associated with health for both genders. However, the interactive associations between total productive housework, sleep duration, and self-reported health varied among men and women. Among women, long hours of housework combined with either short or long sleep was negatively associated with health.

CONCLUSIONS

Although time allocation to housework activities may be beneficial to the health among both genders, elderly women have higher odds of reporting poor health when more time is devoted total housework combined with either short or long sleep duration.

Surveying predictors of late-life longitudinal change in daily activity energy expenditure

Background

Total daily energy expenditure (TEE) is composed of resting metabolic rate (RMR), post-prandial thermogenesis and activity energy expenditure (AEE). Higher AEE is strongly associated with lower mortality and physical limitations among older adults, but factors that predict changes in AEE in septu and octogenarians are not clearly understood.

Objective

To identify factors associated with late-life longitudinal change in AEE.

Design

Energy expenditure was re-assessed in 83 participants (average age at baseline, 74.4±3.2 years)—an average of 7.5±0.54 years since the baseline measure. RMR was measured using indirect calorimetry and the thermic effect of meals was estimated at 10% of TEE. AEE was calculated as: TEE(0.9)-RMR. Participants were categorized into two groups according to the estimated day-to-day precision of the doubly-labeled water technique. Those who were within 10% or increased relative to their initial AEE measurement were categorized as having preserved AEE. Participants who declined greater than 10% of their initial measurement were categorized as having reduced AEE. A variety of socio-demographic, functional and mental factors, body composition, community and personal behaviors, blood measurements and health conditions were evaluated between groups at baseline and changes during follow-up.

Results

Daily AEE declined 106.61±293.25 kcal, which equated to a 14.63±40.57 kcal/d decrease per year. Fifty-nine percent (n = 49) preserved their AEE and 41% (n = 34) declined. Those who demonstrated a decline in AEE were older, had lower walking speed at baseline and showed a higher lean mass loss during follow up. Otherwise, groups were similar for socio-demographic characteristics, body composition, mental and physical function, health conditions and community and personal behaviors at baseline and change in these factors during follow-up.

Conclusions

This study demonstrates that AEE declines through the 8^th decade of life and is associated with age, lower walking speed at baseline and lean mass loss. Additionally, there are a significant number of individuals who appear to be resilient to these declines despite having health events that are expected to have a negative impact on their physical activity.

Gender-specific issues in cardiac rehabilitation: do women with ischaemic heart disease need specially tailored programmes?

Ischaemic heart disease (IHD) has changed from a disease of middle-aged men in the late 1970s to a disease of elderly women in the 2000s. Most clinical studies during the past three decades have been conducted with men. Cardiac rehabilitation programmes were also developed with special regard to improving the rate of return to work in middle-aged men. The rehabilitation needs of older patients and women in particular have been largely neglected. The aim of this review is briefly to outline our present knowledge on gender issues in cardiac rehabilitation, and to specify barriers with regard to physical activities especially in (older) women. Coping with a cardiac event, women tend to minimize or play down the impact of their health situation and avoid burdening their social contacts. After a first cardiac event, women report greater psychological distress and lower self-efficacy and self-esteem. In addition, older age, lower exercise levels and reduced functional capacity or co-morbid conditions such as osteoporosis and urinary incontinence are barriers to physical activities in women with IHD. Recent studies on psychosocial intervention revealed less favourable results in women compared with men. These findings have not yet been well explained. This emphasizes our current lack of knowledge about the processes and determinants of successful psychosocial interventions in men and women with IHD. A large (European) trial on gender-specific coping styles, needs, and preferences of older women, and the effects of psychosocial intervention is proposed.

The Relationship between Convenience of Destinations and Walking Levels in Older Women

Purpose.

To examine the relationship between physical activity and (1) convenience of destinations, measured by whether destinations (such as a park, trail, businesses, and services) are within walking distance of the home, and (2) participants' perception of the quality of their neighborhood surroundings for walking, captured with a global neighborhood “walkability” rating.

Design.

Cross-sectional analysis of data obtained in 1999.

Setting.

Community in southwest Pennsylvania.

Subjects.

Older Caucasian women (n = 149, mean age = 74.2 years). Response rate = 79%.

Measures.

Walking levels, leisure-time physical activity, and features of the neighborhood environment were measured with interviewer-administered questionnaires. Physical activity was also measured objectively with a pedometer.

Results.

Living within walking distance (defined as within a 20-minute walk of home) of a park; biking or walking trail; or department, discount, or hardware store was related to higher pedometer readings ( p < .01). In addition, there was a positive trend between the sum of destinations within walking distance of home and activity levels measured by pedometer and questionnaire ( p < .01). There was also a positive trend between participants' neighborhood “walkability” rating and activity levels measured by pedometer and questionnaire ( p < .01).

Conclusion.

These findings suggest that the ability to make utilitarian walking trips from home and the perception of having favorable neighborhood surroundings for walking are associated with increased physical activity levels in older women.

Objectively measured physical activity is associated with parameters of bone in 70-year-old men and women

As the world's population ages, the occurrence of osteoporosis-related fractures is projected to increase. Low areal bone mineral density (aBMD), a well-known risk factor for fractures, may be influenced by physical activity (PA). In this cross-sectional study, we aimed to investigate potential associations between objective measures of PA and bone properties, in a population-based cohort of 1228 70-year-old men and women. We measured volumetric BMD (vBMD, mg/cm(3)) together with cross-sectional area (CSA, mm(2)) by peripheral quantitative computed tomography at sites located 4% and 66% in the distal-proximal trajectory at the tibia and radius. We also measured aBMD (g/cm(2)) by dual energy X-ray absorptiometry at the femoral neck, lumbar spine (L1-L4) and radius. Participants wore triaxial accelerometers for 7 consecutive days to obtain objective estimates of PA. The intensity of the objective PA was divided into light (100-1951 counts/min [CPM]), moderate (1952-5724 cpm) and vigorous (≥ 5725 cpm). Maximal accelerations for the anterior-posterior (z), medio-lateral (x), and vertical (y) axes were also separately assessed. Associations were investigated using bivariate correlations and multiple linear regression, adjusted for height, weight and sex. Vigorous PA showed the strongest association with femoral neck aBMD (β=0.09, p<0.001), while both moderate and vigorous PAs were associated with cortical area and trabecular vBMD in the weight-bearing tibia (all p<0.05). Peak vertical accelerations were associated significantly with cortical area (β=0.09, p<0.001) and trabecular vBMD (β=0.09, p=0.001) of the tibia, whereas peak anterior-posterior accelerations showed no correlation with these properties. No positive association was found between objectively measured PA and bone parameters of the radius. In conclusion, vertical accelerations and moderate to vigorous PA independently predict bone properties, especially in the weight-bearing tibia, in 70-year-old men and women.

Patterns in health-related behaviours and fall injuries among older people: a population-based study in Stockholm County, Sweden

AIM

we identified clusters of older people with similar health-related behaviours and assessed the association between those clusters and the risk of injurious fall.

METHODS

we linked self-reported and register-based data on the over-65s from the Stockholm public health cohort (N = 20,212). Groups of people with similar health-related behaviours were identified by cluster analysis using four measures of physical activity, two of smoking and alcohol habits and two individual attributes (age and type of housing). The association between clusters and falls leading to hospitalisation (422 cases) was studied using a nested case-control design. Odds ratios (ORs), crude and adjusted for health status, were compiled by cluster using the one with the most 'protective' health behaviour profile as the reference.

RESULTS

five clusters were identified revealing a variety of combinations of health-related behaviours, all linked to specific age groups and types of housing and with a tendency towards higher levels of physical activity among the younger ones. The risk of injurious falls differed across clusters, and for three out of four, it was significantly higher than in the comparison cluster. Adjusting for health status only partially reduced the ORs for those clusters and this was observed both in men and women.

CONCLUSION

health-related behaviours aggregate in different manners among older people. Some health-related profiles are associated with an excess risk of falls leading to hospitalisation. Although this is partly a reflection of age differences across clusters, health status alone cannot fully explain the association.

Prevalence and correlates of physical inactivity in community-dwelling older adults in Ireland

The public health challenges associated with rapid population ageing are likely to be exacerbated by poor physical activity levels. The purpose of this study was to identify correlates of physical inactivity in a population-representative sample of older adults in Ireland. This paper reports a secondary analysis of data from 4892 adults aged 60+ from the Irish Longitudinal Study on Ageing (TILDA). TILDA includes an assessment of the mental and physical health, and social and financial circumstances of participants assessed in a home interview and self-completion questionnaire. Chi squared statistics and forced entry logistic regression were used to identify factors associated with physical inactivity. Females were over twice as likely to be inactive as their male counterparts (Odds Ratio 2.2). Increasing old age was associated with inactivity among males and females. Those who reported above secondary level education, no reported falls in the last year and no fear of falling were less likely to be physically inactive. While older adults who noted poor/fair self-reported health, that they did not look after grandchildren, did not own a car or did not attend a course were also more likely to be inactive than those who reported positively for these items. Gender displayed a strong but often contrasting influence on factors that affect physical activity among older adults. Among females, living alone or in a rural area, retirement, fair/poor emotional health and activity being limited by illness were all significantly associated with inactivity. While cohabiting, being employed and residing in an urban area were related to low levels of activity in males. Our findings identify specific groups of the older Irish population who may be at particular risk of physical inactivity and thereby the associated physiological and psychological hazards. These results can support the development of tailored interventions to promote healthy ageing.

Gardening as the dominant leisure time physical activity (LTPA) of older adults from a post-communist country. The results of the population-based PolSenior Project from Poland

OBJECTIVE

To describe the LTPA of older Polish citizens in the nationwide, representative population-based PolSenior Project.

METHODS

A study group comprising 4813 randomly recruited participants aged 65 and over was surveyed. Data concerning LTPA in relation to age, gender, place of residence, and social class have been reported.

RESULTS

Only 33.6% fulfilled the recommended LTPA criteria. Gardening (64.6%), walking (39.0%) and cycling (37.3%) were the most popular physical activities, followed by gymnastic exercises (18.2%) and dancing (12.8%). Village residents reported walking, gymnastics, swimming, tennis and dancing (32.5%, 9.1%, 1.8%, 0.1%, 8.1%) less frequently than those who live in cities, especially as compared to the residents of the largest cities (45.2%, 28.3%, 13.4%, 1.3%, 15.7%, respectively). However, the frequency of cycling generally decreased with the size of the place of residence. Village residents reported cycling and gardening more frequently (49.2% and 75.8%) than residents of the largest cities (20.6% and 45.8%, respectively).

CONCLUSION

There are several differences in the LTPA of older adults in Poland compared with those in North America or Western Europe. Community-based and environmental policies should concentrate on a combination of sustaining existing favorable physical activity (PA) habits (gardening and cycling), and developing access and motivation for participation in LTPA characteristic of developed countries.

Negative social interactions and incident hypertension among older adults

OBJECTIVE

To determine if negative social interactions are prospectively associated with hypertension among older adults.

METHOD

This is a secondary analysis of data from the 2006 and 2010 waves of the Health and Retirement Study, a survey of community-dwelling older adults (age > 50 years). Total average negative social interactions were assessed at baseline by averaging the frequency of negative interactions across 4 domains (partner, children, other family, friends). Blood pressure was measured at both waves. Individuals were considered to have hypertension if they reported use of antihypertensive medications, had measured average resting systolic blood pressure of 140 mmHg or higher, or measured average resting diastolic blood pressure of 90 mmHg or higher. Analyses excluded those who were hypertensive at baseline and controlled for demographics, personality, positive social interactions, and baseline health.

RESULTS

Twenty-nine percent of participants developed hypertension over the 4-year follow-up. Each 1-unit increase in the total average negative social interaction score was associated with a 38% increased odds of developing hypertension. Sex moderated the association between total average negative social interactions and hypertension, with effects observed among women but not men. The association of total average negative interactions and hypertension in women was attributable primarily to interactions with friends, but also to negative interactions with family and partners. Age also moderated the association between total average negative social interactions and hypertension, with effects observed among those ages 51-64 years, but not those ages 65 or older.

CONCLUSION

In this sample of older adults, negative social interactions were associated with increased hypertension risk in women and the youngest older adults.

A prospective study of volunteerism and hypertension risk in older adults

The purpose of the current study was to determine whether volunteerism is prospectively associated with hypertension risk among older adults. Participants provided data during the 2006 and 2010 waves of the Health and Retirement Study, a longitudinal panel survey using a nationally representative sample of community-dwelling older adults (age > 50 years). Volunteerism and blood pressure were measured at baseline and again 4 years later. Analyses excluded individuals hypertensive at baseline and controlled for age, race, sex, education, baseline systolic/diastolic blood pressure, and major chronic illnesses. Those who had volunteered at least 200 hr in the 12 months prior to baseline were less likely to develop hypertension (OR = 0.60; 95% CI [0.40, 0.90]) than nonvolunteers. There was no association between volunteerism and hypertension risk at lower levels of volunteer participation. Volunteering at least 200 hr was also associated with greater increases in psychological well-being (B = 0.99, β = .05, p = .006) and physical activity (B = 0.21, β = .05, p = .04) compared with nonvolunteers; however, these factors did not explain the association of volunteerism with hypertension risk.

Understanding older adults' motivators and barriers to participating in organized programs supporting exercise behaviors

Little is known about older adults' perceptions of organized programs that support exercise behavior. We conducted semi-structured interviews with 39 older adults residing in King County, Washington, who either declined to join, joined and participated, or joined and then quit a physical activity-oriented program. We sought to explore motivators and barriers to physical activity program participation and to elicit suggestions for marketing strategies to optimize participation. Two programs supporting exercise behavior and targeting older persons were the source of study participants: Enhance(®)Fitness and Physical Activity for a Lifetime of Success. We analyzed interview data using standard qualitative methods. We examined variations in themes by category of program participant (joiner, decliner, quitter) as well as by program and by race. Interview participants were mostly females in their early 70s. Approximately half were non-White, and about half had graduated from college. The most frequently cited personal factors motivating program participation were enjoying being with others while exercising and desiring a routine that promoted accountability. The most frequent environmental motivators were marketing materials, encouragement from a trusted person, lack of program fees, and the location of the program. The most common barriers to participation were already getting enough exercise, not being motivated or ready, and having poor health. Marketing messages focused on both personal benefits (feeling better, social opportunity, enjoyability) and desirable program features (tailored to individual needs), and marketing mechanisms ranged from traditional written materials to highly personalized approaches. These results suggest that organized programs tend to appeal to those who are more socially inclined and seek accountability. Certain program features also influence participation. Thoughtful marketing that involves a variety of messages and mechanisms is essential to successful program recruitment and continued attendance.

Assessment of factors that predict physical activity among Oklahoma clergy: a theory of planned behavior approach

The purpose of this study was to examine predictors of physical activity among clergy members in Oklahoma, using the theory of planned behavior. A 51-item valid and reliable instrument, measuring theory of planned behavior constructs and physical activity, was developed and administered to 141 clergy members. Results indicated that the majority of those surveyed were white (93%), college educated (97%), and overweight or obese (84%). Stepwise multiple regression analysis found that intentions accounted for 13.8% of the variance of physical activity whereas attitudes, subjective norms, and perceived behavioral control accounted for 54.8% of the variance of intention. Implications for intervention development are discussed.

Racial/ethnic differences in midlife women's attitudes toward physical activity

INTRODUCTION

Women's racial/ethnic-specific attitudes toward physical activity have been pointed out as a plausible reason for their low participation rates in physical activity. However, very little is actually known about racial/ethnic commonalities and differences in midlife women's attitudes toward physical activity. The purpose of this study was to explore commonalities and differences in midlife women's attitudes toward physical activity among 4 major racial/ethnic groups in the United States (whites, Hispanics, African Americans, and Asians).

METHODS

This was a secondary analysis of the qualitative data from a larger study that explored midlife women's attitudes toward physical activity. Qualitative data from 4 racial/ethnic-specific online forums among 90 midlife women were used for this study. The data were analyzed using thematic analysis, and themes reflecting commonalties and differences in the women's attitudes toward physical activity across the racial/ethnic groups were extracted.

RESULTS

The themes reflecting the commonalities were: 1) physical activity is good for health, 2) not as active as I could be, 3) physical activity was not encouraged, 4) inherited diseases motivated participation in physical activity, and 5) lack of accessibility to physical activity. The themes reflecting the differences were: 1) physical activity as necessity or luxury, 2) organized versus natural physical activity, 3) individual versus family-oriented physical activity, and 4) beauty ideal or culturally accepted physical appearance.

DISCUSSION

Developing an intervention that could change the social influences and environmental factors and address the women's racial/ethnic-specific attitudes would be a priority in increasing physical activity of racial/ethnic minority midlife women.

Contingency Management to Induce Exercise Among College Students

Objective: The effects of contingency management to induce physical activity levels were examined in seven non-obese physically inactive undergraduate students by providing monetary payments using a multiple baseline, changing-criterion procedure. Methods: Participants attended a baseline phase, a subsequent intervention phase consisting of three exercise sessions per week for 4 weeks, and a follow-up session 2 weeks post intervention. A total of $145 was available for attendance and exercise contingency payments. Results: Results indicate that all participants significantly increased exercise during intervention from inactivity at baseline to exercising three 30-minute sessions per week. Participants maintained some gains during follow-up. Limitations: The study employed a small and homogenous sample size and required participants to exercise in a lab setting thus limiting external validity. Conclusions: These findings suggest that incentive-based interventions are an effective and viable means for inducing exercise.

Built environment and change in body mass index in older women

We examined the association between neighborhood walkability and changes in body mass index (BMI) and obesity during a 14-year follow-up among community-dwelling women 71 years of age on average (n=1008 representing 253 census tracts). Multilevel models predicted change in BMI or incidence of obesity controlling for age, marital status, number of incident comorbidities, self rated health, and death, over a follow-up of 14 years. Among non-sedentary older women, average BMI remained stable (β=0.007, p=0.291); risk of becoming obese increased 3% per year (odds ratio=1.03, 95% CI 1.01, 1.05). Walkability was not associated with BMI or risk of obesity. Future research should consider additional neighborhood characteristics relevant to older adults, such as proximity to retail, public transit, or parks.

The prevalence and correlates of meeting the current physical activity for health guidelines in older people: a cross-sectional study in Brazilian women

This study aimed to identify the prevalence and correlates of meeting the current physical activity for health (PAfH) guidelines, proposed by the World Health Organization in 2010, in community-dwelling older women from Brazil. A cross-sectional study was performed with 1806 women (aged 60.0-92.7 years) who were randomly selected from eighteen care centers. The short version of the International Physical Activity Questionnaire was used to determine the weekly time spent in physical activities, and this variable was categorized into three categories (0<150min/wk; 1: 150-299.9min/wk; 2: ≥300min/wk). Age, race/ethnicity, economic class, education level, occupational and marital status, body mass index and blood pressure status, medical conditions, use of medications, and self-rated health status were the potential correlates. The ordinal logistic regression was used as a measure of association. From the total group of participants, 49.9% followed the current recommendations related to basic health benefits (150-299min/wk), and 35.9% met the guidelines for additional health effects (300 or more min/wk). Women with secondary complete education (OR=1.43, 95% confidence interval [CI]: 1.17-1.74), positive self-rated health (OR=5.25, 95% CI: 2.10-13.09), and high blood pressure (OR=1.33, 95% CI: 1.09-1.62) were more likely to meet the current PAfH guidelines than their peers with primary incomplete education, negative self-rated health, and normal blood pressure. Increasing age was inversely associated with meeting the PAfH guidelines (odds ranging: 0.77-0.48). These results highlighted the elderly population subgroups, in a developing country, that needspecific guidelinesfor inclusion inhealth programs andmotivation toparticipate in physical activities.

Facilitators of and barriers to physical activity in retirement communities: experiences of older women in urban areas

BACKGROUND

Older people are being encouraged to be physically active for as long as possible as a preventive measure against disease and functional decline. It remains, however, uncertain how living in a retirement community affects physical activity (PA).

OBJECTIVES

This study was conducted to understand the PA experiences of older women living in retirement communities and what they experience as facilitators of and barriers to PA.

DESIGN

The study was qualitative and guided by the Vancouver School of doing phenomenology, a unique blend of phenomenology, hermeneutics, and constructivism.

METHOD

Participants were 10 women, aged from 72 to 97 years (mean=84 years). In-depth interviews were conducted, recorded, transcribed, and thematically analyzed.

RESULTS

A model was constructed with 3 main themes: (1) the women themselves, including their experienced health condition, individual aspects of functioning, and various personal factors; (2) the physical environment; and (3) the social environment. These main themes all include subthemes of experienced influences on PA, such as health, design of housing and environment, and local culture. These influences could both facilitate and hinder PA, depending on the context. The facilitating effects of good outdoor areas, accessible physical training facilities, a familiar neighborhood, and finding joy in PA were clear in the study. The barriers included worsening health, a colder climate with ice and wind, and lack of a PA culture within the retirement community.

CONCLUSIONS

An older woman's residence may strongly influence her ability and motivation to be physically active. Physical therapists should acquaint themselves with the facilitators of and barriers to PA of women within retirement communities and use that knowledge to influence the physical and social environment and to target PA interventions to the women themselves.

Physical activity patterns in older men and women in Germany: a cross-sectional study

Background

Data on physical activity in older adults in Germany is scarce. The aim of this study was to analyze physical activity patterns and to explore factors associated with physical activity in different domains, i.e. sporting activities (SA) and domestic activities (DA), in older men and women.

Methods

As part of the 7-year follow-up telephone interviews of the getABI cohort (community-dwelling older adults in Germany), the PRISCUS-PAQ was used to survey participants about their everyday physical activity patterns. Time per week (hh:mm) spent in SA and DA (heavy housework, gardening) was analyzed for men and women. Multivariate logistic regression analyses were performed in order to assess the odds of participating in SA and DA for at least 2.5 hours/week in association with sociodemographic factors, a broad range of physical health-related factors and interview date (season of the year).

Results

A total of 1,610 primary health care patients (51.6% women) with a median age of 77 (range 72-93) years were included in the analyses. Men engaged in SA more often than women (01:45 vs. 01:10), whereas women did more DA per week than men (04:00 vs. 03:00).

Being interviewed in spring or summer was associated with increased performance of DA in both sexes. Participation in these activities was reduced in more highly educated men and women. Living alone increased the odds of sports participation in women, but not in men. Most physical health-related factors were only selectively associated with either SA or DA, in men or women, respectively. The need for a walking aid was the only factor that consistently lowered the odds of being active in both activity domains and sexes.

Conclusions

This exploratory study delivers reliable and relevant data on the participation in and correlates of sporting and domestic activities of community-dwelling older adults for whom there had previously been only limited information at a population level in Germany. Findings are discussed and implications for epidemiological research and health promotion practice are provided.

Built environment and lower extremity physical performance: prospective findings from the study of osteoporotic fractures in women

OBJECTIVE

We examined the association between walkability of the built environment and changes in physical performance among women aged 65 or older (n = 1,671, 253 neighborhoods).

METHOD

Street connectivity and street density, markers for neighborhood walkability, were assessed through linkage to secondary data sources. Physical performance was measured with timed-walk and chair-stand tests assessed during follow-up visits about every 2 years for 12 to 14 years. Multilevel models predicted change in physical performance, controlling for age, number of incident comorbidities, self-rated health, and death during follow-up.

RESULTS

Overall, physical performance declined during follow-up (p < .001). Neighborhood walkability had no effect on change in physical performance among women who reported not walking at baseline. However, among women who walked, greater neighborhood walkability was associated with a slower decline in dynamic leg strength, indicated by score on chair stand.

DISCUSSION

Neighborhood walkability may protect against decline in physical performance.

Leisure-time physical activities for community older people with chronic diseases

AIMS

(1) To explore the types and three components (frequency, duration and caloric expenditure) of leisure-time physical activity in community older people with chronic diseases. (2) To identify leisure-time physical activity-related factors in these community older people.

BACKGROUND

Previous research has focused primarily on measuring the actual physiological or psychological benefits of exercise or leisure-time physical activity, little is known about the factors that determine the frequency, intensity and duration of exercise or leisure-time physical activity. The identification of reliable predictors of the various components of leisure-time physical activity will enable healthcare providers to intervene and change the patterns of leisure-time physical activity in the sedentary older people more effectively.

DESIGN

A cross-sectional design was used for this study.

METHODS

Participants were recruited from the Xinyi District in Taipei, Taiwan. A total of 206 older people were recruited and were asked to complete three questionnaires during a face-to-face interview with a researcher at the activity setting.

RESULTS

The results showed that walking leisurely was the most frequent leisure-time physical activity for participants. The age, gender, living arrangement, affective feeling and environmental control were significant variables of leisure-time physical activity.

CONCLUSIONS

The study constructs accounted for moderate amounts of variance (22% for leisure-time physical activity frequency, 27% for leisure-time physical activity duration and 24% for leisure-time physical activity caloric expenditure). This study also showed that different variables play different influential roles in the different components of LTPA.

RELEVANCE TO CLINICAL PRACTICE

An effective intervention strategy for improving leisure-time physical activity of older people may involve tailoring the type, format, intensity, frequency and duration of a physical activity according to an individual's needs. This study described some environmental barriers to LTPA and recommended an increase in the accessibility to LTPA areas.

[Association of the physical activity of community-dwelling older adults with transportation modes, depression and social networks]

AIM

The purpose of this study was to cross-sectionally examine the relationships among leisure, household and occupational physical activity with the frequency of going out by various transportation modes, depression and social networks in older adults.

METHODS

We randomly selected a total of 2,100 community-dwelling adults aged 65 to 85 years of age from the Basic Resident Register. Of these, 340 people were the subjects of this study. The scales of measurement used were the Physical Activity Scale for the Elderly, the Lubben Social Network Scale (LSNS) and the Geriatric Depression Scale (GDS).

RESULTS

In a regression model, leisure-time physical activity significantly correlated with frequency of going out by bicycle (β=0.17) and LSNS score (β=0.17). Household physical activity and occupational physical activity were significantly correlated with LSNS score (β=0.21) and frequency of going out by motor vehicle (β=0.25), respectively. For total physical activity, in the 3 above-mentioned activities a significant correlation was observed among frequency of going out by bicycle (β=0.10), by motor vehicle (β=0.23), GDS score (β=-0.16) and LSNS score (β=0.23).

CONCLUSION

These results indicate that the frequency of going out by bicycle and by motor vehicle were significant factors to predict leisure and occupational physical activity. Furthermore, social networks appear to be important determiners in leisure and household physical activity in community-dwelling older adults.

Predictors of longitudinal changes in older adults' physical activity engagement

The study aimed to investigate factors influencing older adults' physical activity engagement over time. The authors analyzed 3 waves of data from a sample of Israelis age 75-94 (Wave 1 n = 1,369, Wave 2 n = 687, Wave 3 n = 154). Findings indicated that physical activity engagement declined longitudinally. Logistic regressions showed that female gender, older age, and taking more medications were significant risk factors for stopping exercise at Wave 2 in those physically active at Wave 1. In addition, higher functional and cognitive status predicted initiating exercise at Wave 2 in those who did not exercise at Wave 1. By clarifying the influence of personal characteristics on physical activity engagement in the Israeli old-old, this study sets the stage for future investigation and intervention, stressing the importance of targeting at-risk populations, accommodating risk factors, and addressing both the initiation and the maintenance of exercise in the face of barriers.

Osteoporosis and gait and balance disturbances in older sarcopenic obese New Zealanders

Bone, muscle, and fat may affect gait and balance in older adults. Osteoporosis was prevalent in low muscle mass participants and related to gait and balance deficits. Low muscle combined with high fat mass had more functional deficits and poorer bone health, which has implications for falls risk and fractures.

INTRODUCTION

Decreasing bone density and muscle mass and increasing fat mass may act synergistically to affect gait and balance in older adults.

METHODS

One hundred eighty-three older adults (age 72.7 +/- 6 years, range 56-93; body mass index 28.2 +/- 4.9, range 16.6-46.0) were recruited from a New Zealand falls prevention intervention trial. Total and appendicular skeletal muscle mass (ASM), percent fat, and bone mineralization were assessed by dual energy X-ray absorptiometry and used to characterize normal lean (NL, n = 51), sarcopenic (SS, n = 18), sarcopenic obese (SO, n = 29), and obese (OO, n = 85) phenotypes. Functional performance was assessed using timed up and go, chair stand, single leg stand, and step test. Regression models were adjusted for age, sex, medications, and physical activity.

RESULTS

Femoral neck osteoporosis was present in 22% SS, 17% SO, 12% NL, and 7% OO. Femoral neck osteoporosis with low ASM predicted poor chair stand performance (beta -3.3, standard error 1.6, p = 0.04). SO scored lowest on the chair stand (p = 0.03) and step test (p = 0.03). Higher ASM predicted faster timed up and go performance (p = 0.001).

CONCLUSIONS

Osteoporosis was prevalent in low ASM groups (SS and SO) and related to gait and balance deficits, particularly in the SO. This has implications for falls risk, fractures, and interventions.

Estimating older adults' preferences for walking programs via conjoint analysis

BACKGROUND

Physical inactivity is a major driver of costly health problems, especially in older adults. Structured walking programs are one approach for increasing physical activity, although there is little information about how the characteristics of these programs influence their effectiveness. It was hypothesized that cash incentives would increase acceptability and effectiveness while a group participation requirement would place a net burden on participants.

METHODS

To measure preferences for specific characteristics of walking programs (i.e., minutes per day, days per week, organized or individual/informal group, cash incentive) and the likelihood of participation, a conjoint-analysis survey of 501 inactive adults aged >or=50 years was conducted in October 2006. Data were analyzed in 2007-2008.

RESULTS

The most-preferred program was three 20-minute walks per week. Respondents had a strong preference for programs conducted outside of a formal group setting. Offering an incentive of $9 in cash per week ($468 per year) increased predicted participation by 31%.

CONCLUSIONS

The results suggest that the characteristics of walking programs, such as whether they involve participation in a formal group, substantially influence their perceived acceptability and the likelihood of participation. The results also suggest that, independent of other program attributes, modest financial incentives increase the likelihood of program participation by sedentary older adults, and thus are a potential means to increase the effectiveness of walking programs.

Healthy cognitive aging and leisure activities among the oldest old in Japan: Takashima study

BACKGROUND

Little is known regarding the normative levels of leisure activities among the oldest old and the factors that explain the age-associated decline in these activities.

METHODS

The sample included 303 cognitively intact community-dwelling elderly persons with no disability in Activities of Daily Living (ADL) and minimal dependency in Instrumental ADL (IADL) in Shiga prefecture, Japan. We examined (i) the nature and frequency of leisure activities, comparing the oldest old versus younger age groups; (ii) factors that explain the age-associated differences in frequencies of engagement in these activities; and (iii) domain-specific cognitive functions associated with these activities, using three summary index scores: physical and nonphysical hobby indexes and social activity index.

RESULTS

The oldest old (85 years old or older) showed significantly lower frequency scores in all activity indexes, compared with the youngest old (age 65-74 years). Gait speed or overall mobility consistently explained the age-associated reduction in levels of activities among the oldest old, whereas vision or hearing impairment and depressive symptoms explained only the decline in social activity. Frequency of engagement in nonphysical hobbies was significantly associated with all cognitive domains examined.

CONCLUSIONS

Knowing the factors that explain age-associated decline in leisure activities can help in planning strategies for maintaining activity levels among elderly persons.

Impact of health perception, balance perception, fall history, balance performance, and gait speed on walking activity in older adults

BACKGROUND AND PURPOSE

Disagreement currently exists regarding the contributions of various factors to physical activity in older adults. The purpose of this cross-sectional study was to investigate the simultaneous impact of psychological (health perception and balance perception) and physiological (gait speed, fall history, and balance performance) factors on walking activity in older adults.

SUBJECTS AND METHODS

This cross-sectional secondary data analysis included 2,269 community-dwelling older adults from the Cardiovascular Health Study. A series of simultaneous linear regression models were constructed to examine the association of walking activity with health and balance perception, gait speed, fall history, and balance performance after controlling for potential confounding factors.

RESULTS

Health and balance perception and gait speed were significantly related to walking activity after controlling for potential confounding factors. Participants who perceived both their health and their balance to be good walked more blocks per week than those who reported a discordant perception, who walked more than those who perceived both their health and their balance to be poor. Participants who walked at a normal speed walked more blocks per week than those who walked at a slow speed.

DISCUSSION AND CONCLUSION

The measure of physical activity used in this study included only walking, not other low- to moderate-intensity activities that are common in older adults. Health and balance perception and gait speed were associated with walking activity more so than fall history or balance performance after controlling for potential confounding factors.

Mobility limitation in self-described well-functioning older adults: importance of endurance walk testing

BACKGROUND

Mobility limitations are prevalent, potentially reversible precursors to mobility loss that may go undetected in older adults. This study evaluates standardized administration of an endurance walk test for identifying unrecognized and impending mobility limitation in community elders.

METHODS

Men and women (1480 and 1576, respectively) aged 70-79 years with no reported mobility limitation participating in the Health, Aging and Body Composition study were administered the Long Distance Corridor Walk. Walk performance was examined to determine unrecognized mobility deficits at baseline and predict new self-recognition of mobility limitation within 2 years.

RESULTS

On testing, 23% and 36% of men and women evidenced mobility deficits defined as a contraindication to exertion, meeting stopping criteria or exceeding 7 minutes to walk 400 m. Unrecognized deficits increased with age and were more prevalent in blacks, smokers, obese individuals, and infrequent walkers. Within 2 years, 21% and 34% of men and women developed newly recognized mobility limitation; those with baseline unrecognized deficits had higher rates, 40% and 54% (p <.001), respectively. For each additional 30 seconds over 5 minutes needed to walk 400 m, likelihood of newly recognized mobility limitation increased by 65% and 37% in men and women independent of age, race, obesity, smoking status, habitual walking, reported walking ease, and usual gait speed.

CONCLUSIONS

A sizable proportion of elders who report no walking difficulty have observable deficits in walking performance that precede and predict their recognition of mobility limitation. Endurance walk testing can help identify these deficits and provide the basis for treatment to delay progression of mobility loss.

[The comparison of health behaviors between widowed women and married women in Jeollanamdo Province, Korea]

OBJECTIVES

To compare the health behaviors of widowed women with those of currently married women.

METHODS

We randomly sampled the subjects from the Jeollanamdo Resident Registration Data and we then selected 2,331 widowed women and 4,775 married women. Well-trained examiners measured the height, weight, blood pressure and abdomen circumference, and the women were interviewed with using a questionnaire. Logistic regression analysis was used to estimate the odds ratios(OR) of the two groups.

RESULTS

The smoking rate (OR=2.46; 95% confidence interval [CI]1.65, 3.66) was significantly higher for the widowed women. On the contrary, the awareness rate of a smoking cessation campaign (OR=0.80; 95% CI=0.70, 0.92), a quit tobacco telephone line (OR=0.73; 95% CI=0.61, 0.88) and a quit smoking clinic (OR=0.74; 95% CI=0.62, 0.89) were lower for the widowed women. The rate of receiving a health exam (OR=0.80; 95% CI=0.70, 0.91), the rate of undergoing gastric cancer screening (OR=0.77; 95% CI=0.68, 0.88), breast cancer screening (OR=0.79; 95% CI=0.69, 0.89), cervix cancer screening in the last 2 years (OR=0.81; 95% CI=0.71, 0.92), colon cancer screening in the last 5 years (OR=0.74; 95% CI=0.63, 0.87) were significantly lower for the widowed women.

CONCLUSIONS

This study revealed that the health behaviors are significantly different between the widowed women and the married women. To improve the health behaviors of the widowed women, further study and research that will investigate the socioeconomic and environmental factors that affect the health behaviors of widowed women will be needed.