Leveraging Citizen Science for Healthier Food Environments: A Pilot Study to Evaluate Corner Stores in Camden, New Jersey

Over the last 6 years, a coordinated “healthy corner store” network has helped an increasing number of local storeowners stock healthy, affordable foods in Camden, New Jersey, a city with high rates of poverty and unemployment, and where most residents have little or no access to large food retailers. The initiative’s funders and stakeholders wanted to directly engage Camden residents in evaluating this effort to increase healthy food access. In a departure from traditional survey- or focus group-based evaluations, we used an evidence-based community-engaged citizen science research model (called Our Voice) that has been deployed in a variety of neighborhood settings to assess how different features of the built environment both affect community health and wellbeing, and empower participants to create change. Employing the Our Voice model, participants documented neighborhood features in and around Camden corner stores through geo-located photos and audio narratives. Eight adult participants who lived and/or worked in a predefined neighborhood of Camden were recruited by convenience sample and visited two corner stores participating in the healthy corner store initiative (one highly-engaged in the initiative and the other less-engaged), as well as an optional third corner store of their choosing. Facilitators then helped participants use their collected data (in total, 134 images and 96 audio recordings) to identify and prioritize issues as a group, and brainstorm and advocate for potential solutions. Three priority themes were selected by participants from the full theme list (n = 9) based on perceived importance and feasibility: healthy product selection and display, store environment, and store outdoor appearance and cleanliness. Participants devised and presented a set of action steps to community leaders, and stakeholders have begun to incorporate these ideas into plans for the future of the healthy corner store network. Key elements of healthy corner stores were identified as positive, and other priorities, such as improvements to safety, exterior facades, and physical accessibility, may find common ground with other community development initiatives in Camden. Ultimately, this pilot study demonstrated the potential of citizen science to provide a systematic and data-driven process for public health stakeholders to authentically engage community residents in program evaluation.

Effect of Physical Activity on Frailty: Secondary Analysis of a Randomized Controlled Trial

BACKGROUND

Limited evidence suggests that physical activity may prevent frailty and associated negative outcomes in older adults. Definitive data from large long-term randomized trials are lacking.

OBJECTIVE

To determine whether a long-term, structured, moderate-intensity physical activity program is associated with a lower risk for frailty and whether frailty status alters the effect of physical activity on the reduction in major mobility disability (MMD) risk.

DESIGN

Multicenter, single-blind, randomized trial.

SETTING

8 centers in the United States.

PARTICIPANTS

1635 community-dwelling adults, aged 70 to 89 years, with functional limitations.

INTERVENTION

A structured, moderate-intensity physical activity program incorporating aerobic, resistance, and flexibility activities or a health education program consisting of workshops and stretching exercises.

MEASUREMENTS

Frailty, as defined by the SOF (Study of Osteoporotic Fractures) index, at baseline and 6, 12, and 24 months, and MMD, defined as the inability to walk 400 m, for up to 3.5 years.

RESULTS

Over 24 months of follow-up, the risk for frailty (n = 1623) was not statistically significantly different in the physical activity versus the health education group (adjusted prevalence difference, -0.021 [95% CI, -0.049 to 0.007]). Among the 3 criteria of the SOF index, the physical activity intervention was associated with improvement in the inability to rise from a chair (adjusted prevalence difference, -0.050 [CI, -0.081 to -0.020]). Baseline frailty status did not modify the effect of physical activity on reducing incident MMD (P for interaction = 0.91).

LIMITATION

Frailty status was neither an entry criterion nor a randomization stratum.

CONCLUSION

A structured, moderate-intensity physical activity program was not associated with a reduced risk for frailty over 2 years among sedentary, community-dwelling older adults. The beneficial effect of physical activity on the incidence of MMD did not differ between frail and nonfrail participants.

PRIMARY FUNDING SOURCE

National Institute on Aging, National Institutes of Health.

Effect of Low-Fat vs Low-Carbohydrate Diet on 12-Month Weight Loss in Overweight Adults and the Association With Genotype Pattern or Insulin Secretion: The DIETFITS Randomized Clinical Trial

IMPORTANCE

Dietary modification remains key to successful weight loss. Yet, no one dietary strategy is consistently superior to others for the general population. Previous research suggests genotype or insulin-glucose dynamics may modify the effects of diets.

OBJECTIVE

To determine the effect of a healthy low-fat (HLF) diet vs a healthy low-carbohydrate (HLC) diet on weight change and if genotype pattern or insulin secretion are related to the dietary effects on weight loss.

DESIGN, SETTING, AND PARTICIPANTS

The Diet Intervention Examining The Factors Interacting with Treatment Success (DIETFITS) randomized clinical trial included 609 adults aged 18 to 50 years without diabetes with a body mass index between 28 and 40. The trial enrollment was from January 29, 2013, through April 14, 2015; the date of final follow-up was May 16, 2016. Participants were randomized to the 12-month HLF or HLC diet. The study also tested whether 3 single-nucleotide polymorphism multilocus genotype responsiveness patterns or insulin secretion (INS-30; blood concentration of insulin 30 minutes after a glucose challenge) were associated with weight loss.

INTERVENTIONS

Health educators delivered the behavior modification intervention to HLF (n = 305) and HLC (n = 304) participants via 22 diet-specific small group sessions administered over 12 months. The sessions focused on ways to achieve the lowest fat or carbohydrate intake that could be maintained long-term and emphasized diet quality.

MAIN OUTCOMES AND MEASURES

Primary outcome was 12-month weight change and determination of whether there were significant interactions among diet type and genotype pattern, diet and insulin secretion, and diet and weight loss.

RESULTS

Among 609 participants randomized (mean age, 40 [SD, 7] years; 57% women; mean body mass index, 33 [SD, 3]; 244 [40%] had a low-fat genotype; 180 [30%] had a low-carbohydrate genotype; mean baseline INS-30, 93 μIU/mL), 481 (79%) completed the trial. In the HLF vs HLC diets, respectively, the mean 12-month macronutrient distributions were 48% vs 30% for carbohydrates, 29% vs 45% for fat, and 21% vs 23% for protein. Weight change at 12 months was -5.3 kg for the HLF diet vs -6.0 kg for the HLC diet (mean between-group difference, 0.7 kg [95% CI, -0.2 to 1.6 kg]). There was no significant diet-genotype pattern interaction (P = .20) or diet-insulin secretion (INS-30) interaction (P = .47) with 12-month weight loss. There were 18 adverse events or serious adverse events that were evenly distributed across the 2 diet groups.

CONCLUSIONS AND RELEVANCE

In this 12-month weight loss diet study, there was no significant difference in weight change between a healthy low-fat diet vs a healthy low-carbohydrate diet, and neither genotype pattern nor baseline insulin secretion was associated with the dietary effects on weight loss. In the context of these 2 common weight loss diet approaches, neither of the 2 hypothesized predisposing factors was helpful in identifying which diet was better for whom.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT01826591.

Effects of a Long-Term Physical Activity Program on Activity Patterns in Older Adults

PURPOSE

To examine the effect of a long-term structured physical activity (PA) intervention on accelerometer-derived metrics of activity pattern changes in mobility-impaired older adults.

METHODS

Participants were randomized to either a PA or health education (HE) program. The PA intervention included a walking regimen with strength, flexibility, and balance training. The HE program featured health-related discussions and a brief upper body stretching routine. Participants (n = 1341) wore a hip-worn accelerometer for ≥10 h·d for ≥3 d at baseline and again at 6, 12, and 24 months postrandomization. Total PA (TPA)-defined as movements registering 100+ counts per minute-was segmented into the following intensities: low-light PA (LLPA; 100-759 counts per minute), high light PA (HLPA; 760-1040 counts per minute), low moderate PA (LMPA; 1041-2019 counts per minute), and high moderate and greater PA (HMPA; 2020+ counts per minute). Patterns of activity were characterized as bouts (defined as the consecutive minutes within an intensity).

RESULTS

Across groups, TPA decreased an average of 74 min·wk annually. The PA intervention attenuated this effect (PA = -68 vs HE: -112 min·wk, P = 0.002). This attenuation shifted TPA composition by increasing time in LLPA (10+ bouts increased 6 min·wk), HLPA (1+, 2+, 5+, and 10+ bouts increased 6, 3, 2, and 1 min·wk, respectively), LMPA (1+, 2+, 5+, and 10+ bouts increased: 19, 17,16, and 8 min·wk, respectively), and HMPA (1+, 2+, 5+, and 10+ bouts increased 23, 21, 17, and 14 min·wk, respectively).

CONCLUSIONS

The PA intervention increased PA by shifting the composition of activity toward higher-intensity activity in longer-duration bouts. However, a long-term structured PA intervention did not completely eliminate overall declines in total daily activity experienced by mobility-impaired older adults.

Association of Accelerometry-Measured Physical Activity and Cardiovascular Events in Mobility-Limited Older Adults: The LIFE (Lifestyle Interventions and Independence for Elders) Study

Background

Data are sparse regarding the value of physical activity (PA) surveillance among older adults—particularly among those with mobility limitations. The objective of this study was to examine longitudinal associations between objectively measured daily PA and the incidence of cardiovascular events among older adults in the LIFE (Lifestyle Interventions and Independence for Elders) study.

Methods and Results

Cardiovascular events were adjudicated based on medical records review, and cardiovascular risk factors were controlled for in the analysis. Home‐based activity data were collected by hip‐worn accelerometers at baseline and at 6, 12, and 24 months postrandomization to either a physical activity or health education intervention. LIFE study participants (n=1590; age 78.9±5.2 [SD] years; 67.2% women) at baseline had an 11% lower incidence of experiencing a subsequent cardiovascular event per 500 steps taken per day based on activity data (hazard ratio, 0.89; 95% confidence interval, 0.84–0.96; P=0.001). At baseline, every 30 minutes spent performing activities ≥500 counts per minute (hazard ratio, 0.75; confidence interval, 0.65–0.89 [P=0.001]) were also associated with a lower incidence of cardiovascular events. Throughout follow‐up (6, 12, and 24 months), both the number of steps per day (per 500 steps; hazard ratio, 0.90, confidence interval, 0.85–0.96 [P=0.001]) and duration of activity ≥500 counts per minute (per 30 minutes; hazard ratio, 0.76; confidence interval, 0.63–0.90 [P=0.002]) were significantly associated with lower cardiovascular event rates.

Conclusions

Objective measurements of physical activity via accelerometry were associated with cardiovascular events among older adults with limited mobility (summary score >10 on the Short Physical Performance Battery) both using baseline and longitudinal data.

Clinical Trial Registration

URL: http://www.clinicaltrials.gov. Unique identifier: NCT01072500.

Cognitive Performance Does not Limit Physical Activity Participation in the Lifestyle Interventions and Independence for Elders Pilot Study (LIFE-P)

OBJECTIVES

We examined whether multiple domains of baseline cognitive performance were associated with prospective physical activity (PA) adherence in the Lifestyle Interventions and Independence for Elders Pilot study (LIFE-P).

DESIGN, SETTING, PARTICIPANTS

The LIFE-P study was a single-blind, multicenter, randomized controlled trial of a PA intervention compared to a successful aging educational intervention in sedentary, mobility-limited older adults.

INTERVENTION

A 12-month structured, moderate-intensity, multi-modal PA program that included walking, resistance training, and flexibility exercises. For the first 2 months (adoption), 3 center-based exercise sessions (40-60 min) / week were conducted. During the next 4 months (transition), center-based sessions were conducted 2 times / week. The subsequent maintenance phase consisted of optional once-to-twice-per-week center-based sessions and home-based PA.

MEASUREMENTS

Tests of executive and global cognitive functioning, working memory and psychomotor speed were administered at baseline. Median test scores were used to dichotomize participants into low or high cognitive performance groups.

RESULTS

52 mobility-limited older adults (age: 76.9 ±5 yrs) were randomized to the PA arm of LIFE-P. Compared to participants with high cognitive performance, participants with low performance had similar PA adherence rates (all P ≥ 0.34). Furthermore, weak and non-significant univariate relationships were elicited between all measures of cognition and overall PA adherence levels (r values ranged: -0.20 to 0.12, P ≥ 0.12).

CONCLUSION

These data suggest that cognitive performance does not limit long-term PA adherence in mobility-limited older adults. Additional studies in larger cohorts are warranted to verify these findings.

Distance mentoring of health researchers: Three case studies across the career-development trajectory

Despite the crucial role of mentoring, little literature exists that addresses distance mentoring among health researchers. This article provides three case studies showcasing protégés at different stages of career development (one in graduate school, one as an early-stage researcher, and one as an established researcher). Each case study provides a brief history of the relationship, examines the benefits and challenges of working together at a distance, and discusses the lessons learned from both the mentor and the protégé over the course of these relationships. A mentoring model, examples of mentoring communications, and potential promising practices are also provided and discussed.

Testing the comparative effects of physical activity advice by humans vs. computers in underserved populations: The COMPASS trial design, methods, and baseline characteristics

While physical inactivity is a key risk factor for a range of chronic diseases and conditions associated with aging, a significant proportion of midlife and older adults remain insufficiently active. This is particularly true for ethnic minority populations such as Latino adults for whom few culturally adapted programs have been developed and tested. The major objective of this 12-month cluster-randomized controlled trial is to test the comparative effectiveness of two linguistically and culturally adapted, community-based physical activity interventions with the potential for broad reach and translation. Ten local community centers serving a sizable number of Latino residents were randomized to receive one of two physical activity interventions. The Virtual Advisor program employs a computer-based embodied conversational agent named "Carmen" to deliver interactive, individually tailored physical activity advice and support. A similar intervention program is delivered by trained Peer Advisors. The target population consists of generally healthy, insufficiently active Latino adults ages 50years and older living within proximity to a designated community center. The major outcomes are changes in walking and other forms of physical activity measured via self-report and accelerometry. Secondary outcomes include physical function and well-being variables. In addition to these outcome analyses, comparative cost analysis of the two programs, potential mediators of intervention success, and baseline moderators of intervention effects will be explored to better determine which subgroups do best with which type of intervention. Here we present the study design and methods, including recruitment strategies and yield as well as study baseline characteristics.

TRIAL REGISTRATION

clinicaltrial.gov Identifier=NCT02111213.

Citizen science applied to building healthier community environments: advancing the field through shared construct and measurement development

BACKGROUND

Physical inactivity across the lifespan remains a public health issue for many developed countries. Inactivity has contributed considerably to the pervasiveness of lifestyle diseases. Government, national and local agencies and organizations have been unable to systematically, and in a coordinated way, translate behavioral research into practice that makes a difference at a population level. One approach for mobilizing multi-level efforts to improve the environment for physical activity is to engage in a process of citizen science. Citizen Science here is defined as a participatory research approach involving members of the public working closely with research investigators to initiate and advance scientific research projects. However, there are no common measures or protocols to guide citizen science research at the local community setting.

OBJECTIVES

We describe overarching categories of constructs that can be considered when designing citizen science projects expected to yield multi-level interventions, and provide an example of the citizen science approach to promoting PA. We also recommend potential measures across different levels of impact.

DISCUSSION

Encouraging some consistency in measurement across studies will potentially accelerate the efficiency with which citizen science participatory research provides new insights into and solutions to the behaviorally-based public health issues that drive most of morbidity and mortality. The measures described in this paper abide by four fundamental principles specifically selected for inclusion in citizen science projects: feasibility, accuracy, propriety, and utility. The choice of measures will take into account the potential resources available for outcome and process evaluation. Our intent is to emphasize the importance for all citizen science participatory projects to follow an evidence-based approach and ensure that they incorporate an appropriate assessment protocol.

CONCLUSIONS

We provided the rationale for and a list of contextual factors along with specific examples of measures to encourage consistency among studies that plan to use a citizen science participatory approach. The potential of this approach to promote health and wellbeing in communities is high and we hope that we have provided the tools needed to optimally promote synergistic gains in knowledge across a range of Citizen Science participatory projects.

The built environment and older adults: A literature review and an applied approach to engaging older adults in built environment improvements for health

AIMS AND OBJECTIVES

This paper presents a review of the literature about the built environment as it impacts the health of older people. It then introduces the gerontological nurse and researcher to the Our Voice framework for engaging older people as citizen scientists in order to empower them as agents of change in improving their local built environment and ultimately advancing community health.

BACKGROUND

Community-level strategies to promote successful ageing in place are critical both to optimising health outcomes and containing healthcare costs. Such strategies must take into account the influence of the built environment both on individual health behaviours and on overall community health. At the same time, the perspectives and experiences of older people themselves ought to inform policies and practices in a systematic way.

DESIGN

Integrative literature review.

METHOD

A wide scan of English language articles published in the EMBASE, PubMed and CINAHL bibliographic databases was conducted. Additional articles were sourced by mining relevant reference lists (i.e., snowball sampling). Papers included were published between 2005 and 2016.

RESULTS

Three distinct components emerged from the review: the impact of the built environment on health-in particular the health of older persons; citizen science and its applicability for older people research; and the promise of the Our Voice citizen science framework to activate changes in the built environment that improve older peoples' health.

CONCLUSION

The ageing of the world's population brings with it an increased population-level risk of chronic disease and disability. We present the Our Voice framework, developed by researchers at Stanford University, as a promising strategy for engaging and empowering older people as citizen scientists, as a framework to apply to gerontological nursing and improving community health.

IMPLICATIONS FOR PRACTICE

Gerontology nurses are encouraged to: (i) Recognise the impact of the built environment and other community-level factors on the health of their patients. (ii) Encourage older adults to take an active role in documenting features of their environments that promote or hinder healthy living. (iii) Support policies and programmes that promote healthy environments.

Dose of physical activity, physical functioning and disability risk in mobility-limited older adults: Results from the LIFE study randomized trial

Understanding the minimal dose of physical activity required to achieve improvement in physical functioning and reductions in disability risk is necessary to inform public health recommendations. To examine the effect of physical activity dose on changes in physical functioning and the onset of major mobility disability in The Lifestyle Interventions and Independence for Elders (LIFE) Study. We conducted a multicenter single masked randomized controlled trial that enrolled participants in 2010 and 2011 and followed them for an average of 2.6 years. 1,635 sedentary men and women aged 70-89 years who had functional limitations were randomized to a structured moderate intensity walking, resistance, and flexibility physical activity program or a health education program. Physical activity dose was assessed by 7-day accelerometry and self-report at baseline and 24 months. Outcomes included the 400 m walk gait speed, the Short Physical Performance Battery (SPPB), assessed at baseline, 6, 12, and 24 months, and onset of major mobility disability (objectively defined by loss of ability to walk 400 m in 15 min). When the physical activity arm or the entire sample were stratified by change in physical activity from baseline to 24 months, there was a dose-dependent increase in the change in gait speed and SPPB from baseline at 6, 12, and 24 months. In addition, the magnitude of change in physical activity over 24 months was related to the reduction in the onset of major mobility disability (overall P < 0.001) (highest versus the lowest quartile of physical activity change HR 0.23 ((95% CI:0.10-0.52) P = 0.001) in the physical activity arm. We observed a dose-dependent effect of objectively monitored physical activity on physical functioning and onset of major mobility disability. Relatively small increases (> 48 minutes per week) in regular physical activity participation had significant and clinically meaningful effects on these outcomes.

TRIAL REGISTRATION

ClinicalsTrials.gov NCT00116194.

Effects of Physical Activity Intervention on Physical and Cognitive Function in Sedentary Adults With and Without Diabetes

Background

Type 2 diabetes mellitus may alter the effect of physical activity on physical and cognitive function.

Methods

The Lifestyle Interventions and Independence for Elders (LIFE) trial randomized controlled clinical trial of physical activity intervention (walking, resistance training, and flexibility exercises) enrolled adults aged 70-89 years who were sedentary and non-demented and who had functional limitations. Standardized measures of physical and cognitive function were collected an average of 2 years post-randomization. Differences between the intervention and control groups from 415 individuals with diabetes and 1,061 individuals without diabetes were contrasted with analyses of covariance.

Results

At 24 months, assignment to the physical activity intervention resulted in 0.019 m/s relatively faster average 400-meter gait speeds (p = .007 overall) both for individuals with and without diabetes (intervention × diabetes interaction p = .99). No benefits were seen on scores from a physical performance battery. Performance on cognitive tests was better among participants assigned to the physical activity intervention compared with control only for those with diabetes, particularly for global cognitive function (p = .02) and delayed memory (p = .005), with mean [95% confidence intervals] for benefit from physical activity intervention of 0.114 [0.007,0.111] and 0.208 [0.030,0.387] standard deviations, respectively.

Conclusions

Physical activity intervention improved the gait speed of older, sedentary individuals with and without diabetes. The cognitive function benefits occurred among participants with, but not without, diabetes. The mechanisms through which physical activity affects physical and cognitive function in older adults may differ for individuals by diabetes status.

Device-Measured Physical Activity As a Predictor of Disability in Mobility-Limited Older Adults

OBJECTIVES

To examine associations between objectively measured physical activity (PA) and incidence of major mobility disability (MMD) and persistent MMD (PMMD) in older adults in the Lifestyle Interventions and Independence for Elders (LIFE) Study.

DESIGN

Prospective cohort of individuals aged 65 and older undergoing structured PA intervention or health education.

SETTING

The LIFE Study was a multicenter (eight sites) randomized controlled trial designed to compare the efficacy of a long-term structured PA intervention with that of a health education (HE) program in reducing the incidence of MMD in mobility-limited older adults.

PARTICIPANTS

LIFE Study participants (n = 1,590) had a mean age±standard deviation of 78.9 ± 5.2, low levels of PA, and measured mobility-relevant functional impairment at baseline.

MEASUREMENTS

Activity data were collected using hip-worn 7-day accelerometers at baseline and 6, 12, and 24 months after randomization to test for associations with incident MMD and PMMD (≥2 consecutive instances of MMD).

RESULTS

At baseline, every 30 minutes spent being sedentary (<100 accelerometry counts per minute) was associated with higher rate of subsequent MMD (10%) and PMMD (11%) events. Every 500 steps taken was associated with lower rate of MMD (15%) and PMMD (18%). Similar associations were observed when fitting accelerometry-based PA as a time-dependent variable.

CONCLUSION

Accelerometry-based PA levels were strongly associated with MMD and PMMD events in older adults with limited mobility. These results support the importance of daily PA and lower amounts of sedentary time levels in this population and suggest that accelerometry may be a useful tool for assessing risk of mobility disability.

Impacts of a Temporary Urban Pop-Up Park on Physical Activity and Other Individual- and Community-Level Outcomes

Physical inactivity is a known risk factor for obesity and a number of chronic diseases. Modifying the physical features of neighborhoods to provide residents with equitable and convenient access to spaces for physical activity (PA) is a promising strategy for promoting PA. Public urban recreation spaces (e.g., parks) play an important role in promoting PA and are potentially an important neighborhood element for optimizing social capital and liveability in cities. Most studies examining the effects of park availability and use on PA have focused on traditional, permanent parks. The aims of this study were to (1) document patterns of park use and park-based PA at a temporary urban pop-up park implemented in the downtown business district of Los Altos, California during July-August 2013 and May-June 2014, (2) identify factors associated with park-based PA in 2014, and (3) examine the effects of the 2014 pop-up park on additional outcomes of potential benefit for park users and the Los Altos community at large. Park use remained high during most hours of the day in 2013 and 2014. Although the park attracted a multigenerational group of users, children and adolescents were most likely to engage in walking or more vigorous PA at the park. Park presence was significantly associated with potentially beneficial changes in time-allocation patterns among users, including a reduction in screen-time and an increase in overall park-time and time spent outdoors. Park implementation resulted in notable use among people who would otherwise not be spending time at a park (85% of surveyed users would not be spending time at any other park if the pop-up park was not there-2014 data analysis). Our results (significantly higher odds of spending time in downtown Los Altos due to park presence) suggest that urban pop-up parks may also have broader community benefits, such as attracting people to visit downtown business districts. Pending larger, confirmatory studies, our results suggest that temporary urban pop-up parks may contribute to solving the limited access to public physical activity recreation spaces many urban residents face.

Hospitalizations During a Physical Activity Intervention in Older Adults at Risk of Mobility Disability: Analyses from the Lifestyle Interventions and Independence for Elders Randomized Clinical Trial

OBJECTIVES

To determine whether moderate-intensity physical activity (PA) and health education (HE) are differentially associated with categories of hospitalizations or subgroups of participants.

DESIGN

Multicenter randomized controlled trial in which participants were randomized to a PA or HE program for an average of 2.6 years.

SETTING

Eight field centers.

PARTICIPANTS

Sedentary men and women aged 70-89 with lower extremity physical limitations but able to walk 400-m in 15 minutes or less (N = 1,635).

INTERVENTIONS

Structured, moderate-intensity PA (n =  818) at a center (2×/wk) and at home (3-4×/wk) that included aerobic, strength, balance, and flexibility training or HE (n =  817) of educational workshops and upper extremity stretching exercises.

MEASUREMENTS

All-cause inpatient hospitalizations ascertained at 6-month intervals.

RESULTS

There were 1,458 hospitalizations (49.1% of PA, 44.4% of HE; risk difference = 4.68%, 95% confidence interval (CI) = -0.18-9.54; hazard ratio (HR) = 1.16, 95% CI = 1.00-1.34). The intervention effect on incident hospitalization did not differ according to race, sex, Short Physical Performance Battery score, age, or history of cardiovascular disease or diabetes mellitus. PA was associated with higher rates of hospitalization in the middle baseline gait speed category, than HE (<0.8 m/s: HR = 0.93, 95% CI = 0.76-1.14; 0.8-1.0 m/s: HR = 1.54, 95% CI = 1.23-1.94; >1.0 m/s: HR = 1.05, 95% CI = 0.67-1.65; interaction P = .005).

CONCLUSION

A PA program in older adults at risk for mobility disability did not lead to a different risk of specific types of hospitalizations than a HE program overall. Baseline gait speed may be a marker for risk of hospitalization during a PA intervention, because individuals with moderate baseline gait speed in the PA group had slightly higher rates of hospitalization than those in the HE group.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT01072500.

Large-scale physical activity data reveal worldwide activity inequality

To be able to curb the global pandemic of physical inactivity and the associated 5.3 million deaths per year, we need to understand the basic principles that govern physical activity. However, there is a lack of large-scale measurements of physical activity patterns across free-living populations worldwide. Here we leverage the wide usage of smartphones with built-in accelerometry to measure physical activity at the global scale. We study a dataset consisting of 68 million days of physical activity for 717,527 people, giving us a window into activity in 111 countries across the globe. We find inequality in how activity is distributed within countries and that this inequality is a better predictor of obesity prevalence in the population than average activity volume. Reduced activity in females contributes to a large portion of the observed activity inequality. Aspects of the built environment, such as the walkability of a city, are associated with a smaller gender gap in activity and lower activity inequality. In more walkable cities, activity is greater throughout the day and throughout the week, across age, gender, and body mass index (BMI) groups, with the greatest increases in activity found for females. Our findings have implications for global public health policy and urban planning and highlight the role of activity inequality and the built environment in improving physical activity and health.

Exploring the Objective and Perceived Environmental Attributes of Older Adults' Neighborhood Walking Routes: A Mixed Methods Analysis

Walking is a central form of physical activity among older adults that is associated with the physical environment at various scales. This mixed-methods study employs a concurrent nested design to explore objective and perceived environmental characteristics of older adults' local walking routes. This was achieved by integrating quantitative Geographic Information System (GIS) data with qualitative data obtained using the Stanford Discovery Tool (DT). Fifty-nine community-dwelling middle-aged and older adults (14 men and 45 women aged 50+) were recruited in a snowball approach through community centers in the city of Haifa (Israel). Four neighborhood environment themes were identified: pedestrian infrastructure, access to destinations, aesthetics, and environmental quality. Both geometrical traits (i.e., distance, slope) and urban features (i.e., land-uses, greenery) of the route may impact the experience of walking. The findings thus highlight the importance of micro-scale environmental elements in shaping environmental perceptions, which may consequently influence the choice of being active.

Developing and Validating an Abbreviated Version of the Microscale Audit for Pedestrian Streetscapes (MAPS-Abbreviated)

PURPOSE

Macroscale built environment factors (e.g., street connectivity) are correlated with physical activity. Less-studied but more modifiable microscale elements (e.g., sidewalks) may also influence physical activity, but shorter audit measures of microscale elements are needed to promote wider use. This study evaluated the relation of an abbreviated 54-item streetscape audit tool with multiple measures of physical activity in four age groups.

METHODS

We developed a 54-item version from the original 120-item Microscale Audit of Pedestrian Streetscapes (MAPS). Audits were conducted on 0.25-0.45 mile routes from participant residences toward the nearest nonresidential destination for children (N=758), adolescents (N=897), younger adults (N=1,655), and older adults (N=367). Active transport and leisure physical activity were measured with surveys, and objective physical activity was measured with accelerometers. Items to retain from original MAPS were selected primarily by correlations with physical activity. Mixed linear regression analyses were conducted for MAPS-Abbreviated summary scores, adjusting for demographics, participant clustering, and macroscale walkability.

RESULTS

MAPS-Abbreviated and original MAPS total scores correlated r=.94 The MAPS-Abbreviated tool was related similarly to physical activity outcomes as the original MAPS. Destinations and land use, streetscape and walking path characteristics, and overall total scores were significantly related to active transport in all age groups. Street crossing characteristics were related to active transport in children and older adults. Aesthetics and social characteristics were related to leisure physical activity in children and younger adults, and cul-de-sacs were related with physical activity in youth. Total scores were related to accelerometer-measured physical activity in children and older adults.

CONCLUSION

MAPS-Abbreviated is a validated observational measure for use in research. The length and related cost of implementation has been cited as a barrier to use of microscale instruments, so availability of this shorter validated measure could lead to more widespread use of streetscape audits in health research.

Effect of Physical Activity on Self-Reported Disability in Older Adults: Results from the LIFE Study

BACKGROUND/OBJECTIVES

To test the hypothesis that a long-term structured, moderate intensity physical activity (PA) program is more effective than a health education (HE) program in reducing the risk of s elf-reported dependency and disability in basic activities of daily living (BADLs), disability in instrumental ADLs (IADL), and mobility disability.

DESIGN

The Lifestyle Interventions and Independence for Elders (LIFE) study was a multicenter, single-blinded randomized trial.

SETTING

University-based research clinic.

PARTICIPANTS

Thousand six hundred and thirty five sedentary men and women aged 70-89 years, who had functional limitations, defined as a score ≤9 on the Short Physical Performance Battery.

INTERVENTION

Participants were randomized to a structured, moderate intensity PA program (n = 818) that included aerobic, resistance, and flexibility exercises or to a HE program (n = 817).

MEASUREMENTS

All outcomes were derived by self-report using periodic interviews that asked about the degree of difficulty and receipt of help during the past month. Dependency was defined as "receiving assistance" or "unable" to do ≥1 activities. Disability was defined as having "a lot of difficulty" or "unable" doing ≥1 activities. Severe disability was defined as reporting difficulty or being unable to perform ≥3 activities.

RESULTS

Over an average follow-up of 2.6 years, the cumulative incidence of BADL dependency was 15.2% among PA and 15.1% among HE participants (HR = 1.0, 95% CI = 0.78-0.1.3). Intervention groups had similar rates of incident BADL disability, IADL disability and reported mobility disability. Reporting severe mobility disability (HR = 0.78, 95% CI = 0.64-0.96) and ratings of difficulty on mobility tasks were reduced in the PA group.

CONCLUSION

A structured physical activity intervention reduces reported severe mobility disability and difficulty on mobility tasks, but not BADL and IADL disability in older adults with functional limitations.

Physical Activity in Older Adults: an Ecological Approach

BACKGROUND

Studies identifying correlates of physical activity (PA) at all levels of the ecological model can provide an empirical basis for designing interventions to increase older adults' PA.

PURPOSE

Applying ecological model principles, this study concurrently examined individual, psychosocial, and environmental correlates of older adults' PA to determine whether built environment factors contribute to PA over and above individual/demographic and psychosocial variables.

METHODS

Using a cross-sectional observational design, 726 adults, aged ≥66 years, were recruited from two US regions. Explanatory variables included demographics, self-efficacy, social support, barriers, and environmental variables measured by using geographic information systems (GIS) and self-report. Outcomes included reported walking for errands and leisure/exercise and accelerometer-measured daily moderate to vigorous PA (MVPA). Analyses employed mixed-model regressions with backward elimination.

RESULTS

For daily MVPA, the only significant environmental variable was GIS-based proximity to a park (p < 0.001) after controlling for individual/demographic and psychosocial factors. Walking for errands was positively related to four environmental variables: reported walking/cycling facilities (p < 0.05), GIS-based intersection density (p < 0.01), mixed land use (p < 0.01), and private recreation facilities (p < 0.01). Walking for leisure/exercise was negatively related to GIS-based mixed land use (p < 0.05). Non-Hispanic white race/ethnicity, self-efficacy, and social support positively related to all three PA outcomes (p < 0.05).

CONCLUSIONS

Correlates of older adults' PA were found at all ecological levels, supporting multiple levels of influence and need for multilevel interventions. Environmental correlates varied by PA outcome. Walking for errands exhibited the most environmental associations.

FEAST: Empowering Community Residents to Use Technology to Assess and Advocate for Healthy Food Environments

Creating environments that support healthy eating is important for successful aging, particularly in light of the growing population of older adults in the United States. There is an urgent need to identify innovative upstream solutions to barriers experienced by older adults in accessing and buying healthy food. FEAST (Food Environment Assessment STudy) is an effort that is part of the global Our Voice initiative, which utilizes a combination of technology and community-engaged methods to empower citizen scientists (i.e., community residents) to: (1) use the Healthy Neighborhood Discovery Tool (Discovery Tool) mobile application to collect data (geocoded photos, audio narratives) about aspects of their environment that facilitate or hinder healthy living; and (2) use findings to advocate for change in partnership with local decision and policy makers. In FEAST, 23 racially/ethnically diverse, low-income, and food-insecure older adults residing in urban, North San Mateo County, CA, were recruited to use the Discovery Tool to examine factors that facilitated or hindered their access to food as well as their food-related behaviors. Participants collectively reviewed data retrieved from the Discovery Tool and identified and prioritized important, yet feasible, issues to address. Access to affordable healthy food and transportation were identified as the major barriers to eating healthfully and navigating their neighborhood food environments. Subsequently, participants were trained in advocacy skills and shared their findings with relevant decision and policymakers, who in turn dispelled myths and discussed and shared resources to address relevant community needs. Proximal and distal effects of the community-engaged process at 3, 6, 12, and 24 months were documented and revealed individual-, community-, and policy-level impacts. Finally, FEAST contributes to the evidence on multi-level challenges that low-income, racially/ethnically diverse older adults experience when accessing, choosing and buying healthy foods.

Effect of Metabolic Syndrome on the Mobility Benefit of a Structured Physical Activity Intervention-The Lifestyle Interventions and Independence for Elders Randomized Clinical Trial

OBJECTIVES

To test whether structured physical activity (PA) is associated with a greater reduction in major mobility disability (MMD) in older persons with metabolic syndrome (MetS) than in those without.

DESIGN

Data from the Lifestyle Interventions and Independence for Elders (LIFE) Study, a multicenter randomized trial of 1,635 persons with assessments every 6 months (average 2.7 years).

SETTING

Eight U.S. centers.

PARTICIPANTS

Sedentary men and women aged 70 to 89 with functional limitations (N = 1,535); 100 participants were excluded because of missing MetS data.

INTERVENTION

Participants were randomized to a moderate-intensity PA program (n = 766) or a health education program (n = 769).

MEASUREMENTS

MetS was defined according to the 2009 multiagency harmonized criteria. Outcomes included incident MMD (loss of ability to walk 400 m) and persistent MMD (two consecutive MMD diagnoses or one MMD diagnosis followed by death).

RESULTS

Seven hundred sixty-three (49.7%) participants met criteria for MetS. PA reduced incident MMD more than health education did in participants with MetS (hazard ratio (HR) = 0.72, 95% confidence interval (CI) = 0.57-0.91, P = .007) but not in those without MetS (HR = 0.96, 95% CI = 0.73-1.25, P = .75); the test for statistical interaction was not significant (P = .13). PA reduced the risk of persistent MMD in participants with MetS (HR = 0.57, 95% CI = 0.41-0.79, P < .001) but not in those without MetS (HR = 0.97, 95% CI = 0.67-1.41, P = .87). The test for statistical interaction was significant (P = .04).

CONCLUSION

Moderate-intensity PA substantially reduces the risk of persistent MMD in older persons with functional limitations with MetS but not in those without MetS. Comparable results were observed for incident MMD. The LIFE PA program may be an effective strategy for reducing mobility disability in vulnerable older persons with MetS.

Preserving older adults' routine outdoor activities in contrasting neighborhood environments through a physical activity intervention

While neighborhood design can potentially influence routine outdoor physical activities (PA), little is known concerning its effects on such activities among older adults attempting to increase their PA levels. We evaluated the effects of living in neighborhoods differing in compactness on changes in routine outdoor activities (e.g., walking, gardening, yard work) among older adults at increased mobility disability risk participating in the LIFE-Pilot PA trial (2003-07; ages 70-89years; from Dallas, TX, San Francisco Bay area, Pittsburgh, PA, and Winston-Salem, NC). Analyses were conducted on the 400 LIFE-Pilot participants randomized to a one-year endurance-plus-strengthening PA intervention or health education control that completed one-year PA assessment (CHAMPS questionnaire). Outcomes of interest were exercise and leisure walking, walking for errands, and moderate-intensity gardening. Neighborhood compactness was assessed objectively using geographic information systems via a subsequent grant (2008-12). PA increased weekly exercise and leisure walking relative to control, irrespective of neighborhood compactness. However, walking for errands decreased significantly more in PA relative to control (net mean [SD] difference=16.2min/week [7.7], p=0.037), particularly among those living in less compact neighborhoods (net mean [SD] difference=29.8 [10.8] minutes/week, p=0.006). PA participants living in less compact neighborhoods maintained or increased participation in gardening and yard work to a greater extent than controls (net mean [SD] difference=29.3 [10.8] minutes/week, p=0.007). The results indicate that formal targeting of active transport as an adjunct to structured PA programs may be important to diminish potential compensatory responses in functionally impaired older adults. Structured endurance-plus-strengthening PA may help older adults maintain or increase such routine activities over time.

TRIAL REGISTRATION

clinicaltrials.gov Identifier=NCT01072500.

Effect of Physical Activity versus Health Education on Physical Function, Grip Strength and Mobility

BACKGROUND

Physical activity (PA) reduces the rate of mobility disability, compared with health education (HE), in at risk older adults. It is important to understand aspects of performance contributing to this benefit.

OBJECTIVE

To evaluate intervention effects on tertiary physical performance outcomes.

DESIGN

The Lifestyle Interventions and Independence for Elders (LIFE) was a multi-centered, single-blind randomized trial of older adults.

SETTING

Eight field centers throughout the United States.

PARTICIPANTS

1635 adults aged 78.9 ± 5.2 years, 67.2% women at risk for mobility disability (Short Physical Performance Battery [SPPB] <10).

INTERVENTIONS

Moderate PA including walking, resistance and balance training compared with HE consisting of topics relevant to older adults.

OUTCOMES

Grip strength, SPPB score and its components (balance, 4 m gait speed, and chair-stands), as well as 400 m walking speed.

RESULTS

Total SPPB score was higher in PA versus HE across all follow-up times (overall P = .04) as was the chair-stand component (overall P < .001). No intervention effects were observed for balance (overall P = .12), 4 m gait speed (overall P = .78), or grip strength (overall P = .62). However, 400 m walking speed was faster in PA versus HE group (overall P =<.001). In separate models, 29% of the rate reduction of major mobility disability in the PA versus HE group was explained by change in SPPB score, while 39% was explained by change in the chair stand component.

CONCLUSION

Lower extremity performance (SPPB) was significantly higher in the PA compared with HE group. Changes in chair-stand score explained a considerable portion of the effect of PA on the reduction of major mobility disability-consistent with the idea that preserving muscle strength/power may be important for the prevention of major mobility disability.