Controlled outcome evaluation of the First Step Program: a daily physical activity intervention for individuals with type II diabetes

OBJECTIVE

To conduct a randomised trial of a physical activity (PA) intervention, The First Step Program (FSP) for adults with type II diabetes.

DESIGN

A 16-week intervention study and 24-week follow-up assessment.

PARTICIPANTS

A total of 47 overweight/obese, sedentary individuals (age=52.7 +/- 5.2 y; BMI=33.3 +/- 5.6 kg/m2) recruited through a diabetes education centre.

MEASUREMENTS

PRIMARY OUTCOME

daily PA assessed by pedometer (steps/day).

SECONDARY OUTCOMES

anthropometric measures (weight, BMI, waist girth, hip girth); indicators of cardiovascular health (resting heart rate and blood pressure); glycemic control (fasting glucose, insulin, HbA1c, glucose concentration 120 min postglucose load); plasma lipid status (total cholesterol, HDL cholesterol, LDL cholesterol, and triglycerides).

RESULTS

Relative to the CONTROL group, FSP participants increased their PA >3000 steps/day (approximately 30 min/day) during the intervention (P<0.0001). Waist and hip girth decreased (approximately 2-3 cm), but did not differ significantly between groups. Significant changes did not emerge for any of the other variables.

CONCLUSIONS

The FSP is a practical intervention that elicits an immediate and profound change in walking behaviour. Such change is an important 'first step' towards increasing the volume and/or intensity of PA necessary to improve long-term health outcomes in this largely sedentary and overweight or obese population. Relapse by 24 weeks indicates that other strategies such as booster sessions are needed to maintain lifestyle change. Further research must determine realistic and responsive health outcomes for this population that are achievable through practical, real-world programming.

A randomized outcome evaluation of group exercise programs in long-term care institutions

BACKGROUND

Physical activity programs in nursing homes typically consist of seated, range of motion (ROM) exercises, regardless of resident abilities. The Functional Fitness for Long-Term Care (FFLTC) Program was designed not only to maintain ROM, but also to improve strength, balance, flexibility, mobility, and function. In addition, it was tailored to meet the needs of both high and low mobility residents.

METHODS

The feasibility and efficacy of the FFLTC Program were evaluated with 68 residents (mean age 80) from five institutions. Persons were classified as low or high mobility and randomized into either the FFLTC program or a seated ROM program. Classes were conducted in groups of 4 to 10 residents by trained facility staff for 45 minutes, three times per week. Assessments at baseline and 4 months consisted of mobility, balance, gait, flexibility, functional capacity, and several upper and lower extremity strength measures.

RESULTS

Attendance averaged 86% for the FFLTC and 79% for the ROM classes. Four months of exercise led to significant improvements in mobility (16%), balance (9%), flexibility (36%), knee (55%), and hip (12%) strength for the FFLTC group. Shoulder strength was the only improvement found for the ROM group. The ROM group significantly deteriorated in some areas, particularly hip strength, mobility, and functional ability.

CONCLUSIONS

Institutionalized seniors, even those who are physically frail, incontinent and/or have mild dementia, can respond positively to a challenging exercise program. The FFLTC program demonstrated clear benefits over typical, seated ROM exercises. Moreover, with minimal training, the program can be safely delivered at low cost by institutional staff and volunteers.

Measuring accumulated health-related benefits of exercise participation for older adults: the Vitality Plus Scale

BACKGROUND

Existing measures fail to capture the perceived benefits attributed to exercise participation by older adults themselves. Noticeable improvements in sleep, energy level, bodily aches and pains, constipation, and other psychophysical aspects of "feeling good" may represent ongoing sources of motivation for continued participation. The Vitality Plus Scale (VPS) was developed to measure these potential health-related benefits of exercising.

METHODS

The 10-item VPS was developed using an inductive approach, in collaboration with regularly exercising older adults and their instructors. Multiple samples of exercises and nonexercisers ranging in age from 40 to 94 were used to examine the reliability and validity of the new scale.

RESULTS

The VPS showed good internal consistency and test-retest reliability over one week. Scores were able to discriminate on the basis of various indicators of health status and self-reported level of physical activity, and were related to two measures of functional mobility. Convergence was found with several subscales of the SF-36, whereas low correlations emerged with a measure of episode-specific sensations. Responsiveness to change was found with various types of exercise for individuals with low to moderate scores prior to participation.

CONCLUSIONS

Improvements in sleep, energy level, mood, and generally feeling good appear to be the most noticeable benefits of exercising for many adults. These associations are reinforced by sustained exercise participation. Capturing these interrelated psychophysical constructs in a single, short measure will enable exercise researchers and instructors to measure incremental improvements previously reported only anecdotally.

Ventilatory response to exercise in men and women 55 to 86 years of age

This study examines the relationship between minute ventilation (VE) and carbon dioxide production (VCO2) during exercise in men (n = 128) and women (n = 96), 55 to 86 yr of age. The means for the slopes of VE-VCO2 (delta VE/delta VCO2), examined for graded exercise below the ventilation threshold (TVE), increased significantly for men (p < 0.0001), from 25.0 +/- 0.7 (SEM) at mean age 58 (55 to 59) yr to 32.2 +/- 1.8 at mean age 83 (80 to 86) yr, but did not change for women (p = 0.0812), from 22.3 +/- 0.9 at mean age 58 (56-59) yr to 24.2 +/- 2.4 at mean age 79 (75 to 85) yr. A correlation that was significantly greater than zero was found between delta VE/delta VCO2 and age. The increase in delta VE/delta VCO2 was 0.29/yr for men (r = 0.47, p < 0.001) and 0.20/yr for women (r = 0.28, p = 0.0051). In both cases, the explained variance was small (men = 22%; women = 8%). VE, tidal volume (VT), and breathing frequency (fb) were examined at VCO2 = 1.0 L/min, the highest intensity that most older men and women could exercise without exceeding TVE. VE was significantly higher by 14% in men 80 to 86 yr of age (38.2 +/- 1.4 L/min) compared with men 55 to 59 yr of age (33.5 +/- 0.8), whereas there were no differences in VE for the women.(ABSTRACT TRUNCATED AT 250 WORDS)

Response rates in a survey of physical capacity among older persons

A representative sample of 420 subjects aged 55 to 84 was sought for participation in a study of the relationship between physical activity and health. A stratified random sample with 35 subjects in each of 12 age-gender categories was designed, using lists generated consecutively until the target number for each category was reached. Although the protocol required walking and treadmill tests, 60.3 percent of those eligible participated, a figure comparable to that of NHANES II and superior to that of the Canada Fitness Survey. Participants were younger, more likely to be male, less likely to be currently married, and more likely to have had a white-collar job and some postsecondary education than were nonparticipants. Difficulties of obtaining subjects and methods for avoiding these difficulties include offering many opportunities to attend and determining accurately the reason for nonparticipation.