Exercise and older patients: guidelines for the clinician

Individualized Cognition-Action intervention to prevent behavioral disturbances and functional decline in institutionalized older adults: a randomized pilot trial

OBJECTIVE

To evaluate the effectiveness of an individualized Cognition-Action (CA) intervention to reduce behavioral disturbances in severely deconditioned institutionalized old adults.

DESIGN

12 weeks randomized pilot trial of either individualized Cognition-Action program (n = 24) or routine medical care as control (C, n = 25).

SETTING

Long-term care (LTC) of the Geriatric Department from the University State Hospital in Bordeaux, France.

PARTICIPANTS

49 institutionalized old patients with at least one Neuropsychiatric symptoms > or =4.

INTERVENTION

The CA rationale was a non-preconceived ideas approach over the patient's abilities and discourse. Patients received short bouts of 5-15 min and accumulated 50 min of interaction per week. CA intervention used five standardized exercises as tools to enhance communication and social interactions. CA was compared to usual care.

MEASUREMENTS

Primary outcomes were the Neuropsychiatric inventory (NPI) total and symptoms scores. Secondary outcomes were the BERG balance scale, the Geriatric Depression Scale (GDS), Quality of life AM-PAC-CAT and Muscle strength.

RESULTS

The CA group had a clinically significant NPI total score reduction compared to C, -7, 95%CI [-10.8 to -3], eta2 = 0.24. CA group showed a risk reduction of NPI total score worsening, OR = 0.09, 95%CI [0.02-0.37]. BERG total score was clinically improved in the CA group compared to C, 4.9 95%CI [0.7-9.2], eta2(p)= 0.11. CA patients reduced their GDS score and improved their Quality of life and Strength.

CONCLUSIONS

The combination of tailored guidance and simple standardized exercises was an effective behavioral management approach for behavioral disturbances reduction and functional autonomy improvement in institutionalized old adult populations.

Dog-Walking: Motivation for Adherence to a Walking Program

Healthy People 2010 cited walking as a major health indicator; however, adherence is challenging, especially among those with multiple chronic illnesses. Studies suggest that walking one’s own dog may motivate adherence. However, no research has studied whether walking a “loaner” dog may facilitate adherence. Using a pretest—posttest design, the authors studied adherence to and outcomes of a graduated walking program when 26 public housing residents walked certified therapy dogs with a handler. Participants walked 20 minutes, 5 days/week, for 26 or 50 weeks. In all, 13 participants in the 50-week group had a mean adherence rate of 72% and weight loss of 14.4 pounds ( p = .013). Thirteen participants in the 26-week group had a mean adherence rate of 52% and weight loss of 5 pounds (nonsignificant). Participants’ most commonly stated reason for adherence was that the dogs “need us to walk them.” Commitment to a dog that is not one’s own may effectively facilitate physical activity.

Aerobic training restores arterial baroreflex sensitivity in older adults with type 2 diabetes, hypertension, and hypercholesterolemia

OBJECTIVE

Lowered baroreflex sensitivity (BRS) predicts mortality and occurs with increasing age and diabetes. We examined whether aerobic exercise could restore arterial BRS in adults at high cardiovascular risk (diabetes, geriatric age group, hypercholesterolemia, and hypertension).

DESIGN

Randomized, controlled, single-blind study.

SETTING

VITALiTY (Vancouver Initiative to Add Life to Years) Research Laboratory.

PARTICIPANTS

Thirty-nine older adults (mean age, 71.5 +/- 0.7 years) with diet-controlled or oral hypoglycemic-controlled type 2 diabetes, hypertension, and hypercholesterolemia.

INTERVENTIONS

Subjects were recruited to each of 2 groups: an aerobic group (3 months of vigorous aerobic exercise as defined by 80% to 85% of maximal heart rate), and a nonaerobic (no aerobic exercise) group. Exercise sessions were supervised by a certified exercise trainer 3 times per week.

MAIN OUTCOME MEASURES

: Baroreflex function was assessed using the spontaneous baroreflex method. Main outcome measures included BRS, BRS(up), BRS(down), and [latin capital V with dot above]o(2)max.

RESULTS

The aerobic group demonstrated an increase in BRS that was not demonstrated in the nonaerobic group (+60.9 +/- 23.5 vs +2.2 +/- 7.9%; P = 0.010).

CONCLUSIONS

Our findings indicate that a relatively short aerobic exercise intervention can reverse functional impairments of the arterial baroreflex function in older adults at high cardiovascular risk.

Reducing risk of falling in older people discharged from hospital: a randomized controlled trial comparing seated exercises, weight-bearing exercises, and social visits

OBJECTIVE

To compare the efficacy of seated exercises and weight-bearing (WB) exercises with social visits on fall risk factors in older people recently discharged from hospital.

DESIGN

Twelve-week randomized, controlled trial.

SETTING

Home-based exercises.

PARTICIPANTS

Subjects (N=180) aged 65 and older, recently discharged from hospital.

INTERVENTIONS

Seated exercises (n=60), WB exercises (n=60), and social visits (n=60).

MAIN OUTCOME MEASURES

Primary outcome factors were Physiological Profile Assessment (PPA) fall risk score, and balance while standing (Coordinated Stability and Maximal Balance Range tests). Secondary outcomes included the component parts of the PPA and other physical and psychosocial measures.

RESULTS

Subjects were tested at baseline and at completion of the intervention period. After 12 weeks of interventions, subjects in the WB exercise group had significantly better performance than the social visit group on the following: PPA score (P=.048), Coordinated Stability (P<.001), Maximal Balance Range (P=.019); body sway on floor with eyes closed (P=.017); and finger-press reaction time (P=.007) tests. The seated exercise group performed better than the social visit group in PPA score (P=.019) but for no other outcome factor. The seated exercise group had the highest rate of musculoskeletal soreness.

CONCLUSIONS

In older people recently discharged from the hospital, both exercise programs reduced fall risk score in older people. The WB exercises led to additional beneficial impacts for controlled leaning, reaction time, and caused less musculoskeletal soreness than the seated exercises.

Short-term aerobic exercise reduces arterial stiffness in older adults with type 2 diabetes, hypertension, and hypercholesterolemia

OBJECTIVE The relationship between increased arterial stiffness and cardiovascular mortality is well established in type 2 diabetes. We examined whether aerobic exercise could reduce arterial stiffness in older adults with type 2 diabetes complicated by comorbid hypertension and hyperlipidemia. RESEARCH DESIGN AND METHODS A total of 36 older adults (mean age 71.4 +/- 0.7 years) with diet-controlled or oral hypoglycemic-controlled type 2 diabetes, hypertension, and hypercholesterolemia were recruited. Subjects were randomly assigned to one of two groups: an aerobic group (3 months vigorous aerobic exercise) and a nonaerobic group (no aerobic exercise). Exercise sessions were supervised by a certified exercise trainer three times per week, and a combination of cycle ergometers and treadmills was used. Arterial stiffness was measured using the Complior device. RESULTS When the two groups were compared, aerobic training resulted in a decrease in measures of both radial (-20.7 +/- 6.3 vs. +8.5 +/- 6.6%, P = 0.005) and femoral (-13.9 +/- 6.7 vs. +4.4 +/- 3.3%, P = 0.015) pulse-wave velocity despite the fact that aerobic fitness as assessed by Vo(2max) did not demonstrate an improvement with training (P = 0.026). CONCLUSIONS Our findings indicate that a relatively short aerobic exercise intervention in older adults can reduce multifactorial arterial stiffness (type 2 diabetes, aging, hypertension, and hypercholesterolemia).

Multidisciplinary approach for the treatment of diabetes in the elderly

Elderly patients living with diabetes are a highly heterogeneous population with unique care needs. Unlike younger patients, elderly patients may experience an atypical presentation and nontraditional complications of diabetes. Diabetes management and education require greater individualization in elderly adults because of differences in goals of care, risks and benefits of intensive treatment and abilities to practically carry out care regimens. A multidisciplinary approach to diabetes care requires an in-depth knowledge of diabetes, an awareness of geriatric issues and access to decision and educational support. This approach may be the most successful way of delivering individualized diabetes care. Future trials of diabetes care innovations in the elderly will be required to confirm the clinical benefits of this approach.

Health benefits of physical activity in older patients: a review

As the number of elderly persons in our country increases, more attention is being given to geriatric healthcare needs and successful ageing is becoming an important topic in medical literature. Concept of successful ageing is in first line on a preventive approach of care for older people. Promotion of regular physical activity is one of the main non-pharmaceutical measures proposed to older subjects as low rate of physical activity is frequently noticed in this age group. Moderate but regular physical activity is associated with a reduction in total mortality among older people, a positive effect on primary prevention of coronary heart disease and a significant benefit on the lipid profile. Improving body composition with a reduction in fat mass, reducing blood pressure and prevention of stroke, as well as type 2 diabetes, are also well established. Prevention of some cancers (especially that of breast and colon), increasing bone density and prevention of falls are also reported. Moreover, some longitudinal studies suggest that physical activity is linked to a reduced risk of developing dementia and Alzheimer's disease in particular.

Preventive health care among older women: missed opportunities and poor targeting

BACKGROUND

Experts recommend that clinicians target mammography and colon cancer screening to individuals with at least 5 years life expectancy. Generally, immunizations and exercise counseling are recommended for all women aged > or =65 years, while Pap smears are generally not encouraged for these women.

METHODS

We used the 2005 National Health Interview Survey to examine receipt of several preventive health measures simultaneously among community dwelling US women aged > or =65 years by age and health status. We used functional status, significant diseases, and perceived health to categorize women into those most likely to be in above-average, average, or below-average health status. We used age and health status to estimate life expectancy.

RESULTS

Of 4683 participants, 25.8% were > or =80 years; 81.8% were non-Hispanic white; 21% were in above-average and 20% were in below-average health status. Receipt of mammography and colon cancer screening decreased with age and was not associated with health status for women aged > or =80 years. Nearly half (49%) of women aged > or =80 years in below-average health received mammography screening, while 19% of women aged 65-79 years in above-average health did not report receiving mammography. Nearly half of women aged 65-79 years (49%) in above-average health did not report receiving colon cancer screening. Pap smear screening was common among older women. Few (34%) reported receiving exercise counseling. Many did not report receiving pneumococcal (43%) or flu vaccinations (40%).

CONCLUSIONS

In our comprehensive review of preventive health measures for older women, we found evidence to suggest a need to improve delivery and targeting of preventive health services.

The value older women in an academic primary care practice place on preventive health care services: implications for counseling

PURPOSE

We sought to determine how women aged 80 years or older value different preventive health measures compared to women aged 65 to 79 years.

DESIGN AND METHODS

We surveyed 107 women aged 80 years or older and 93 women aged 65 to 79 years; we randomly selected all of them from a large academic primary care practice. We measured perceived importance and priority placed on different preventive health measures, including screening tests; counseling on healthy lifestyle and geriatric health issues; immunizations; and recommendations for over-the-counter prevention medications.

RESULTS

Of the 200 women, 28.5% were aged 80 to 84 and 25.0% were aged 85 years or older. The majority of the women were non-Hispanic White (65.5%), had private insurance (82.0%), and were in good health condition (52.0%). Women aged between 65 and 79 were more likely than women aged 80 or older to consider screening tests and exercise counseling essential or very important to maintaining their health. Women aged 80 or older did not value any preventive health measure more highly than did younger women. Women who were 65 to 79 years of age ranked mammography screening as their most valued preventive health measure, with five of their top six measures being screening tests. Women who were 85 years of age or older prioritized flu shots, recommendations for aspirin, and then mammography screening.

IMPLICATIONS

Screening tests and exercise counseling are more highly valued by women aged 65 to 79 years than by women aged 80 years or older. Regardless of age, mammography screening is prioritized over other preventive health measures. Understanding how older women value different preventive health measures may help clinicians improve their preventive health counseling.

Self-Rated Activity Levels and Longevity: Evidence from a 20 Year Longitudinal Study

The study reports on factors predicting the longevity of 328 people over the age of 65 drawn from an English city and followed over 20 years. Both the reported activities score and the individual's comparative evaluation of their own level of activity independently reduced the risk of death, even when health and cognitive status were taken into account. The analysis has provided a strong test of the relevance of measures of reported activity and measures of self-perception to longevity. The study confirms the important predictive role of reported activity levels even when detailed health measures are taken into account. But in addition personal perception of one's own relative level of activity, and to a lesser extent subjective assessment of health, also predicted longevity.

Personality predictors of longevity: activity, emotional stability, and conscientiousness

OBJECTIVE

To examine the association between personality traits and longevity.

METHODS

Using the Guilford-Zimmerman Temperament Survey, personality traits were assessed in 2359 participants (38% women; age = 17 to 98 years, mean = 50 years) from the Baltimore Longitudinal Study of Aging, starting in 1958. Over the duration of the study, 943 (40%) participants died, on average 18 years after their personality assessment. The association of each trait with longevity was examined by Cox regression controlling for demographic variables.

RESULTS

In preliminary analyses among the deceased, those who scored 1 standard deviation (SD) above the mean on General Activity (a facet of Extraversion), Emotional Stability (low Neuroticism), or Conscientiousness lived on average 2 to 3 years longer than those scoring 1 SD below the mean. Survival analyses on the full sample confirmed the association of General Activity, Emotional Stability, and Conscientiousness with lower risk of death, such that every 1-SD increase was related to about 13%, 15%, and 27% risk reduction, respectively. The association of personality traits with longevity was largely independent from the influence of smoking and obesity. Personality predictors of longevity did not differ by sex, except for Ascendance (a facet of Extraversion). Emotional Stability was a significant predictor when the analyses were limited to deaths due to cardiovascular disease, with comparable effect sizes for General Activity and Conscientiousness.

CONCLUSIONS

In a large sample of generally healthy individuals followed for almost five decades, longevity was associated with being conscientious, emotionally stable, and active.

Preventive health care among older women in an academic primary care practice

PURPOSE

We sought to examine the use of preventive health services among older women and to assess how age and illness burden influence care patterns.

METHODS

The charts of 299 women aged > or =80 and 229 women aged 65-79 years who did not have dementia or terminal illness at 1 academic primary care practice in Boston were reviewed between July and December 2005 to determine receipt of screening tests (e.g., mammography), counseling on healthy lifestyle (e.g., exercise), and/or geriatric health issues (e.g., incontinence), and immunizations. Illness burden was quantified using the Charlson Comorbidity Index (CCI).

RESULTS

Women aged > or =80 were more likely than women aged 65-79 to have a CCI of > or =3 (24.0% vs. 16.7%) and were less likely to receive all screening tests. However, receipt of mammography (47.8%) and colon cancer screening (51.2%) was still common among women aged > or =80 and was not targeted to older women in good health. Women aged > or =80 were less likely to be screened for depression (adjusted relative risk [aRR] 0.6; 95% confidence interval [CI], 0.5-0.8), osteoporosis (aRR, 0.6; 95% CI, 0.5-0.9), or counseled about exercise (aRR 0.8; 95% CI, 0.6-0.9) than younger women, but were more likely to receive counseling about falls (aRR 1.9; 95% CI, 1.4-2.6) and/or incontinence (aRR 1.8; 95% CI, 1.2-2.6). However notes documenting discussions about mood (28.6%), exercise (40.0%), falls (28.8%), or incontinence (20.8%) were low among all women.

CONCLUSION

In a comprehensive review of preventive health measures for elderly women, many in poor health were screened for cancer. Meanwhile, many older women were not screened for depression or counseled about exercise, falls, or incontinence. There is a need to improve delivery of preventive health care to older women.

Beneficial effects of physical exercise on hypertension and cardiovascular adverse remodeling of diet-induced obese rats

BACKGROUND AND AIMS

Obesity is present among all age groups and in all socioeconomic groups. This study on obese rats aims to quantify the beneficial effects of physical exercise on blood pressure (BP), the heart, the elasticity and resistance of arteries.

METHODS AND RESULTS

Obese male Wistar rats, (obesity due to a high fat diet with 30% fat), and non-obese rats, were assigned to four groups (n=5): sedentary obese; exercise-practice obese; sedentary control; and exercise-practice control (motor treadmill for 13 weeks). Their organs were studied through light microscopy and stereology. The diet-induced obesity caused mild hypertension with adverse cardiovascular changes. Physical exercise diminished the alterations associated with BP elevation and obesity. The pressure-lowering effect observed in obese rats submitted to physical exercise improved the myocardial vascularization and the aortic and the carotid wall structure by reducing the thickness and normalizing both the elastic lamellae and the smooth muscle cells. The adaptive response of the gluteus superficialis muscle to physical exercise also improved the peripheral resistance arteries of obese rats.

CONCLUSION

Current research supports the notion of physical exercise as a potential non-pharmacological antihypertensive treatment for diet-induced obesity hypertension.

Health promotion in later life: it's never too late

The clinical and epidemiological rationale for the health improvement benefits of health promotion in the later years of life are provided in this article. The authors review the emerging scientific consensus concerning the utility of lifestyle interventions for health improvement in the context of a narrowed definition of health promotion. Governmental initiatives for testing health promotion among Medicare beneficiaries are also discussed. Major research findings are reviewed and implications for health promotion practioners are also provided.

Treatment of minor depression in older adults: a pilot study comparing sertraline and exercise

The purpose of this study was to conduct a pilot clinical trial to test the feasibility and efficacy of an exercise program and anti-depressant treatment compared with usual care in improving the emotional and physical functioning of older adults with minor depression. Participants were 37 older adults with minor depression who were randomized to exercise, sertraline, or usual care; 32 participants completed the 16-week study. Outcomes included measures of both emotional (clinician and self-report) and physical (observed and self-report) functioning. There were trends for the superiority of the exercise and sertraline conditions over usual care in improving SF-36 mental health scores and clinician-rated depression scores. Individuals in the exercise condition showed greater improvements in physical functioning than individuals in the usual care condition. Both sertraline and exercise show promise as treatments for late-life minor depression. However, exercise has the added benefit of improving physical functioning as well.

Can health promotion programs save Medicare money?

The impact of an aging population on escalating US healthcare costs is influenced largely by the prevalence of chronic disease in this population. Consequently, preventing or postponing disease onset among the elderly has become a crucial public health issue. Fortunately, much of the total burden of disease is attributable to conditions that are preventable. In this paper, we address whether well-designed health promotion programs can prevent illness, reduce disability, and improve the quality of life. Furthermore, we assess evidence that these programs have the potential to reduce healthcare utilization and related expenditures for the Medicare program. We hypothesize that seniors who reduce their modifiable health risks can forestall disability, reduce healthcare utilization, and save Medicare money. We end with a discussion of a new Senior Risk Reduction Demonstration, which will be initiated by the Centers for Medicare and Medicaid Services in 2007, to test whether risk reduction programs developed in the private sector can achieve health improvements among seniors and a positive return on investment for the Medicare program.

Which model of successful ageing should be used? Baseline findings from a British longitudinal survey of ageing

BACKGROUND

there is increasing interest in how to age 'successfully' and in reaching consensus over its definition.

OBJECTIVE

to assess different models of successful ageing, using a British longitudinal survey of ageing in 2000-1.

SETTING

community settings in Britain.

METHODS

five models of successful ageing were tested on a British cross-sectional population survey of 999 people aged 65+. The models were biomedical, broader biomedical, social, psychological and lay based.

RESULTS

the lay model emerged as the strongest. Respondents who were classified as successfully aged with this model, compared with those not successfully aged, had over five times the odds of rating their quality of life (QoL) as good rather than not good [odds ratio (OR) = 5.493, 95% confidence interval (95% CI) = 2.655-11.364].

CONCLUSION

the lay-based, more multidimensional, model of successful ageing predicted perceived QoL more powerfully than unidimensional models and should be used to evaluate the outcomes of health promotion in older populations.

A home-based multidimensional exercise program reduced physical impairment and fear of falling

OBJECTIVE

To investigate the efficacy of a guided and graded home-based exercise program for improving a range of physical outcomes in older people.

DESIGN

Controlled clinical trial of 16 weeks.

SETTING

Two geographical areas in Gent, Belgium.

PARTICIPANTS

66 independent-living older people (age: 71-98) with a history of falls and moderate physical impairment.

INTERVENTION

Twenty-four 30-minute training sessions were given by a trained physiotherapist over a period of 16 weeks in the participant's home. Different types of exercises on balance, aerobic performance, flexibility, and muscle strength were provided.

MAIN OUTCOME MEASURES

Muscle strength, static and dynamic balance, aerobic performance, activities in daily living, fear of falling and avoidance of daily activities were assessed at baseline and after 16 weeks intervention.

RESULTS

At baseline, there were no significant differences in the measured variables between exercise and control groups. After 16 weeks, the exercise group showed significantly improved ankle muscle strength, balance performance and aerobic capacity, and decreased fear of falling, dependency in daily activities and avoidance of daily activities compared to the control group. The improvements in knee muscle strength, timed chair stands, and functional reach were not significant.

CONCLUSION

The home-based, individualized exercise program was effective in reducing several physical factors associated with falls in community-dwelling older people with moderate physical impairment. The decrease in fear of falling and other behavioural variables needs to be considered with care and needs further investigation.

Low serum concentrations of 25-hydroxyvitamin D in older persons and the risk of nursing home admission

BACKGROUND

The prevalence of vitamin D deficiency in nursing home patients is high.

OBJECTIVE

We aimed to ascertain whether lower serum 25-hydroxyvitamin D [25(OH)D] concentrations increase the risk of future nursing home admission and early death.

DESIGN

We included 1260 independent, community-dwelling persons aged > or =65 y who were participating in the Longitudinal Aging Study Amsterdam (1995-1996). Study outcomes were time to nursing home admission during 6 y of follow-up and time to death until 1 April 2003.

RESULTS

Vitamin D deficiency [25(OH)D < 25 nmol/L] and insufficiency [25(OH)D = 25-49.9 nmol/L] were present in 127 (10.1%) and 462 (36.7%) subjects, respectively. During follow-up, 138 subjects (11.0%) were admitted to nursing homes, and 380 subjects (30.2%) died. The risk of nursing home admission for participants with 25(OH)D deficiency was 53 cases per 1000 person-years higher than that for those with high 25(OH)D (> or =75 nmol/L) concentrations (58 compared with 5 cases). After adjustment for potential confounders, the hazard ratio (95% CI) of nursing home admission was 3.48 (1.39, 8.75) for vitamin D-deficient, 2.77 (1.17, 6.55) for vitamin D-insufficient, and 1.92 (0.79, 4.66) for vitamin D-borderline persons as compared with persons with high 25(OH)D (P for trend = 0.002). The results remained after additional adjustment for frailty indicators. Lower 25(OH)D was associated with higher mortality risk, but this association was not significant after adjustment for frailty indicators.

CONCLUSION

Lower serum 25(OH)D concentrations in older persons are associated with a greater risk of future nursing home admission and may be associated with mortality.

Receipt of exercise counseling by older women

OBJECTIVES

To compare the national prevalence of reported receipt of clinician exercise counseling across four age groups of women (50-64, 65-74, 75-84, and > or =85) and to determine whether age or health are barriers to reported receipt of exercise counseling.

DESIGN

2000 National Health Interview Survey (NHIS).

SETTING

United States.

PARTICIPANTS

Six thousand three hundred eighty-five women aged 50 and older who responded to the 2000 NHIS, representing an estimated 34.5 million noninstitutionalized women nationally.

MEASUREMENTS

Exercise counseling, disease burden, functional dependency, and physical inactivity were assessed by questionnaire.

RESULTS

Of the 6,385 women, 52.2% were aged 50 to 64, 24.8% were aged 65 to 74, 18.0% were age 75 to 84, and 5.1% were aged 85 and older. Overall, 28.3% reported that a clinician had recommended that they begin or continue to perform any type of exercise or physical activity during the previous year: 31.4% of women aged 50 to 64, 29.2% of women aged 65 to 74, 21.6% of women aged 75 to 84, and 14.4% of women aged 85 and older. Women aged 75 to 84 (adjusted odds ratio (AOR)=0.8, 95% confidence interval (CI)=0.6-1.0) and women aged 85 and older (AOR=0.6, 95% CI=0.4-0.9) were substantially less likely to report clinician counseling about exercise, before and after adjustment. Further adjustment for illness burden and functional dependency did not attenuate the effect of receipt of exercise counseling.

CONCLUSION

Reported receipt of exercise counseling by older women is low nationally. Despite known benefits of late-life exercise, women aged 75 and older are less likely to report receiving exercise counseling from their clinicians than women aged 50 to 64. Interventions should be aimed at increasing clinician counseling about exercise, especially to older women.

The effects of resistance training and walking on functional fitness in advanced old age

The authors assessed the effects of resistance training and walking exercise on measures of functional fitness. Sixty-four volunteers (average age 83.5 years) from an independent-living facility were randomly assigned to walking, resistance training, or control groups. Participants in the walking and resistance-training groups engaged in two exercise sessions per week for 16 weeks. Measures of functional fitness included upper and lower body strength, hip and shoulder flexibility, agility and balance, coordination, blood pressure, and resting heart rate. Repeated measures analysis of variance was used to examine pretest to posttest differences. Both exercise groups showed significant improvements relative to control group in upper and lower body strength, shoulder flexibility, and agility and balance exercise. Findings demonstrate that exercise can lead to improvements in multiple domains of functional fitness even among very old, previously sedentary individuals, possibly making activities of daily living easier to perform.

Non-Equipment Exercise-Related Injuries Among U.S. Women 65 and Older: Emergency Department Visits from 1994–2001

The objective of this study was to estimate the relative frequency, types of injury, types of exercise, and mechanism of non-equipment exercise-related injury among women 65 and older. Methods included a descriptive analysis of emergency department (ED) visits to hospitals participating in the National Electronic Injury Surveillance System (NEISS). Researchers identified 851 exercise-related injuries to women 65 and older. Estimates are that 37729 older women were treated in emergency departments for injuries related to non-equipment type exercise activity from 1994-2001. Although there are many benefits to exercise, injuries due to overuse and existing physical conditions such as osteoporosis are a concern for active older women. Promotion of safe exercise activities and programs for older women are recommended.

Exercise as a treatment for depression in elders

PURPOSE

To describe the use of exercise when treating depression in elders and to discuss the data supporting the relationship between increased physical activity and decreased depression.

DATA SOURCES

Extensive review of recent scientific literature, both medical and gerontological in content.

CONCLUSIONS

Increasing physical activity markedly reduces depressive symptoms and is a safe adjunct or alternative to medication therapy.

IMPLICATIONS FOR PRACTICE

Exercise has numerous physical and psychological benefits to patients. Physical activity should be recommended to all patients of all ages.

Test-retest reliability of Yale Physical Activity Survey among older Mexican American adults: a pilot investigation

The objective of the work reported in this paper is to assess test-retest reliability of Yale Physical Activity Survey Total Time, Estimated Energy Expenditure, Activity Dimension Indices, and Activities Check-list in older Mexican American men and women. A convenience-based healthy sample of 49 (42 women and 7 men) older Mexican American adults recruited from senior recreation centers aged 68 to 80 years volunteered to participate in this pilot study. Forty-nine older Mexican American adults filled out the Yale Physical Activity Survey for this study. Fifteen (12 women and 3 men) of the 49 volunteers responded twice to the Yale Physical Activity Survey after a 2-week period, and helped assess the test-retest reliability of the Yale Physical Activity Survey. Results indicate that based on a 2-week test-retest administration, the Yale Physical Activity Survey was found to have moderate (rhoI= .424, p < .05) to good reliability (rs = .789, p < .01) for physical activity assessment in older Mexican American adults who responded.

Motivating elders to initiate and maintain exercise

This article addresses the motivation of elders to initiate exercise. It is part of the study guide on geriatric rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation and geriatric medicine. This article specifically focuses on the health benefits of exercise, describes a theoretical model for assessing and improving an individual's motivation to pursue exercise, details the particular challenges elders face in initiating and adhering to an exercise program, and outlines professional interventions to address these obstacles.

OVERALL ARTICLE OBJECTIVE

To explore the particular challenges elders face in motivation to exercise and to develop a systematic approach for counseling elders toward greater activity.

Physical inactivity and overweight among Los Angeles County adults

OBJECTIVES

The present study examines sociodemographic, health status, health behavioral, and health-related self-perception correlates of physical inactivity in a large, multiethnic urban population.

METHODS

A random-digit-dialed telephone survey of a representative sample of 8353 Los Angeles County adults aged >/= 18 years was conducted between September 17, 1999 and December 31, 2000. Data were analyzed to assess the prevalence and identify independent correlates of physical inactivity, defined as <10 minutes of continuous physical activity weekly ("sedentary").

RESULTS

Overall, the prevalence of sedentary adults was 41%. Lower educational attainment, female gender, advancing age, non-U.S. birthplace, poorer self-perceived health status, self-perceived depression, smoking, leisure-time television watching/computer use, and receiving a diabetes diagnosis were significantly related to sedentariness in both bivariate and multivariate analyses.

CONCLUSIONS

Mental and physical health status were prominent correlates of sedentariness. Lower socioeconomic class was also associated with sedentary behavior. Further research is needed to understand the relationship between self-perceived overweight and sedentary behavior.

Geriatric rehabilitation. 3. Physical medicine and rehabilitation interventions for common disabling disorders1∗1No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors(s) or upon any organization with which the author(s) is/are associated.∗Key references

This self-directed learning module highlights physical medicine and rehabilitation (PM and R) interventions for common disorders that cause disability in older adults. It is part of the study guide on geriatric rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in PM and R and geriatric medicine. This article specifically focuses on PM and R interventions for arthritides, fractures, cardiovascular disorders, peripheral vascular disease, amputations, pulmonary disorders, cancer, stroke, traumatic brain injury, Parkinson's disease, spinal cord injury, peripheral neuropathies, and diabetic complications.

OVERALL ARTICLE OBJECTIVE

To summarize the physical medicine and rehabilitation interventions for commonly disabling conditions of older adults.

Can physical activity improve the mental health of older adults?

The world population is aging rapidly. Whilst this dramatic demographic change is a desirable and welcome phenomenon, particularly in view of people's increasing longevity, it's social, financial and health consequences can not be ignored. In addition to an increase of many age related physical illnesses, this demographic change will also lead to an increase of a number of mental health problems in older adults and in particular of dementia and depression. Therefore, any health promotion approach that could facilitate introduction of effective primary, secondary and even tertiary prevention strategies in old age psychiatry would be of significant importance. This paper explores physical activity as one of possible health promotion strategies and evaluates the existing evidence that supports its positive effect on cognitive impairment and depression in later life.

Exercise and aging

There is increasing evidence that the black box we have referred to as"biologic aging" is composed of genetic factors and many types of environmental exposures. Some of the most potentially modifiable elements of this syndrome are those attributable to disuse or insufficient exposure to certain kinds or intensities of physical stressors during the course of the life span. Beneficial adaptations to exercise once thought restricted to genetically endowed master athletes now are seen to occur just as predictably in frail elders with chronic disease, opening the door to vastly improved physical function and associated health benefits. Knowledge of the benefits of physical activity, however well substantiated, may be necessary, but it is not sufficient to change either physician-prescribing habits or the likelihood of adoption and long-term adherence to exercise on the part of patients. Ultimately, the penetration of an exercise prescription to optimize aging into the most inactive cohorts in the community,who have the most to gain from increases in levels of physical activity and fitness, will depend on a combination of clear evidence-based guidelines coupled with health professional training and behavioral programs tailored to age-specific barriers and motivational factors.

Fall prevention in frail elderly nursing home residents: a challenge to case management: part II

Parts I and II of this article examine the impact of a falls prevention program on the fall incidents among the residents in a nursing home. It was hypothesized that a diagnostic, therapeutic, and preventive approach should be used for nursing home residents identified as being at high risk for falls in order to reduce the number of fall incidents and to improve quality of life for this vulnerable population. The program effectively targeted both intrinsic and extrinsic factors to reduce risks facing the residents. The effectiveness of the program was evaluated by examining changes in the rate of falls after the program was implemented. The results identified that a multifaceted program, one that utilized multiple personalized interventions, was effective in reducing the falls rate of frail (those with complex medical and psychosocial problems) nursing home residents, and that muscle-strengthening interventions may be beneficial for this vulnerable population. Program outcomes verified that case managers can impact quality of life for frail elderly nursing home residents by promoting their independence and safety, and postponing problems resulting from inactivity. Part I (LCM, Nov-Dec 2001) discussed the background and process of a falls program and factors contributing to the occurrence of falls. This month we examine the interdisciplinary team approach to assessment, method, and implementing strategies for an effective fall prevention program. Tools used for prevention, monitoring, and investigation of falls are also detailed.

Fall Prevention in Frail Elderly Nursing Home Residents

Parts I and II of this article examine the impact of a falls prevention program on the fall incidents among the residents in a nursing home. It was hypothesized that a diagnostic, therapeutic, and preventive approach should be used for nursing home residents identified as being at high risk for falls in order to reduce the number of fall incidents and to improve quality of life for this vulnerable population. The program effectively targeted both intrinsic and extrinsic factors to reduce risks facing the residents. The effectiveness of the program was evaluated by examining changes in the rate of falls after the program was implemented. The results identified that a multifaceted program, one that utilized multiple personalized interventions, was effective in reducing the falls rate of frail (those with complex medical and psychosocial problems) nursing home residents, and that muscle-strengthening interventions may be beneficial for this vulnerable population. Program outcomes verified that case managers can impact quality of life for frail elderly nursing home residents by promoting their independence and safety, and postponing problems resulting from inactivity. Part I discusses the background and process of a falls program and factors contributing to the occurrence of falls. Part II will examine the interdisciplinary team approach to assessment, method, and implementing strategies for an effective fall prevention program. Tools used for prevention, monitoring, and investigation of falls will be detailed in Part II.

Increased physiotherapy in sheltered housing in Sweden: a study of structure and process in elderly care

The effect of increasing the level of physiotherapy services in elderly care was studied using an intervention and a control unit. The units had 20 and 2 hours of physiotherapy services per week, respectively. Physiotherapy and occupational therapy records were reviewed before and during the project. Physiotherapists also kept extended documentation over an 11-month period. Data analyses employed the chi-square test and content analysis. There was a significant increase in the number of patients receiving physiotherapy and occupational therapy within both units. No significant differences between the units were found for the number of patients receiving physiotherapy. The number of patients receiving occupational therapy differed significantly between units before as well as during the intervention. Primarily care assistants and auxiliary nurses initiated contact with the physiotherapists mainly for patient-orientated errands. Fifty per cent of the instructions given by the physiotherapist at the 20-hour unit related to movement-orientated activities of daily living. At the 2-hour unit, the majority of instructions (52%) were programme-orientated.

Benefits of exercise and dietary measures to optimize shifts in body composition with age

Ageing is associated with changes in body composition, including an increase and redistribution of adipose tissue and a decrease in muscle and bone mass, beginning as early as the fourth decade of life. These changes have significant implications for the health and functioning of the individual because of their associations with chronic disease expression and severity, as well as geriatric syndromes such as mobility impairment, falls, frailty and functional decline. Therefore, understanding the preventive and therapeutic options for optimizing body composition in old age is central to the care of patients in mid-life and beyond. Pharmacological interventions are currently available for maintaining or improving bone mass, and much current interest is focused on anabolic agents that will preserve or restore muscle mass, as well as those that can potentially limit adipose tissue deposition. However, in this brief review, non-pharmacological modulation of body composition through appropriate dietary intake and physical activity patterns, will be discussed. There is sufficient evidence currently to suggest that a substantial portion of what have been considered 'age-related' changes in muscle, fat and bone are in fact related either to excess energy consumption, decreased energy expenditure in physical activity, or both factors in combination. In addition, selective underconsumption of certain macro- or micronutrients contributes to losses of muscle and bone mass. Each of the three compartments will be considered in turn, with recommendations for optimizing the size of these body tissue stores in early adulthood, and minimizing undesirable changes typically seen in middle and old age.

Leisure activities and the risk of dementia in the elderly

BACKGROUND

Participation in leisure activities has been associated with a lower risk of dementia. It is unclear whether increased participation in leisure activities lowers the risk of dementia or participation in leisure activities declines during the preclinical phase of dementia.

METHODS

We examined the relation between leisure activities and the risk of dementia in a prospective cohort of 469 subjects older than 75 years of age who resided in the community and did not have dementia at base line. We examined the frequency of participation in leisure activities at enrollment and derived cognitive-activity and physical-activity scales in which the units of measure were activity-days per week. Cox proportional-hazards analysis was used to evaluate the risk of dementia according to the base-line level of participation in leisure activities, with adjustment for age, sex, educational level, presence or absence of chronic medical illnesses, and base-line cognitive status.

RESULTS

Over a median follow-up period of 5.1 years, dementia developed in 124 subjects (Alzheimer's disease in 61 subjects, vascular dementia in 30, mixed dementia in 25, and other types of dementia in 8). Among leisure activities, reading, playing board games, playing musical instruments, and dancing were associated with a reduced risk of dementia. A one-point increment in the cognitive-activity score was significantly associated with a reduced risk of dementia (hazard ratio, 0.93 [95 percent confidence interval, 0.90 to 0.97]), but a one-point increment in the physical-activity score was not (hazard ratio, 1.00). The association with the cognitive-activity score persisted after the exclusion of the subjects with possible preclinical dementia at base line. Results were similar for Alzheimer's disease and vascular dementia. In linear mixed models, increased participation in cognitive activities at base line was associated with reduced rates of decline in memory.

CONCLUSIONS

Participation in leisure activities is associated with a reduced risk of dementia, even after adjustment for base-line cognitive status and after the exclusion of subjects with possible preclinical dementia. Controlled trials are needed to assess the protective effect of cognitive leisure activities on the risk of dementia.

Southern women's response to a walking intervention

The need to change the sedentary habits of many American adults is well recognized. Middle-aged women are an important target group for increased physical activity because of certain health risks such as osteoporosis. In the current study, 31 women between the ages of 30 and 60 from high- and low-income groups (high-income >$50,000; low-income <$50,000 per year) took part in a physical activity intervention. The goal was to increase walking activity to a minimum of 90 min per week. Each woman received 16 telephone calls over a 6-month period in which she was asked to reflect upon the benefits of walking, goal setting, restructuring plans, social support, exercise efficacy, relapse prevention, and maintenance. Content analysis revealed a number of themes emerging from intervention conversations. There were differences between races in walking location and walking partners. Furthermore, there were differences between income groups in beliefs about the benefits of walking and social support. Overall, the intervention appeared to provide a basis for women to develop a walking routine. The women were able to reflect upon their walking routine and attempts to begin a walking routine and to identify how each component of the intervention affected their individual daily routine.

The Impact of Exercise on Age-Related Physiological Changes and Pathological Manifestations

The most inactive Americans are over the age of 65. Age-related physiological changes affect the ability to perform certain types of exercise. The cardiovascular and musculoskeletal systems are directly affected by these age-related changes, resulting in the modification of an exercise regimen. Individualized exercise programs depend on comorbidities, which limit the risks and maximize the benefits of exercise. Evidence supports the benefits of wellness exercise programs. The type of exercise beneficial for an individual is dependent on his or her overall health, disease state, and medications. Age-related physiological changes lead to the development of a wide range of chronic disorders that are often mistakenly assumed to be part of the normal aging process. The purpose of this article is to review the age-related physiological changes associated with exercise, the benefits and risks of exercise, and the wellness guidelines for initiating exercise in an individual over 65 years old. Included in this article is a discussion of the specific exercise guidelines for osteoarthritis, osteoporosis, obesity, psychological health, and diabetes mellitus.

Leisure-Time Activity among Older U.S. Women in Relation to Hormone-Replacement-Therapy Initiation

Hormone-replacement therapy (HRT) and physical activity are both related to aging and health. U.S. minorities are more likely to be inactive and less likely to initiate HRT than are non-Hispanic White women. The purpose of this investigation was to examine the relationship of race and HRT use with physical inactivity among older women (60+ years). The authors used data from 3,479 women who had participated in the Third National Health and Nutrition Examination Survey (NHANES III), conducted in 1988-1994. NHANES III included an in-person interview and a medical examination. The prevalence of physical inactivity among women who reported ever having used HRT was 28.5% (CI 22.9–34.1%), compared with 40.0% (CI 35.9–44.1%) among those who had never used HRT. Mexican American and non-Hispanic Black women reported higher levels of inactivity than did non-Hispanic White women across HRT-use categories. To promote successful aging, physicians should educate postmenopausal women on the possible health benefits of HRT combined with an active lifestyle.

Prevalence and risk factors for falls in an older community-dwelling population

BACKGROUND

Falls are responsible for considerable morbidity, immobility, and mortality among elderly people. The aim of this study was to determine the prevalence of falls and related intrinsic and extrinsic risk factors in a community-dwelling older population.

METHODS

An observational study was performed on all patients (N = 5570) admitted from 1997 to 2001 to home care programs in 19 home health agencies that participated in the National Silver Network project in Italy. Patient evaluation was performed through the Minimum Data Set-Home Care (MDS-HC) instrument.

RESULTS

A 35.9% falls prevalence was found within 90 days of the patient assessment through the MDS-HC instrument. After adjusting for all potential confounding factors, the logistic regression showed a high increase in risk of falling for those patients who wandered (odds ratio [OR] 2.38; 95% confidence interval [CI] 1.81-3.12) or suffered with gait problems (OR 2.13; 95% CI 1.81-2.51). Patients affected by depression were more likely to fall (OR 1.53; 95% CI 1.36-1.73). Those who lived in an unsafe place with environmental hazards had an increase in the risk of falling (OR 1.51; 95% CI 1.34-1.69). The associations of main risk factors for falls were also evaluated.

CONCLUSIONS

Rate of falls among frail elderly people living in the community is very high and frequently correlates with potentially reversible factors. To identify those with higher falling risk, home care staff and general practitioners could use the MDS-HC assessment tool.

Neighborhood and physical activity outcomes in women: regional comparisons

The environment a person lives in can play a large role in determining whether they exercise. This study examined the physical activity level of women living in either a northern or a southern region of the United States. Sedentary women were recruited to be part of a program designed to increase walking. Women were measured on the time it took to walk 1 mile, lung capacity, BMI, percent body fat, and mood. We found significant regional differences at baseline and change on outcomes over time. Awareness of the relationship between community/neighborhood and physical activity can be useful for designing fitness programs that are sensitive to environmental differences in women's lives.

Physical activity attenuates the effect of increased left ventricular mass on the risk of ischemic stroke: The Northern Manhattan Stroke Study

OBJECTIVES

The goal of this study was to determine whether the risk of ischemic stroke associated with increased left ventricular mass (LVM) is modified by physical activity (PA).

BACKGROUND

Increased LVM is associated with an increased risk for stroke. Physical activity can decrease the risk of stroke and may have variable effects on LVM.

METHODS

We used a case-control study design in a multiethnic population in northern Manhattan, New York, to study 394 case subjects who had a first ischemic stroke and 413 stroke-free control subjects. All subjects were interviewed and two-dimensional echocardiograms obtained to determine LVM.

RESULTS

A sharp increase in risk of ischemic stroke was seen in the highest quartile of LVM (odds ratio [OR]: 6.14 [95% confidence interval [CI]: 3.04 to 12.38]). Thus, increased LVM was defined by the highest quartile of LVM. In multivariate analysis, the effect of increased LVM on the risk of stroke was significantly decreased by the presence of any level of PA versus no PA (OR: 1.59 [95% CI: 0.99 to 2.57] p < 0.07 vs. 3.53 [95% CI: 1.94 to 6.42] p < 0.0001). Although PA decreased the risk of stroke in all patients, the effect was stronger in subjects with increased LVM than among those without increased LVM (p = 0.033).

CONCLUSIONS

Increased LVM is associated with an increased risk of stroke, especially among sedentary patients. Physical activity decreases the risk of stroke among patients with increased LVM to a level comparable to that of patients without increased LVM. Recommending PA may be a nonpharmacologic tool to reduce the stroke risk, especially among patients with increased LVM.