The Effects of Health and Environment on Exercise-Class Participation in Older, Urban Women

Ecological Predictors of Older Adults' Participation and Retention in a Physical Activity Intervention

Research is still lacking regarding the question as to how programs to promote healthy ageing should be organized in order to increase acceptance and thus effectiveness. For older adults, ecological factors, such as the physical distance to program sites, might predict participation and retention. Thus, the key aim of this analysis was to examine these factors in a physical activity intervention trial. Adults (N = 8299) aged 65 to 75 years were invited to participate and n = 589 participants were randomly assigned to one of two intervention groups with 10 weeks of physical activity home practice and exercise classes or a wait-list control group. Response, participation, and dropout data were compared regarding ecological, individual, and study-related variables. Kaplan-Meier curves and Cox regression models were used to determine predictors of dropout. In total, 405 participants completed the study. Weekly class attendance rates were examined regarding significant weather conditions and holiday periods. The highest rates of nonresponse were observed in districts with very high neighborhood levels of socioeconomic status. In this study, ecological factors did not appear to be significant predictors of dropout, whereas certain individual and study-related variables were predictive. Future studies should consider these factors during program planning to mobilize and keep subjects in the program.

Risk-of-falling related outcomes improved in community-dwelling older adults after a 6-week sideways walking intervention: a feasibility and pilot study

BACKGROUND

Aging increases fall risk and alters gait mechanics and control. Our previous work has identified sideways walking as a potential training regimen to decrease fall risk by improving frontal plane control in older adults' gait. The purposes of this pilot study were to test the feasibility of sideways walking as an exercise intervention and to explore its preliminary effects on risk-of-falling related outcomes.

METHODS

We conducted a 6-week single-arm intervention pilot study. Participants were community-dwelling older adults ≥ 65 years old with walking ability. Key exclusion criteria were neuromusculoskeletal and cardiovascular disorders that affect gait. Because initial recruitment rate through University of Nebraska at Omaha and Omaha community was slower than expected (3 participants∙week- 1), we expanded the recruitment pool through the Mind & Brain Health Labs registry of the University of Nebraska Medical Center. Individualized sideways walking intervention carried out under close supervision in a 200 m indoor walking track (3 days∙week- 1). Recruitment and retention capability, safety, and fidelity of intervention delivery were recorded. We also collected (open-label) walking speed, gait variability, self-reported and performance-based functional measures to assess participants' risk-of-falling at baseline and post-intervention: immediate, and 6 weeks after the completion of the intervention.

RESULTS

Over a 7-month period, 42 individuals expressed interest, 21 assessed for eligibility (21/42), and 15 consented to participate (15/21). Most of the potential participants were reluctant to commit to a 6-week intervention. Desired recruitment rate was achieved after revising the recruitment strategy. One participant dropped out (1/15). Remaining participants demonstrated excellent adherence to the protocol. Participants improved on most outcomes and the effects remained at follow-up. No serious adverse events were recorded during the intervention.

CONCLUSIONS

Our 6-week sideways walking training was feasible to deliver and demonstrated strong potential as an exercise intervention to improve risk-of-falling outcomes in community-dwelling older adults. In a future trial, alternative clinical tools should be considered to minimize the presence of ceiling/floor effects. A future large trial is needed to confirm sideways walking as a fall prevention intervention.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT04505527 . Retrospectively registered 10 August 2020.

Pokémon GO and Physical Activity in Asia: Multilevel Study

BACKGROUND

Physical activity has long been considered as an important component of a healthy lifestyle. Although many efforts have been made to promote physical activity, there is no effective global intervention for physical activity promotion. Some researchers have suggested that Pokémon GO, a location-based augmented reality game, was associated with a short-term increase in players' physical activity on a global scale, but the details are far from clear.

OBJECTIVE

The objective of our study was to study the relationship between Pokémon GO use and players' physical activity and how the relationship varies across players with different physical activity levels.

METHODS

We conducted a field study in Hong Kong to investigate if Pokémon GO use was associated with physical activity. Pokémon GO players were asked to report their demographics through a survey; data on their Pokémon GO behaviors and daily walking and running distances were collected from their mobile phones. Participants (n=210) were Hong Kong residents, aged 13 to 65 years, who played Pokémon GO using iPhone 5 or 6 series in 5 selected types of built environment. We measured the participants' average daily walking and running distances over a period of 35 days, from 14 days before to 21 days after game installation. Multilevel modeling was used to identify and examine the predictors (including Pokémon GO behaviors, weather, demographics, and built environment) of the relationship between Pokémon GO use and daily walking and running distances.

RESULTS

The average daily walking and running distances increased by 18.1% (0.96 km, approximately 1200 steps) in the 21 days after the participants installed Pokémon GO compared with the average distances over the 14 days before installation (P<.001). However, this association attenuated over time and was estimated to disappear 24 days after game installation. Multilevel models indicated that Pokémon GO had a stronger and more lasting association among the less physically active players compared with the physically active ones (P<.001). Playing Pokémon GO in green space had a significant positive relationship with daily walking and running distances (P=.03). Moreover, our results showed that whether Pokémon GO was played, the number of days played, weather (total rainfall, bright sunshine, mean air temperature, and mean wind speed), and demographics (age, gender, income, education, and body mass index) were associated with daily walking and running distances.

CONCLUSIONS

Pokémon GO was associated with a short-term increase in the players' daily walking and running distances; this association was especially strong among less physically active participants. Pokémon GO can build new links between humans and green space and encourage people to engage in physical activity. Our results show that location-based augmented reality games, such as Pokémon GO, have the potential to be a global public health intervention tool.

Day length is associated with physical activity and sedentary behavior among older women

Physical activity may be influenced by one’s physical environment, including day length and weather. Studies of physical activity, day length, and weather have primarily used self-reported activity, broad meteorological categorization, and limited geographic regions. We aim to examine the association of day length and physical activity in a large cohort of older women, covering a wide geographic range. Participants (N = 16,741; mean (SD) age = 72.0 (SD = 5.7) years) were drawn from the Women’s Health Study and lived throughout the United States. Physical activity was assessed by accelerometer (ActiGraph GT3X+) between 2011 and 2015. Day length and weather information were obtained by matching weather stations to the participants’ location using National Oceanic and Atmospheric Administration databases. Women who experienced day lengths greater than 14 hours had 5.5% more steps, 9.4% more moderate-to-vigorous physical activity, and 1.6% less sedentary behavior, compared to women who experienced day lengths less than 10 hours, after adjusting for age, accelerometer wear, temperature, and precipitation. Day length is associated with physical activity and sedentary behavior in older women, and needs to be considered in programs promoting physical activity as well as in the analyses of accelerometer data covering wide geographic regions.

Season and Weather Effects on Travel-Related Mood and Travel Satisfaction

This study examines the effects of season and weather on mood (valence and activation) and travel satisfaction (measured by the Satisfaction with Travel Scale). Analyses are presented of 562 time-sampled morning commutes to work made by 363 randomly sampled people in three different Swedish cities asking them to use smartphones to report their mood in their home before and directly after the commutes. These reports as well as satisfaction with the commute obtained in summer and winter are linked to weather data and analyzed by means of fixed-effects regression analyses. The results reveal main effects of weather (temperature and precipitation) on mood and travel satisfaction (temperature, sunshine, precipitation, and wind speed). The effects of weather on mood and travel satisfaction differ depending on travel mode. Temperature leads to a more positive mood, wind leads to higher activation for public transport users, and sunshine leads to a more negative mood for cyclists and pedestrians. Sunshine and higher temperatures make travel more relaxed although not for cycling and walking, and rain and snow lead to a higher cognitive assessed quality of travel.

Review of how we should define (and measure) adherence in studies examining older adults' participation in exercise classes

: Exercise classes provide a range of benefits to older adults, reducing risk of illness, promoting functional ability and improving well-being. However, to be effective and achieve long-term outcomes, exercise needs to be maintained. Adherence is poor and reporting of adherence differs considerably between studies.

OBJECTIVE

To explore how adherence to exercise classes for older people is defined in the literature and devise a definition for pooling data on adherence in future studies.

DESIGN

Methodological review of the approaches used to measure adherence.

METHODS

A review of the literature was carried out using narrative synthesis, based on systematic searches of MEDLINE, EMBASE, CINAHL and PsychINFO. 2 investigators identified eligible studies and extracted data independently.

RESULTS

37 papers including 34 studies were identified. 7 papers (7 studies) defined adherence as completion (retention). 30 papers (27 studies) identified adherence using attendance records. 12 papers (11 studies) based adherence on duration of exercise and 5 papers (4 studies) specified the intensity with which participants should exercise. Several studies used multiple methods.

CONCLUSIONS

There was little consensus between studies on how adherence should be defined, and even when studies used the same conceptual measure, they measured the concept using different approaches and/or had different cut-off points. Adherence related to health outcomes requires multiple measurements, for example, attendance, duration and intensity. It is important that future studies consider the outcome of the intervention when considering their definition of adherence, and we recommend a series of definitions for future use.

What factors support older people to increase their physical activity levels? An exploratory analysis of the experiences of PACE-Lift trial participants

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A nurse led primary care walking based physical activity (PA) intervention showed increased step counts at 3 and 12 months.

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We explored the factors that promoted this long-term behaviour change.

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We selected intervention group participants who increased PA and those who had not to explore facilitators and barriers to behaviour change.

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We expected the two groups to give contrasting narratives but these did not emerge.

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The groups differed in the identification of the same factor, eg social support,as either a facilitator or barrier.

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Participants who sustained increased walking participated in the trial as couple and had a companion to walk with.

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Those who did not improve lacked these, had higher levels of chronic illness and were more sceptical of the goal setting element of the intervention.

Background

Physical Activity (PA) has significant health benefits for older adults, but nearly all UK over 60′s are not achieving recommended levels. The PACE-Lift primary care-based walking intervention for 60–75 year-olds used a structured, theoretically grounded intervention with pedometers, accelerometers, handbooks and support from practice nurses trained in behaviour change techniques. It demonstrated an objective increase in walking at 3 and 12 months. We investigated the experiences of intervention participants who did (and did not) increase their walking, in order to explore facilitators to increased walking.

Methods

Semi-structured telephone interviews used an interview schedule with a purposive sample of 30 intervention participants, 19 who had objectively increased their walking over the previous year and 11 who had not. Interviews were audio-recorded, transcribed and coded independently by researchers to generate a thematic coding framework.

Results

Both groups confirmed that walking was an appropriate PA for people of ‘their age’. The majority of those with increased walking participated in the trial as a couple, were positive about individualised goal-setting, developed strategies for maintaining their walking, and had someone to walk with. Non-improvers reported their attempts to increase walking were difficult because of lack of social support and were less positive about the intervention’s behaviour change components.

Discussion

Walking is an acceptable and appropriate PA intervention for older people. The intervention’s goal-setting components were important for those who increased their walking. Mutual support between partners participating as a couple and having someone to walk with also facilitated increased walking.

Utilizing an integrated infrastructure for outcomes research: a systematic review

OBJECTIVE

To explore the ability of an integrated health information infrastructure to support outcomes research.

METHODS

A systematic review of articles published from 1983 to 2012 by Regenstrief Institute investigators using data from an integrated electronic health record infrastructure involving multiple provider organisations was performed. Articles were independently assessed and classified by study design, disease and other metadata including bibliometrics.

RESULTS

A total of 190 articles were identified. Diseases included cognitive, (16) cardiovascular, (16) infectious, (15) chronic illness (14) and cancer (12). Publications grew steadily (26 in the first decade vs. 100 in the last) as did the number of investigators (from 15 in 1983 to 62 in 2012). The proportion of articles involving non-Regenstrief authors also expanded from 54% in the first decade to 72% in the last decade. During this period, the infrastructure grew from a single health system into a health information exchange network covering more than 6 million patients. Analysis of journal and article metrics reveals high impact for clinical trials and comparative effectiveness research studies that utilised data available in the integrated infrastructure.

DISCUSSION

Integrated information infrastructures support growth in high quality observational studies and diverse collaboration consistent with the goals for the learning health system. More recent publications demonstrate growing external collaborations facilitated by greater access to the infrastructure and improved opportunities to study broader disease and health outcomes.

CONCLUSIONS

Integrated information infrastructures can stimulate learning from electronic data captured during routine clinical care but require time and collaboration to reach full potential.

Effects of Square-Stepping Exercise on balance and depressive symptoms in older adults

The aim of this study was analyze the effects of Square-Stepping Exercise (SSE) on depressive symptoms, balance and functional mobility in older adults. Participants were distributed into two groups: Trained Group (TG), who performed a 16-week intervention with SSE and Control Group (CG), who performed only evaluations. The Berg Balance Scale and Time Up and Go Test (TUG) constituted the evaluation protocol to verify balance and functional mobility. Geriatric Depression Scale-short form (GDS-15) was applied for measure depressive symptoms. Evaluations were realized pre and post 16-week. Significant improvements were observed in the TG with the maintenance of GDS-15 scores and on the time to perform the TUG test which reflects better functional mobility than the CG. This could lead to conclude that the SSE is an important tool for improve balance, prevent falls and decrease depression symptoms.

How design of places promotes or inhibits mobility of older adults: realist synthesis of 20 years of research

OBJECTIVE

The objective of this study was to determine the environmental features that best support aging in place.

METHOD

We conducted a realist synthesis, a theory-driven interpretive method of evidence synthesis, of 120+ articles (published 1991-2011) that attempts to explain how place may influence older adults' decisions about mobility (e.g., physical activity). We developed an initial program theory, reviewed the literature, identified outcomes, analyzed and synthesized patterns, and created a final program theory.

RESULTS

Safety was a central mechanism, serving as one of the bridges between environmental components (e.g., connectivity, aesthetics, retail and services) and decisions about mobility. Population density, sidewalk presence, and park proximity did not emerge as key factors.

DISCUSSION

Safety considerations are one of the most prominent influences of older adults' decisions about mobility. Street connectivity, pedestrian access and transit, and retail and services were also important. These factors are amenable to change and can help promote mobility for older adults.

Barriers to outdoor physical activity and unmet physical activity need in older adults

OBJECTIVE

To profile participants based on reported outdoor physical activity barriers using a data-driven approach, describe the profiles and study their association with unmet physical activity need.

METHOD

Cross-sectional analyses of 848 community-dwelling men and women aged 75-90 living in Central Finland in 2012. Barriers to outdoor physical activity and unmet physical activity need were enquired with a questionnaire. The latent profiles were identified by profiling participants into latent groups using a mixture modeling technique on the multivariate set of indicators of outdoor physical activity barriers. A path model was used to study the associations of the profiles with unmet physical activity need.

RESULTS

Five barrier profiles were identified. Profile A was characterized with minor barriers, profile B with weather barriers, profile C with health and weather barriers, profile D with barriers concerning insecurity, health and weather; and profile E with mobility and health barriers. The participants in the profiles differed in the proportion of individual and environmental barriers. The risk for unmet physical activity need was highest among people whose severe mobility difficulties restricted their outdoor physical activity.

CONCLUSION

Outdoor physical activity barriers reflect the imbalance in person-environment fit among older people, manifested as unmet physical activity need.

Insights into the reluctance of patients with late-stage cancer to adopt exercise as a means to reduce their symptoms and improve their function

CONTEXT

Exercise reduces cancer-related disablement and adverse symptoms, yet patients' attitudes toward exercise remain largely unexamined.

OBJECTIVES

This qualitative study sought to characterize the beliefs of patients with late-stage disease regarding exercise, its relationship to their symptoms, and their clinicians' roles in providing related counseling.

METHODS

Semistructured interviews with 20 adults (half male and half aged 65 years or older) with Stage IIIB or IV nonsmall cell lung cancer were qualitatively analyzed. Participants were questioned about their levels of activity, the influence of their symptoms on their activities, perceived barriers and facilitators for exercise, and exercise-related instructions received from their professional caregivers.

RESULTS

Participants overwhelmingly cited usual daily activities as their source of "exercise." Symptoms, particularly treatment-related, discouraged participation, with fear of harm being a significant concern only among younger women. Exercise was recognized as important for physical and mental well-being but seldom as a means to mitigate symptoms. Weather, recalled levels of premorbid fitness, and exercise participation modulated current exercise behaviors. Although respondents preferred to receive guidance from their oncologist, none reported receiving more than general encouragement to "stay active." A lack of direction was typically accepted as a sanction of their current activity levels. Participants appeared less receptive to guidance from ancillary health professionals.

CONCLUSION

Effective use of exercise and activity modification to ameliorate cancer-related symptoms appears to require a linkage to a patient's usual and past activities, proactive negotiation of potential barriers, education regarding symptoms and exercise, and the positive support of their oncologist.

Determinants of physical activity and exercise in healthy older adults: a systematic review

Background

The health benefits of regular physical activity and exercise have been widely acknowledged. Unfortunately, a decline in physical activity is observed in older adults. Knowledge of the determinants of physical activity (unstructured activity incorporated in daily life) and exercise (structured, planned and repetitive activities) is needed to effectively promote an active lifestyle. Our aim was to systematically review determinants of physical activity and exercise participation among healthy older adults, considering the methodological quality of the included studies.

Methods

Literature searches were conducted in PubMed/Medline and PsycINFO/OVID for peer reviewed manuscripts published in English from 1990 onwards. We included manuscripts that met the following criteria: 1) population: community dwelling healthy older adults, aged 55 and over; 2) reporting determinants of physical activity or exercise. The outcome measure was qualified as physical activity, exercise, or combination of the two, measured objectively or using self-report. The methodological quality of the selected studies was examined and a best evidence synthesis was applied to assess the association of the determinants with physical activity or exercise.

Results

Thirty-four manuscripts reporting on 30 studies met the inclusion criteria, of which two were of high methodological quality. Physical activity was reported in four manuscripts, exercise was reported in sixteen and a combination of the two was reported in fourteen manuscripts. Three manuscripts used objective measures, twenty-two manuscripts used self-report measures and nine manuscripts combined a self-report measure with an objective measure. Due to lack of high quality studies and often only one manuscript reporting on a particular determinant, we concluded "insufficient evidence" for most associations between determinants and physical activity or exercise.

Conclusions

Because physical activity was reported in four manuscripts only, the determinants of physical activity particularly need further study. Recommendations for future research include the use of objective measures of physical activity or exercise as well as valid and reliable measures of determinants.

Weather impacts on leisure activities in Halifax, Nova Scotia

The aim of this study was to investigate the impact of daily atmospheric weather conditions on daily leisure activity engagement, with a focus on physically active leisure. The methods capitalize on time diary data that were collected in Halifax, Nova Scotia to calculate objective measures of leisure activity engagement. Daily meteorological data from Environment Canada and daily sunrise and sunset times from the National Research Council of Canada are used to develop objective measures of the natural atmospheric environment. The time diary data were merged with the meteorological data in order to quantify the statistical association between daily weather conditions and the type, participation rate, frequency, and duration of leisure activity engagement. The results indicate that inclement and uncomfortable weather conditions, especially relating to thermal comfort and mechanical comfort, pose barriers to physically active leisure engagement, while promoting sedentary and home-based leisure activities. Overall, daily weather conditions exhibit modest, but significant, effects on leisure activity engagement; the strongest associations being for outdoor active sports and outdoor active leisure time budgets. In conclusion, weather conditions influence the type, participation rate, frequency, and duration of leisure activity engagement, which is an important consideration for health-promotion programming.

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

OBJECTIVE

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

Assessing the effects of weather conditions on physical activity participation using objective measures

Habitual physical activity is an important determinant of health, yet many people are considered to be inactive. Identification of the obstacles to greater participation is necessary for the development of strategies to overcome those obstacles. The weather has been identified as a perceived barrier to participation in physical activity, but exactly which adverse weather conditions are most important, and the extent to which they contribute to decreases in physical activity have rarely been quantified in populations. In the past decade, a small number of studies have used publicly available databases to examine the quantitative effects of weather (e.g., temperature, precipitation, wind) on physical activity in children, adolescents and adults. This review examines our historical, qualitative versus emerging, quantitative understanding of how specific weather conditions affect a population's activity.

Physical activity levels of older community-dwelling adults are influenced by summer weather variables

Adequate daily physical activity (PA) is important for maintaining functional capacity and independence in older adults. However, most older adults in Canada do not engage in enough PA to sustain fitness and functional independence. Environmental influences, such as warmer daytime temperatures, may influence PA participation; however, few studies have examined the effect of summertime temperatures on PA levels in older adults. This investigation measured the influence of summertime weather variables on PA in 48 community-dwelling older adults who were randomly recruited from a local seniors' community centre. Each participant wore an accelerometer for a single 7-consecutive-day period (between 30 May and 9 August 2006) during waking hours, and completed a PA logbook to remark on major daily PA events. Local weather variables were collected from a national weather service and compared with PA counts per minute. Regression analysis revealed a curvilinear relationship between log-transformed PA and mean daily temperature (r2 = 0.025; p < 0.05). Linear mixed effects models that accounted for repeated measures nested within individuals were performed for monthly periods, meteorological variables, sex, age, and estimated maximal oxygen consumption, with PA as the dependent variable. Age and Air Quality Index remained significant variables within the model. Higher fitness levels had no effect on allowing individuals to perform more vigorous PA in warmer temperatures.

Effects of a 12-month exercise program on cardiorespiratory health indicators of Vietnam War veterans resident in the tropics

OBJECTIVE

To measure the effect of a combined aerobic and resistance exercise program on key cardiovascular disease risk factors (i.e. body composition or anthropometry and cardiorespiratory function) of Australian male, Vietnam War veterans living in the tropics.

DESIGN

Twelve-month exercise program with assessments at commencement, 3, 6 and 12 months.

SETTING

North Queensland regional centre.

PARTICIPANTS

Australian male, Vietnam War veterans (n = 164) resident in north Queensland.

MAIN OUTCOME MEASURES

Measurement of heart rate, blood pressure, skinfold and girth measurements, exercise heart rate response and estimated aerobic capacity to determine whether the implementation of a simple aerobic and resistance exercise program could positively change selected cardiovascular disease risk factors in Vietnam Veterans.

RESULTS

Significant improvements were reported for systolic blood pressure (131.1 (SD 15.7) reduced to 122.7 (12.4) mmHg), diastolic blood pressure (82.7 (9.1) reduced to 76.3 (10.3) mmHg), resting heart rate (73 (11) reduced to 69 (11) bpm), sum of skinfolds (127.5 (40.3) reduced to 99.5 (32.1) mm), waist girth (103.2 (12.0) reduced to 100.5 (12.1) cm), hip girth (105.3 (9.6) reduced to 103.7 (10.4) cm) and aerobic capacity (2.17 (0.39) increased to 2.36 (0.34) L min(-1)).

CONCLUSION

Participation in a combined aerobic and resistance training program elicited significant anthropometric and cardiorespiratory benefits that might lead to a decreased risk of developing cardiovascular disease for male Vietnam War veterans resident in rural and regional areas.

Impact of provider self-management education, patient self-efficacy, and health status on patient adherence in heart failure in a Veterans Administration population

To address the need for more information on predictors of adherence to heart failure (HF) self-management regimens, this study analyzed surveys completed by 259 HF patients receiving care at 2 Veterans Affairs hospitals in 2003. Linear multivariable regression models were used to examine general health status, HF-specific health status (Kansas City Cardiomyopathy Questionnaire) self-management education, and self-efficacy as predictors of self-reported adherence to salt intake and exercise regimens. Self-management education was provided most often for salt restriction (87%) followed by exercise (78%). In multivariable regression analyses, education about salt restriction (P=.01), weight reduction (P=.0004), self-efficacy (P=.03), and health status (P=.003) were significantly associated with patient-reported adherence to salt restriction. In a similar model, self-efficacy (P=.006) and health status (P< or = .0001), but not exercise education, were significantly associated with patient-reported exercise adherence. Findings suggest that provider interventions may lead to improved adherence with HF self-management and thus improvements in patients' health.

Square-stepping exercise and fall risk factors in older adults: a single-blind, randomized controlled trial

BACKGROUND

Decreased fitness of the lower extremities is a potentially modifiable fall risk factor. This study aimed to compare two exercise programs--square-stepping exercise (SSE), which is a low-cost indoor program, and walking--for improving the fitness of the lower extremities.

METHODS

We randomly allocated 68 community-dwelling older adults (age 65-74 years) to either the SSE or walking group (W group). During the 12-week regimen, the SSE group participated in 70-minute exercise sessions conducted twice a week at a local health center, and the W group participated in outdoor supervised walking sessions conducted weekly. The W group was instructed to increase the number of daily steps. Prior to and after the program, we obtained information on 11 physical performance tests for known fall risk factors and 3 self-reported scales. The fall incidence was followed-up for 8 months.

RESULTS

At 12 weeks postregimen, significant differences were observed between the two exercise groups with respect to leg power (1 item), balance (2 items), agility (2 items), reaction time (2 items), and a self-reported scale (1 item); the SSE group demonstrated a marked improvement in the above-mentioned items with Group x Time interactions. Significant time effects were observed in the tests involving chair stands, functional reach, and standing up from a lying-down position without Group x Time interactions. During the follow-up period, the fall rates per person-year in the SSE and W groups were 23.4% and 33.3%, respectively (p =.31).

CONCLUSION

Although further studies are required, SSE is apparently more effective than walking in reducing fall risk factors, and it appears that it may be recommended as a health promotion exercise in older adults.

Reducing attrition in physical activity programs for older adults

This study investigated attrition in a 6-month physical activity intervention for older adults. The program was based on the social-cognitive theory incorporating self-efficacy factors. Two hundred forty-eight insufficiently active 65- to 74-year-olds were recruited from the Australian federal electoral roll. The intervention comprised walking and strength and flexibility exercises and was conducted in 30 local neighborhoods where the participants resided. Characteristics of individuals lost to attrition (n = 86, 35%) were compared with those of program completers (n = 162, 65%). Logistic-regression analysis showed that those lost to attrition came from areas of lower socioeconomic status, were overweight and less physically active, and had lower walking self-efficacy scores and higher loneliness scores. The results suggest that early assessment of these characteristics should be undertaken to identify individuals at risk of attrition, to improve retention, and to avoid potential bias.

Promoting Physical Activity and Exercise in Older Adults

Although the benefits of increased physical activity and exercise are universally recognized, many older persons remain sedentary, and relatively few achieve recommended levels of activity. Effective interventions to reverse the lack of physical activity in older adults are clearly needed. By understanding correlates of inactivity and appreciating those factors that contribute to a sedentary lifestyle, appropriate strategies can be employed to help order patients reap the benefits of increased physical activity and exercise. In this article, we offer to the reader a brief overview of the field as well as our own thoughts on how clinicians might help individual patients at a more practical level.

Motivational factors influencing older adults diagnosed with knee osteoarthritis to join and maintain an exercise program

In order to provide successful interventions to increase physical activity among inactive older adults, it is imperative to understand motivational factors influencing exercise. The authors present data from 191 (baseline) and 125 (12-month) community-dwelling men and women with mean ages of 68.71 (7.47) and 67.55 (7.55) years, respectively, from a strength-training trial. Approximately 53% had diagnosed knee osteoarthritis. Using a Likert scale, participants self-reported their degree of motivation from personal, social, and environmental factors. Using multivariate analyses, the authors evaluated demographic and clinical correlates of motivational factors to join and continue with exercise. The following results were reported: Knee osteoarthritis was positively related to motivation from an organized exercise opportunity and from efficacy/outcome expectations, and knee pain was positively related to motivation from social support and experience with the exercise task. Understanding these motivators might help in targeting recruitment efforts and interventions designed to increase physical activity in older adults with lower extremity arthritis.