Reasons given by older people for limitation or avoidance of leisure time physical activity

Barriers and motivators to undertaking physical activity in adults over 70-a systematic review of the quantitative literature

BACKGROUND

Physical activity (PA) has multiple benefits for older adults (≥70 years old). Despite this many older adults do not undertake the World Health Organisation guideline recommended amount of PA. This systematic review examines barriers and motivators to PA in adults aged ≥70 years.

METHODS

We analysed the quantitative literature, including observational studies and baseline data from randomised controlled trials. Studies examining specific diseases (e.g. cognitive impairment), or care home residents were excluded. Database searches of ASSIA, CINAHL, Embase, Medline, PsycINFO and Web of Science were undertaken on 7 March 2023. Quality assessment was performed using the ROBANS tool. We synthesised the results using the socioecological model. The protocol was registered on PROSPERO (CRD42021160503).

RESULTS

We identified 37 papers, n = 26,961, age 70-101 years (median 78), 62% female. We undertook a narrative review; meta-analysis was not possible. Overall risk of bias was low. A total of 23 studies addressed barriers, seven motivators, seven both. The most cited barriers were: concern about physical health/fitness (14 studies), lack of motivation/interest (13 studies), fear of falls/history of falling (11 studies) and environmental barriers (10 studies). Key motivators were: support from family/friends (five studies), social interaction (five studies), personal benefits (five studies) and outside facilities (five studies). Results varied across gender, age, functional ability and geographical location.

DISCUSSION

To maximise PA in older adults, important modifiable factors identified in this review should be targeted: support from healthcare professionals; reducing fear of falls; and prioritising ease of access and safety of outdoor facilities. When considering future policy, a person-centred, age group appropriate approach will have the most impact.

Exploring outdoor activity limitation (OAL) factors among older adults using interpretable machine learning

BACKGROUND

The occurrence of outdoor activity limitation (OAL) among older adults is influenced by multidimensional and confounding factors associated with aging.

AIM

The aim of this study was to apply interpretable machine learning (ML) to develop models for multidimensional aging constraints on OAL and identify the most predictive constraints and dimensions across multidimensional aging data.

METHODS

This study involved 6794 community-dwelling participants older than 65 from the National Health and Aging Trends Study (NHATS). Predictors included related to six dimensions: sociodemographics, health condition, physical capacity, neurological manifestation, daily living habits and abilities, and environmental conditions. Multidimensional interpretable machine learning models were assembled for model construction and analysis.

RESULTS

The multidimensional model demonstrated the best predictive performance (AUC: 0.918) compared to the six sub-dimensional models. Among the six dimensions, physical capacity had the most remarkable prediction (AUC: physical capacity: 0.895, daily habits and abilities: 0.828, physical health: 0.826, neurological performance: 0.789, sociodemographic: 0.773, and environment condition: 0.623). The top-ranked predictors were SPPB score, lifting ability, leg strength, free kneeling, laundry mode, self-rated health, age, attitude toward outdoor recreation, standing time on one foot with eyes open, and fear of falling.

DISCUSSION

Reversible and variable factors, which are higher in the set of high-contribution constraints, should be prioritized as the main contributing group in terms of interventions.

CONCLUSION

The integration of potentially reversible factors, such as neurological performance in addition to physical function into ML models, yields a more accurate assessment of OAL risk, which provides insights for targeted, sequential interventions for older adults with OAL.

The effects of leisure time physical activity on depression among older women depend on intensity and frequency

BACKGROUND

Leisure time physical activity (LTPA) is beneficial for late-life depression (LLD). The main purpose of this study was to estimate the associations between LTPA parameters (intensity, duration, frequency) and LLD.

METHODS

Through the 2018 Women Health Needs Survey, data on 1,892 women aged 55-70 in Hunan, China, were studied. Depression was measured by the 9-item Patient Health Questionnaire (PHQ-9). Self-reported LTPA parameters were collected. Binary logistic regression models were used to compute odds ratios (OR) for LTPA for predicting depression. Sensitivity analyses were conducted to examine the effect of missing values.

RESULTS

Moderate LTPA volume (OR = 0.582, p = 0.027, 95% CI [0.360-0.941] for 150-299 min/week and OR = 0.392, p = 0.002, 95% CI [0.215-0.714] for ≥300 min/week) was associated with reduced depression, while vigorous LTPA could increase the risk (OR = 2.414, p = 0.029, 95% CI [1.095-5.325] for <75 min/week and OR = 3.824, p = 0.007, 95% CI [1.439-10.158] for ≥75 min/week). Frequent (6-7 days/week), moderate LTPA had a lower risk (OR = 0.570, p = 0.021, 95% CI [0.353-0.918]), while frequent (≥3 days/week), vigorous LTPA increased the risk (OR = 5.103, p = 0.001, 95% CI [1.977-13.172]). The adjusted relationship between the duration and depression was not observed. The results were supported by the sensitivity analysis based on missing value replacement.

LIMITATIONS

In this cross-sectional study, LTPA data were self-reported and no data on light LTPA were collected.

CONCLUSIONS

Moderate LTPA, associated with mental health benefits, should be recommended for older women instead of vigorous LTPA.

Chlorella vulgaris in combination with high intensity interval training in overweight and obese women: a randomized double-blind clinical trial

Background

Chlorella vulgaris (CV) as a multifunctional dietary supplement is known with lots of health benefits. It is possible that CV consumption along with high-intensity interval training (HIIT), a short period exercise is more beneficial. This investigation aimed to evaluate the effects of CV and/or HIIT on anthropometric parameters and cardiometabolic risk factors among overweight or obese women.

Methods

Present randomized double-blind clinical trial, included 46 women with overweight or obesity and randomly assigned them to four groups including CV, HIIT, CV+HIIT, and placebo. CV supplementation was 900 mg a day and HIIT program 3 sessions a week. Dietary intake, anthropometric assays and blood samples were taken at the commencement and completion of 8-week intervention.

Results

After 8 weeks, waist circumference (WC) significantly reduced in CV+HIIT group in comparison with placebo group. Significant decreases in triglycerides (TG) and low-density lipoprotein (LDL) cholesterol levels were found after CV supplementation and/or HIIT exercise in comparison with placebo group. A significant rise in high-density lipoprotein (HDL) cholesterol level was observed in HIIT and HIIT + CV groups in comparison with placebo group, however CV consumption failed to affect HDL cholesterol levels. CV and/or HIIT significantly lowered, visceral adiposity index (VAI), lipid accumulating product (LAP) and atherogenic index of plasma (AIP) in comparison with placebo. However, concurrent administration of CV and HII resulted in greater reduction in this indexes. Among glycemic indices a significant reduction in insulin resistance in CV+HIIT group compared with placebo group were seen.

Conclusions

In conclusion, CV and HIIT could improve lipid profile and glycemic status in overweight and obese women.

Care home residents on the move: the significance of cultural context for physical activity

Increased physical activity is widely promoted as beneficial for older people, but previous research indicates this may be difficult to implement in care homes, especially for people with dementia who form an increasing proportion of residents. Care home cultures can mitigate against physical activity for residents, but there is also scope for them to embed personalised physical activity. They are under-researched, but significant in terms of outcomes and quality of life for residents. This paper builds understanding of care home cultures of physical activity through qualitative, empirical research in five care homes. Key findings are that culturally framed views about physical activity, sometimes reflecting stereotypical views of dependency, can be seen in care homes. Managers, staff and residents may be invested in or resistant to physical activity and dominant managerial or societal views may be reflected or contested. The relatively closed boundaries of care homes reinforce sedentariness, and resident involvement in either chosen or enforced physical activity is varied. Interactions demonstrate potential to negotiate physical activity more or less effectively in any given care home. Rigid routines, external regulations and pressure on staffing can be negative, but management commitment has positive potential. In conclusion, the paper identifies that to increase physical activity in a sustainable manner, any intervention needs to address issues of culture change and individual needs and preferences.

An examination of the socio-demographic correlates of patient adherence to self-management behaviors and the mediating roles of health attitudes and self-efficacy among patients with coexisting type 2 diabetes and hypertension

BACKGROUND

Patients with coexisting type 2 diabetes and hypertension generally exhibit poor adherence to self-management, which adversely affects their disease control. Therefore, identification of the factors related to patient adherence is warranted. In this study, we aimed to examine (i) the socio-demographic correlates of patient adherence to a set of self-management behaviors relevant to type 2 diabetes and hypertension, namely, medication therapy, diet therapy, exercise, tobacco and alcohol avoidance, stress reduction, and self-monitoring/self-care, and (ii) whether health attitudes and self-efficacy in performing self-management mediated the associations between socio-demographic characteristics and adherence.

METHODS

We performed a secondary analysis of data collected in a randomized controlled trial. The sample comprised 148 patients with coexisting type 2 diabetes mellitus and hypertension. Data were collected by a questionnaire and analyzed using logistic regression.

RESULTS

Female patients were found to be less likely to exercise regularly (odds ratio [OR] = 0.49, P = 0.03) and more likely to avoid tobacco and alcohol (OR = 9.87, P < 0.001) than male patients. Older patients were found to be more likely to adhere to diet therapy (OR = 2.21, P = 0.01) and self-monitoring/self-care (OR = 2.17, P = 0.02). Patients living with family or others (e.g., caregivers) were found to be more likely to exercise regularly (OR = 3.44, P = 0.02) and less likely to avoid tobacco and alcohol (OR = 0.10, P = 0.04) than those living alone. Patients with better perceived health status were found to be more likely to adhere to medication therapy (OR = 2.02, P = 0.03). Patients with longer diabetes duration (OR = 2.33, P = 0.01) were found to be more likely to adhere to self-monitoring/self-care. Self-efficacy was found to mediate the association between older age and better adherence to diet therapy, while no significant mediating effects were found for health attitudes.

CONCLUSIONS

Adherence to self-management was found to be associated with socio-demographic characteristics (sex, age, living status, perceived health status, and diabetes duration). Self-efficacy was an important mediator in some of these associations, suggesting that patient adherence may be improved by increasing patients' self-management efficacy, such as by patient empowerment, collaborative care, or enhanced patient-physician interactions.

Percepção de barreiras e facilitadores dos usuários para participação em programas de promoção da atividade física

Resumo: No Brasil, a atividade física é eixo prioritário das ações de promoção da saúde no Sistema Único de Saúde (SUS). O presente estudo tem como objetivo descrever o perfil dos usuários, as barreiras e os facilitadores para participação em programas para promoção de atividades físicas na atenção básica à saúde. Trata-se de um estudo transversal com abrangência estadual realizado nos municípios de Pernambuco. Foram entrevistados de 2 a 21 indivíduos, por município, por meio de instrumento previamente testado e validado nas dimensões: sociodemográfica; estado de saúde; participação; informações sobre o programa; motivos de participação; facilitadores para a prática; barreiras para a prática e preferência de atividades. Foram realizadas análises descritivas e inferenciais (qui-quadrado). A amostra foi de 1.153 usuários, sendo 35,9% com idade entre 41-59 anos; 90,1% residentes em áreas urbanas; 58,2% dos usuários participavam das atividades há, pelo menos, um ano. A frequência semanal de 3-4 dias foi de 44,9%, e 71,1% praticavam atividades de uma hora ou mais. Observou-se que 40% das barreiras para a participação nos programas de atividade física e 77,5% dos facilitadores relatados foram de domínio intrapessoal. A barreira mais prevalente foi “condição atual de saúde”, e o facilitador foi “ter uma condição melhor de saúde”. As mulheres percebem mais barreiras do que os homens. Conclui-se que as barreiras e os facilitadores de domínio intrapessoal, relacionados com a saúde, são os fatores envolvidos na manutenção e no engajamento dos usuários dos programas e intervenções para promoção da atividade física desenvolvidos pela atenção básica à saúde do Estado de Pernambuco.

Health for Older Adults: The Role of Social Capital and Leisure-Time Physical Activity by Living Arrangements

BACKGROUND

The purposes of this study were to (1) explore the influence of social capital and leisure-time physical activity on older adults' physical and mental health and (2) test whether these relationships varied by living arrangement.

METHODS

This cross-sectional study used national data from the 2013 National Health Interview Study. The subjects included 7714 adults aged 65 years or older. Logistic regressions were used to predict the probability of subjects being overweight or obese. Ordinary linear regressions were performed to predict mental health outcomes.

RESULTS

Older adults living alone were more likely to report feeling sad (alone: 1.5; with others: 1.36), hopeless (alone: 1.25; with others: 1.18), and worthless (alone: 1.22; with others: 1.15). They were also more likely to experience lower levels of social support (alone: 3.24; with others: 3.30), trust (alone: 3.34; with others: 3.44), cohesion (alone: 2.95; with others: 2.98), and enjoy less leisure-time physical activity (alone: 49.85 min; with others: 64.64 min) than those living with others. Hispanic and divorced/separated older adults who lived alone were prioritized for health intervention.

CONCLUSIONS

Older adults living alone had poorer mental health, less social capital, and engaged in less frequent leisure-time physical activity. Promoting social capital could improve mental health in older adults living alone.

Building Community: Stakeholder Perspectives on Walking in Malls and Other Venues

Mall walking has been a popular physical activity for decades. However, little is known about why mall managers support these programs or why adults choose to walk. Our study aim was to describe mall walking programs from the perspectives of walkers, managers, and leaders. Twenty-eight walkers, 16 walking program managers, and six walking program leaders from five states participated in a telephone or in-person semi-structured interview (N = 50). Interview guides were developed using a social-ecological model. Interviews were recorded, transcribed verbatim, and analyzed thematically. All informants indicated satisfaction with their program and environmental features. Differences in expectations were noted in that walkers wanted a safe, clean, and social place whereas managers and leaders felt a need to provide programmatic features. Given the favorable walking environments in malls, there is an opportunity for public health professionals, health care organizations, and providers of aging services to partner with malls to promote walking.

Financial incentives for a healthy life style and disease prevention among older people: a systematic literature review

Background

To motivate people to lead a healthier life and to engage in disease prevention, explicit financial incentives, such as monetary rewards for attaining health-related targets (e.g. smoking cessation, weight loss or increased physical activity) or disincentives for reverting to unhealthy habits, are applied. A review focused on financial incentives for health promotion among older people is lacking. Attention to this group is necessary because older people may respond differently to financial incentives, e.g. because of differences in opportunity costs and health perceptions. To outline how explicit financial incentives for healthy lifestyle and disease prevention work among older persons, this study reviews the recent evidence on this topic.

Methods

We applied the method of systematic literature review and we searched in PUBMED, ECONLIT and COCHRANE LIBRARY for studies focused on explicit financial incentives targeted at older adults to promote health and stimulate primary prevention as well as screening. The publications selected as relevant were analyzed based on directed (relational) content analysis. The results are presented in a narrative manner complemented with an appendix table that describes the study details. We assessed the design of the studies reported in the publications in a qualitative manner. We also checked the quality of our review using the PRISMA 2009 checklist.

Results

We identified 15 studies on the role of explicit financial incentives in changing health-related behavior of older people. They include both, quantitative studies on the effectiveness of financial rewards as well as qualitative studies on the acceptability of financial incentives. The quantitative studies are characterized by a great diversity of designs and provide mixed results on the effects of explicit financial incentives. The results of the qualitative studies indicate limited trust of older people in the use of explicit financial incentives for health promotion and prevention.

Conclusions

More research is needed on the effects of explicit financial incentives for prevention and promotion among older people before their broader use can be recommended. Overall, the design of the financial incentive system may be a crucial element in their acceptability.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-016-1517-0) contains supplementary material, which is available to authorized users.

Exercise strategies to protect against the impact of short-term reduced physical activity on muscle function and markers of health in older men: study protocol for a randomised controlled trial

Background

Muscles get smaller and weaker as we age and become more vulnerable to atrophy when physical activity is reduced or removed. This research is designed to investigate the potentially protective effects of two separate exercise strategies against loss in skeletal muscle function and size, and other key indices of health, following 14 days of reduced physical activity in older men.

Methods

Three groups of 10 older men (aged 65–80 years) will undertake 2 weeks of reduced activity by decreasing daily steps from more than 3500 to less than 1500 (using pedometers to record step count). Two of the three groups will then undertake additional exercise interventions, either: 4 weeks of progressive resistance training prior to the step-reduction intervention (PT-group), or home-based ‘exercise snacking’ three times per day during the step-reduction intervention (ES-group). The third group undertaking only the step-reduction intervention (control) will provide a comparison against which to assess the effectiveness of the protective exercise strategies. Pre and post step-reduction assessments of muscle function, standing balance, anthropometry and muscle architecture will be taken. Pre and post step-reduction in postprandial metabolic control, resting systemic inflammation, adipose inflammation, oxidative stress, immune function, sleep quality, dietary habits, and quality of life will be measured. The stress response to exercise, and signalling protein and gene expression for muscle protein synthesis and breakdown following an acute bout of exercise will also be assessed pre and post step-reduction. Rates of muscle protein synthesis and adipose triglyceride turnover during the step-reduction intervention will be measured using stable isotope methodology. All participants will then undertake 2 weeks of supervised resistance training with the aim of regaining any deficit from baseline in muscle function and size.

Discussion

This study aims to identify exercise strategies that could be implemented to protect against loss of muscle power during 2 weeks of reduced activity in older men, and to improve understanding of the way in which a short-term reduction in physical activity impacts upon muscle function and health.

Trial registration

ClinicalTrials.gov: NCT02495727 (Initial registration: 25 June 2015)

Safe, Affordable, Convenient: Environmental Features of Malls and Other Public Spaces Used by Older Adults for Walking

BACKGROUND

Midlife and older adults use shopping malls for walking, but little research has examined mall characteristics that contribute to their walkability.

METHODS

We used modified versions of the Centers for Disease Control and Prevention (CDC)-Healthy Aging Research Network (HAN) Environmental Audit and the System for Observing Play and Recreation in Communities (SOPARC) tool to systematically observe 443 walkers in 10 shopping malls. We also observed 87 walkers in 6 community-based nonmall/nongym venues where older adults routinely walked for physical activity.

RESULTS

All venues had public transit stops and accessible parking. All malls and 67% of nonmalls had wayfinding aids, and most venues (81%) had an established circuitous walking route and clean, well-maintained public restrooms (94%). All venues had level floor surfaces, and one-half had benches along the walking route. Venues varied in hours of access, programming, tripping hazards, traffic control near entrances, and lighting.

CONCLUSIONS

Despite diversity in location, size, and purpose, the mall and nonmall venues audited shared numerous environmental features known to promote walking in older adults and few barriers to walking. Future research should consider programmatic features and outreach strategies to expand the use of malls and other suitable public spaces for walking.

Measuring Preferences for a Diabetes Pay-for-Performance for Patient (P4P4P) Program using a Discrete Choice Experiment

OBJECTIVE

To elicit a patient's willingness to participate in a diabetes pay-for-performance for patient (P4P4P) program using a discrete choice experiment method.

METHODS

The survey was conducted in March 2013. Our sample was drawn from patients with diabetes at five hospitals in Taiwan (International Classification of Diseases, Ninth Revision, Clinical Modification code 250). The sample size was 838 patients. The discrete choice experiment questionnaire included the attributes monthly cash rewards, exercise time, diet control, and program duration. We estimated a bivariate probit model to derive willingness-to-accept levels after accounting for the characteristics (e.g., severity and comorbidity) of patients with diabetes.

RESULTS

The preferred program was a 3-year program involving 30 minutes of exercise per day and flexible diet control. Offering an incentive of approximately US $67 in cash per month appears to increase the likelihood that patients with diabetes will participate in the preferred P4P4P program by approximately 50%.

CONCLUSIONS

Patients with more disadvantageous characteristics (e.g., elderly, low income, greater comorbidity, and severity) could have less to gain from participating in the program and thus require a higher monetary incentive to compensate for the disutility caused by participating in the program's activities. Our result demonstrates that a modest financial incentive could increase the likelihood of program participation after accounting for the attributes of the P4P4P program and patients' characteristics.

Barreiras e facilitadores para a prática da atividade física de longevas inativas fisicamente

INTRODUÇÃO: o avanço da idade ocasiona uma diminuição das capacidades físicas, aumentando o risco de inatividade física nas idades mais avançadas.OBJETIVO: analisar as percepções quanto às barreiras e os facilitadores para a prática de atividade física.MÉTODOS: desenvolveu-se um estudo qualitativo, com 30 idosas fisicamente inativas, participantes dos Grupos de Convivência cadastrados na Prefeitura Municipal de Florianópolis-SC. Para a coleta de dados, foi utilizado o roteiro das questões norteadoras dos grupos focais e os dados foram tratados pela análise de conteúdo temática.RESULTADOS: as idosas fisicamente inativas perceberam mais barreiras do que facilitadores para a prática de atividades físicas. As principais barreiras foram: a limitação física, a falta de disposição, o excesso de cuidado da família, os exercícios físicos inadequados, as doenças, a falta de segurança, o casamento e o cuidar dos filhos, nunca ter realizado atividades físicas para lazer, o medo de quedas e o aumento da idade. Os principais facilitadores foram: o prazer pela prática de atividade física, a socialização, os benefícios da atividade física, os exercícios físicos adequados, ter companhia para praticar atividades físicas e o programa de atividades físicas da Prefeitura Municipal de Florianópolis-SC.CONCLUSÃO: o conhecimento dessas barreiras e facilitadores pode contribuir para o planejamento de estratégias a serem aplicadas em intervenções com a população de idosas fisicamente inativas, buscando modificações de comportamentos para a adoção de um estilo de vida ativo, que lhes proporcionará anos de vida com melhor capacidade funcional, condições de saúde e independência.

Supervised Phase II Cardiac Exercise Therapy Shortens the Recovery of Exercise Capacity in Patients with Acute Myocardial Infarction

[Purpose] To investigate the effects of Phase II cardiac exercise therapy (CET) on exercise capacity and changes in coronary risk factors (CRFs) of patients with acute myocardial infarction (AMI). [Subjects] Thirty male subjects with AMI were divided into an experimental group (EG) and a control group (CG). Another 30 age-matched subjects with patent coronary arteries served as a normal-control group (NCG). [Methods] Subjects in EG (n=20) trained using a stationary bicycle for 30 min at their target heart rate twice a week for 8 weeks. Exercise capacity was defined as the maximal metabolic equivalents (METs) that subjects reached during the symptom-limited maximal exercise test. HR, BP and RPP were recorded. Subjects in EG and CG received exercise tests and screening for CRFs at the beginning of, end of, and 3 months after Phase II CET, while subjects in NCG participated only in the 1st test. [Results] METs of CG did not improve until the 3rd test, while RPP at the 2nd test showed a significant increase. However, EG showed increased METs at the 2nd test without increase of RPP, and increased their high density lipoprotein cholesterol (HDL-C) during the follow-up period between the 2nd and 3rd tests. [Conclusion] Phase II CET shortens the recovery time of exercise capacity, helps to maintain the gained exercise capacity and increases HDL-C in phase III.

The effects of tai chi exercise on elders with osteoarthritis: a longitudinal study

PURPOSE

Tai Chi exercise has been proven to be beneficial among elders with osteoarthritis (OA). The long-term effects of this exercise remain unclear. The purpose of this study was to evaluate the effects of the Tai Chi exercise for Arthritis (TCEA) program on the physical status and quality of life of OA elders.

METHODS

This was a time series study with one group design. Subjects diagnosed with OA of the lower extremities, aged 60 years or over, were recruited from an outpatient clinic at a community teaching hospital. Thirteen participants joined a TCEA exercise class three times per week for 2 years. Physical status including body mass index (BMI), lean body mass, hand grasp strength, flexibility, and equilibrium were measured four times-at baseline, 3 months, 1 year, and 2 years of the TCEA exercise class. Quality of life was also measured at these time points.

RESULTS

Lean body mass was significantly decreased within the study period (p < .05). Participants experienced significant improvements in physical functioning, role limitations, and social functioning on the dimensions of quality of life (SF-36) (p < .05).

CONCLUSION

Elderly people with OA should be encouraged to exercise using Tai Chi for maintaining physical function and improving quality of life.

Effects of Combined Phase III and Phase II Cardiac Exercise Therapy for Middle-aged Male Patients with Acute Myocardial Infarction

[Purpose] To investigate the effects of cardiac exercise therapy (CET) on exercise capacity and coronary risk factors (CRFs) of patients with acute myocardial infarction (AMI). [Methods] Patients who participated in an 8-week supervised, hospital-based phase II and 6-month home-based phase III CET with monthly telephone and/or home visits were defined as the exercise group (EG) (n=20), while those who did not receive phase II or phase III CET were defined as the no-exercise group (NEG) (n=10). CRFs were evaluated pre- and post-phase II and eight months after discharge. One and two-way repeated measures ANOVA were used to perform intra- and inter-group comparisons. [Results] Thirty men with AMI aged 49.3 ± 8.3 years were studied. EG increased their exercise capacity (METs) (6.8 ± 1.6 vs.10.0 ± 1.9) after phase II CET and was able to maintain it at 8-month follow-up. Both groups had significantly fewer persons who kept on smoking compared to the first examination. High density lipoprotein cholesterol (HDL-C) increased from 38.1 ± 11.0 to 43.7 ± 8.7 mg/dl at follow-up in EG while no significant difference was noted in NEG. [Conclusion] After phase III CET subjects had maintained the therapeutic effects of smoking cessation, and increasing exercise capacity obtained in phase II CET. HDL-C in EG continued to improve during phase III CET.

Patterns of 12-year change in physical activity levels in community-dwelling older women: can modest levels of physical activity help older women live longer?

Few studies have addressed changes in physical activity participation over time among the elderly. The authors hypothesized that there were distinct trajectories of physical activity level over time and identifiable predictors of such trajectories, as well as that the maintenance of regular physical activity, even below recommended levels, was associated with lower mortality risk. Using longitudinal data (1994-2009) from 433 initially high-functioning older women aged 70-79 years at baseline, a joint latent class and survival mixture model identified 4 activity trajectory classes: always active (16.6%), fast declining (19.2%), stable moderate (32.3%), and always sedentary (31.9%). Obesity, coronary artery disease, chronic obstructive pulmonary disease, depressive symptoms, low self-efficacy, mobility disability, and low energy were associated with sedentary behavior and/or a fast decline in activity. Women in the fast declining and always sedentary classes had hazard ratios for death of 2.34 (95% confidence interval: 1.20, 4.59) and 3.34 (95% confidence interval: 1.72, 6.47), respectively, compared with the always active class; no mortality difference was found between the stable moderate and always active groups (hazard ratio = 1.24, 95% confidence interval: 0.63, 2.47). Our findings suggest that physical activity does not have to be vigorous to be beneficial and that the gain may be the greatest among women who reported the lowest levels of activity.

Efeitos da participação em um Grupo de Coluna sobre as dores musculoesqueléticas, qualidade de vida e funcionalidade dos usuários de uma Unidade Básica de Saúde de Porto Alegre - Brasil

O objetivo deste estudo foi avaliar a eficácia do Grupo de Coluna ministrado em uma Unidade Básica de Saúde de Porto Alegre. Foram avaliados e reavaliados 29 usuários, os quais participaram do Grupo de Coluna. Foi utilizada a Escala Visual Analógica para avaliar a intensidade da dor, o questionário Oswestry Disability Índex para avaliar a capacidade funcional, e o questionário Short-Form Health Survey - SF-36 para avaliar a qualidade de vida. Os resultados, obtidos a partir do teste de Wilcoxon (a=0,05), demonstraram a eficácia do Grupo de Coluna na melhora da intensidade das dores musculoesqueléticas (p<0,05), na capacidade funcional (p=0,005), e na qualidade de vida nos domínios capacidade funcional (p=0,001), limitações por aspectos físico (p=0,001), dor (p=0,001), vitalidade (p=0,004), limitação emocional (p=0,026) e saúde mental (p=0,010). Conclui-se que o Grupo de Coluna foi eficaz na melhora da dor, funcionalidade e qualidade de vida dos usuários.

Depressive symptoms, social support, and walking among Hispanic older adults

OBJECTIVE

Depressive symptoms and physical inactivity are health risks among minority older adults. This study examined whether social support moderated the relationship of depressive symptoms to walking behavior among 217 community-dwelling, Hispanic older adults.

METHOD

Cross-sectional analyses were used to test whether different forms of social support interacted with depressive symptoms to affect both likelihood and amount of walking.

RESULTS

Analyses showed a significant interaction between depressive symptoms and instrumental support related to the likelihood of walking and a marginally significant interaction between depressive symptoms and instrumental social support related to the amount of walking. Depressive symptoms were associated with a lower likelihood and lower amount of walking among participants receiving high levels of instrumental social support (e.g., help with chores) but not low instrumental support. Emotional and informational support did not moderate the depression to walking relationship.

CONCLUSION

Receiving too much instrumental support was related to sedentary behavior among depressed older adults.

Overcoming barriers to physical activity among culturally and linguistically diverse older adults: a randomised controlled trial

AIM

To investigate by randomised trial, health professional facilitated sessions aiming to overcome barriers to physical activity (PA), improve readiness to undertake PA, increase PA participation and improve fitness among older Australian adults from Macedonian and Polish backgrounds.

METHOD

One hundred and twenty-one participants (mean age 70 years, 63% female) were block randomised to the intervention group (three one-hour group education and goal setting sessions over 7 weeks) or control group (one-hour health promotion talk) following baseline assessment, with reassessment approximately 9 weeks later.

RESULTS

No significant differences were found between experimental groups in primary (Stages of Change Questionnaire (SocQ), steps per day and Human Activity Profile) or secondary outcomes.

CONCLUSION

This study has highlighted methodological considerations for PA health promotion and research with older adults from culturally and linguistically diverse (CALD) backgrounds in a community setting. Investigation of older CALD adults' perceptions of what are 'adequate levels of PA' and methods of increasing PA is warranted.

Longitudinal physical activity changes in older men in the Osteoporotic Fractures in Men Study

OBJECTIVES

To describe the change in physical activity (total, leisure, household, occupational) in men over a mean 5-year follow-up period and to identify sociodemographic and health factors associated with change in physical activity.

DESIGN

Prospective cohort study; Osteoporotic Fractures in Men Study; data collected March 2000 through May 2006.

SETTING

Six U.S. clinical centers.

PARTICIPANTS

Volunteer sample of ambulatory community-dwelling men aged 65 and older (N=5,161).

MEASUREMENTS

Self-reported physical activity assessed at baseline and Visit 2 (V2) (5 years apart) according to the Physical Activity Scale for the Elderly (PASE) (unitless, relative measure of physical activity).

RESULTS

At baseline, PASE scores averaged 16.8+/-35.5 for occupational, 37.0+/-34.0 for leisure, 95.9+/-43.2 for household, and 149.7+/-67.6 for total physical activity. Occupational (-6.2+/-33.9), leisure (-3.2+/-37.3), household (-9.9+/-44.3), and total (-19.3+/-67.7) physical activity change scores declined, on average, from baseline to V2. On average, change in total PASE scores declined more with age: -15.6+/-71.6 for men younger than 70, -16.4+/-67.0 for men aged 70 to 74, -21.4+/-66.9 for men aged 75 to 79, and -29.5+/-60.7 for men aged 80 and older. Living alone, smoking cigarettes, poor health, and higher blood pressure were associated with greater declines in physical activity over time. Although average scores declined, some older men (1,335, 26%) reported increasing physical activity levels. Better physical and mental health, living with others, and being younger were associated with the probability of increasing physical activity over time.

CONCLUSION

Over the 5-year period, the majority of men reported declines in total physical activity. Older men in poor health who live alone have a high risk of physical activity declines and may be an important group to target for exercise interventions.

The relationship between depressive symptoms and walking among Hispanic older adults: a longitudinal, cross-lagged panel analysis

OBJECTIVES

This study examines the relationship between depressive symptoms and walking behavior across 30 months in a prospective study of 217 community-dwelling, Hispanic older adults in Miami, Florida (ages 70-100 years).

METHOD

Analyses examine the direction of the relationship between depressive symptoms and physical activity (i.e., walking) over time, as well as test for a potential bi-directional or reciprocal relationship between these two variables.

RESULTS

Structural equation modeling (SEM) with a cross-lagged panel design revealed that walking was unrelated to subsequent depressive symptoms. However, depressive symptoms were related to subsequent walking behavior at every time-point, such that higher levels of depressive symptoms were predictive of less walking in the future. Older adults who had clinically-relevant depressive symptoms at the initial assessment had 1.34 times the risk of not walking 30 months later, compared to older adults without clinically-relevant depressive symptoms.

CONCLUSION

Results support the need for primary care providers to evaluate and address depressive symptoms among older adults, as a means of reducing sedentary behavior and potentially improving health. Further research on the prevention and management of depressive symptoms and sedentary behavior is needed, given the morbidity related to both of these health risks, particularly for minority and low-socio-economic status (SES) older adults.

Absence of outdoor activity and mortality risk in older adults living at home

The primary objective of this study was to determine whether the absence of outdoor activities is associated with an increased risk of mortality among elderly people living at home. In January 1995, the authors enrolled 863 household residents, 65 years old and older, who were able to fully understand and complete a baseline interview unassisted. Participant demographics, functional capabilities, activities of daily living, and three dimensions of outdoor activities (initiative, transport, and frequency) were examined. Cohort mortality was assessed through December 1999. Of the 863 participants, 139 (16.1%) died within the study observation period. After adjusting for gender and age, three dimensions of functional impairment (vision, hearing, and speech), impairment in activities of daily living, and all three dimensions of outdoor activities were predictive of 5-year mortality. In multivariate analysis, these three dimensions remained as explanatory variables for mortality at 5 years. Assessment of outdoor-activity levels can help identify elderly individuals with greater mortality risk.

Factors affecting the increased risk of physical inactivity among older people with depressive symptoms

The purpose of this study was to investigate the association between depressive symptoms and physical inactivity, and whether motives for and barriers to exercise explain the potential association between depressive symptoms and physical inactivity in older people. The design of the study was cross-sectional. The study population comprised 645 people born between 1922 and 1928 who were residents in a city-center area of Jyväskylä in central Finland. Depressive symptoms were assessed using Center for the Epidemiologic Studies Depression Scale, physical activity using Grimby's (1986) validated scale, and motives for and barriers to exercise using a questionnaire and mobility limitation with a test of walking time over 10 m. The results demonstrated that the risk of physical inactivity was more than twofold among persons with depressive symptoms compared with non-depressed people. A higher prevalence of perceived barriers to physical activity, such as poor health, fear and negative experiences, together with lack of knowledge, explained part of the increased risk of physical inactivity among those with depressive symptoms while differences in motives for physical activity did not have a material effect. Adjustment for walking time over 10 m attenuated the increased risk of inactivity further. When planning exercise promotion programs, finding ways to overcome fear and negative experiences and providing information may help to increase physical activity among people with depressive symptoms. Additionally, difficulties caused by poor mobility should not be ignored.

Quality of life in opium-addicted patients with coronary artery disease as measured with WHOQOL-BREF

OBJECTIVE

Several factors can influence the quality of life in patients with coronary artery disease (CAD). The goal of this research was to measure quality of life in opium-addicted patients with CAD in order to assess the effect of CAD risk factors on their quality of life.

METHOD

The WHOQOL-BREF questionnaire was completed through interviews with 275 patients who underwent isolated coronary artery bypass surgery in Tehran Heart Centre between May and September 2006.

RESULTS

No significant differences were found in the mean scores of the four domains of quality of life between the addicted and non-addicted patients. Furthermore, the evaluation of QOL in the groups with CAD risk factors showed that the mean QOL domains were statistically similar between opium addicted and non-opium addicted patients. In the addicted group, men had a higher psychological health score than women. A previous history of myocardial infarction reduced the psychological score in this group. Also, in the addicted patients with a history of diabetes mellitus, social functioning was better than that of the non-diabetics.

CONCLUSIONS

The different domains of quality of life in our opium-addicted and non-addicted patients with CAD were similar; and among all the major risk factors for coronary artery disease, only female gender and a previous history of myocardial infarction could influence quality of life in the opium-addicted patients.

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.

Successful dissemination of a community-based strength training program for older adults by peer and professional leaders: the people exercising program

The objective of this longitudinal study was to determine the feasibility of a model for disseminating community-based strength training programs for older adults through leadership training of laypersons or "peers" and health and fitness professionals. The intervention consisted of a progressive strength training, balance, and flexibility exercise program and a leader training and certification workshop. Feasibility was defined as 75% or more of individuals who completed leader training establishing or teaching at least two 12-week strength training classes within 1 year. Program dissemination was quantified as the number of classes established between January 2005 and December 2006. Demographic characteristics and health status of leaders and program participants were evaluated. Two hundred forty-four leaders (peers, n=149; professionals, n=95) were trained and certified. Seventy-nine percent of all leaders (n=193) met the feasibility criteria of establishing or teaching strength training classes. There was no difference in the percentage of peer leaders (80%, n=119) and professional leaders (78%, n=74) who established or taught classes (P5.71) despite significant differences in their demographic and health profiles. Ninety-seven self-sustaining strength training classes were established in senior and community centers, and 2,217 older adults (women, n=1,942; men, n=275) aged 50 to 97 with multiple chronic medical conditions enrolled. In conclusion, training peer and professional leaders is a feasible and successful model for disseminating a community strength training program for older adults. Widespread dissemination of this program has significant public health implications for increasing physical activity participation by older adults.

Exercise and epilepsy: a survey of Midwest epilepsy patients

Obesity and lack of physical activity are an increasing problem. In addition to common barriers to physical activity, people with epilepsy also face fear of exercise-induced seizures, medication side effects, and, often, confusing advice regarding the safety of exercise. To explore barriers faced by people with epilepsy, we mailed a survey to 412 adult patients with epilepsy from an epilepsy center in Kansas. Survey items assessed patients' exercise habits, attitudes regarding exercise, and barriers to exercise. Forty-seven percent completed the survey. Most respondents reported that they did exercise, though most did so 3 or fewer days per week and at light intensity. Respondents who reported seizures as a barrier to exercise did not exercise with less frequency or intensity than those who did not report seizures as a barrier, but these respondents reported greater fear of seizures. Patient-specific education about the benefits of exercise needs to be initiated by physicians.

Leisure activities and mortality: does gender matter?

OBJECTIVES

This study examines the association between participation in leisure activities and mortality risk among older men and women.

METHODS

A representative sample of 1,246 men and women ages 65 to 95, interviewed in 1991-1992, were followed for 12 years. Cox regressions analyzed mortality risk.

RESULTS

Participating in only a few activities doubled mortality risk compared to those with the highest participation levels, even after controlling for age, education, walking ability, and other health indicators. Women had a dose-response relationship between overall participation and survival. Strong associations with survival were found for engagement in organizational activities and study circles among women and hobby activities and gardening among men.

DISCUSSION

Results suggest gender differences in the association between leisure activities and mortality. Women display a decreasing mortality risk for each additional activity. Social activities have the strongest effects on survival among women, whereas men seem to benefit from solitary activities.

Comportamento e barreiras

Este estudo analisa as barreiras percebidas à prática de atividade física e os estágios de mudança de comportamento de idosos institucionalizados preservados cognitivamente. Trinta participantes responderam ao Mini-Exame do Estado Mental, ao Questionário sobre Estágios de Mudança de Comportamento e ao Questionário sobre Barreiras à Prática de Atividade Física. Os resultados mostraram que poucos idosos institucionalizados apresentam uma alta percepção de descrença nos benefícios da atividade física. Entretanto, muito poucos praticam atividades físicas e a maioria não pretende incluí-las em seu estilo de vida. O estágio de comportamento no qual se encontram pode estar sendo mediado pela percepção de barreiras. Conclui-se, coerentemente com as principais barreiras reportadas, que a promoção de atividade física para o idoso institucionalizado deve, prioritariamente, enfatizar a conscientização sobre os riscos do sedentarismo e os benefícios da prática mesmo na presença de doenças, bem como preparar um ambiente seguro e sem gasto financeiro individual.

ATIVIDADE FÍSICA E PREVALÊNCIA DE QUEDAS EM IDOSOS RESIDENTES NO SUL DO BRASIL

Resumo O objetivo do estudo foi investigar a relação entre os níveis de atividade física e a prevalência de quedas em idosos residentes em Florianópolis, SC, Brasil. Trata-se de estudo com amostragem do tipo probabilística e estratificada por setor censitário e sexo, com 875 idosos. Os instrumentos adotados para a coleta de dados foram o Questionário Brazil Old Age Schedule (BOAS) e o Questionário Internacional de Atividades Físicas (IPAQ). Os resultados apontaram que 59,3% dos idosos eram considerados mais ativos. Idosos com acometimento de quedas durante o período de três meses que antecederam a entrevista foram 11,4%, dos quais a maioria era mais ativa. Houve associação estatística entre quedas e as variáveis: problemas nos pés (p=0,002) e articulações (p=0,006). Sendo assim, conclui-se que a educação para os cuidados de prevenção de quedas se faz necessária, ao mesmo tempo em que se estimulem atividades físicas livres de riscos entre a população idosa.

Antecedents of Physical Activity Among Family Caregivers

OBJECTIVES

We examined exercise behaviors among family caregivers and the degree to which aspects of the caregiving role influenced exercise behaviors. Understanding factors associated with caregiver physical activity provides practitioners the means to design and tailor interventions to be effective for caregivers.

METHODS

Caregivers (N=208) participating in a self-care intervention to promote caregiving skills were surveyed at baseline, prior to training. Measures included caregiver characteristics, care recipient characteristics, attitudes and intentions toward exercise and levels of physical activity.

RESULTS

Mental health variables and self-efficacy for exercise were significantly related to exercise levels in bivariate analyses. Regression analyses revealed that caregiver and care recipient characteristics accounted for a small percentage of the variance in exercise behavior.

DISCUSSION

Caregiver vitality and self-efficacy for exercise were key variables most significantly related to exercise behaviors. Findings suggest that mental health factors and attitudes about exercise may be more important predictors of exercise than caregiving factors.

Participation in health-promoting behaviour: influences on community-dwelling older Chinese people

AIM

This paper reports a study to determine the factors affecting community-dwelling older Chinese people's health-promoting behaviour in the domains of physical activity, healthy dietary practices and stress management, and to identify any barriers to these behaviours.

BACKGROUND

Previous studies have identified factors affecting different types of health-promoting behaviours, including perceived self-efficacy, perceived benefits and five individual characteristics (age, sex, marital status, education and perceived health) of older non-Chinese people. However, few studies have simultaneously taken these factors into account in examining community-dwelling Chinese older people's health-promoting behaviour.

METHOD

Individual face-to-face interviews were completed in 2002-2003 with a convenience sample of 896 community-dwelling older Chinese people in Hong Kong aged between the ages of 60 and 98 (years mean 76). Participants had no apparent communication and cognition impairments. A structured interview schedule was used to collect the data.

RESULTS

Multiple regression analysis showed that perceived self-efficacy, perceived benefits and sex together explained 38.4% of health-promoting behaviour among community-dwelling older Chinese people in Hong Kong. Fatigue during and after physical activity, enjoyment of unhealthy foods and inadequate family and peer support were the most frequently reported barriers to health-promoting behaviour.

CONCLUSION

When developing health promotion programmes to motivate community-dwelling older Chinese clients to participate in health-promoting behaviour and to minimize barriers, community nurses should include some activities to increase both the perceived self-efficacy and perceived benefits of health-promoting behaviour. Future studies should include more critical factors based on theories, empirical evidence and knowledge of culture with samples that are random and from more diverse community settings.

Influence of marital status on physical activity levels among older adults

PURPOSE

The purpose of these analyses was to describe the levels and types of activity in relationship to current marital status among older adults and determine if the physical activity level of the husband was related to the physical activity level of his wife.

METHODS

Participants included 3075 well-functioning white and black men and women aged 70-79 yr with further examination of 345 spousal pairs. Marital status was self-reported and participants were grouped as married versus not married. Based on responses to a leisure-time questionnaire, total physical activity was calculated and participants were classified as low or high active. Descriptive statistics were used to describe level and proportions of type of activity by marital status. Logistic regression was used to determine if marital status was an important determinant of physical activity participation. Regression models were adjusted for demographics, body mass index (BMI), and chronic disease conditions.

RESULTS

When compared with their single counterparts, married men reported higher median levels of exercise participation (P = 0.008) and married women reported higher levels of total (P < 0.0001) and nonexercise activity (P < 0.0001) with a trend toward higher exercise participation (P = 0.05). In spousal pairs, compared with men in the low active group, highly active men were almost three times as likely (OR = 2.97; 95% CI = 1.73, 5.10) to have a similarly active spouse. The model only modestly attenuated when adjusted for age, BMI, and health status of the husband [OR = 2.49 (1.41, 4.42)].

CONCLUSIONS

Marital status and spousal physical activity (PA) levels are important determinants for PA participation among older adults.

Difficulties in performing leisure activities among persons with newly diagnosed rheumatoid arthritis: a prospective, controlled study

OBJECTIVE

To compare leisure activities and associated factors in a group with recent onset RA and matched community derived controls, to examine whether leisure activities are altered during the early years of disease and to seek predictors.

METHODS

One hundred and forty-seven consecutive persons with early RA were followed for 0.9-5.9 yr. One hundred and forty-four RA patients were compared cross-sectionally at baseline with community-derived controls matched for age, gender and residential area. Leisure activities were evaluated with an interest checklist (20 domains). Socio-demographic variables, disease activity (DAS) and disability (HAQ) were evaluated as possible predictors for loss of participation in leisure activities at baseline and longitudinally (using area under the curve analyses).

RESULTS

At baseline (mean disease duration 7 months) RA patients performed less (8.2 vs 9.9 domains, P < 0.001) but did not have significantly less interest (10.9 vs 11.4 domains, P = 0.15) in leisure activities compared with controls. Decrease in performed leisure activities was only significant in those with a low level of education. At baseline, in RA patients, low education (P = 0.035), age (P = 0.019) and HAQ (P < 0.001) significantly predicted performed leisure activity. No loss in performed leisure activities was seen during follow-up and no significant predictors were found for individual change.

CONCLUSION

Loss of performed leisure activities occurs early in RA and chiefly in those with low formal education. Disability was associated with early loss, but not with change during follow-up. Other factors, possibly related to individual personality and resources, may be more important for predicting changes in leisure activities.

Driving cessation and increased depressive symptoms

BACKGROUND

To understand the consequences of driving cessation in older adults, the authors evaluated depression in former drivers compared with active drivers.

METHODS

Depression (as assessed using the Center for Epidemiological Studies Depression Scale), driving status, sociodemographic factors, health status, and cognitive function were evaluated for a cohort of 1953 residents of Sonoma County, California, aged 55 years and older, as part of a community-based study of aging and physical performance. The authors re-interviewed 1772 participants who were active drivers at baseline 3 years later.

RESULTS

At baseline, former drivers reported higher levels of depression than did active drivers even after the authors controlled for age, sex, education, health, and marital status. In a longitudinal analysis, drivers who stopped driving during the 3-year interval (i.e., former drivers) reported higher levels of depressive symptoms than did those who remained active drivers, after the authors controlled for changes in health status and cognitive function. Increased depression for former drivers was substantially higher in men than in women.

CONCLUSIONS

With increasing age, many older adults reduce and then stop driving. Increased depression may be among the consequences associated with driving reduction or cessation.

Health-related social disengagement in elderly diabetic patients: association with subsequent disability and survival

OBJECTIVE

We examined the relationship between health-related social disengagements, as opposed to disengagements related to financial and other non-health-related factors, and subsequent risk of disability and death among initially nondisabled elderly diabetic patients enrolled in Medicare Managed Care plans.

RESEARCH DESIGN AND METHODS

We used data from the Medicare Health Outcomes Survey (HOS) Cohort 1 Baseline (1998) and Cohort 1 Follow-Up (2000). Through mail and telephone surveys, trained interviewers collected information on sociodemographic variables, physical and mental health functioning (using Medical Outcomes Study Short Form-36 [SF-36]), activities of daily living (ADL), and medical conditions. This study reported on diabetic subjects aged >or=65 years with no ADL disability at baseline (n = 8949). Health-related social disengagement (degree to which physical health or emotional problems interfere with social activities) was derived from the social functioning subscale of SF-36 (range 0-100; higher scores depicting better social functioning).

RESULTS

For each 10-point increase in social functioning score at baseline, older diabetic subjects in our study experienced an 18% less chance of any ADL disability (odds ratio [OR] 0.82, 95% CI 0.75-0.89; P < 0.001) and a 12% less chance of death (0.88, 0.78-1.00; P = 0.043) over a 2-year period, adjusting for demographic factors, comorbidities, depression, and general health (assessed by the SF-36).

CONCLUSIONS

Among initially nondisabled older diabetic subjects, health-related interferences with social activities at baseline may be early warning signs of subsequent ADL disability and premature death, independent of other measures of health status.

Reasons Given by Older People for Limitation or Avoidance of Driving

PURPOSE

To understand the driving behavior of older adults, this study examines self-reported reasons for driving limitation or avoidance.

DESIGN AND METHODS

Baseline interviews were conducted (n = 2,046) as part of a community-based study of aging and physical performance in persons aged 55 years or older in Sonoma, California. Twenty-one medical and nonmedical reasons for limiting or avoiding driving were examined by age and gender.

RESULTS

Most older people continue to drive; however, many, especially older women, report one or more reasons to limit or avoid driving. Among medical reasons, problems with eyesight are by far the most often cited; no other health problem was identified as a major reason for limitation. Among nonmedical reasons, being concerned about an accident, being concerned about crime, and having no reason to drive were often cited. Important predictors of reported driving limitations were low income, limited functional status, and self-report of poor vision.

IMPLICATIONS

Understanding factors that affect driving patterns in older adults, including medical and nonmedical reasons, will assist in developing both enhancements to extend safe driving years and responses to the consequences of driving reduction.

Two years later: a prospective long-term follow-up of a training intervention in geriatric patients with a history of severe falls

OBJECTIVE

To study the long-term outcome of a physical training regimen of ambulant postward rehabilitation in community-dwelling geriatric patients with a history of injurious falls.

DESIGN

Prospective 2-year follow-up of a randomized placebo-controlled intervention trial.

SETTING

Postward rehabilitation in a geriatric hospital in Germany.

PARTICIPANTS

Fifty-seven geriatric patients (mean age, 84.3+/-4.4 y) with a history of severe falls.

INTERVENTION

Ambulatory training of strength, functional performance, and balance 3 times a week for 3 months for 31 patients versus placebo activities for 26 patients.

MAIN OUTCOME MEASURES

Strength, functional performance, fall-related psychologic parameters, and physical activity assessed by standardized protocols 2 years after the training intervention, compared with baseline results.

RESULTS

Motor performance decreased substantially in both groups. As patients in the intervention group declined from significantly improved motor performance levels achieved in the initial training intervention, differences between the groups were still significant in most functional performances 2 years later. Functional decline was greater in persons who were institutionalized or being cared for by family members. Physical activity, which increased during the exercise intervention, returned to low baseline levels.

CONCLUSIONS

Improved functional performance in the training group did not lead to an increased level of physical activity after training, which might have preserved the functional improvements. In mobility-restricted, frail, geriatric patients such as our study population, training programs should continue to keep patients active and to prevent the decline in strength and functional performance that precedes loss of autonomy.

Living arrangements and participation in leisure-time physical activities in an older population

OBJECTIVES

This is a cross-sectional investigation of living arrangements, social contacts, and level of leisure-time physical activity (LTPA) among residents of Sonoma, California, aged 55 and older.

METHODS

The odds of different levels of LTPA were assessed by living arrangements and social contacts following adjustment for measures of health, functioning, physical performance, selected health behaviors, and socioeconomic status for men and women separately (n = 2,073). Level of LTPA also was examined among married couples only (subset of sample, n = 511 spouse pairs).

RESULTS

The relationship between living arrangements, social contacts, and LTPA varied by gender and level of LTPA. Among married couples, the LTPA of the partner was the most significant predictor of the LTPA of the participant, with the exception of those who engaged in less than brisk activity.

DISCUSSION

Living arrangements and social contacts are important determinants of LTPA and should serve as the basis for future interventions.

Factors influencing participation of African American elders in exercise behavior

This study was designed to examine factors influencing exercise behavior of older African American adults. Using the Transtheoretical Stages of Change Model and focus group methodology, 103 participants were assigned to gender and stage specific groups of 5 to 12 each. The focus group discussion guide was developed to explore the meaning of health and exercise, and factors that influence exercise behavior for each stage of the model. Responses varied by stage and gender. Men and women alike described health as the ability to remain active and participate in desired activities. The meaning of exercise varied, by stage, from the ability to perform household chores to engaging in aerobic activities. Many factors such as health, social support, efficacy, and motivation influenced the desire and ability to exercise. Women were more likely than men to identify family responsibility as a barrier to participation in exercise activities. Participants identified strategies to recruit and retain African American elders in exercise programs. Findings of the study have implications for health professionals designing exercise health promotion programs for older African American adults in community settings.