Resistance training and HIIT improve cardiometabolic health in high risk older adults

Progressive resistance training (PRT) and high-intensity interval training (HIIT) improve cardiometabolic health in older adults. Whether combination PRT+HIIT (COMB) provides similar or additional benefit is less clear. This systematic review with meta-analysis of controlled trials examined effects of PRT, HIIT and COMB compared to non-exercise control in older adults with high cardiometabolic risk. Databases were searched until January 2021, with study quality assessed using the PEDro scale. Risk factor data was extracted and analysed using RevMan V.5.3. We analysed 422 participants from nine studies (7 PRT, n=149, 1 HIIT, n=10, 1 COMB, n=60; control n=203; mean age 68.1±1.4 years). Compared to control, exercise improved body mass index (mean difference (MD) -0.33 [-0.47, -0.20], p≤0.0001), body fat % (standardised mean difference (SMD) -0.71 [-1.34, -0.08], p=0.03), aerobic capacity (SMD 0.41 [0.05, 0.78], p=0.03), low-density lipoprotein (SMD -0.27 [-0.52, -0.01], p=0.04), and blood glucose (SMD -0.31 [-0.58, -0.05], p=0.02). Therefore, PRT, HIIT and COMB can improve cardiometabolic health in older adults with cardiometabolic risk. Further research is warranted, particularly in HIIT and COMB, to identify the optimal exercise prescription, if any, for improving older adults cardiometabolic health.

Low creatinine levels in diabetes mellitus among older individuals: the Yuport Medical Checkup Center Study

ORIC ID

0000-0002-3401-8191. It is unknown whether the interrelationship between diabetes and muscle loss is affected by ageing. Therefore, the serum creatinine levels, an indicator of muscle mass, were compared between older people with diabetes and those without diabetes, using a cross-sectional dataset from the Yuport Medical Checkup Center Study. We classified 6133 participants without kidney dysfunction into three age-groups: early-elderly (65-69 years), middle-elderly (70-74 years), and late-elderly (≥ 75 years). The association between diabetes and the lowest creatinine level, defined as less than or equal to the 25 percentile of serum creatinine, was evaluated in each age group, by calculating the odds ratio (OR) using logistic regression. Serum creatinine levels increased with ageing in the participants, and these trends were markedly observed in the non-diabetic group. Late-elderly people with diabetes were significantly more likely to have low creatinine levels than those without diabetes, with adjusted ORs 2.50 (95% CI 1.99-4.50) in men and 2.88 (95% CI 1.47-5.64) in women. Ageing modified the effect of their diabetes status towards a lower creatinine level (p for interactions between the diabetic status and age-groups were 0.01 in men and 0.05 in women, respectively). Ageing may thus accelerate the loss of muscle mass in people with diabetes.

Effectiveness of physical activity interventions in older adults with frailty or prefrailty: a systematic review and meta-analysis

Background:

Methods:

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Interpretation:

PROSPERO registration:

Effects of an unsupervised Nordic walking intervention on cognitive and physical function among older women engaging in volunteer activity

Background

Nordic walking (NW) has been reported as a safe and effective exercise mode. However, the effects of NW on cognitive function are unknown. This study examined the effects of an unsupervised NW intervention on cognitive and physical function among older women engaging in volunteering.

Methods

Forty-seven women aged ≥70 years were enrolled and assigned into three groups (NW (n = 16); walking (n = 19); control group (n = 12)) based on residential areas. Participants in NW and walking groups received a pedometer and recorded daily step counts. The NW group received poles and 2 h of NW instruction. Participants were encouraged to perform the exercise individually more than once a week during the 3-month intervention. As baseline and follow-up assessments, cognitive function (Montreal Cognitive Assessment [MoCA-J] and Trail Making Test), physical function (handgrip strength, walking speed, balance ability, the Timed Up and Go test, and functional capacity), and objective physical activity were evaluated.

Results

In the NW group, physical activity, maximal walking speed, and MoCA-J scores were improved during the intervention period. In the walking group, physical activity was increased after the intervention. Analysis of covariance showed that maximal walking speed among the NW group significantly improved compared with the walking group. Sub-group analysis of participants who exercised more than once a week showed that handgrip strength, gait speed, and MoCA-J scores were significantly improved in the NW compared with the walking group.

Conclusion

NW intervention improved cognitive and physical function compared with simple walking among older women.

Impact of physical activity, protein intake and social network and their combination on the development of frailty

BACKGROUND

Frailty is a geriatric condition associated with adverse health outcomes. As physical inactivity, low protein intake and poor social network are known risk factors, we aimed to assess the influence of these parameters and their interaction in an 11-year follow-up study on a Europe-wide level.

METHODS

Data from the Study on Health, Ageing and Retirement in Europe were used, including 22 226 community-dwelling robust and prefrail persons aged ≥50 years, from 11 countries. Frailty was assessed with the 'Frailty Instrument for Primary care of the Survey of Health, Ageing and Retirement in Europe'. Additionally, self-reported physical activity (PA), protein intake and satisfaction with social network were assessed. The impact of these parameters on the development of frailty was calculated using multivariate cox regressions.

RESULTS

Performing no regular PA, was associated with higher hazards ratio (HRs) for frailty compared with performing regular PA [men: 1.90 (95%CI: 1.50-2.42); women: 1.65 (95%CI: 1.25-2.18)]; HRs for low protein intake were 1.16 (95%CI: 0.93-1.46) for men and 1.05 (95%CI: 0.80-1.37) for women. And HR for poor social network were 0.92 (95%CI: 0.74-1.15) for men and 1.72 (95%CI: 1.31-2.27)] for women. In general, persons with a combination of two of the assessed risk factors had a higher risk for frailty compared with those with no or only one of the risk factors. However, no significant synergy index could be found.

CONCLUSION

The results illustrate the importance of PA, but also of nutritional and social network to prevent frailty.

Changes in daily life and wellbeing in adults, 70 years and older, in the beginning of the COVID-19 pandemic

BACKGROUND

In the beginning of the COVID-19 pandemic, Swedish authorities enforced specific recommendations on social distancing for adults 70 years and older (70+). Day-to-day life changed for 15% of the Swedish population. The aim of the study was to explore how adults 70+ experienced and managed changes in everyday life due to the COVID-19 pandemic and how those changes affected wellbeing at the beginning of the virus outbreak.

METHODS

Eleven women and six men, (mean age 76 years), living in ordinary housing, participated in remote semi-structured interviews in April 2020. The interviews were analysed with qualitative content analysis.

FINDINGS

The theme Suddenly at risk - '…but it could have been worse' included four categories My world closed down; Negotiations, adaptations and prioritizations to manage staying at home; Barriers and facilitators to sustain occupational participation; and Considerations of my own and other's health and wellbeing emerged from the data analysis.

CONCLUSION

Everyday life changes had implications for health and well-being. The participants questioned previous conceptions of meaning in relation to habitual activities, likely leading to consistent occupational changes. However, these long-term effects remain to be explored, and considered to enable older adult's health during the pandemic and beyond.

Individualised physical activity programme in patients over 65 years with haematological malignancies (OCAPI): protocol for a single-arm feasibility trial

INTRODUCTION

Older adults with cancer suffer from the combined effects of ageing, cancer disease and treatment side effects. The main treatment for patients with haematological malignancies is chemotherapy, associated with significant toxicities. Chemotherapy can alter patients' physical function and quality of life which are often already diminished in older patients due to ageing and comorbidities. It therefore seems essential to develop and to evaluate interventions capable of preventing physical and psychosocial decline and its consequences. Promoting physical activity is a promising approach to improve physical function and quality of life in older adults with cancer, but there are limited data on the feasibility of such interventions among older patients with haematological malignancies, concomitant to chemotherapy.

METHODS AND ANALYSIS

OCAPI (OnCogeriatric and Individualized Physical Activity) is a single-arm, interdisciplinary, prospective, interventional, feasibility study. It is intended to include 40 patients (20 patients with acute myeloid leukaemia and 20 patients with non-Hodgkin's lymphoma) over 65 years in an individualised 6-month physical activity programme. The programme consists of individually supervised exercise sessions with an increasing volume of physical activity either at home and/or in a laminar airflow room (depending on the disease and treatment regimen) followed by unsupervised sessions and phone follow-ups. Patients will receive an activity tracker during the 6 months of the programme. Evaluations will take place at inclusion and at 3, 6 and 12 months to assess the feasibility of the programme and to explore potential changes in physical, psychosocial and clinical outcomes. The results will generate preliminary data to implement a larger randomised controlled trial.

ETHICS AND DISSEMINATION

The study protocol was approved by the French ethics committee (Comité de protection des personnes Est I, N°ID-RCB 2019-A01231-56, 12 July 2019). All participants will have to sign and date an informed consent form. The findings will be disseminated in peer-reviewed journals and academic conferences.

TRIAL REGISTRATION NUMBER

NCT04052126.

Exploring the role of built environments and depressive symptoms in community-dwelling older adults: A case of Taiwan

OBJECTIVES

Depression in older adults is a growing public health concern. However, limited research has focused on the issues of physical environments and depression in the elderly in Asia. The purpose of the study is to examine the relationship between the built environments and depressive symptoms in older adults using Taiwan as an example.

METHODS

Two national datasets were used in this study, including the 2009 National Health Interview Survey and the 2006 National Land Use Investigation in Taiwan. A total of 2,155 older adults were recruited, and eight built environments were examined among 161 townships. Depressive symptoms were measured using a 10-item CES-D scale, and four sophisticated models were built using a multi-level analysis.

RESULTS

Five types of built environments were found to be significantly associated with depressive symptoms in older adults. Among them, two types of built environments, 'health and medical services' and 'schools' were highly related to a lower CES-D score and lower odds of being depressed, whereas the other three built environments, 'cultural and historical facilities,' 'recreational and amusement areas,' and 'playgrounds and sports venues' were significantly associated with an increasing risk of being depressed.

CONCLUSIONS

Different built environments had different effects on depression and some even showed a dose-response relationship. These results can help urban planners or city designers reconsider how to facilitate the construction of built environments in neighborhoods that will improve the mental health of older adults.

Association Between Penile Color Doppler Ultrasonography and Cardiorespiratory Fitness in Patients With Vascular Erectile Dysfunction

INTRODUCTION

Vascular erectile dysfunction (ED) is a burdensome condition, associated with increased cardiovascular risk. Peak systolic velocity (PSV) represents the maximum pulse velocity in the cavernous artery measured by a penile color doppler ultrasonography (PCDU) during a pharmacologically induced erection and is considered a reliable parameter for the diagnosis of vascular ED. However, the cut-off value of standard PSV (30 cm/s) provides high sensitivity only in the diagnosis of advanced arteriogenic disease. Thus, an age-adjusted PSV (6.73 + 0.7 x age cm/s) has been proposed to offer a more accurate diagnosis of vascular ED.

AIM

In this study it was aimed to answer the following question: "Is there any positive association between indexes of vascular erectile dysfunction and cardiorespiratory fitness?"

MAIN OUTCOME MEASURE AND METHODS

25 patients with a medical history of ED (median age 55.3 years) underwent PCDU after pharmacological stimulation. Subsequently, a functional evaluation with ECG-monitored, incremental, maximal cardiopulmonary exercise testing was performed.

RESULTS

Peak oxygen uptake (VO2 peak), peak oxygen uptake per body weight (VO2 peak/kg) and Watt/kg correlated with standard PSV, even when corrected for age and BMI (p < 0.05). No differences emerged in cardiopulmonary fitness between pathological and healthy patients (4 vs 21) identified using the standard PSV cut-off. Conversely, the age-adjusted PSV cut-off identified a greater number of patients as pathological (18 vs 7), presenting a significantly lower cardiopulmonary fitness, exercise capacity and efficiency when compared to patients with normal age-adjusted PSV (all p < 0.05).

CONCLUSION

Data showed an age and BMI independent association between vascular disfunction of cavernous artery and cardiopulmonary fitness, a known solid predictor of all-cause and disease-specific mortality. Moreover, the age-adjusted PSV better identified a subgroup of patients with vascular ED presenting impaired cardiorespiratory fitness and thus increased cardiovascular risk. De Rocco Ponce M, Vecchiato M, Neunhaeuserer D, et al. Association Between Penile Color Doppler Ultrasonography and Cardiorespiratory Fitness in Patients With Vascular Erectile Dysfunction. Sex Med 2021;9:100347.

“Someone’s Got My Back”: Older People’s Experience of the Coaching for Healthy Ageing Program for Promoting Physical Activity and Preventing Falls

The Coaching for Healthy Ageing trial evaluated the impact on physical activity (PA) and falls based on a year-long intervention in which participants aged 60+ receive a home visit, regular health coaching by physiotherapists, and a free activity monitor. This interview study describes the participants’ experiences of the intervention and ideas for improvement. The authors sampled purposively for maximum variation in experiences. The data were analyzed thematically by two researchers. Most of the 32 participants reported that the intervention increased PA levels, embedded activities, and generated positivity about PA. They were motivated by quantified PA feedback, self-directed goals, and person-centered coaching. Social connectivity motivated some, but the intervention did not support this well. The intervention structure allowed participants to trial and embed activities. Autonomy and relatedness were emphasized and should be included in future program theory. The authors identified synergistic effects, likely “essential ingredients,” and potential areas for improving this and similar interventions.

Effect of Training-Detraining Phases of Multicomponent Exercises and BCAA Supplementation on Inflammatory Markers and Albumin Levels in Frail Older Persons

Nowadays, it is accepted that the regular practice of exercise and branched-chain amino acids supplementation (BCAAs) can benefit the immune responses in older persons, prevent the occurrence of physical frailty (PF), cognitive decline, and aging-related comorbidities. However, the impact of their combination (as non-pharmacological interventions) in albumin and the inflammatory markers is not fully understood. Therefore, we investigated the effect of a 40-week multifactorial intervention [MIP, multicomponent exercise (ME) associated or not with BCAAs] on plasma levels of inflammatory markers and albumin in frail older persons (≥75 years old) living at residential care homes (RCH). This study consisted of a prospective, naturalistic, controlled clinical trial with four arms of multifactorial and experimental (interventions-wahshout-interventions) design. The intervention groups were ME + BCAAs (n = 8), ME (n = 7), BCAAs (n = 7), and control group (n = 13). Lower limb muscle-strength, cognitive profile, and PF tests were concomitantly evaluated with plasma levels of albumin, anti- and pro-inflammatory cytokines [Interleukin-10 (IL-10) and Tumor Necrosis Factor-alpha (TNF-α) respectively], TNF-α/IL-10 ratio, and myeloperoxidase (MPO) activity at four different time-points: Baseline (T1), after 16 weeks of multifactorial intervention (T2), then after a subsequent 8 weeks washout period (T3) and finally, after an additional 16 weeks of multifactorial intervention (T4). Improvement of cognitive profile and muscle strength-related albumin levels, as well as reduction in the TNF-α levels were found particularly in ME plus BCAAs group. No significant variations were observed over time for TNF-α/IL-10 ratio or MPO activity. Overall, the study showed that MIP triggered slight alterations in the inflammatory and physical function of the frail older participants, which could provide independence and higher quality of life for this population.

The effect of the group-based Otago exercise program on frailty among nursing home older adults with cognitive impairment

This study investigated the effect of the group-based Otago exercise program (OEP) on frailty and physical function in older adults with cognitive impairment. We recruited eighteen older adults with cognitive impairment from a nursing-home to perform the OEP three times a week, for a period of three months in a nursing home. The intervention was feasible with attending an average of 21 out of 36 sessions. The frailty score decreased significantly (p<0.05). Physical function including Time Up and Go test (TUG), 30 seconds Sit-To-Stand Test (30 s-SST) and Four-Stage Balance Test was significantly positive after intervention (all p<0.001). The group-based OEP is a potentially effective strategy for reversing frailty and improving physical function among older adults with cognitive impairment.

What Affects Older Adults' Viewing Behaviors in Neighborhood Open Space: A Study in Hong Kong

Research on older adults' behaviors, living environments, and their quality of life (QoL) has grown rapidly. Viewing behaviors, although broadly acknowledged as critical for older adults' QoL, have not been systematically examined in situ. What affects the viewing behaviors of older adults in neighborhood open space (NOS) is still unclear. This study conducted unobtrusive continuous observations in NOS of two residential estates in Hong Kong. With spatio-temporal analyses with ArcGIS Pro and statistical analyses with SPSS, principal influential factors to viewing behaviors of older adults in NOS were identified, including distances for viewing, landscape attractiveness, body supporting elements, as well as moving and interactive behaviors. How these factors would affect older adults' well-being and QoL is discussed from the perspectives of supportive landscape design, sense of control, prospect and refuge, and social support, etc. Corresponding design implications are proposed to enrich existing NOS design knowledge for older adults' quality of life.

Use of Measuring Tools in Practice Development Projects: A Critical Perspective

BACKGROUND.

Occupational therapists are generally positive towards use of measuring tools. However, such use may be problematic.

PURPOSE.

To illuminate hidden and adverse effects of using measuring tools in occupational therapy.

METHOD.

A Foucauldian inspired thematic analysis of the use of measuring tools in 13 reports of practice development projects in Denmark.

FINDINGS.

Three themes were constructed: "Categorisation of loss", "Conduct of conduct: Self-tracking and competition", and "Conforming to expected forms of everyday living". Measuring tools tended to produce generalised truths about older adults and were used to predict outcome of or access to reablement programs. The measurements guided both older people and professionals, and measurements created both motivation and resistance. The tools served as an extension of the healthcare professionals' authority.

IMPLICATIONS.

When appropriately situated, measuring tools have the potential to empower and enhance older adults' lives and should be the focus of greater clinical attention.

Moving more, ageing happy: findings from six low- and middle-income countries

BACKGROUND

low levels of well-being (including happiness) in the older population are major global concern given rapid population ageing especially in low- and middle-income countries (LMICs). Physical activity may increase levels of happiness, but data on the older population are scarce, while there are no data from LMICs.

OBJECTIVE

we investigated the relationship between physical activity and happiness, and the influential factors in this association among older adults employing nationally representative datasets from six LMICs.

METHODS

community-based cross-sectional data from the Global Ageing and Adult Health study were analysed. Physical activity was assessed with the Global Physical Activity Questionnaire. Participants were grouped into those who do and do not meet physical activity recommendations. Happiness was assessed with a cross-culturally validated single-item question (range 0-4) with higher scores indicating higher levels of happiness. Multivariable ordinal logistic regression and mediation analyses were performed.

RESULTS

the sample included 14,585 adults aged ≥65 years (mean age = 72.6 ± SD 11.4 years; 55% female). After adjusting for multiple confounders, meeting physical activity guidelines was positively associated with more happiness (fully adjusted model, odds ratio = 1.27; 95% confidence interval = 1.04-1.54). The physical activity-happiness association was largely explained by difficulties in mobility, cognitive impairment, disability and social cohesion, which explained ≥20% of the association.

CONCLUSIONS

meeting recommended physical activity levels was positively linked with happiness in older adults from LMICs. Longitudinal and interventional studies among older people in LMICs are warranted to assess directionality and the potential for physical activity promotion to improve mental well-being in this population.

Social Contact with Family and Non-Family Members Differentially Affects Physical Activity: A Parallel Latent Growth Curve Modeling Approach

Background: Social contact leads to an increased likelihood of engaging in physical activity (PA). However, the influence of social contact on PA would be different depending on the social contact source. This study aimed to identify the association of changes in social contact with family and non-family members with the change in PA using a parallel latent growth curve modeling. Methods: Participants were randomly selected from among residents in the study area age ≥ 20 years (n = 7000). We conducted mail surveys in 2014, 2016, and 2019. The 1365 participants completed all surveys. PA was assessed with validated single-item physical activity measure. Social contact was assessed by summing frequencies of face-to-face and non-face-to-face contacts with family/relatives not living with the participant and friends/neighbors. Parallel latent growth curve modeling was used to assess the cross-sectional, prospective, and parallel associations of social contact with PA change. Results: There was a positive cross-sectional association between contact with friends/neighbors and PA, whereas prospective and parallel associations between contact with family/relatives and PA. Conclusion: Contacting friends/neighbors did not predict the change in PA, and a high frequency of contact with family/relatives at baseline and increasing contact with family/relatives was associated with increased PA over 5-year.

Effects of the Active Choices Program on Self-Managed Physical Activity and Social Connectedness in Australian Defence Force Veterans: Protocol for a Cluster-Randomized Trial

Background

A stepped-down program is one in which clients transition from the care of a health professional to self-managed care. Very little is known about the effectiveness of stepped-down physical activity (PA) programs for military service veterans.

Objective

This study will test Active Choices, a stepped-down behavioral support program designed to help Australian Defence Force veterans and their dependents who are clients of the Department of Veterans’ Affairs, transition from treatment by an exercise physiologist or physiotherapist to self-managed PA.

Methods

The study is a parallel-group, randomized trial, with city-based exercise physiology or physiotherapy practices that recruit eligible Department of Veterans’ Affairs clients assigned to Active Choices or a comparison program. The study aims to recruit 52 participants (26 in each group). The Active Choices program will consist of 2 face-to-face (Weeks 1, 12) and 2 telephone (Weeks 4 and 8) consultations. During these sessions, the participant and Active Choices consultant will utilize an evidence-based resource booklet to review the key benefits of an active lifestyle, build an action plan for PA preferences, set and review goals, self-monitor progress relative to set goals, and discuss strategies to overcome PA barriers. Linking participants to local PA communities to overcome social isolation will be a program priority. The comparison program will consist of 2 consultations (Weeks 1 and 12) and use fewer behavioral support strategies (education, self-monitoring, and action planning only) than Active Choices. Outcome measures will be administered at baseline, end-intervention (12 weeks), and follow-up (24 weeks) to assess changes in moderate intensity self-managed PA, psychological well-being, and social connectedness. We will also measure health service utilization and costs as well as PA choices across the intervention period. End-intervention interviews will capture participant experiences.

Results

Due to the impacts of the COVID-19 pandemic on human research activities in Australia, participant recruitment will commence when it is safe and feasible to do so.

Conclusions

Findings will provide valuable pilot data to support up-scaling of the program and larger effectiveness trials with regional and rural as well as city-based Australian Defence Force veterans and their dependents.

Trial Registration

Australian and New Zealand Clinical Trials Registry (ANZCTR): ACTRN12620000559910; https://www.anzctr.org.au/ACTRN12620000559910.aspx

International Registered Report Identifier (IRRID)

PRR1-10.2196/21911

Many physiotherapists lack preparedness to prescribe physical activity and exercise to people with musculoskeletal pain: A multi-national survey

OBJECTIVES

Determine physiotherapists' (i) awareness of physical activity, and exercise prescription guidelines; (ii) perceived role, knowledge, confidence, skills and training in prescribing and progressing aerobic exercise and resistance training to people with musculoskeletal pain; (iii) professional development preferences; and (iv) perceived influences of external factors on exercise prescription for people with musculoskeletal pain.

DESIGN

Multi-national cross-sectional survey.

METHODS

An open online survey was developed specifically for this study.

RESULTS

1,352 physiotherapists from 56 countries participated. The majority of respondents correctly stated physical activity guidelines for adults (60%) and children (53%), but only 37% correctly stated guidelines for older adults. Eleven percent and 16% could name an accepted guideline for aerobic exercise and resistance training, respectively. Most agreed their role included prescribing aerobic exercise (75%) and resistance training (89%). Fewer reported they had the confidence, training or skills to prescribe aerobic exercise (38-50%) and resistance training (49-70%). Workshops were the most preferred (44%) professional development option. Most respondents believed appointment scheduling and access to equipment and professional development (62-79%) affected their ability to prescribe effective exercise.

CONCLUSION

Many physiotherapists lack knowledge and training to provide physical activity advice, and to prescribe aerobic exercise and resistance training to people with musculoskeletal pain.

Improving centre-based group exercise participation of older adults using the behaviour change wheel

An emphasis on active ageing could help to delay the onset of frailty. In Singapore, Senior Activity Centres provide free and guided group exercise sessions for older adults. However, one such centre had very low participation rates among community-dwelling older adults despite running standardised programmes. Based on a needs analysis from a prior project, this paper reports on strategies implemented to improve the daily centre-based group exercise participation rate among community-dwelling older adults. Using the behaviour change wheel model, participant motivation domains were identified as primary gaps, while the psychological capability and physical opportunity were categorised as secondary gaps. A logic model was used to design a project to respond to these identified gaps and guide the evaluation approach. Three strategies were implemented over a 4-week period and reviewed at 6 months: (1) promotion of the exercise classes, (2) delayed rewards for participation and (3) health ambassadors. Evaluation findings highlighted that more resources were needed for the training of community-dwelling older adult healthcare ambassadors in the use of motivational interviewing. The interventions were found to be efficacious in increasing daily group exercise participation rate at the centre, from an average of three to nine participants per day over the 4 weeks. Furthermore, more than 60% of these participants achieved the WHO's weekly minimum exercise recommendation for older adults (150 min moderate-intensity physical activity). To increase the engagement of older adults in physical activity or exercise participation, we recommend the use of behaviour change wheel model and the use of community-based health ambassadors. In conclusion, the project found improved daily centre-based group physical exercise participation rates when all the domains in the behaviour change wheel model were addressed.

Influence of Resistance Training on Gait & Balance Parameters in Older Adults: A Systematic Review

In this work we aimed to perform a systematic review of randomized controlled trials within an aging population that investigated the general impacts of a resistance training (RT) protocol on key outcome measures relating to gait and/or balance. Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement guidelines, two electronic databases (PubMed, and Scopus) were searched for randomized controlled trials that measured at least one key outcome measure focusing on gait and/or balance in older adults. 3794 studies were identified, and after duplicates were removed, 1913 studies remained. 1886 records were removed due to the abstract not meeting the inclusion criteria. 28 full-text articles were assessed further, and 20 of the articles were identified as meeting the criteria for inclusion. The remaining 20 studies were assessed for quality using the Physiotherapy Evidence Database (PEDro) scale; 12 studies remained and were included in this systematic review. Our review suggests that RT has a positive effect on both gait and balance in an elderly population. RT improves gait, specifically straight-line walking speed in older adults. RT is an adequate training method to improve balance in an aging population. Improvements in strength, attributed to RT, may allow for greater autonomy and independence to carry out activities of daily living as we age.

Neighborhood Environmental Factors and Physical Activity Status among Rural Older Adults in Japan

(1) Background: Although several neighborhood environmental factors have been identified to be associated with older adults’ physical activity, little research has been done in rural areas where the population is aging. This study aimed to investigate neighborhood environmental factors and the longitudinal change of physical activity status among rural older adults in Japan. (2) Methods: The study included 2211 older adults, aged over 60 years, residing in three municipalities in Shimane prefecture and participating at least twice in annual health checkups between 2010 and 2019. Physical activity was identified based on self-report. Hilliness, bus stop density, intersection density, residential density, and distance to a community center were calculated for each subject. Hazard ratios for the incidence of physical inactivity were estimated using Cox proportional hazards models. (3) Results: We found that 994 (45%) of the study subjects became physically inactive during the follow-up. Those living far from a community center had a lower risk of becoming physically inactive compared to those living close to a community center. When the analysis was stratified by residential municipality, this association remained in Ohnan town. Those living in hilly areas had a higher risk of becoming physically inactive in Okinoshima town. (4) Conclusions: The impact of neighborhood environmental factors on older adults’ physical activity status might differ by region possibly due to different terrain and local lifestyles.

Evaluation of Light Physical Activity Measured by Accelerometry and Mobility Disability During a 6-Year Follow-up in Older Women

IMPORTANCE

Almost 1 in 4 women older than 65 years is unable to walk 2 to 3 blocks, and mobility disability is a key factor associated with loss of independence. Lack of moderate to vigorous-intensity physical activity is associated with mobility disability, but whether lighter physical activity is associated with mobility disability is unknown.

OBJECTIVE

To determine the association of light-intensity physical activity and incident mobility disability among older women.

DESIGN, SETTING, AND PARTICIPANTS

This prospective cohort study included women enrolled in the Objectively Measured Physical Activity and Cardiovascular Health study, an ancillary study of the Women's Health Initiative, between March 2012 and April 2014, with follow-up through March 31, 2018. The Women's Health Initiative was a population-based, multisite study that recruited from 40 clinical sites across the US. Participants in the present analysis included 5735 of 7058 ambulatory, community-dwelling women aged 63 years and older who returned an accelerometer with usable data, were free of mobility disability, and had follow-up data on mobility status. Data were analyzed from August 2018 to May 2019.

EXPOSURES

Light-intensity physical activity, defined as movement requiring energy expenditure between 1.6 and 2.9 metabolic equivalents, captured using an accelerometer over 7 days.

MAIN OUTCOMES AND MEASURES

Incident mobility disability, defined as the first self-reported inability to walk 1 block or up a flight of stairs at annual follow-up, and persistent incident mobility disability, defined as incident mobility loss that persisted through the end of follow-up.

RESULTS

A total of 5735 participants were included for primary analysis of all incident mobility disability (mean [SD] age, 78.5 [6.6] years [range, 63-97 years]; 2811 [49.0%] White participants). Compared with women in the lowest quartile of light-intensity physical activity, lower risk of incident mobility disability was observed in quartile 2 (multivariable hazard ratio [HR], 0.78; 95% CI, 0.67-0.90), quartile 3 (HR, 0.60; 95% CI, 0.51-0.71), and quartile 4 (HR, 0.60; 95% CI, 0.51-0.71) (P < .001). This beneficial association was stronger for persistent mobility disability in quartile 2 (multivariable HR, 0.72; 95% CI, 0.60-0.85), quartile 3 (HR, 0.55; 95% CI, 0.46-0.67), and quartile 4 (HR, 0.52; 95% CI, 0.42-0.63) (P < .001). Stratified analyses showed the association was stronger among women with a body mass index of less than 30.0 (HR, 0.73; 95% CI, 0.66-0.82) compared with women with a body mass index of 30.0 or higher (HR, 0.91; 95% CI; 0.79-1.04; P = .04 for interaction).

CONCLUSIONS AND RELEVANCE

In this cohort study, increased time spent in light-intensity physical activity was associated with reduced incident mobility disability. These findings support placing greater emphasis on promoting light-intensity physical activity for preserving mobility in later life.

Physical Activity in Crisis: The Impact of COVID-19 on Danes' Physical Activity Behavior

Objectives: Because of the COVID-19 pandemic, societies have been shut down, changing the lives of citizens worldwide, including their physical activity (PA) behavior. This cross-sectional study aimed to investigate the impact of the shutdown on Danish citizens' leisure PA throughout different stages of life: 15-18, 19-29, 30-59, and 60+ years. Methods: Between April 3 and 15, 2020, while Denmark was shut down, a survey was distributed through online platforms. Danish citizens (>15 years) could participate in the study, answering questions about their PA behavior before, and during the shutdown. Results: The number of total participants was 1,802; 7.9% teens, 21.5% younger adults, 58.7% adults, and 11.9% older adults. Mean minutes of PA decreased 16.1% from before to during the shutdown. Teens had the largest decrease in PA (36.6%) followed by older (24.9%) and younger adults (21.3%). Low educated (31.5%) and those living in rural areas (30.9%) experienced the largest decrease in PA. Main factors for not doing PA during the shutdown were that they missed what they used to do, lacked social support, and did not have access to the right facilities. Conclusions: During the shutdown, the Danish population struggled even more to comply with national PA guidelines compared with before the shutdown. Although social distancing and shutting down sports facilities are important for preventing the spread of the virus, it can have negative consequences for teens' and younger and older adults' opportunities and motivation for PA, leading to an alarming decrease in PA, and, consequently, will have major public health consequences.

Group or individual lifestyle-integrated functional exercise (LiFE)? A qualitative analysis of acceptability

Background

The Lifestyle-integrated Functional Exercise (LiFE) program is an effective but resource-intensive fall prevention program delivered one-to-one in participants’ homes. A recently developed group-based LiFE (gLiFE) could enhance large-scale implementability and decrease resource intensity. The aim of this qualitative focus group study is to compare participants’ experiences regarding acceptability of gLiFE vs LiFE.

Methods

Programs were delivered in seven group sessions (gLiFE) or seven individual home visits (LiFE) within a multi-center, randomized non-inferiority trial. Four structured focus group discussions (90–100 min duration; one per format and study site) on content, structure, and subjective effects of gLiFE and LiFE were conducted. Qualitative content analysis using the method of inductive category formation by Mayring was applied for data analysis. Coding was managed using NVivo.

Results

In both formats, participants (N = 30, 22 women, n_gLiFE = 15, n_LiFE = 15, mean age 78.8 ± 6.6 years) were positive about content, structure, and support received by trainers. Participants reflected on advantages of both formats: the social aspects of learning the program in a peer group (gLiFE), and benefits of learning the program at home (LiFE). In gLiFE, some difficulties with the implementation of activities were reported. In both formats, the majority of participants reported positive outcomes and successful implementation of new movement habits.

Conclusion

This is the first study to examine participants’ views on and experiences with gLiFE and LiFE, revealing strengths and limitations of both formats that can be used for program refinement. Both formats were highly acceptable to participants, suggesting that gLiFE may have similar potential to be adopted by adults aged 70 years and older compared to LiFE.

Trial registration

ClinicalTrials.gov, NCT03462654. Registered on March 12, 2018.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-020-01991-0.

A systematic review of qualitative studies exploring the factors influencing the physical activity levels of Arab migrants

Background

Evidence suggests that Arab migrant populations engage in low levels of physical activity. To our knowledge, there are no reviews that explore the perspectives of Arab migrant populations on the factors influencing physical activity. The aim of this systematic review was to thematically synthesise qualitative literature on the factors influencing physical activity among Arab migrant populations.

Methods

Five electronic databases (CINAHL, SPORTDiscus, PsychoInfo, MEDLINE, Embase) were searched in July 2018 and searched again in April 2020. A manual search in Google Scholar was also performed using keywords and the reference lists of included studies were also screened to identify further articles. The eligibility criteria for inclusion were studies that sampled adult (≥18 years) Arab migrant populations, used qualitative methodology, explored the factors influencing physical activity as a primary aim, and were published in English. The 10-item Critical Appraisal Skills Programme (CASP) checklist was used to assess methodological quality of individual studies. The results of the studies were thematically synthesised using the qualitative software Quirkos v1.6.

Results

A total of 15 studies were included, with the largest proportion of studies conducted in Australia, followed by the United States, Netherlands, Sweden, and then Canada. Five studies exclusively sampled Arab migrant populations in their study. A total of 7 major themes influencing physical activity among Arab migrants emerged from the synthesis: culture and religion, competing commitments and time, social factors, health-related influences, accessibility issues, outdoor environment, and the migratory experience.

Conclusions

The findings of this review highlighted the various factors influencing the physical activity levels of Arab migrant adults. While many of the factors influencing physical activity are shared with those experienced by other populations (e.g., time constraints), for Arab migrant populations there are other more unique factors closely associated with culture and religion that appear to influence their levels of physical activity. The findings of this review could be used to inform the design of physical activity interventions targeting Arab migrant populations.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-020-01056-w.

Are Changes in Walking for Transportation in Brazilian Older Adults Associated With Attributes of the Neighborhood Environment?

This study aims to examine the association between neighborhood environment attributes and changes in walking for transportation among older adults. Longitudinal analysis was performed considering a population-based study (EpiFloripa Idoso), carried out in 2009-2010 with follow-up in 2013-2014. Changes in walking, obtained with the International Physical Activity Questionnaire during both waves were associated with data from the environment perception, evaluated using individual items from the Neighborhood Environment Walkability Scale (baseline only) performing multinomial logistic regression. A total of 1,162 older adults (65.2% women, mean age = 73.7 years) participated. Those who reported the presence of parks and squares (OR = 2.44, 95% confidence interval [CI; 1.70, 3.51]), sidewalks (OR = 1.66, 95% CI [1.03, 2.70]), crosswalks (OR = 1.69, 95% CI [1.05, 2.72]), illuminated streets (OR = 2.80, 95% CI [1.24, 6.33]), and safety for day walks (OR = 1.93, 95% CI [1.14, 3.24]) were more likely to remain active or become active when commuting (≥150 min/week). Older adults are more active in neighborhoods that present more favorable attributes regarding walking for transportation.

An ecological approach to the development of an active aging measurement in urban areas (AAMU)

BACKGROUND

An essential element in the process of "aging well" is the concept of Active Aging (AA). To propose an operational definition of Active Aging, the present study seeks to develop a new measurement tool through an ecological approach. The aim is to recognize significant indicators that play a role in assessing AA in urban areas.

METHODS

This study was conducted through a two-phase process of consensus-building: 1) identifying a set of indicators that were likely candidates for inclusion based on literature review, and 2) a two-round modified Delphi survey using an international panel of academic experts in environmental sciences and gerontology to achieve consensus on the importance of the extracted indicators and validate the items. The panelists were asked to complete a researcher-developed questionnaire with an 11-point Likert scale based on the indicators derived in phase 1. Finally, the Delphi survey's valid indicators and criteria were utilized to develop the measurement tool.

RESULTS

At the outset, a list of 111 indicators of AA was prepared through the desk study. A panel of 22 experts reviewed the extracted items and arrived at a consensus on 99 items in the first round and finalised in the second round. Thematic analysis of the panelists' open-ended responses revealed new concepts that would be explicitly considered by the consensus group. This developed measurement scale consists of five domains, i.e., individual, spatial, socio-economic, governance, and health-related, which contain 15 criteria and 99 indicators.

CONCLUSIONS

The present researchers have developed the active aging measure for urban settlements (AAMU), which can be used both by policy-makers and as an informal self-reported statement among the elderly. AAM's results in the elderly's residential environmental communities can improve policy-making to address urban design to sustain an active, healthy life among older people in urban environments.

Associação entre atividade física de lazer e conhecimento e participação em programas públicos de atividade física entre idosos brasileiros

Resumo Objetivo Avaliar a prevalência da atividade física de lazer entre idosos brasileiros e sua associação com conhecimento e participação em programas públicos de promoção dessa prática. Método Estudo transversal com dados de 11.177 pessoas idosas entrevistadas na Pesquisa Nacional de Saúde 2013. A variável resposta foi a prática de atividade física de lazer. As variáveis explicativas foram conhecimento e participação em programas públicos de promoção de atividade física, características sociodemográficas e de estilo de vida. A associação bruta e ajustada foi estimada pela regressão de Poisson com variância robusta. Resultados A maioria das pessoas idosas era do sexo feminino e tinha entre 60 e 69 anos; 17% conheciam, mas não participavam dos programas públicos de promoção de atividade física e somente 3,2% conheciam e participavam. A prevalência de ativos no lazer foi de 13,3%, e na análise ajustada, foi maior entre as pessoas idosas que conheciam, mas não participavam e conheciam e participavam de programas públicos de promoção a atividade física, nos homens, na faixa etária de 60 a 69 anos, com 12 anos ou mais de escolaridade; das regiões Nordeste e Centro-Oeste, com 2 doenças crônicas, que realizaram três ou mais consultas médicas nos 12 últimos meses e consumiam frutas e hortaliças cinco ou mais dias por semana. Conclusão O estudo mostrou uma baixa adesão das pessoas idosas à prática de atividade física, e pouco conhecimento e participação em programas públicos. Esforços são necessários para ampliar a divulgação desses programas, promover o envolvimento da população nessas práticas e contribuir para o envelhecimento ativo.

Transtheoretical Model for Physical Activity in Older Adults: Systematic Review

Healthy aging makes the practice of physical activity (PA) a necessity. However, PA guidelines achievement in older adults is scarce. The use of behavioral theories such as Transtheoretical Model (TTM), helps in older adults PA promotion. The aim of this review was to identify the use of TTM for PA in older adults (>60 years). PubMed, SPORTdiscus, and Medline databases were used to conduct the search. All steps of the process followed the recommendations of the PRISMA flow-diagram. We identified eight studies: Six were descriptive cross-sectional studies, one prospective-cohort study and one with a quasi-experimental design. Only two papers evaluated the four behavior change dimensions within the same study, three evaluated the processes of change and the decisional balance, four evaluated the exercise self-efficacy and all assessed the stages of change for PA behavior. From this review, we can conclude that TTM is a useful and suitable behavior model in creating, developing, and evaluating interventions with the aim of acquiring and improving PA habits in the older adults. However, there is paucity of research in this area, and more studies including the four behavioral change dimensions are needed to analyze the effect of TTM on the promotion of PA in the older adults.

Effectiveness of Outdoor Exercise Parks on Health Outcomes in Older Adults-A Mixed-Methods Systematic Review and Meta-Analysis

The objective of this systematic review was to examine the effectiveness of outdoor exercise park equipment on physical activity levels, physical function, psychosocial outcomes, and quality of life of older adults living in the community and to evaluate the evidence of older adults' use of outdoor exercise park equipment. A search strategy was conducted from seven databases. Nine articles met the inclusion criteria. The study quality results were varied. Meta-analyses were undertaken for two physical performance tests: 30-s chair stand test and single-leg stance. The meta-analysis results were not statistically significant. It was not possible to conclude whether exercise parks were effective at improving levels of physical activity. The review shows that older adults value the benefits of health and social interaction from the use of exercise parks. Findings should be interpreted with caution due to the small sample sizes and the limited number of studies.

Cognitive Functioning, Life Satisfaction, and Their Relationship with the Financial Attitudes of Older Individuals Who Participate in an Active Aging Program

Life expectancy has increased in many countries throughout the world over recent years, leading to new challenges related to aging. A large part of the population is over 60 years old, and therefore studies that focus on financial autonomy and active aging are necessary. In this paper, we analyze the relationship between cognitive functioning and life satisfaction in relation to financial attitudes in a sample of 251 elderly adults (71% women) participating in an active aging program (M = 67.5, SD = 4.5). We used the Mini-Mental State Examination, the Satisfaction with Life scale, and a questionnaire about financial attitudes to gather data. Our results show that cognitive functioning and life satisfaction are related to certain financial attitudes. We also observed differences associated with gender, education level, and financial independence. According to our findings, life satisfaction should be taken into account when the financial attitudes of older adults are evaluated. The importance of support groups for the elderly is highlighted as well as of all those recreation and health programs, since they constitute a means of promoting well-being.

Walking-friendly built environments and objectively measured physical function in older adults

BACKGROUND

Few studies have examined the associations between urban design attributes and older adults' physical function. Especially, it is not well known how built-environment attributes may influence physical function in Asian cities. The aim of this study was to examine associations between objectively measured environmental attributes of walkability and objectively assessed physical function in a sample of Japanese older adults.

METHODS

Cross-sectional data collected in 2013 from 314 older residents (aged 65-84 years) living in Japan were used. Physical function was estimated from objectively measured upper- and lower-body function, mobility, and balance by a trained research team member. A comprehensive list of built-environment attributes, including population density, availability of destinations, intersection density, and distance to the nearest public transport station, were objectively calculated. Walk Score as a composite measure of neighborhood walkability was also obtained.

RESULTS

Among men, higher population density, availability of destinations, and intersection density were significantly associated with better physical function performance (1-legged stance with eyes open). Higher Walk Score was also marginally associated with better physical function performance (1-legged stance with eyes open). None of the environmental attributes were associated with physical function in elderly women.

CONCLUSION

Our findings indicate that environmental attributes of walkability are associated with the physical function of elderly men in the context of Asia. Walking-friendly neighborhoods can not only promote older adults' active behaviors but can also support their physical function.

A balance between meaningfulness and risk of harm - frail elderly patients' perceptions of physical activity and exercise - an interview study

Background

There is growing evidence of the benefits of physical activity and exercise for frail elderly patients with comorbidity. In order to improve participation in physical activity and exercise interventions, there is a need to increase our understanding of the patient’s perspective.

Aim

The aim of this study is to explore the perceptions of physical activity and exercise among frail elderly patients with a severe comorbidity burden.

Method

Face-to-face, in-depth interviews were conducted with eighteen frail elderly patients with a severe comorbidity burden, median age 85.5 years (min-max 75–94). The interviews were transcribed verbatim and analyzed according to content analysis inspired by Krippendorf.

Results

An overall theme, defined as “Meaningfulness and risk of harm in an aging body” was identified, followed by three main categories, labeled physical activity in daily life, goals of physical activity and exercise and prerequisites for physical activity and exercise, and eight sub-categories.

Conclusion

This study suggests that, in frail elderly patients with severe multimorbidity, physical activity and exercise is a balance between what is perceived as meaningful and the risk of harm. Patients perceived aging as an inevitable process that they needed to accept and gradually adapt their physical activities in daily life to match. As patients said they were unclear about the benefits and risks of exercise and referred to their previous life and experiences when describing physical activity and exercise, it is likely that the communication relating to this within the healthcare system needs to be further developed To promote physical activity and exercise to maintain or improve physical fitness in this frail population, healthcare providers need to use extended, personalized information to tailor the type of physical activities, goals and prerequisites for each patient.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-020-01868-2.

A patient-oriented approach to the development of a primary care physical activity screen for embedding into electronic medical records

Physical activity questionnaires exist, but effective implementation in primary care remains an issue. We sought to develop a physical activity screen (PAS) for electronic medical record (EMR) integration by 1) identifying healthcare professionals' (HCPs), patients' and stakeholders' barriers to and preferences for physical activity counselling in primary care; and 2) using the information to co-create the PAS. We conducted semi-structured interviews with primary care HCPs, patients and stakeholders, and used content and thematic analyses to inform iterative co-design of the PAS. Interviews with 38 participants (mean age 41 years) resulted in 2 themes: 1) HCPs are willing to conduct physical activity screening, but acknowledge they don't do it well; and 2) HCPs have limited opportunity and capacity to discuss physical activity, and need a streamlined process for EMR that goes beyond quantifying physical activity. HCPs, patients and stakeholders co-designed a physical activity screen for integration into the EMR that can be tested for feasibility and effects on HCP behaviour and patients' physical activity levels. Novelty: EMR-integration of physical activity screening needs to go beyond just asking about physical activity minutes. Primary care professionals have variable knowledge and time, and need physical activity counselling prompts and resources. We co-developed a physical activity EMR tool with patients and primary care providers.

Determinants of Multidimensional and Physical Frailty and Their Individual Components: Interactions between Frailty Deficits

Purpose: To identify the interrelations among determinants of multidimensional frailty, physical frailty, and their individual components. Methods: A group of 1024 community-dwelling people older than 65 years completed questionnaires regarding: multidimensional frailty (Tilburg Frailty Indicator, TFI) and physical frailty (FRAIL scale), and common frailty risk factors. Results: Multidimensional frailty was recognized in 559 subjects (54.6%) and determined by 13 factors (R² = 0.21 in logistic regression). After incorporating TFI components to the models, the majority of previous risk factors became non-essential, and the frailty deficits mainly determined each other with R² ranging between 0.07-0.67. Physical frailty and non-robust status (i.e., either physical frailty or pre-frailty) were recognized in 64 (6.3%) and 542 (52.9%) participants, and were determined by 5 factors (R² = 0.33) and 11 factors (R² = 0.34), respectively. Associations between the frailty deficits were detected within and between different dimensions (i.e., physical, psychological and social); the physical domain was mainly related to the psychological one which in turn was additionally associated with the social one. Conclusion: Frailty is the accumulation of deficits and is determined by factors other than the determinants of the individual deficits. The associations between deficits coming from various dimensions of human functioning presumably amplify their effects and accelerate frailty development.

The Association of Daily Physical Activity Behaviors with Visceral Fat

The association between health benefits and physical activity has received increasing attention among researchers working on the prevention of noncommunicable disease. However, the number of studies on the association between daytime activities and visceral fat is limited. In this study, we evaluated how daily physical activity behaviors impact the visceral adipose tissue (VAT) and body mass index (BMI). A total of 3543 participants (1240 men, 2303 women) were included in this cross-sectional study. The duration of daily physical activities (sedentary time, standing time, and walking time) was classified into the six categories. Multiple regression analysis was carried out to compare continuous variables. VAT and BMI were used as dependent variables, and the daily physical activities were used as independent variables. All results were expressed after adjusting for confounders, including sex, age, Brinkman index, daily alcohol consumption, sleeping time, and medication for hypertension, dyslipidemia, and diabetes. The multiple regression analysis showed that sedentary time was significantly associated with VAT (beta = 1.145, p value = 0.002), whereas standing time was negatively associated with VAT (beta = -0.763, p value = 0.043). Walking time was negatively and robustly associated with all depending variables as follows: BMI (beta = -0.172, p value = 0.001) and VAT (beta = -2.023, p value <0.001). This study showed that a daily behavior time affects the accumulation of VAT and BMI. A shift from sedentary time to standing or walking time might be a key population approach to prevent cardiometabolic diseases.

Facilitators and Inhibitors of Lifestyle Modification and Maintenance of KOREAN Postmenopausal Women: Revealing Conversations from FOCUS Group Interview

Modifiable lifestyle behaviors, such as lack of physical activity, smoking, and unhealthy diet, are associated with the risk of cardiovascular diseases in postmenopausal women, in addition to other risk factors, such as aging and physiological changes. Therefore, it is necessary to emphasize the importance of encouraging healthy lifestyles and health-promoting behaviors among postmenopausal women, to achieve a better health status. However, it is difficult to modify lifestyle and maintain that change. This study was aimed at identifying the factors that affect the maintenance of healthy lifestyle habits in postmenopausal women, using various theoretical models. This qualitative study included focus-group interviews with 21 Korean postmenopausal women aged 54 to 69 years. A theory-guided thematic analysis was performed based on the Health Belief Model, Self-Determination Theory, Social Cognitive Theory, and Theory of Planned Behavior. As a result, facilitators and inhibitors to healthy lifestyle modification and maintenance are identified. Various sources of motivation and reinforcement are important for menopausal women to maintain a healthy lifestyle. Autonomy support and self-regulation strategies play an important role in integrating health-promoting behaviors into a daily routine. In addition to personal effort, a social support system is also important to help individuals maintain a healthy lifestyle

The association between light intensity physical activity with gait speed in older adults (≥ 50 years). A longitudinal analysis using the English Longitudinal Study of Ageing (ELSA)

AIMS

Fall prevention is an important health consideration for older adults. The benefits of moderate-to-vigorous intensity physical activity (MVPA) for fall prevention are well established. Few studies have explored the association between low intensity physical activity (LPA) and fall risk in older adults over time.

METHODS

Six waves of data from the English Longitudinal Study of Ageing (ELSA) were analysed. The measures of physical activity (PA) intensity were developed using latent class analysis (LCA). Then, the association between PA intensity and gait speed was analysed using a latent growth model (LGM).

RESULTS

Latent class analysis identified three classes of PA-inactive, low intensity, and moderate-vigorous intensity PA. LGM analysis showed that MVPA (Est 1.12, SE 0.05) was associated with a faster gait speed and slower rate of decline over time. LPA (Est 0.96; SE 0.12) was more beneficial than being inactive. Age was found to influence gait speed where MVPA was associated with better gait speed in adults aged ≤ 70 years, and LPA was associated with better gait speed for adults aged ≥ 70 years.

DISCUSSION

Moderate-to-vigorous intensity physical activity maybe more beneficial for older adults and current policy supports this. However, LPA is associated with better gait speed in older adults aged ≥ 70 years and also maybe more achievable for older adults.

CONCLUSION

Therefore, future fall prevention interventions should also include recommendations for LPA for old-older adults (≥ 70 years).

The Effects of Physical Exercise on Cognition: How Heart Rate Variability Can Predict Cognitive Performances

Objectives: Investigate and identify the relationship between physical exercise and cognitive performance measured by using different cognitive tests taken from Cambridge Brain Science (CBS).

Methods: Thirty subjects, divided into two groups (aerobic and effort), undergo twelve cognitive tests from CBS. A comparison between the pre- and post-exercise results in terms of cognitive performance differences is carried out. Regression analysis between Heart Rate Variability (HRV) features and CBS tests results is performed.

Results: In most CBS tests, there is an improvement, or at least a confirmation, of the subject's cognitive ability, for both groups. Reasoning (80–100%), concentration (80–87%), and planning tests (93–100%) seem to undergo critical positive changes. The regression analysis, performed by using a set of different algorithms, has demonstrated that it is possible, by monitoring the HRV during the exercise, to predict to some extent the cognitive performance, i.e., the CBS tests results. The best performing regression algorithms are Simple Linear (Quade Test—aerobic group: 2.098, effort group: 3.350, both groups: 2.747) and REPTree (Quade Test—aerobic group: 2.955, effort group: 3.315, both groups: 3.121). The statistical analysis has proved that physical activity is statistically useful for the subjects in improving their cognitive performance.

Conclusions: This study has numerically appraised the improvement, the conservation, or the worsening on different aspects of cognition. The found mathematical relationship between physical exercise and cognitive performance suggests that it is possible to predict the beneficial effect of various exercises on executive and attentive control.

Patterns of older Australians’ engagement in health-promoting activities: a latent profile analysis

Being active in later life is key to remaining physically and mentally healthy, and health in turn influences individuals’ ability to remain active. Activity prevalence figures can disguise the existence of clusters of older people who are very active due to regular participation in multiple categories of activity versus those who are sedentary. The aim of this study was to conduct segmentation analyses based on retired seniors’ engagement in various activities (walking, active sport/exercise, gardening and volunteering) to identify groups characterised by varying patterns of participation. The sample comprised 746 Western Australians aged 60+ years (range 60–95 years, average age 71.66 years, standard deviation = 6.57), 61 per cent of whom were female. Using latent profile analysis, four distinct segments emerged. Those respondents classified as belonging to the most active group exhibited moderate to high levels of participation across all four forms of activity, and tended to be older and more educated than other respondents. Those allocated to the least active group had very low levels of participation across most of the assessed activities and the least favourable physical and mental health scores. Overall, the results indicate the existence of highly divergent segments within the older population in terms of participation across various combinations of health-promoting activities. Segment membership appears to be more closely associated with physical and psychological factors than socio-demographic characteristics.

Physical activity is good for older adults-but is programme implementation being overlooked? A systematic review of intervention studies that reported frameworks or measures of implementation

OBJECTIVE

To examine older adult physical activity (PA) intervention studies that evaluated implementation and/or scale-up. Research question 1: What implementation and/or scale-up indicators (specific, observable and measurable characteristics that show the progress of implementation) were reported? Research question 2: What implementation and/or scale-up frameworks were reported? Research question 3: Did studies evaluate the relationship between implementation or scale-up of the intervention and individual level health/behaviour outcomes? If yes, how?

DESIGN

Systematic review.

DATA SOURCES

Publications from electronic databases and hand searches (2000 to December 2019).

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Any PA intervention studies with community-dwelling older adult participants (mean age ≥60 years). Required indicators: (a) Must report amount of PA as an outcome, with validated self-report or objective measures, and (b) Must have reported at least one implementation or scale-up framework and/or one implementation or scale-up indicator.

RESULTS

137 studies were included for research question 1, 11 for question 2 and 22 for question 3. 137 studies reported an implementation indicator: 14 unique indicators. None were specified as indicators for scale-up evaluation. 11 studies were guided by an implementation or scale-up framework. 22 studies described a relationship between an implementation indicator and an individual-level health outcome.

CONCLUSION

There is need for implementation research that extends beyond analysis at the individual level, includes clearly defined indicators and provides a guiding framework to support PA initiatives in older adults. Such implementation studies should evaluate factors in the broader context (eg,political, environmental) that influence scale-up.

PROSPERO REGISTRATION

CRD42018091839.

The role and attitude of senior leaders in promoting group-based community physical activity: a qualitative study

Background

In the context of worldwide public health, it is very important to promote physical activity among the older people. This study explored the roles and attitudes of senior leaders in promoting group-based exercise in their local communities, specifically to determine the level and extent to which to elderly participation was encouraged.

Methods

This study conducted semi-structured face-to-face in-depth interviews and employed a subsequent thematic analysis. Participants included 10 club leaders and five sub-leaders who were working at senior clubs in Fujisawa-city, Kanagawa, Japan, from July to September 2018.

Results

Four themes emerged from the interview responses, including “unwavering attitude/conviction in relation to the vision,” “leaders must set an example,” “a search for balance in delegating responsibilities to members,” and “creating and fostering culture and environment of mutual help.” Further, each participant outlined several aims, including “achieving healthy longevity for the entire local community,” “having older people promote healthy activities among the older people,” and “creating a pro-health town.”

Conclusions

Findings indicate that policymakers, public health workers, and healthcare providers should recognize the pivotal roles that senior group leaders play in promoting healthy activities for the older people. These efforts should be strongly considered when developing policies and strategies designed to promote overall healthy longevity from a general community perspective.

Relationship between fall risks and activities of daily living in older individuals

Objective

To investigate the relationship between fall risks and maintaining activities of daily living in individuals aged 65 and over.

Methods

This study is cross-sectional. It was conducted with 233 individuals who were aged 65 and over in Family Health Centers located in the eastern part of Turkey between February and June 2018.

Results

The mean older individuals’ DENN Fall Risks Assessment Scale score was 11.73 ± 7.13, and 62.2% of the participants were in the high-risk group. Barthel Index of Activities of Daily Living (ADL) mean score was 68.03 ± 25.36, and 45.1% of the participants were in the moderately dependent group. There was a statistically significant, negative correlationship between Barthel Index of ADL score and age and DENN Fall Risks Assessment Scale score. In addition, there was a statistically significant, positive relationship between the DENN Fall Risks Assessment Scale score and age (p < 0.01).

Conclusions

This study found that level of dependency and fall risks increased with the increase in age. Effective global and multidisciplinary interventions are needed to decrease older individuals’ dependency levels and fall risks today when the number of older individuals is increasing.

Is There an Association Between Self-Reported Physical Activity and Self-Rated Vision Over Time? Results From the Irish Longitudinal Study of Ageing

Research suggests that physical activity (PA) has many health benefits for an aging population. Evidence exploring the association between PA and vision is limited. This study includes the measures of self-reported PA (International Physical Activity Questionnaire) and self-rated vision at three points in time over a 6-year period used in the Irish Longitudinal study of Ageing, a cohort of community-dwelling older adults (50 years or older). A path analysis found that PA was indirectly associated with vision over 6 years controlling for age, sex, marital status, employment, education, depression (Centre for Epidemiologic Studies Depression Scale), self-reported general health, cardiovascular disease (e.g., heart attack), high blood pressure, diabetes, eye disease (e.g., glaucoma, diabetic eye disease, macular degeneration, cataract), and disabilities associated with activities of daily living. Further research is needed to fully understand the relationship over time and generalize the findings.

The Healthy Aging Index analyzed over 15 years in the general population: The Doetinchem Cohort Study

The Healthy Aging Index (HAI), an index of physiological aging, has been demonstrated to predicts mortality, morbidity and disability. We studied the longitudinal development of the HAI to identify aging trajectories and evaluated the role of baseline sociodemographic characteristics and lifestyle factors of the trajectories. Four measurements with intervals of 5 years were included from the Doetinchem Cohort Study. The HAI reflects levels of systolic blood pressure, non-fasting plasma glucose levels, global cognitive functioning, plasma creatinine levels and lung functioning. The HAI score ranges from 0 to 10: higher scores indicate a better health profile. Latent class mixture modelling was used to model within-person change and to identify aging trajectories. Area under the curve was calculated per trajectory to estimate total healthy years. In total, 2324 women and 2013 men were included. One HAI trajectory was identified for women, and two trajectories for men, labelled 'gradual' aging (76%) and 'early' aging (24%). Men who were medium/high educated, below 36 years at baseline, complied with guidelines on physical activity and were not obese in any round were associated with increased odds to 'gradual' aging of 1.46 (CI: 1.18-1.81), 1.93 (CI: 1.42-2.62), 1.26 (1.02-1.57) and 1.76 (1.32-2.35), respectively. Between 30 and 70 years of age, men in the 'early' aging trajectory had the least healthy years (29.6 years), followed by women (30.1 years), and 'gradual' aging men (34.7 years). This study emphasizes that 'physiological aging' is not only an issue of older ages. Between 30 and 70 years of age, 'early' aging men and women had approximately five healthy years less compared to 'gradual' aging men. Lifestyle factors (e.g. nutrition and physical activity) seem to play an important role in optimal aging.

Longitudinal associations of social group engagement with physical activity among Japanese older adults

BACKGROUND

Although social group engagement (SGE) has been suggested to affect physical activity (PA) in older age, the longitudinal relationship between these variables is unclear. This study used 2-year panel data to investigate the link between changes in SGE and changes in PA among community-dwelling older adults.

METHODS

This study was a 2-year community-based longitudinal study enrolling older adults living in a rural municipality in Japan. The subjects were all residents in the study area aged ≥ 65 at the baseline. Mail surveys were administered in 2016 and 2018. The 3688 subjects responding to both surveys were included in the analyses. PA was evaluated with the International Physical Activity Questionnaire, and weekly time and metabolic equivalent were computed. SGE was assessed in each wave and classified as consistent engagement (engagement reported in both surveys), new engagement (non-engagement at baseline and engagement at follow-up), leaving the group (engagement at baseline and non-engagement at follow-up), and consistent non-engagement (non-engagement in both surveys). Analysis of covariance was performed to examine the associations of changes in SGE with changes in PA.

RESULTS

Compared with those with consistent non-engagement, who showed declines in every PA category, subjects with consistent engagement or new engagement showed significantly smaller changes in total PA, moderate-intensity PA, and brisk walking. Leaving the group (vs. consistent non-engagement) was associated with maintaining moderate-intensity PA.

CONCLUSIONS

SGE helps to suppress the age-associated decline in PA in older age, with new engagement and continuous engagement, especially, mitigating decreasing PA.

Trends in Walking, Moderate, and Vigorous Physical Activity Participation Across the Socioeconomic Gradient in New South Wales, Australia From 2002 to 2015

BACKGROUND

A combination of walking, other moderate physical activity, and vigorous physical activity is recommended for achieving good health. Vigorous activity has unique health benefits but may be less accessible to disadvantaged people. To reduce health inequity, we need to understand the differences in physical activity participation among socioeconomic subgroups and whether this is changing over time.

METHODS

Data from the 2002 to 2015 Adult New South Wales Population Health Surveys (164,652 responses) were analyzed to investigate trends in walking, moderate and vigorous physical activity participation by socioeconomic status as measured by educational attainment. Analysis used age- and sex-adjusted multivariable linear models that accounted for complex survey design.

RESULTS

In 2002, the highest socioeconomic group spent 18.5 (95% confidence interval, 8.2-28.8) minutes per week more than the lowest socioeconomic group being vigorously active. By 2015, this gap had steadily increased to 41.4 (95% confidence interval, 27.6-55.1) minutes per week. Inequity between groups was also found for duration of moderate activity but not for time spent walking.

CONCLUSIONS

Low participation in vigorous activity in the lowest socioeconomic group is likely driving increasing inequities in physical activity and widening participation gaps over time. Barriers preventing the most disadvantaged people in New South Wales from engaging in vigorous activity should be addressed urgently.

Effects of Attitude, Motivation, and Eagerness for Physical Activity among Middle-Aged and Older Adults

Background

Although physical activity (PA) is a noninvasive and cost-effective method of improving the quality of health, global statistics show that only a few middle-aged and older adults engage in the recommended PAs. This is due to a lack of motivation and companionship.

Objective

This study analyses the attitudes and self-determined motivation of Chinese middle-aged and older adults for PAs and their eagerness to participate in PAs such as sports, exercise, and recreational and cultural activities (RCAs), from attitudinal, eagerness, and motivational objectives of PAs perspective.

Methods

A cross-sectional study was carried out on 840 middle-aged (35-54 years) and older adults (55+ years). To determine their attitude, eagerness, and self-determined motivation for PA, we used attitudinal, Eagerness for Physical Activity Scale (EPAS), and Situational Motivational Scale (SIMS). The data were analyzed with SPSS 23.0.

Results

The results show that 39.1% of the participants were not satisfied with PAs. Compared with females, males reported a less positive attitude towards PAs. Moreover, a positive attitude decreases with age. Participants' motivation and eagerness in activities such as RCAs, exercise, and sports are decreasing. Regarding self-determined motivation, there are gender differences in RCAs, but there is none for exercise and sports participation.

Conclusion

The findings show the importance of RCAs and the support of family and friends enhancing the eagerness, attitude, and motivation to participate in PAs. Furthermore, the findings can help to create more effective PA programs for middle-aged and older adults. By engaging in RCAs, participants can reap the benefits of PAs. Participating in RCAs can lead to social equity in health.

Results From the 2019 ParticipACTION Report Card on Physical Activity for Adults

BACKGROUND

The ParticipACTION Report Card on Physical Activity for Adults is a knowledge exchange tool representing a synthesis of the literature and data available at the national level. The purpose of this paper is to summarize the results of the inaugural 2019 edition.

METHODS

Thirteen physical activity indicators, grouped into 4 categories, were graded by a committee of experts using a process that was informed by the best available evidence. Sources included national surveys, peer-reviewed literature, and gray literature such as government and nongovernment reports and online content.

RESULTS

Grades were assigned to Daily Behaviors (overall physical activity: D; daily movement: C; moderate to vigorous physical activity: F; muscle and bone strength: INC; balance: INC; sedentary behavior: INC; sleep: B-), Individual Characteristics (intentions: B+), Settings and Sources of Influence (social support: INC; workplace: INC; community and environment: B-; health and primary care settings: C-), and Strategies and Investments (government: B-).

CONCLUSIONS

Generally, lower grades were given to behavior-related indicators (eg, overall physical activity) and better grades for indicators related to investments, community supports, and strategies and policies. Research gaps and future recommendations and directions are identified for each indicator to support future practice, policy, and research directions.