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Manning KM, Hall KS, Sloane R, Magistro D, Rabaglietti E, Lee CC, Castle S, Kopp T, Giffuni J, Katzel L, McDonald M, Miyamoto M, Pearson M, Jennings SC, Bettger JP, Morey MC. Longitudinal analysis of physical function in older adults: The effects of physical inactivity and exercise training. Aging Cell 2024; 23:e13987. [PMID: 37681737 PMCID: PMC10776115 DOI: 10.1111/acel.13987] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/09/2023] Open
Abstract
Lack of exercise contributes to systemic inflammation and is a major cause of chronic disease. The long-term impact of initiating and sustaining exercise in late life, as opposed to sustaining a sedentary lifestyle, on whole-body health measures such as physical performance is not well known. This is an exploratory study to compare changes in physical performance among older adults initiating exercise late in life versus inactive older adults. Data from two observational cohorts were included in this analysis, representing two activity groups. The Active group cohort comprises older adults (n = 318; age 72.5 ± 7.2 years) enrolled in a supervised exercise program, "Gerofit." The inactive group comprises older adults (n = 146; age 74.5 ± 5.5 years) from the Italian study "Act on Ageing" (AOA) who self-reported being inactive. Participants in both groups completed physical performance battery at baseline and 1-year including: 6-min walk test, 30-s chair stand, and timed up-and-go. Two-sample t-tests measured differences between Gerofit and AOA at baseline and 1-year across all measures. Significant between-group effects were seen for all performance measures (ps = 0.001). The AOA group declined across all measures from baseline to 1 year (range -18% to -24% change). The Gerofit group experienced significant gains in function for all measures (range +10% to +31% change). Older adults who initiated routine, sustained exercise were protected from age-related declines in physical performance, while those who remained sedentary suffered cumulative deficits across strength, aerobic endurance, and mobility. Interventions to reduce sedentary behaviors and increase physical activity are both important to promote multi-system, whole-body health.
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Parker DC, Kraus WE, Huffman KM, Morey MC, Hall KS, Cohen HJ. Association of plasma inflammatory and metabolic biomarkers with plasma ADRD biomarkers in community‐dwelling older adults. Alzheimers Dement 2022. [DOI: 10.1002/alz.065521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Fernandez D, Wilkins SS, Melrose RJ, Hall KM, Abbate LM, Morey MC, Castle SC, Zeng A, Lee CC. Physical Function Effects of Live Video Group Exercise Interventions for Older Adults: A Systematic Review and Veteran's Gerofit Group Case Study. Telemed J E Health 2022. [DOI: 10.1089/tmj.2022.0175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Kaufman BG, Allen KD, Coffman CJ, Woolson S, Caves K, Hall K, Hoenig HM, Huffman KM, Morey MC, Hodges NJ, Ramasunder S, van Houtven CH. Cost and Quality of Life Outcomes of the STepped Exercise Program for Patients With Knee OsteoArthritis Trial. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:614-621. [PMID: 35365305 DOI: 10.1016/j.jval.2021.09.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 08/31/2021] [Accepted: 09/30/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES This study aimed to evaluate the cost-effectiveness of the randomized clinical trial STEP-KOA (STepped Exercise Program for patients with Knee OsteoArthritis). METHODS The trial included 230 intervention and 115 control participants from 2 Veterans Affairs (VA) medical centers. A decision tree simulated outcomes for cohorts of patients receiving arthritis education (control) or STEP-KOA (intervention), which consisted of an internet-based exercise training program (step 1), phone counseling (step 2), and physical therapy (step 3) according to patient's response. Intervention costs were assessed from the VA perspective. Quality of life (QOL) was measured using 5-level EQ-5D US utility weights. Incremental cost-effectiveness ratios (ICERs) were calculated as the difference in costs divided by the difference in quality-adjusted life-years (QALYs) between arms at 9 months. A Monte Carlo probabilistic sensitivity analysis was used to generate a cost-effectiveness acceptability curve. RESULTS The adjusted model found differential improvement in QOL utility weights of 0.042 (95% confidence interval 0.003-0.080; P=.03) for STEP-KOA versus control at 9 months. In the base case, STEP-KOA resulted in an incremental gain of 0.028 QALYs and an incremental cost of $279 per patient for an ICER of $10 076. One-way sensitivity analyses found the largest sources of variation in the ICER were the impact on QOL and the need for a VA-owned tablet. The probabilistic sensitivity analysis found a 98% probability of cost-effectiveness at $50 000 willingness-to-pay per QALY. CONCLUSIONS STEP-KOA improves QOL and has a high probability of cost-effectiveness. Resources needed to implement the program will decline as ownership of mobile health devices increases.
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Oyedeji CI, Hall K, Luciano A, Morey MC, Strouse JJ. The Sickle Cell Disease Functional Assessment (SCD-FA) tool: a feasibility pilot study. Pilot Feasibility Stud 2022; 8:53. [PMID: 35246265 PMCID: PMC8895638 DOI: 10.1186/s40814-022-01005-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 02/16/2022] [Indexed: 01/15/2023] Open
Abstract
Background The life expectancy for individuals with sickle cell disease (SCD) has greatly increased over the last 50 years. Adults with SCD experience multiple complications such as cardiopulmonary disease, strokes, and avascular necrosis that lead to limitations that geriatric populations often experience. There are no dedicated instruments to measure functional decline and functional age to determine risk of future adverse outcomes in older adults with SCD. The objective of this study was to assess the feasibility of performing the Sickle Cell Disease Functional Assessment (SCD-FA). Methods We enrolled 40 adults with SCD (20 younger adults aged 18–49 years as a comparison group and 20 older adults aged 50 years and older) in a single-center prospective cohort study. Participants were recruited from a comprehensive sickle cell clinic in an academic center in the southeastern United States. We included measures validated in an oncology geriatric assessment enriched with additional physical performance measures: usual gait speed, seated grip strength, Timed Up and Go, six-minute walk test, and 30-second chair stand. We also included an additional cognitive measure, which was the Montreal Cognitive Assessment, and additional patient-reported measures at the intersection of sickle cell disease and geriatrics. The primary outcome was the proportion completing the assessment. Secondary outcomes were the proportion consenting, duration of the assessment, acceptability, and adverse events. Results Eighty percent (44/55) of individuals approached consented, 91% (40/44) completed the SCD-FA in its entirety, and the median duration was 89 min (IQR 80–98). There were no identified adverse events. On the acceptability survey, 95% (38/40) reported the length as appropriate, 2.5% (1/40) reported a question as upsetting, and 5% (2/40) reported portions as difficult. Exploratory analyses of physical function showed 63% (25/40) had a slow usual gait speed (< 1.2 m/s). Conclusion The SCD-FA is feasible, acceptable, and safe and physical performance tests identified functional impairments in adults with SCD. These findings will inform the next phase of the study where we will assess the validity of the SCD-FA to predict patient-important outcomes in a larger sample of adults with SCD.
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Briggs BC, Hall KS, Jain C, Macrea M, Morey MC, Oursler KK. Assessing Moderate to Vigorous Physical Activity in Older Adults: Validity of a Commercial Activity Tracker. Front Sports Act Living 2022; 3:766317. [PMID: 35047769 PMCID: PMC8761971 DOI: 10.3389/fspor.2021.766317] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 12/06/2021] [Indexed: 12/14/2022] Open
Abstract
Purpose: Despite the potential for commercial activity devices to promote moderate to vigorous physical activity (MVPA), limited information is available in older adults, a high-priority target population with unique gait dynamics and energy expenditure. The study purpose was to investigate the content validity of the Garmin Vivosmart HR device for step counts and MVPA in adults ≥65 years of age in free-living conditions. Methods: Thirty-five participants (M age= 73.7 (6.3) years) wore Garmin and ActiGraph GT3X+ devices for a minimum of 2 days. Accuracy and intra-person reliability were tested against a hip worn ActiGraph device. Separate analyses were conducted using different accelerometer cut-off values to define MVPA, a population-based threshold (≥2,020 counts/minute) and a recommended threshold for older adults (≥1,013 counts/minute). Results: Overall, the Garmin device overestimated MVPA compared with the hip-worn ActiGraph. However, the difference was small using the lower, age-specific, MVPA cut-off value [median (IQR) daily minutes; 50(85) vs. 32(49), p = 0.35] in contrast to the normative standard (50(85) vs. 7(24), p < 0.001). Regardless of the MVPA cut-off, intraclass correlation showed poor reliability [ICC (95% CI); 0.16(-0.40, 0.55) to 0.35(-0.32, 0.7)] which was supported by Bland-Altman plots. Garmin step count was both accurate (M step difference: 178.0, p = 0.22) and reliable [ICC (95% CI; 0.94) (0.88, 0.97)]. Conclusion: Results support the accuracy of a commercial activity device to measure MVPA in older adults but further research in diverse patient populations is needed to determine clinical utility and reliability over time.
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Browne J, Morey MC, Beckham JC, Bosworth HB, Porter Starr KN, Bales CW, McDermott J, Sloane R, Gregg JJ, Hall KS. Diet quality and exercise in older veterans with PTSD: a pilot study. Transl Behav Med 2021; 11:2116-2122. [PMID: 34487181 PMCID: PMC8846334 DOI: 10.1093/tbm/ibab116] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Older veterans with posttraumatic stress disorder (PTSD) are at increased risk of obesity and cardiometabolic disease. Physical activity and healthy eating are two behaviors that impact health, functional independence, and disease risk in later life, yet few studies have examined the relationship between PTSD and diet quality. This secondary analysis aimed to: (a) characterize the diet quality of older veterans with PTSD in comparison to U.S. dietary guidelines and (b) explore if participation in a supervised exercise intervention spurred simultaneous changes in dietary behavior. Diet quality was assessed with the Dietary Screener Questionnaire (DSQ), which measures daily intake of fiber, calcium, added sugar, whole grain, dairy, and fruits/vegetables/legumes. The sample included 54 military veterans ≥ 60 years old with PTSD who participated in a randomized controlled pilot trial comparing 12 weeks of supervised exercise (n = 36) to wait-list usual care (n = 18). The DSQ was administered at baseline and 12 weeks. Consumption of added sugar exceeded U.S. dietary guideline recommendations and consumption of whole grains, fruits/vegetables/legumes, fiber, calcium, and dairy fell short. Participation in the supervised exercise intervention was not associated with changes in diet quality. Results revealed that the diet quality of older veterans with PTSD is poor, and while the exercise intervention improved health through exercise, it did not make veterans any more likely to adopt a more healthful diet. Interventions targeting diet, or diet + exercise, are needed to manage the increased risk of obesity and cardiometabolic disease present in older veterans with PTSD.
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Ogawa EF, Harris R, Dufour AB, Morey MC, Bean J. Reliability of Virtual Physical Performance Assessments in Veterans During the COVID-19 Pandemic. Arch Rehabil Res Clin Transl 2021; 3:100146. [PMID: 34589696 PMCID: PMC8463460 DOI: 10.1016/j.arrct.2021.100146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objective To determine the reliability of 3 physical performance tests performed via a telehealth visit (30-s arm curls test, 30-s chair stand test, 2-min step test) among community-dwelling older veterans. Design Cross sectional study. Setting Virtual. Participants Veterans (N=55; mean age 75y) who enrolled in Gerofit, a virtual group exercise program. Interventions Not applicable. Main Outcome Measures Participants were tested by 2 different assessors at 1 time point. The intraclass correlation coefficient (ICC) with 95% confidence intervals and Bland-Altman plots were used as measures of reliability. To assess generalizability, ICCs were further evaluated by health conditions (type 2 diabetes, arthritis, obesity, depression). Results Assessments were conducted among 55 participants. The ICC was above 0.98 for all 3 tests across health conditions and Bland-Altman plots indicated that there were no significant systematic errors in the measurement. Conclusions The virtual physical performance measures appear to have high reliability and the findings are generalizable across health conditions among veterans. Thus, they are reliable for evaluating physical performance in older veterans in virtual settings.
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Pavon JM, Fish LJ, Colón-Emeric CS, Hall KS, Morey MC, Pastva AM, Hastings SN. Towards "mobility is medicine": Socioecological factors and hospital mobility in older adults. J Am Geriatr Soc 2021; 69:1846-1855. [PMID: 33755991 DOI: 10.1111/jgs.17109] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 02/11/2021] [Accepted: 02/19/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Understanding the factors that influence hospital mobility, especially in the context of a heightened focus on falls prevention, is needed to improve care. OBJECTIVE This qualitative study uses a socioecological framework to explore factors that influence hospital mobility in older adults. DESIGN Qualitative research PARTICIPANTS: Semi-structured interviews and focus groups were conducted with medically-ill hospitalized older adults (n = 19) and providers (hospitalists, nurses, and physical and occupational therapists (n = 48) at two hospitals associated with an academic health system. APPROACH Interview and focus group guides included questions on perceived need for mobility, communication about mobility, hospital mobility culture, and awareness of patients' walking activity. Data were analyzed thematically and mapped onto the constructs of the socioecological model. KEY RESULTS A consistent theme among patients and providers was that "mobility is medicine." Categories of factors reported to influence hospital walking activity included intrapersonal factors (patients' health status, fear of falls), interpersonal factors (patient-provider communication about mobility), organizational factors (clarity about provider roles and responsibilities, knowledge of safe patient handling, reliance on physical therapy for mobility), and environmental factors (falls as a never event, patient geographical locations on hospital units). Several of these factors were identified as potentially modifiable targets for intervention. Patients and providers offered recommendations for improving awareness of patient's ambulatory activity, assigning roles and responsibility for mobility, and enhancing education and communication between patients and providers across disciplines. CONCLUSION Patients and providers identified salient factors for future early mobility initiatives targeting hospitalized older adults. Consideration of these factors across all stages of intervention development and implementation will enhance impact and sustainability.
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Allen KD, Woolson S, Hoenig HM, Bongiorni D, Byrd J, Caves K, Hall KS, Heiderscheit B, Hodges NJ, Huffman KM, Morey MC, Ramasunder S, Severson H, Van Houtven C, Abbate LM, Coffman CJ. Stepped Exercise Program for Patients With Knee Osteoarthritis : A Randomized Controlled Trial. Ann Intern Med 2021; 174:298-307. [PMID: 33370174 PMCID: PMC10405203 DOI: 10.7326/m20-4447] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Evidence-based models are needed to deliver exercise-related services for knee osteoarthritis efficiently and according to patient needs. OBJECTIVE To examine a stepped exercise program for patients with knee osteoarthritis (STEP-KOA). DESIGN Randomized controlled trial. (ClinicalTrials.gov: NCT02653768). SETTING 2 U.S. Department of Veterans Affairs sites. PARTICIPANTS 345 patients (mean age, 60 years; 15% female; 67% people of color) with symptomatic knee osteoarthritis. INTERVENTION Participants were randomly assigned in a 2:1 ratio to STEP-KOA or an arthritis education (AE) control group, respectively. The STEP-KOA intervention began with 3 months of an internet-based exercise program (step 1). Participants who did not meet response criteria for improvement in pain and function after step 1 progressed to step 2, which involved 3 months of biweekly physical activity coaching calls. Participants who did not meet response criteria after step 2 went on to in-person physical therapy visits (step 3). The AE group received educational materials via mail every 2 weeks. MEASUREMENTS Primary outcome was Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. Scores for the STEP-KOA and AE groups at 9 months were compared by using linear mixed models. RESULTS In the STEP-KOA group, 65% of participants (150 of 230) progressed to step 2 and 35% (81 of 230) to step 3. The estimated baseline WOMAC score for the full sample was 47.5 (95% CI, 45.7 to 49.2). At 9-month follow-up, the estimated mean WOMAC score was 6.8 points (CI, -10.5 to -3.2 points) lower in the STEP-KOA than the AE group, indicating greater improvement. LIMITATION Participants were mostly male veterans, and follow-up was limited. CONCLUSION Veterans in STEP-KOA reported modest improvements in knee osteoarthritis symptoms compared with the control group. The STEP-KOA strategy may be efficient for delivering exercise therapies for knee osteoarthritis. PRIMARY FUNDING SOURCE Department of Veterans Affairs, Health Services Research and Development Service.
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Wilkins SS, Melrose RJ, Hall KS, Blanchard E, Castle SC, Kopp T, Katzel LI, Holder A, Alexander N, McDonald MKS, Tayade A, Forman DE, Abbate LM, Harris R, Valencia WM, Morey MC, Lee CC. PTSD Improvement Associated with Social Connectedness in Gerofit Veterans Exercise Program. J Am Geriatr Soc 2020; 69:1045-1050. [PMID: 33368144 DOI: 10.1111/jgs.16973] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 11/05/2020] [Accepted: 11/08/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Post-traumatic stress disorder (PTSD) is common in Veterans. Symptoms can perpetuate into late life, negatively impacting physical and mental health. Exercise and social support are beneficial in treating anxiety disorders such as PTSD in the general population, although less is known about the impact on Veterans who have lived with PTSD for decades. This study assessed associations between social connectedness, physical function and self-reported change in PTSD symptoms among older Veterans specifically participating in Gerofit. DESIGN Prospective clinical intervention. SETTING Twelve sites of Veterans Affairs (VA) Gerofit exercise program across the United States. PARTICIPANTS Three hundred and twenty one older Veteran Gerofit participants (mean age = 74) completed physical assessments and questionnaires regarding physical and emotional symptoms and their experience. MEASUREMENTS Measures of physical function, including 30-second chair stands, 10-m and 6-min walk were assessed at baseline and 3 months; change in PTSD symptoms based on the Diagnostic Statistical Manual-5 (DSM-5) assessed by a self-report questionnaire; and social connection measured by the Relatedness Subscale of the Psychological Need Satisfaction in Exercise scale (PNSE) were evaluated after 3 months of participation in Gerofit. RESULTS Ninety five (29.6%) Veterans reported PTSD. Significant improvement was noted in self-rated PTSD symptoms at 3 months (P < .05). Moderate correlation (r = .44) was found between social connectedness with other participants in Gerofit and PTSD symptom improvement for those Veterans who endorsed improvement (n = 59). All participants improved on measures of physical function. In Veterans who endorsed PTSD there were no significant associations between physical function improvement and PTSD symptoms. CONCLUSION Veterans with PTSD that participated in Gerofit group exercise reported symptom improvement, and social connectedness was significantly associated with this improvement. In addition to physical health benefits, the social context of Gerofit may offer a potential resource for improving PTSD symptoms in older Veterans that warrants further study.
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Hall KS, Morey MC, Beckham JC, Bosworth HB, Sloane R, Pieper CF, Pebole MM. Warrior Wellness: A Randomized Controlled Pilot Trial of the Effects of Exercise on Physical Function and Clinical Health Risk Factors in Older Military Veterans With PTSD. J Gerontol A Biol Sci Med Sci 2020. [DOI: 10.1093/gerona/glz255 7973256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Military veterans living with post-traumatic stress disorder (PTSD) face significant physical and functional health disparities, which are often aggravated over time and in the context aging. Evidence has shown that physical activity can positively impact age-related health conditions, yet exercise trials in older adults with mental disorders are rare. Our study was a tailored and targeted pilot exercise intervention for older veterans with PTSD.
Methods
Fifty-four older veterans with PTSD (mean age = 67.4 years, 90.7% male, 85.2% non-white) were randomized to supervised exercise (n = 38) or wait-list usual care (n = 18) for 12 weeks. Physical activity (MET-min/wk) and aerobic endurance (assessed with the 6-minute walk test) were primary outcomes. Secondary outcomes were physical performance (strength, mobility, balance), cardiometabolic risk factors (eg, waist circumference), and health-related quality of life.
Results
At 12 weeks, a large effect of the intervention on physical activity levels (Cohen’s d = 1.37) was observed compared to wait-list usual care. Aerobic endurance improved by 69 m in the exercise group compared to 10 m in wait-list group, reflecting a moderate between-group effect (Cohen’s d = 0.50). Between-group differences on 12-week changes in physical performance, cardiometabolic risk factors, and health-related quality of life ranged from small to large effects (Cohen’s d = 0.28–1.48), favoring the exercise arm.
Conclusion
Participation in supervised exercise improved aerobic endurance, physical performance, and health-related clinical factors in older veterans with PTSD; a medically complex population with multiple morbidity. Group exercise is a low-cost, low-stigma intervention, and implementation efforts among older veterans with PTSD warrants further consideration.
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Hall KS, Morey MC, Beckham JC, Bosworth HB, Sloane R, Pieper CF, Pebole MM. Warrior Wellness: A Randomized Controlled Pilot Trial of the Effects of Exercise on Physical Function and Clinical Health Risk Factors in Older Military Veterans With PTSD. J Gerontol A Biol Sci Med Sci 2020; 75:2130-2138. [PMID: 31646339 DOI: 10.1093/gerona/glz255] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Military veterans living with post-traumatic stress disorder (PTSD) face significant physical and functional health disparities, which are often aggravated over time and in the context aging. Evidence has shown that physical activity can positively impact age-related health conditions, yet exercise trials in older adults with mental disorders are rare. Our study was a tailored and targeted pilot exercise intervention for older veterans with PTSD. METHODS Fifty-four older veterans with PTSD (mean age = 67.4 years, 90.7% male, 85.2% non-white) were randomized to supervised exercise (n = 38) or wait-list usual care (n = 18) for 12 weeks. Physical activity (MET-min/wk) and aerobic endurance (assessed with the 6-minute walk test) were primary outcomes. Secondary outcomes were physical performance (strength, mobility, balance), cardiometabolic risk factors (eg, waist circumference), and health-related quality of life. RESULTS At 12 weeks, a large effect of the intervention on physical activity levels (Cohen's d = 1.37) was observed compared to wait-list usual care. Aerobic endurance improved by 69 m in the exercise group compared to 10 m in wait-list group, reflecting a moderate between-group effect (Cohen's d = 0.50). Between-group differences on 12-week changes in physical performance, cardiometabolic risk factors, and health-related quality of life ranged from small to large effects (Cohen's d = 0.28-1.48), favoring the exercise arm. CONCLUSION Participation in supervised exercise improved aerobic endurance, physical performance, and health-related clinical factors in older veterans with PTSD; a medically complex population with multiple morbidity. Group exercise is a low-cost, low-stigma intervention, and implementation efforts among older veterans with PTSD warrants further consideration.
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Pepin MJ, Valencia WM, Bettger JP, Pearson M, Manning KM, Sloane R, Schmader KE, Morey MC. Impact of Supervised Exercise on One-Year Medication Use in Older Veterans with Multiple Morbidities. Gerontol Geriatr Med 2020; 6:2333721420956751. [PMID: 32995368 PMCID: PMC7503003 DOI: 10.1177/2333721420956751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 08/14/2020] [Indexed: 11/16/2022] Open
Abstract
Exercise is touted as the ideal prescription to treat and prevent many chronic diseases. We examined changes in utilization and cost of medication classes commonly prescribed in the management of chronic conditions following participation in 12-months of supervised exercise within the Veterans Affairs Gerofit program. Gerofit enrolled 480 veterans between 1999 and 2017 with 12-months participation, with 453 having one or more active prescriptions on enrollment. Active prescriptions overall and for five classes of medications were examined. Changes from enrollment to 12 months were calculated, and cost associated with prescriptions filled were used to estimate net cost changes. Active prescriptions were reduced for opioids (77 of 164, 47%), mental health (93 of 221, 42%), cardiac (175 of 391, 45%), diabetes (41 of 166, 25%), and lipid lowering (56 of 253, 22%) agents. Cost estimates resulted in a net savings of $38,400. These findings support the role of supervised exercise as a favorable therapeutic intervention that has impact across chronic conditions.
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Oyedeji CI, Hall K, Luciano A, Morey MC, Strouse JJ. Geriatric assessment for older adults with sickle cell disease: protocol for a prospective cohort pilot study. Pilot Feasibility Stud 2020; 6:131. [PMID: 32974042 PMCID: PMC7495855 DOI: 10.1186/s40814-020-00673-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 09/01/2020] [Indexed: 11/20/2022] Open
Abstract
Background The life expectancy for people with sickle cell disease (SCD) has improved tremendously over the last 50 years. This population experiences hemolysis and vaso-occlusion in multiple organs that lead to complications such as cardiopulmonary disease, strokes, and avascular necrosis. These complications can limit mobility and aerobic endurance, similar to limitations that often occur in geriatric populations. These sickle-cell and age-related events lead to frequent hospitalization, which further increases the risk of functional decline. We have few tools to measure functional decline in people with SCD. The purpose of this paper is to describe a protocol to evaluate the feasibility of sickle cell disease geriatric assessment (SCD-GA). Methods/design We will enroll 40 adults with SCD (20 age 18–49.99 years and 20 age ≥ 50 years) in a prospective cohort study to assess the feasibility of SCD-GA. The SCD-GA includes validated measures from the oncology geriatric assessment enriched with additional physical and cognitive measures. The SCD-GA will be performed at the first study visit, at 10 to 20 days after hospitalization, and at 12 months (exit visit). With input from a multidisciplinary team of sickle cell specialists, geriatricians, and experts in physical function and physical activity, we selected assessments across 7 domains: functional status (11 measures), comorbid medical conditions (1 measure), psychological state (1 measure), social support (2 measures), weight status (2 measures), cognition (3 measures), and medications (1 measure). We will measure the proportion completing the assessment with feasibility as the primary outcome. Secondary outcomes include the proportion consenting and completing all study visits, duration of the assessment, acceptability, and adverse events. Discussion We present the protocol and rationale for selection of the measures included in SCD-GA. We also outline the methods to determine feasibility and subsequently to optimize the SCD-GA in preparation for a larger multicenter validation study of the SCD-GA.
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Manning KM, McNeill DL, Pinheiro SO, Heflin MT, Valencia WM, Lee CC, Castle SC, Katzel L, Giffuni J, Morey MC. An innovative educational clinical experience promoting geriatric exercise. GERONTOLOGY & GERIATRICS EDUCATION 2020; 41:20-31. [PMID: 29028419 DOI: 10.1080/02701960.2017.1391802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Formal educational training in physical activity promotion is relatively sparse throughout the medical education system. The authors describe an innovative clinical experience in physical activity directed at medical clinicians on a geriatrics rotation. The experience consists of a single 2 1/2 hour session, in which learners are partnered with geriatric patients engaged in a formal supervised exercise program. The learners are guided through an evidence-based exercise regimen tailored to functional status. This experience provides learners with an opportunity to interact with geriatric patients outside the hospital environment to counterbalance the typical geriatric rotation in which geriatric patients are often seen in clinics or hospitals. In this experience, learners are exposed to fit and engaged geriatric patients successfully living in the community despite chronic or disabling conditions. A survey of 105 learners highlighted positive responses to the experience, with 96% of survey respondents indicating that the experience increased their confidence in their ability to serve as advocates for physical activity for older adults, and 89.5% of responders to a follow-up survey indicating that the experience changed their perception of geriatric patients. Modifications to the experience, implemented at partnering facilities are described. The positive feedback from this experience warrants consideration for implementation in other settings.
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Jennings SC, Manning KM, Bettger JP, Hall KM, Pearson M, Mateas C, Briggs BC, Oursler KK, Blanchard E, Lee CC, Castle S, Valencia WM, Katzel LI, Giffuni J, Kopp T, McDonald M, Harris R, Bean JF, Althuis K, Alexander NB, Padala KP, Abbate LM, Wellington T, Kostra J, Allsup K, Forman DE, Tayade AS, Wesley AD, Holder A, Morey MC. Rapid Transition to Telehealth Group Exercise and Functional Assessments in Response to COVID-19. Gerontol Geriatr Med 2020; 6:2333721420980313. [PMID: 33403222 PMCID: PMC7739082 DOI: 10.1177/2333721420980313] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/08/2020] [Accepted: 11/12/2020] [Indexed: 12/25/2022] Open
Abstract
Exercise is critical for health maintenance in late life. The COVID-19 shelter in place and social distancing orders resulted in wide-scale interruptions of exercise therapies, placing older adults at risk for the consequences of decreased mobilization. The purpose of this paper is to describe rapid transition of the Gerofit facility-based group exercise program to telehealth delivery. This Gerofit-to-Home (GTH) program continued with group-based synchronous exercise classes that ranged from 1 to 24 Veterans per class and 1 to 9 classes offered per week in the different locations. Three hundred and eight of 1149 (27%) Veterans active in the Gerofit facility-based programs made the transition to the telehealth delivered classes. Participants' physical performance testing continued remotely as scheduled with comparisons between most recent facility-based and remote testing suggesting that participants retained physical function. Detailed protocols for remote physical performance testing and sample exercise routines are described. Translation to remote delivery of exercise programs for older adults could mitigate negative health effects.
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Parker D, Sloane R, Pieper CF, Hall KS, Kraus VB, Kraus WE, Huebner JL, Ilkayeva OR, Bain JR, Newby LK, Cohen HJ, Morey MC. Age-Related Adverse Inflammatory and Metabolic Changes Begin Early in Adulthood. J Gerontol A Biol Sci Med Sci 2019; 74:283-289. [PMID: 29985987 DOI: 10.1093/gerona/gly121] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Indexed: 12/16/2022] Open
Abstract
Aging is characterized by deleterious immune and metabolic changes, but the onset of these changes is unknown. We measured immune and metabolic biomarkers in adults beginning at age 30. To our knowledge, this is the first study to evaluate these biomarkers in adults aged 30 to over 80. Biomarkers were quantified in 961 adults. Tumor necrosis factor alpha (TNF-α), tumor necrosis factor receptor I (TNFR-I), tumor necrosis factor receptor II (TNFR-II), interleukin (IL)-2, IL-6, VCAM-I, D-Dimer, G-CSF, regulated on activation, normal T cell expressed and secreted (RANTES), matrix metalloproteinase-3 (MMP-3), adiponectin, and paraoxonase activity were measured by ELISA. Acylcarnitines and amino acids (AAs) were measured by mass spectrometry and reduced to a single factor using principal components analysis (PCA). Glycine was analyzed separately. The relationship between age and biomarkers was analyzed by linear regression with sex, race, and body mass index (BMI) as covariates. Age was positively correlated with TNF-α, TNFR-I, TNFR-II, IL-6, IL-2, VCAM-1, D-Dimer, MMP-3, adiponectin, acylcarnitines, and AAs. Age was negative correlated with G-CSF, RANTES, and paraoxonase activity. BMI was significant for all biomarkers except IL-2, VCAM-1, RANTES, paraoxonase activity, and the AA factor. Excluding MMP-3, greater BMI was associated with potentially adverse changes in biomarker concentrations. Age-related changes in immune and metabolic biomarkers, known to be associated with poor outcomes in older adults, begin as early as the thirties.
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Addison O, Serra MC, Katzel L, Giffuni J, Lee CC, Castle S, Valencia WM, Kopp T, Cammarata H, McDonald M, Oursler KA, Jain C, Bettger JP, Pearson M, Manning KM, Intrator O, Veazie P, Sloane R, Li J, Morey MC. Mobility Improvements are Found in Older Veterans After 6-Months of Gerofit Regardless of BMI Classification. J Aging Phys Act 2019; 27:848-854. [PMID: 31170861 PMCID: PMC7184640 DOI: 10.1123/japa.2018-0317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Veterans represent a unique population of older adults as they are more likely to self-report disability and be overweight or obese compared to the general population. We sought to compare changes in mobility function across the obesity spectrum in older Veterans participating in six-months of Gerofit, a clinical exercise program. 270 Veterans completed baseline, three, and six-month functional assessment and were divided post-hoc into groups: normal weight, overweight, and obese. Physical function assessment included: ten-meter walk time, six-minute walk distance, 30-second chair stands, and eight-foot up-and-go time. No significant weight x time interactions were found for any measure. However, significant (P<0.02) improvements were found for all mobility measures from baseline to three-months and maintained at six-months. Six-months of participation in Gerofit, if enacted nationwide, appears to be one way to improve mobility and function in older Veterans at high risk for disability regardless of weight status.
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Pavon JM, Sloane RJ, Pieper CF, Colón-Emeric CS, Cohen HJ, Gallagher D, Hall KS, Morey MC, McCarty M, Hastings SN. Accelerometer-Measured Hospital Physical Activity and Hospital-Acquired Disability in Older Adults. J Am Geriatr Soc 2019; 68:261-265. [PMID: 31747050 DOI: 10.1111/jgs.16231] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 09/16/2019] [Accepted: 09/20/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Hospital-acquired disability (HAD) is common and often related to low physical activity while in the hospital. OBJECTIVE To examine whether wearable hospital activity trackers can be used to predict HAD. DESIGN A prospective observational study between January 2016 and March 2017. SETTING An academic medical center. PARTICIPANTS Community-dwelling older adults, aged 60 years or older, enrolled within 24 hours of admission to general medicine (n = 46). MAIN MEASURES Primary outcome was HAD, defined as having one or more new activity of daily living deficits, decline of four or greater on the Late-Life Function and Disability Instrument (calculated between baseline and discharge), or discharge to a skilled nursing facility. Hospital activity (mean active time, mean sedentary time, and mean step counts per day) was measured using ankle-mounted accelerometers. The association of the literature-based threshold of 900 steps/day with HAD was also evaluated. RESULTS Mean age was 73.2 years (SD = 9.5 years), 48% were male, and 76% were white. Median length of stay was 4 days (interquartile range [IQR] = 2.0-6.0 days); 61% (n = 28) reported being able to walk without assistance of another person or walking aid at baseline. Median daily activity time and step counts were 1.1 h/d (IQR = 0.7-1.7 h/d) and 1455.7 steps/day (IQR = 908.5-2643 steps/day), respectively. Those with HAD (41%; n = 19) had lower activity time (0.8 vs 1.4 h/d; P = .04) and fewer step counts (1186 vs 1808 steps/day; P = .04), but no difference in sedentary time, compared to those without HAD. The 900 steps/day threshold had poor sensitivity (40%) and high specificity (85%) for detecting HAD. CONCLUSIONS Low hospital physical activity, as measured by wearable accelerometers, is associated with HAD. Clinicians can utilize wearable technology data to refer patients to physical/occupational therapy services or other mobility interventions, like walking programs. J Am Geriatr Soc 68:261-265, 2020.
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lowder YP, Romero K, Ren Y, Pastva AM, Morey MC, Cohen HJ, Chao NJ, Sung AD. GERIATRIC ASSESSMENT BEFORE HEMATOPOIETIC STEM CELL TRANSPLANT IDENTIFIES DEFICITS ACROSS ALL AGES. Innov Aging 2019. [PMCID: PMC6840211 DOI: 10.1093/geroni/igz038.1723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Allogeneic hematopoietic stem cell transplant (HCT) is a lifesaving procedure; however, it is associated with significant morbidity, and treatment-related mortality ranges from 10-30%. Morbidity and mortality have been associated with poor functional status. The geriatric assessment (GA) may allow identification of deficits pre-HCT, allowing intervention and improvement. While focused on older adults, we hypothesize that GA may also identify deficits in younger patients who may be debilitated by chemotherapy or cancer before HCT. We performed a GA in all adult patients at the time of initial evaluation for HCT (between 10/1/17-1/31/19) and again immediately before HCT. Deficits were identified and patients referred to specialists (physical therapy, neuropsychology, etc.) prior to HCT. Among 83 patients, the median age was 58 years (age range: 19-75), 59 (71%) had ≥1 deficits, including 41 (49%) had ≥2 deficits that required referral. The most common deficit was physical function (45, 54%), followed by cognitive function (29, 35%), nutrition (26, 31%), and mental health (7, 8%). Deficits were common across all age groups: 9/16 (56%) 60 years old. To date, 40 patients have undergone HCT; of the 24 with deficits at initial evaluation, 10 (42%) improved at least one deficit, 5 (21%) were unchanged, and 9 (38%) not evaluated. Physical and nutrition deficits were most responsive to intervention. These results suggest that there is a high degree of impairment prior to HCT among both older and younger patients; however, these deficits are amenable to improvement prior to HCT.
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Jarvis L, Peterson MJ, Morey MC, Caves K. VALIDATION OF A WALKING SPEED MEASUREMENT DEVICE: GAITBOX. Innov Aging 2019. [PMCID: PMC6840069 DOI: 10.1093/geroni/igz038.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The NIH 4m Walk Test is a clinically validated tool to measure adult walking speed. Human reaction limitations can contribute to measurement error when manually timing gait speed. This is important considering a 0.10m/s decrease in walking speed is associated with a 12% decrease in life expectancy for older adults. The goal of this study was to validate a low cost, custom built device, Gait Box (GB), compared to human timer (HT) and a research grade Sprint Timing System (STS) with an older adult (mean 72.4 + 7.4 years of age) population (N = 35). Validity was assessed via accuracy (correlations), precision (mean differences), and bias (Bland-Altman plots). Results showed strong correlations between the GB and HT (0.99) and the GB and STS (0.98), with negligible mean differences. This demonstrates the GB can be used to accurately and precisely measure gait speed in clinical and research settings.
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Hall KS, Morey MC, Bosworth H, Beckham J, Pebole M. EVALUATING THE ASSOCIATION BETWEEN SLEEP AND MEMORY IN OLDER VETERANS WITH PTSD. Innov Aging 2019. [PMCID: PMC6840043 DOI: 10.1093/geroni/igz038.1000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Sleep disturbances are core symptoms of posttraumatic stress disorder (PTSD), and recent studies also suggest a link between PTSD and cognitive impairment. There is some evidence of an association between sleep disturbances and cognitive abilities, such as memory, though few studies have focused on older adults and fewer still among those with mental health conditions. This study examined the association between subjective memory complaints and sleep (quality and quantity) in older veterans with PTSD. Fifty-four veterans with PTSD (M age=67.4, 85.2% African American, 90.7% men) participated in the study. Sleep was assessed using the Pittsburgh Sleep Quality Inventory (PSQI) and the PSQI Addendum for PTSD (PSQI-A). Memory was assessed using the Frequency of Forgetting Scale (FOF) derived from the Memory Functioning Questionnaire. The relationship between sleep quality parameters and FOF were examined using bivariate correlations and independent samples t test. Over 60% of participants met military-specific criteria for poor sleep (PSQI≥10; PSQI-A>5). Overall sleep quality on the PSQI-A was significantly associated with worse memory (r=-0.38, p<.01). Among specific sleep parameters (e.g., sleep latency, sleep duration), greater daytime dysfunction due to sleepiness was significantly associated with worse memory (r=-0.44, p<.01). Between-group analyses comparing memory complaints across participants classified as ‘poor’ versus ‘good’ sleepers on the PSQI-A approached significance (t(52)=1.93, p=.06). This study suggests that poor sleep may be a correlate of memory complaints among older adults with PTSD. Future studies are needed to determine whether poor sleep is an underlying factor in the link between PTSD and cognitive impairment.
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Abbate LM, Hall K, Pearson M, Sloane R, Allen KD, Kohrt WM, Morey MC. THE IMPACT OF 3 MONTHS OF SUPERVISED EXERCISE ON CHANGE IN FUNCTION: COMPARISONS BY ARTHRITIS STATUS. Innov Aging 2019. [PMCID: PMC6840462 DOI: 10.1093/geroni/igz038.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Physical activity is an established intervention for the management of arthritis. This study evaluated the effect of 3 months of participation in Gerofit on physical function by arthritis status. Participants, 519 Veterans aged ≥ 65 years self-reported either no arthritis (NA) (49%), upper body arthritis (UB) (8.2%), lower body arthritis (LB) (12.7%), or both upper and lower body arthritis (UB&LB) (30.4%) upon enrollment. Physical function measures [10-meter usual gait speed (m/s) (GS), arm curls (AC), chair stands (CS), and 6-minute walk (yards) (SMW)] were assessed at baseline and follow-up. Mean differences between time points were calculated. At baseline, compared to NA, LB and UB&LB had slower GS (1.10 and 1.06 vs 1.13) and shorter SMW distance (468.8 and 448.8 vs 490.7). All groups tended to increase physical function, with greatest improvement among LB (GS=0.27, AC=2.06, CS=2.52, SMW=42.53). Participation in Gerofit is associated with functional gains, regardless of burden of disease.
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Jennings SC, Manning K, Massey O, Bettger JP, Brown CS, Morey MC. MODERNIZING EXERCISE WITH TELE-VIDEO TO REACH A RURAL GERIATRIC POPULATION OF VETERANS. Innov Aging 2019. [PMCID: PMC6841206 DOI: 10.1093/geroni/igz038.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Rural Veterans often lack access to health care. Veterans Affairs (VA) supports telehealth technologies to provide services remotely that are comparable to onsite in-person care. We piloted VA Video Connect (VVC), to deliver an interactive exercise program for Veterans modeled on the VA Gerofit Program, a successful facility-based exercise program. VVC connects an exercise physiologist directly to the home with smart devices. Invitations to join Gerofit were mailed to 216 rural Veterans. Of 17 respondents, 7 (mean age 68) agreed to VVC tele-exercise 1x week for 12 weeks. Two Veterans were lost to follow-up prior to enrollment. Baseline VVC assessments (N=5) were indicative of high functional impairment in comparison to age-based norms: 2-minute step test (67.2 steps, 5th%tile), 30-second chair stands (12.4 stands, 26th%tile), and 30-second arm curls (15.3 curls, 25th%tile). Feasibility, barriers, and program impact will be discussed. Functional impairment indicates need for telehealth to reach Rural Veterans.
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