The association between social support and physical activity in older adults: a systematic review

Predicting physical activity and cardiovascular risk and quality of life in adults with osteoarthritis at risk for metabolic syndrome: A test of the information-motivation-behavioral skills model

Aim

To examine a hypothetical model of physical activity and health outcomes (cardiovascular risk and quality of life) based on the information-motivation-behavioural skills model in adults.

Design

A cross-sectional survey.

Methods

A total of 165 adults with osteoarthritis at risk for metabolic syndrome were recruited between October 2016 and September 2017 from the outpatient clinic in South Korea. Data were collected on the model constructs such as cognitive function, social support, depressive symptoms, barriers to self-efficacy, physical activity and quality of life. A hypothetical model was tested using the AMOS 25.0 program.

Results

Cognitive function and barriers to self-efficacy had a direct effect on physical activity. Physical activity had a direct effect on cardiovascular risk, while social support and depressive symptoms had a direct effect on quality of life.

Conclusions

The information-motivation-behavioural skills model can predict physical activity and, in turn, cardiovascular risk and quality of life in adults with osteoarthritis at risk for metabolic syndrome.

Older Men With Living Spouses Versus Men Without Spouses: An Example From the Arab World-Kuwait

This research is concentrated on elderly Kuwait men and the effect that losing wife, a major determinant of social support, has on their general health. A sample of 472 older male adults aged 60 years and older have been included in this study. A questionnaire was the major tool of the study. The questionnaire included sociocultural information and social support scales (Degree of Religiosity, Social Support Scale, Frequency of Contact, and Strength of Relation scales). Health measurements also were used: two, one-item self-reported health scales in the current year and last year and a Somatic Symptoms Inventory (SSI) were used. Systolic and diastolic blood pressure and glucose levels were taken. Statistical Package for Social Sciences (SPSS, version 21) was used for data entry and analysis. t-test and regression were the major statistical procedures. Data show that there are differences between elderly men with a living wife compared to those without a living wife. Having a living wife was positively associated with better social support and health in Kuwaiti elderly men. Data show that a living wife is an important factor of men's health and well-being in general and that a wife is one of the major social support elements of elderly men.

Designing an AI Health Coach and Studying Its Utility in Promoting Regular Aerobic Exercise

Our research aims to develop interactive, social agents that can coach people to learn new tasks, skills, and habits. In this article, we focus on coaching sedentary, overweight individuals (i.e., “trainees”) to exercise regularly. We employ adaptive goal setting in which the intelligent health coach generates, tracks, and revises personalized exercise goals for a trainee. The goals become incrementally more difficult as the trainee progresses through the training program. Our approach is model-based—the coach maintains a parameterized model of the trainee’s aerobic capability that drives its expectation of the trainee’s performance. The model is continually revised based on trainee-coach interactions. The coach is embodied in a smartphone application, N utri W alking , which serves as a medium for coach-trainee interaction. We adopt a task-centric evaluation approach for studying the utility of the proposed algorithm in promoting regular aerobic exercise. We show that our approach can adapt the trainee program not only to several trainees with different capabilities but also to how a trainee’s capability improves as they begin to exercise more. Experts rate the goals selected by the coach better than other plausible goals, demonstrating that our approach is consistent with clinical recommendations. Further, in a 6-week observational study with sedentary participants, we show that the proposed approach helps increase exercise volume performed each week.

Exploring Social Ecological Determinants of Physical Activity Among Adult Survivors of Childhood Cancer

Purpose: Adult survivors of childhood cancer (ASCCs) are at high risk for cardiovascular disease from chemotherapy- and radiation therapy-related cardiotoxicity. Physical activity (PA) can reduce this risk, but the majority of ASCCs do not engage in sufficient PA. The purpose of this study was to identify barriers, facilitators, and resources for PA among ASCCs using the ecological model of physical activity (EMPA) as a theoretical framework. Methods: A concept elicitation survey was distributed independently to ASCCs (diagnosed with cancer before the age of 18, and currently 18-39 years old) and parents/legal guardians of an ASCC. The survey consisted of open-ended questions asking about barriers, facilitators, and resources for PA. Content analysis of open-ended questions categorized responses into levels of the EMPA and identified key themes. Results: Seventeen ASCCs and eight parents of ASCCs completed the survey. The majority of barriers, facilitators, and resources reported were at the individual and microsystem level of the EMPA. Six themes emerged, suggesting that ASCC's PA was related to proximity/access, social support, equipment, time/schedule, finances, and health-related barriers. Conclusion: This is the first study to examine barriers, facilitators, and resources of PA among ASCCs using the EMPA. Findings from this study provide a multilevel perspective on the influences of PA among ASCCs, and can be used for future, in-depth qualitative studies and quantitative survey development, and as a foundational step toward supportive efforts in increasing PA among ASCCs.

Occupational Physical Activity and Coronary Heart Disease in Women's Health Initiative Observational Study

BACKGROUND

Women comprise nearly half of the labor force in our society, but the impact of the occupational psychical activity on women's heart health in later life was unclear. We conducted a case-cohort study to assess the association of occupational physical activity (OPA), alone and jointly with leisure-time physical activity (LTPA) and risk of coronary heart disease (CHD).

METHODS

We included women enrolled in Women's Health Initiative Observational Study who provided an occupational history at baseline and were followed until 2013 for the first occurrence of myocardial infarction or death from CHD (mean age ± SD = 63.4 ± 7.2). A total of 5,243 women free of CHD at baseline were randomly selected into a subcohort and 3,421 CHD events were adjudicated during follow-up. Through linkage of Standard Occupational Classification codes to the Occupational Information Network, we assessed cumulative and most recent exposure of OPA. LTPA was assessed through Women's Health Initiative's physical activity questionnaire. Weighted Cox proportional hazard models were used to evaluate CHD risk.

RESULTS

After adjustment for demographic and socioeconomic factors, levels of OPA were not associated with CHD risk. Compared with women with low OPA and high LTPA, women with moderate to high cumulative OPA and low LTPA had relative high CHD risk (hazard ratio [HR]: 1.54, 95% confidence interval [CI]: 1.26, 1.88 for moderate OPA and HR: 1.46. 95% CI: 1.20, 1.78 for high OPA).

DISCUSSION

Results from this study suggest no overall association between lifetime OPA and CHD risk in women, but the impact of OPA varies by LTPA levels.

Acceptability of the "MOVEdiabetes" physical activity intervention in diabetes primary care settings in Oman: findings from participants and practitioners

Background

Adequate physical activity (PA) is considered essential in diabetes management. However, evidence on the best method of promoting PA within diabetes care is inconclusive. The current work identifies perceptions on the acceptability of Intervention Group Participants (IGP) and Project Officers (POs) about the “MOVEdiabetes” intervention programme aimed at increasing PA in adults with type 2 diabetes in Oman (a retrospectively registered trial).

Methods

The “MOVEdiabetes” programme (PA consultations, pedometers and WhatsApp messages) was delivered by the POs (primary health care practitioners) in four primary care centres within a one-year cluster randomised control trial. Recruitment and retention were measured from trial attendance records. Programme satisfaction, appropriateness, and content suitability were assessed using exit surveys for both the IGP (interview based) and POs (self-administered). Open text questions on perceptions to the study programme were also included.

Results

Participants were randomised to an intervention group (IG, n = 122) or comparison group (CG, n = 110). The overall retention rate at three and 12 months was 92.7% [110(90.2%) IG vs 105(95.5%) CG] and 75% [82(67.2%) IG vs 92(83.6%) CG] respectively. Most (n = 14, 87.5%) POs and more than half (n = 49, 59.8%) IGP perceived the programme as very appropriate and many reported that they were “quite/ very satisfied” with the programme (n = 16, 100% PO’s and n = 71, 86.6% IGP). Two thirds (n = 55, 66.0%) of IGP were very/quite likely to recommend the programme to others. PA consultations, use of pedometers and Whatsapp messages were well perceived by all. Participants recommended the inclusion of dietary advice and PA promotion for the general public. Exploring PA facilities within the community was suggested by POs.

Conclusions

The “MOVEdiabetes” programme achieved a high retention rate and was perceived as satisfactory and appropriate. Results from this study suggest that it is worthwhile exploring the use of the “MOVEdiabetes” programme in clinical practice and further community links.

Trial registration

International Standard Randomised Controlled Trials No: ISRCTN14425284. Registered retrospectively on 12th April 2016.

Meeting Physical Activity Guidelines by Walking in Older Adults From Three Middle-Income Countries: A Cross-Sectional Analysis From the International Mobility in Aging Study

Physical activity (PA) among older adults is understudied in middle-income countries. The authors examined the associations of factors across levels of the social ecological model (individual, interpersonal, organizational, and community) with older adults meeting guidelines of 150 min of moderate- to vigorous-intensity PA per week through walking in three middle-income countries: Albania (n = 387), Colombia (n = 404), and Brazil (n = 402). Using 2012 International Mobility in Aging Study data, multivariate logistic regression models identified the following significant associations with meeting PA guidelines through walking (a) individual level: depression (odds ratio [OR] = 0.62, 95% confidence interval, CI [0.45, 0.86]), being female (OR = 0.74, 95% CI [0.56, 0.998]), and high relative education (OR = 1.79, 95% CI [1.33, 2.41]) and (b) interpersonal level: high life partner (OR = 1.38, 95% CI [1.04, 1.83]) and friend social ties (OR = 1.39, 95% CI [1.05, 1.83]). While individual and interpersonal variables were associated with meeting PA guidelines, community-level social and environmental variables were not.

Loneliness, Social Isolation, and Objectively Measured Physical Activity in Rural-Living Older Adults

This cross-sectional, observational study examined whether objectively measured physical activity (PA) and specific activities are associated with loneliness and social isolation (SI) in rural-living older adults. A total of 112 participants (Mage = 72.8 [SD = 6.6], 51.8% female) from 23 villages in Wiltshire, United Kingdom, completed questionnaires, 7-day accelerometry, and activity diaries. Regression analysis was used to test associations between objectively measured light PA, moderate to vigorous PA, and total PA; loneliness; and SI from family, neighbors, or friends and to explore these associations using specific activities. Daily mean light, moderate to vigorous, and total PA were not associated with loneliness or SI. Volunteering, accompanying others, and sports/exercise were associated with lower SI from neighbors (odds ratio = 0.23, 95% CI [0.06, 0.91]), family (odds ratio = 0.39, 95% CI [0.22, 0.68]), and friends (odds ratio = 0.56, 95% CI [0.33, 0.97]), respectively. There were no associations between loneliness, SI, and objectively measured PA. The contribution of PA to loneliness and SI needs to be further investigated with larger and diverse samples of rural-living older adults.

The Impact of COVID-19 on Physical Activity Behavior and Well-Being of Canadians

A global pandemic caused by the novel coronavirus (COVID-19) resulted in restrictions to daily living for Canadians, including social distancing and closure of city and provincial recreation facilities, national parks and playgrounds. The objective of this study was to assess how these preemptive measures impacted physical activity behaviour and well-being of Canadians. An online survey was utilized to measure participant physical activity behavior, nature exposure, well-being and anxiety levels. Results indicate that while 40.5% of inactive individuals became less active, only 22.4% of active individuals became less active. Comparatively, 33% of inactive individuals became more active while 40.3% of active individuals became more active. There were significant differences in well-being outcomes in the inactive population between those who were more active, the same or less active (p < 0.001) but this was not seen in the active population. Inactive participants who spent more time engaged in outdoor physical activity had lower anxiety than those who spent less time in outdoor physical activity. Public health measures differentially affected Canadians who were active and inactive and physical activity was strongly associated with well-being outcomes in inactive individuals. This suggests that health promoting measures directed towards inactive individuals may be essential to improving well-being.

Physical Activity Intervention for Loneliness (PAIL) in community-dwelling older adults: a randomised feasibility study

BACKGROUND

Low quality social relationships in older adults are strongly associated with feelings of loneliness. Physical activity interventions could reduce loneliness and improve psychological well-being, among other health benefits. The aim of this study was to examine the feasibility of a Physical Activity Intervention for Loneliness (PAIL) in community-dwelling older adults at risk of loneliness.

METHODS

The PAIL feasibility study was a 12-week randomized controlled feasibility trial (RCT) conducted in Birmingham, United Kingdom, from February 2018 to August 2018, and ran in two waves of data collection. Eligible participants were community-dwelling adults aged 60 years and older, sedentary (less than 20 min of moderate-to-vigorous PA (MVPA) a week), and at risk of loneliness. The intervention included once-weekly group walk and health education workshop up to 90 min per session in total, with a wait-listed (WL) control group. The primary feasibility outcomes were to estimate recruitment, retention rates and adherence to the intervention. Secondary outcome measures (not blinded assessment) were body mass index, blood pressure, physical activity and psychosocial variables. Process and outcome evaluations were conducted using focus groups interviews. The recruitment and retention progression criteria for the definitive large-scale RCT was set a-priori.

RESULTS

Forty-eight participants were recruited over 4 months with a recruitment rate of 25% (48/195); 52% (25/48) met the inclusion criteria and 100% (25/25) were randomised into the intervention (n = 12) and WL control groups (n = 13). Participants were 25 older adults (mean (SD) 68.5(8.05) years), 14 (56%) female, and 18 (72%) white. At 12 weeks, 10/12 (83.3%) intervention and 10/13 (76.9%) control participants completed the final assessments. The average attendance rate was 58.3% for the intervention group (range 33.0%-75.0%) and 42.3% (range 23.1%-69.2%) among controls. The a priori recruitment and retention criteria for progression were not met. No serious adverse events occurred. The focus group results identified three themes which showed overall positive experiences of participation in PAIL in terms of (1) study design and intervention; (2) walking sessions; and (3) health education workshops.

CONCLUSIONS

The findings suggest that community-dwelling older adults at risk of loneliness found the intervention and measures acceptable and could safely participate. However, a more extensive and robust strategy would be needed to support adequate recruitment of lonely older adults and adherence into a definitive RCT.

TRIAL REGISTRATION

Clinicaltrials.gov, NCT03458793.

Associations of Local Social Engagement and Environmental Attributes With Walking and Sitting Among Japanese Older Adults

This cross-sectional study examined associations of local social engagement with walking and sitting, and whether these associations were modified by local environmental attributes. Older residents (aged 65-84 years, n = 849), recruited from a regional city in Japan, reported walking frequency, sitting time, local social engagement, and local environmental attributes. Walk Score® was also used as an environmental measure. Analysis of data from 705 participants found that engaging in community activities was significantly associated with more frequent walking, but not with prolonged sitting. Interaction analyses between social engagement and environmental attributes did not show any significant interactions, suggesting that promoting local social engagement may increase walking frequency among older adults, regardless of local environmental characteristics. Community-level social initiatives that encourage older adults to participate in local meetings, events, and activities may be an effective physical activity promotion strategy among older adults.

Maintenance motives for physical activity among older adults: a protocol for a systematic review and meta-analysis

INTRODUCTION

Physical activity (PA) is an important aspect for health and well-being, yet many older adults do not maintain their PA long term. The identification of key factors that are associated with, and likely causally related to, older adults' PA maintenance is a crucial first step towards developing programmes that are effective at promoting long-term PA behaviour change. The purpose of this protocol is to outline a systematic review that will examine the relationship between four motives (ie, satisfaction, enjoyment, self-determination and identity) and older adults' PA maintenance.

METHODS AND ANALYSIS

Studies that investigated PA maintenance with a sample mean age ≥55 years will be included. Five electronic databases (PubMed, Cumulative Index to Nursing and Allied Health Literature, SPORTDiscus, PsycINFO and ProQuest Dissertations and Theses) were searched on 6 April 2018 with no publication date limit (ie, from inception). One reviewer screened 100% of titles and abstracts (k=21 470) while a random subsample (20%) was screened independently by two reviewers. An update of the search was run on 1 October 2019. All studies for which the full text was retrieved will be independently screened by two reviewers. Data pertaining to study sample, design, motives, PA (eg, measurement validity evidence, study definition of maintenance) and essential bias domains (eg, bias due to missing data) will be extracted. Study-level effect sizes will be calculated, and if the number of studies is ≥5, a random-effects meta-analysis will be performed using inverse-variance methods; a narrative synthesis will be performed otherwise.

ETHICS AND DISSEMINATION

The university's Human Research Protection Program determined that the proposed study qualifies as exempt from the Institutional Review Board review under Exemption Category 4 (PROPEL #: 80047007). Results will be published in a peer-review journal, and the findings will help inform future interventions with older adults.

PROSPERO REGISTRATION NUMBER

CRD42018088161.

Membership in Sport or Exercise Groups Predicts Sustained Physical Activity and Longevity in Older Adults Compared to Physically Active Matched Controls

Background

Physical activity tends to decline in older age, despite being key to health and longevity. Previous investigations have focused on demographic and individual factors that predict sustained physical activity.

Purpose

To examine whether engaging in physical activity in the context of sport or exercise group membership can protect against age-related physical activity decline.

Methods

Drawn from the English Longitudinal Study of Ageing, participants were members of sport or exercise groups aged 50 and over (N = 2015) as well as nonmember controls, who were matched at baseline for age, sex, and physical activity levels (N = 1881). Longitudinal mixed effects models were used to assess the effect of sport or exercise group membership on physical activity and longevity across a 14-year follow-up.

Results

Members of sport or exercise groups experienced an attenuated decline in both moderate and vigorous physical activity over a 14-year follow-up compared to physically active matched controls. Sport or exercise group members were also less likely to have died at follow-up, an effect that was mediated through sustained physical activity.

Conclusions

Promoting membership in sport and exercise groups may be a beneficial strategy for supporting sustained physical activity and health among older people.

'Function First-Be Active, Stay Independent'-promoting physical activity and physical function in people with long-term conditions by primary care: a protocol for a realist synthesis with embedded co-production and co-design

INTRODUCTION

People with long-term conditions typically have reduced physical functioning, are less physically active and therefore become less able to live independently and do the things they enjoy. However, assessment and promotion of physical function and physical activity is not part of routine management in primary care. This project aims to develop evidence-based recommendations about how primary care can best help people to become more physically active in order to maintain and improve their physical function, thus promoting independence.

METHODS AND ANALYSIS

This study takes a realist synthesis approach, following RAMESES guidance, with embedded co-production and co-design. Stage 1 will develop initial programme theories about physical activity and physical function for people with long-term conditions, based on a review of the scientific and grey literature, and two multisector stakeholder workshops using LEGO® SERIOUS PLAY®. Stage 2 will involve focused literature searching, data extraction and synthesis to provide evidence to support or refute the initial programme theories. Searches for evidence will focus on physical activity interventions involving the assessment of physical function which are relevant to primary care. We will describe 'what works', 'for whom' and 'in what circumstances' and develop conjectured programme theories using context, mechanism and outcome configurations. Stage 3 will test and refine these theories through individual stakeholder interviews. The resulting theory-driven recommendations will feed into Stage 4 which will involve three sequential co-design stakeholder workshops in which practical ideas for service innovation in primary care will be developed.

ETHICS AND DISSEMINATION

Healthcare and Medical Sciences Academic Ethics Committee (Reference 2018-16308) and NHS Wales Research Ethics Committee 5 approval (References 256 729 and 262726) have been obtained. A knowledge mobilisation event will address issues relevant to wider implementation of the intervention and study findings. Findings will be disseminated through peer-reviewed journal publications, conference presentations and formal and informal reports.

PROSPERO REGISTRATION NUMBER

CRD42018103027.

Effects of physical activity programs on sleep outcomes in older adults: a systematic review

BACKGROUND

One in two older adults report sleep problems, which not only cause fatigue, but also negatively affect general functioning, activities of daily living, and physical and mental health. Although it is known that physical activity is positively associated with sleep in older adults, the effects of physical activity programs on sleep in older adults has not been reviewed. The aim of this systematic review was to systematically review the effects of physical activity programs on sleep in generally healthy older adults aged 60+ years.

METHODS

Searches were performed in PubMed, Embase, Web of Science, SPORTDiscus, PEDro and CINAHL. The methodological quality of the included studies was rated using the 'Quality Assessment Tool for Quantitative Studies'. Only studies of moderate and strong quality were included. This review was registered in PROSPERO (CRD42018094007).

RESULTS

Fourteen studies met the inclusion criteria (six randomised controlled trials and eight pretest-posttest studies). Of these studies, five were moderate and nine were strong quality studies. Mean age of study samples ranged from 64 to 76 years. Exercise programs included various activities aimed at improving mobility, endurance and strength. Intervention duration ranged from 2 weeks to 12 months. Eleven studies used subjective measures of sleep, two used objective measures and one used both. Sixteen different sleep outcomes were reported. All but one study, found at least one significant improvement on sleep outcomes. No significantly detrimental effects were reported. Effect sizes, calculated in ten studies, ranged from 0,34-1,55 and were substantial (≥0,8) in four studies.

CONCLUSIONS

This systematic review suggests that exercise programs positively affect various aspects of sleep in generally healthy older adults. More specifically, moderate intensity exercise programs, with a frequency of three times per week and a duration of 12 weeks up to 6 months, showed the highest number of significant improvements in different sleep outcomes in older adults. Furthermore, programs that offered single exercise types, such as Baduanjin, Tai chi and the silver yoga program, or a combination of exercises showed the highest proportion of significant versus reported effects on sleep outcomes.

Promoting healthy ageing through light volleyball intervention in Hong Kong: study protocol for a randomised controlled trial

Background

Our pilot study has demonstrated improvements in health outcomes through participation in a new sport, light volleyball (LVB), among older adults. In response to the promising results of the LVB pilot study and the priority of allocating resources to the prevention of age-related fitness degradation by the Hong Kong (HKG) government, the present study aims to investigate the effectiveness of a LVB intervention on physical and psychological health attributes among older adults at a larger scale in HKG.

Methods/design

This study will apply both quantitative and qualitative methods with a large sample (approximately 315 participants). We will adopt a randomized controlled trial (RCT) design to further evaluate the effectiveness of a LVB intervention on health outcomes against a comparison group, Tai Chi (TC), and a control group (C). Older adults will be eligible to join the intervention if they are (a) aged 65 years and above; (b) living in the community independently; (c) absent of diagnosed cognitive impairment; (d) not regular participants in a structured PA program for two years preceding the study; and (e) able to achieve a passing score on the Timed-up-and-go test (TUG) and Abbreviated Mental Test (AMT).About 315 participants will be randomly assigned into 3 groups in 1:1:1 ratio. LVB group participants will receive 16-week LVB program; TC group will utilize a simplified 24-form Yang Style TC, and C group participants will be instructed to maintain their normal daily activity and join regular non-exercise social gatherings. Measurements will be collected before and after the intervention, and 6 months and 12 months after completion of the intervention.

Discussion

This intervention, if effective, will enhance older adult's physical and psychological health, and provide the data and evidence to support policymaking in relation to future PA promotion for older adults.

Trial registration number

ChiCTR1900026657.

Factors associated with habitual time spent in different physical activity intensities using multiday accelerometry

To investigate factors associated with time in physical activity intensities, we assessed physical activity of 249 men and women (mean age 51.3 years) by 7-day 24h-accelerometry (ActiGraph GT3X+). Triaxial vector magnitude counts/minute were extracted to determine time in inactivity, in low-intensity, moderate, and vigorous-to-very-vigorous activity. Cross-sectional associations with sex, age, body mass index, waist circumference, smoking, alcohol consumption, education, employment, income, marital status, diabetes, and dyslipidaemia were investigated in multivariable regression analyses. Higher age was associated with more time in low-intensity (mean difference, 7.3 min/d per 5 years; 95% confidence interval 2.0,12.7) and less time in vigorous-to-very-vigorous activity (−0.8 min/d; −1.4, −0.2), while higher BMI was related to less time in low-intensity activity (−3.7 min/d; −6.3, −1.2). Current versus never smoking was associated with more time in low-intensity (29.2 min/d; 7.5, 50.9) and less time in vigorous-to-very-vigorous activity (−3.9 min/d; −6.3, −1.5). Finally, having versus not having a university entrance qualification and being not versus full time employed were associated with more inactivity time (35.9 min/d; 13.0, 58.8, and 66.2 min/d; 34.7, 97.7, respectively) and less time in low-intensity activity (−31.7 min/d; −49.9, −13.4, and −50.7; −76.6, −24.8, respectively). The assessed factors show distinct associations with activity intensities, providing targets for public health measures aiming to increase activity.

An Effective Model of Diabetes Care and Education: Revising the AADE7 Self-Care Behaviors®

PURPOSE

The AADE7 Self-Care Behaviors^® (AADE7) is a robust framework for self-management of diabetes and other related conditions, such as prediabetes and cardiometabolic diseases. It is the position of the American Association of Diabetes Educators (AADE) that, at the cornerstone of diabetes self-management education and support, the AADE7 is the framework for achieving behavior change that leads to effective self-management through improved behavior and clinical outcome measures. The AADE7 model guides the health care team in effective person-centered collaboration and goal setting to achieve health-related outcomes and improved quality of life. Continued research and evidence are critical to expand this model and broaden its application to other chronic conditions. Given the advances in the science of diabetes management, as well as in diabetes self-management education and support, AADE has evaluated the AADE7 within the framework of these advances, including the digital and dynamic health care landscape.

CONCLUSION

This revised position statement blends the updates in research and AADE's vision and expansion beyond diabetes to refresh the AADE7 framework. This revision reflects the perspectives of all members of the health care team as they problem solve with individuals who are at risk for or who have diabetes and related conditions to achieve healthier outcomes.

Perception and Beliefs Regarding Cardiovascular Risk Factors and Lifestyle Modifications Among High-Risk College Students

BACKGROUND

Studying risk factors and corresponding behavior in young adults is important as atherosclerotic plaque begins to form in early adulthood, resulting in cardiovascular disease (CVD) later in life. The purpose of this study was to explore the perceptions and beliefs regarding cardiovascular risk and lifestyle modification among high-risk college students (based on Framingham 30-year risk score).

METHODS

Semistructured qualitative interviews were conducted and analyzed using qualitative content analysis.

RESULTS

Risk factors included overweight/obesity, alcohol consumption, elevated blood pressure, family history, and smoking. Qualitative interviews revealed six themes: (a) recognizing risk, (b) lifestyle trajectories, (c) factors influencing lifestyles, (d) ideal healthy lifestyle modifications, (e) perceived benefits of healthy lifestyles, and (f) integrating technology and health apps. Participants demonstrated a lack of understanding of how the various factors contributed to CV risk. Influencing factors to a healthy lifestyle were categorized as environmental, relational, financial, work/life/school balance, and internal/intrinsic motivation.

CONCLUSIONS

Understanding high-risk college students' beliefs and perceptions regarding CVD risk factors and lifestyle modification is the first step to assessing the problem facilitating early intervention in the young adult population. Clinicians should assess, develop, and implement risk reduction programs that are tailored to individuals who need it the most, those at high risk.

Physical Activity, Sleep and Quality of Life in Older Adults: Influence of Physical, Mental and Social Well-being

Introduction: Physical activity and sleep quality have been consistently associated with quality of life (QOL) in a number of clinical and non-clinical populations. However, mechanisms underlying this relationship are not well understood. The purpose of this study was to longitudinally test a model examining how changes in physical activity and sleep quality, predict physical, mental and social well-being and global QoL across a 6-month exercise trial in a sample of healthy older adults. Methods: Participants (N = 247, mean age 65.4 ± 4.6) wore an accelerometer to assess objective levels of physical activity and completed measures of sleep, physical and mental well-being, social well-being and QOL at baseline and following a 6-month physical activity intervention. Relationships among model constructs were examined over time using panel analysis within a covariance-modeling framework. Results: The hypothesized model provided a good model-data fit (χ² = 58.77, df = 41, p = .036); CFI = 0.98; SRMR = 0.05; RMSEA = 0.04). At both time-points, physical activity and sleep quality were significantly correlated. Sleep quality indirectly influenced QOL via physical, mental and social well-being (QOL R² = .47, p < .001). These relationships were also supported across time at month 6 (QOL R² = .50, p < .001). Neither physical activity nor sleep quality directly influenced QOL. Conclusion: Our results support a novel sleep and QOL model that may inform the design of health interventions to promote sleep quality, and thereby influencing QOL by targeting physical activity and modifiable mediators of physical, mental and social health. Our findings may have significant implications for older adults as well as clinical populations that report compromised sleep, impaired health related and global QOL.

Impact of Social Isolation Due to COVID-19 on Health in Older People: Mental and Physical Effects and Recommendations

OBJECTIVES

To review the impact of social isolation during COVID-19 pandemic on mental and physical health of older people and the recommendations for patients, caregivers and health professionals.

DESIGN

Narrative review.

SETTING

Non-institutionalized community-living people.

PARTICIPANTS

20.069 individuals from ten descriptive cross-sectional papers.

MEASUREMENTS

Articles since 2019 to 2020 published on Pubmed, Scielo and Google Scholar databases with the following MeSh terms ('COVID-19', 'coronavirus', 'aging', 'older people', 'elderly', 'social isolation' and 'quarantine') in English, Spanish or Portuguese were included. The studies not including people over 60 were excluded. Guidelines, recommendations, and update documents from different international organizations related to mental and physical activity were also analysed.

RESULTS

41 documents have been included in this narrative review, involving a total of 20.069 individuals (58% women), from Asia, Europe and America. 31 articles included recommendations and 10 addressed the impact of social distancing on mental or physical health. The main outcomes reported were anxiety, depression, poor sleep quality and physical inactivity during the isolation period. Cognitive strategies and increasing physical activity levels using apps, online videos, telehealth, are the main international recommendations.

CONCLUSION

Mental and physical health in older people are negatively affected during the social distancing for COVID-19. Therefore, a multicomponent program with exercise and psychological strategies are highly recommended for this population during the confinement. Future investigations are necessary in this field.

Older patients' attitudes towards, and perceptions of, preoperative physical activity and exercise prior to colorectal cancer surgery-a gap between awareness and action

Purpose

Time for preoperative optimisation prior to colorectal cancer surgery is limited and older people tend to decline exercise interventions. This study sought to describe attitudes towards, and perceptions of, preoperative physical activity and exercise in older people prior to colorectal cancer surgery.

Methods

This is a qualitative interview study, analysed with inductive content analysis. Seventeen participants scheduled for colorectal surgery were recruited as a purposeful sample from two hospitals in Stockholm, Sweden. Individual semi-structured interviews were conducted, face-to-face (n = 8) or by telephone (n = 9).

Results

Nine participants were male, median age was 75 years (range 70–91). The theme, ‘a gap between awareness and action’, was identified based on two main categories: ‘Attitudes towards preoperative physical exercise have a multifactorial base’ and ‘Preoperative physical exercise is possible with a push in the right direction’. The material described a gap between awareness of the benefits of physical activity and reports of performing physical activity. The reasons for the gap between thoughts and action in this respect seem to be multifactorial. Support from others emerged as an important possibility for overcoming the gap.

Conclusions

A gap between the patients’ awareness and action appeared in our material. Understanding this can guide healthcare professionals (HCPs) as to the support needed preoperatively. Advice on physical exercise before surgery should be specific, and individually tailored support for action should be offered. This support should also consider the individual’s current physical activity and preoperative attitude towards physical exercise.

Exercise Arrangement Is Associated with Physical and Mental Health in Older Adults

PURPOSE

Although exercising with others might have health benefits, no previous study has comprehensively examined associations of exercise arrangement with physical activity (PA), physical function (PF), and mental health (MH). We examined whether PA, PF, and MH are better when exercising with others than when exercising alone or not exercising.

METHODS

We analyzed cross-sectional data from 7759 (4007 men and 3752 women) nondisabled residents age 65 to 84 yr. PA, PF, and MH were assessed with the International Physical Activity Questionnaire-Short Form (PA sufficiency defined as ≥150 min·wk of moderate-to-vigorous PA), Motor Fitness Scale (higher PF defined as total score ≥12 in men and ≥10 in women), and World Health Organization-Five Well-Being Index (better MH defined as a total score ≥13), respectively. Exercise arrangement was classified as "nonexerciser," "exercising alone," and "exercising with others." Using multilevel logistic regression analyses, we examined independent associations of exercise arrangement with PA, PF, and MH.

RESULTS

Compared with exercising alone, the multivariate-adjusted odds ratios (95% confidence interval) among nonexercisers and those exercising with others were 0.21 (0.17-0.25) and 1.32 (1.04-1.67), respectively, for PA sufficiency, 0.47 (0.40-0.57) and 1.12 (0.94-1.34) for higher PF, and 0.69 (0.58-0.82) and 1.45 (1.17-1.79) for better MH, respectively, in men. In women, the corresponding odds ratios were 0.37 (0.30-0.46) and 1.31 (1.01-1.70) for PA sufficiency, 0.66 (0.54-0.80) and 1.08 (0.88-1.32) for higher PF, and 0.70 (0.58-0.85) and 1.27 (1.03-1.56) for better MH, respectively.

CONCLUSIONS

Exercising alone and with others were better than no exercise for maintaining better PA, PF, and MH in both sexes. Although exercise arrangement had little effect on maintaining PF, exercising with others appears to enhance PA levels and MH in both sexes.

To be or not to be active - a matter of attitudes and social support? Women's perceptions of physical activity five years after Roux-en-Y Gastric Bypass surgery

Purpose: Despite positive health advantages of post-surgery physical activity (PA) for bariatric surgery patients, the majority is not sufficiently physically active. The aim was to explore women’s perceptions and experiences concerning PA five years after Roux-en-Y Gastric Bypass (RYGB) surgery.

Methods: Eleven women were interviewed five years post-surgery. Grounded Theory approach was applied.

Results: The core-category “Attitudes and surrounding environment influence activity levels” includes three attitudes towards PA: “Positive attitudes”, “Shifting attitudes” and “Negative attitudes”. Participants with a positive attitude were regularly physically active, felt supported and proud of their achievements. Contrary, participants with a negative attitude didn’t prioritize PA, didn’t feel supported and saw no need or benefit of PA. Some participants revealed an on-off behaviour, hovering between the attitudes of vigorous PA and sedentary lifestyle, without sustainable balance. The majority mostly viewed PA as a mean to lose weight.

Conclusion: The level of perceived post-surgery PA was related to the participants’ attitudes towards PA and whether or not they had a supportive environment. These findings might explain why bariatric surgery patients often fail to be sufficiently active post-surgery, and highlight the need for prolonged support and motivational interventions to promote sustainable PA post-bariatric surgery.

Physical Impairments Disrupt the Association Between Physical Activity and Loneliness: A Longitudinal Study

This study explores the association between physical activity (PA), loneliness, and the presence of physical chronic impairments among single older adults. A longitudinal study (N = 575; mean age 76 ± 8 years) was conducted. The association between self-reported weekly minutes of moderate to vigorous PA, loneliness, and presence of physical impairments was assessed with multilevel analyses at baseline, 3 months, and 6 months. Improvements in moderate to vigorous PA were associated with decreases in loneliness (B = −0.09, SE = 0.04, p = .020); this association became nonsignificant when including the presence of physical impairments in the analyses (p = .824), which in itself was positively associated with loneliness (B = 0.51, SE = 0.10, p < .001). Findings indicate that physical impairments have a larger influence on loneliness than the level of PA. Interventions targeting PA and loneliness should tailor specifically to physical impairments.

Promoting Health-Enhancing Physical Activity: a State-of-the-art Review of Peer-Delivered Interventions

PURPOSE OF REVIEW

In this review, we critically examined recent evidence pertaining to the efficacy of peer-delivered physical activity interventions.

RECENT FINDINGS

Peer-delivered interventions appear to represent an efficacious, although under-utilized, means of promoting health-enhancing physical activity, among diverse populations across the lifespan, and in different settings. Nevertheless, research has largely failed to identify the salient behaviors/strategies of peer leaders that can promote behavior change among target populations, as well as explanatory mechanisms (i.e., mediators) of intervention effects. Balanced against recent evidence for the efficacy of peer-delivered interventions to promote physical activity, work in this area appears impeded by an absence of peer-centric explanatory frameworks and theory that may optimize both intervention delivery and efficacy/effectiveness.

Physical activity and loneliness among adults aged 50 years or older in six low- and middle-income countries

INTRODUCTION

Loneliness is widespread and associated with deleterious outcomes in middle-aged and older age people in low- and middle-income countries (LMICs). Physical activity is one potential psychosocial strategy with the potential to reduce loneliness in this population. Thus, the aim of this study was to explore associations between physical activity (PA) and loneliness in middle-aged and older people from six LMICs.

MATERIALS AND METHODS

Data from the Study on Global Ageing and Adult Health (SAGE) were analyzed. Self-reported data on loneliness and PA (as assessed by the Global Physical Activity Questionnaire) were collected. Participants were dichotomized into those who do and do not meet the international recommendation of 150 minutes of moderate to vigorous PA per week. Associations between loneliness and PA were examined using logistic regressions.

RESULTS

Among 34 129 individuals aged 50 years or older, the prevalence of loneliness was higher among those not meeting the PA guidelines in all countries, although this difference was not significant in Mexico and South Africa. After full adjustment, not meeting PA guidelines was positively associated with loneliness in the meta-analysis based on country-wise estimates, with a moderate level of between-country heterogeneity being observed (OR = 1.31; 95% CI, 1.07-1.61; I2 = 48.7%). At an individual country level, statistical significance was only reached in Ghana (OR = 1.89; 95% CI = 1.44-2.49).

DISCUSSION

Our data suggest that physical inactivity and loneliness commonly co-occur in adults aged 50 years or older in LMICs overall but that this association differs by country. Longitudinal studies are required to confirm these findings and investigate potential mechanisms that may inform future interventions.

A Pilot Study of an In-Home Multicomponent Exergame Training for Older Adults: Feasibility, Usability and Pre-Post Evaluation

Aging is associated with sensory, motor and cognitive impairments that may lead to reduced daily life functioning including gait disturbances, falls, injuries and mobility restrictions. A strong need exists for implementing effective evidence-based interventions for healthy aging. Therefore, the aim of this study was to (i) evaluate the feasibility and usability of an in-home multicomponent exergame training and (ii) explore its effects on physical functions, cognition and cortical activity. Twenty-one healthy and independently living older adults were included (11 female, 74.4 ± 7.0 years, range: 65-92 years) and performed 24 trainings sessions (each 40 min) over eight weeks. The first part was conducted in a living lab (home-like laboratory environment), the second part at participants' home. The multicomponent exergame included Tai Chi-inspired exercises, dance movements and step-based cognitive games to train strength, balance and cognition. Attendance and attrition rates were calculated and safety during training was evaluated to determine feasibility. Participants rated the usability of the exergame (System Usability Scale) and reported on their game experience (Game Experience Questionnaire). Physical and cognitive functions and cortical activity (resting state electroencephalopathy) were assessed pre and post intervention. Results showed a high training attendance rate for the living lab and the home-based setting (91.7 and 91.0%, respectively) with a rather high attrition rate (28.6%, six drop-outs). Half of the drop-out reasons were related to personal or health issues. System usability was rated acceptable with a mean score of 70.6/100. Affective game experience was rated favorable. Significant improvements were found for minimal toe clearance, short-term attentional span, and information processing speed (p < 0.05). No significant pre-post differences were found for cortical activity. To summarize, the exergame is generally feasible and usable for healthy older adults applied in an in-home setting and provides an overall positive emotional game experience. Nevertheless, flawless technical functionality should be a mandatory consideration. Additionally, the training might have potential positive influence on specific functions in older adults. However, the efficacy has to be evaluated in a future randomized controlled trial assessing the behavioral and neuroplastic changes in a larger population after a longer training period.

Physical Exercise Decreases the Mobile Phone Dependence of University Students in China: The Mediating Role of Self-Control

This study aimed to explore the relationship between physical exercise (PE) and mobile phone dependence (MPD) in Chinese university students and verify the potential role of self-control (SC) in mediating the decrease of MPD by PE. Through the quota sampling, 608 students that complied with the requirements were surveyed from 10 universities in China. PE, MPD, and SC were assessed using standard scales. For data analysis, t-tests, correlation analysis, hierarchical regression, and regression analysis were carried out in turn. The results showed significant gender differences in PE, MPD, and SC. For male students, the level of PE and score of SC were higher than those in females, yet the MPD score was lower. PE and SC were negatively related to MPD (r = -0.124, p < 0.01; r = -0.563, p < 0.001), so both could remarkably predict MPD (β = -1.00, p < 0.05; β = -0.552, p < 0.001). Gender was also a significant predictor for MPD (β = 0.089, p < 0.05). PE could, to some extent, decrease MPD, in which SC played a significant mediating role-its mediating effect accounted for nearly 71% of the total effect. The present study shows that PE is negatively correlated with MPD, and SC mediates the decrease of MPD by PE for university students in China. This indicates that the improvement of SC by PE could be a highly trustworthy and practicable way to effectively address the issue of MPD in university students or other young people across the world.

Determinants of Physical Activity Performed by Young Adults

Despite the World Health Organization considering it important to promote physical activity as part of a healthy lifestyle, the official data show an increase in the percentage of physical inactivity, which has brought about the development of strategies at different levels (national and international) to reverse this trend. For the development of these strategies, it is relevant to know what the determinants of physical activity (at leisure and at work) are. Therefore, this is going to be analysed in the autochthonous young adults from Seville. A cross-sectional survey of their health behaviours was carried out. The sample was selected through a proportionally stratified random sampling procedure. From the results, we highlight that the general perceived health status is good and that most physical activity is performed during leisure time. However, a majority of the population analysed reported overweight or obesity. Participants with a low perceived health status, those who have low social support from their family and friends, and those who do not smoke are the ones who have more probability of engaging in physical activity during their leisure time. However, gender, education level, and alcohol consumption are revealed as determinants of the intensity of physical activity at work. In this regard, men and/or participants with a low level of studies are those who carry out more physically demanding activities at work.

General practice referral of 'at risk' populations to community leisure services: applying the RE-AIM framework to evaluate the impact of a community-based physical activity programme for inactive adults with long-term conditions

BACKGROUND

In the UK a high proportion of adults with long-term conditions do not engage in regular physical activity. General practice (GP) referral to community-based physical activity is one strategy that has gained traction in recent years. However, evidence for the real-world effectiveness and translation of such programmes is limited. This study aimed to evaluate the individual and organisational impacts of the 'CLICK into Activity' programme - GP referral of inactive adults living with (or at risk of) long-term conditions to community-based physical activity.

METHODS

A mixed methods evaluation using the RE-AIM framework was conducted with data obtained from a range of sources: follow-up questionnaires, qualitative interviews, and programme-related documentation, including programme cost data. Triangulation methods were used to analyse data, with findings synthesised across each dimension of the RE-AIM framework.

RESULTS

A total of 602 individuals were referred to CLICK into Activity physical activity sessions. Of those referred, 326 individuals participated in at least one session; the programme therefore reached 30.2% of the 1080 recruitment target. A range of individual-, social-, and environmental-level factors contributed to initial physical activity participation. Positive changes over time in physical activity and other outcomes assessed were observed among participants. Programme adoption at GP surgeries was successful, but the GP referral process was not consistently implemented across sites. Physical activity sessions were successfully implemented, with programme deliverers and group-based delivery identified as having an influential effect on programme outcomes. Changes to physical activity session content were made in response to participant feedback. CLICK into Activity cost £175,000 over 3 years, with an average cost per person attending at least one programme session of £535.

CONCLUSIONS

Despite not reaching its recruitment target, CLICK into Activity was successfully adopted. Positive outcomes were associated with participation, although low 6- and 12-month follow-up response rates limit understanding of longer-term programme effects. Contextual and individual factors, which may facilitate successful implementation with the target population, were identified. Findings highlight strategies to be explored in future development and implementation of GP referral to community-based physical activity programmes targeting inactive adults living with (or at risk of) long-term conditions.

"The Social Side Is as Important as the Physical Side": Older Men's Experiences of Physical Activity

North American “hegemonic masculinity” values strength, autonomy, independence, and resilience among its ideals. As men age, their capacity is increasingly challenged and demands that they adapt to new physical and social realities. Although some reports on effective health-promoting programs for men are emerging, there is a need to better understand older men’s experiences with their mobility and physical activity. This is a photovoice study with men (N = 14) who were enrolled in a choice-based activity program for low active men. Based on in-depth interviews and analysis of over 800 photographs, three key themes emerged: the importance of social connectedness, supportive environments, and positive attitude toward the future. Findings are presented via a theoretical view of masculinities as socially constructed through relational behaviors and norms. Analyses provide insight into older men’s motivation to be physically active and highlight the need for programs and policies customized to promote physical activity of older men.

Comparative Meta-Analysis of the Effect of Concentrated, Hydrolyzed, and Isolated Whey Protein Supplementation on Body Composition of Physical Activity Practitioners

Whey protein (WP) is a dairy food supplement and, due to its effects on fat-free mass (FFM) gain and fat mass (FM) loss, it has been widely consumed by resistance training practitioners. This review analyzed the impact of WP supplementation in its concentrated (WPC), hydrolyzed (WPH) and isolated (WPI) forms, comparing it exclusively to isocaloric placebos. Random effect meta-analyses were performed from the final and initial body composition values of 246 healthy athletes undergoing 64.5 ± 15.3 days of training in eight randomized clinical trials (RCT) collected systematically from five scientific databases. The weighted mean difference (WMD) was statistically significant for FM loss (WMD = −0.96, 95% CI = −1.37, −0.55, p < 0.001) and, in the analysis of subgroups, this effect was maintained for the WPC (WMD = −0.63, 95% CI = −1.19, −0.06, p = 0.030), with protein content between 51% and 80% (WMD = −1.53; 95% CI = −2.13, −0.93, p < 0.001), and only for regular physical activity practitioners (WMD = −0.95; 95% CI = −1.70, −0.19, p = 0.014). There was no significant effect on FFM in any of the scenarios investigated (p > 0.05). Due to several and important limitations, more detailed analyses are required regarding FFM gain.

Personal and Social Environmental Correlates of Square Dancing Habits in Chinese Middle-Aged and Older Adults Living in Communities

This study aimed to examine personal and social environmental correlates of the physical activity habit of middle-aged and older adults, using Chinese square dancing as a natural exploratory example. Participants were 385 adults aged ≥45 years (93% female), who habitually danced on squares or parks of three old districts of Guangzhou. Multinomial logistic regression was used to identify personal, social, psychological, and behavioral correlates of multiyear dance. Old age, high education, sufficient leisure time, and stable social environmental factors were associated with persistent dancing, whereby education (relative risk ratio [RRR] = 1.64, 95% confidence interval [1.05, 2.57]) and social engagement (RRR = 1.66, 95% confidence interval [1.05, 2.63]) showed the largest effects. Participants dancing ≤1 year were least satisfied with their social relationships than their counterparts dancing 1-5 years (RRR = 0.68) or over 5 years (RRR = 0.58). Physical activity promotion for older adults should adapt from culturally appropriate group activities and leverage community social resources to encourage voluntary participation, particularly for low-educated older women.

Protective neuroendocrine effects of environmental enrichment and voluntary exercise against social isolation: evidence for mediation by limbic structures

Previous research indicates that loneliness and social isolation may contribute to behavioral disorders and neurobiological dysfunction. Environmental enrichment (EE), including both cognitive and physical stimulation, may prevent some behavioral, endocrine, and cardiovascular consequences of social isolation; however, specific neural mechanisms for these benefits are still unclear. Therefore, this study examined potential neuroendocrine protective effects of both EE and exercise. Adult female prairie voles were randomly assigned to one of four experimental conditions: paired control, social isolation/sedentary, social isolation/EE, and social isolation/voluntary exercise. All isolated animals were housed individually for 8 weeks, while paired animals were housed with their respective sibling for 8 weeks. Animals in the EE and voluntary exercise conditions received EE items (including a running wheel) and a running wheel only, respectively, at week 4 of the isolation period. At the end of the experiment, plasma and brains were collected from all animals for corticosterone and FosB and delta FosB (FosB/ΔFosB) - immunoreactivity in stress-related brain regions. Overall, social isolation increased neuroendocrine stress responses, as reflected by the elevation of corticosterone levels and increased FosB/ΔFosB-immunoreactivity in the basolateral amygdala (BLA) compared to paired animals; EE and voluntary exercise attenuated these increases. EE and exercise also increased FosB/ΔFosB-immunoreactivity in the medial prefrontal cortex (mPFC) compared to other conditions. Limbic structures statistically mediated hypothalamic immunoreactivity in EE and exercise animals. This research has translational value for socially isolated individuals by informing our understanding of neural mechanisms underlying responses to social stressors. Highlights Prolonged social isolation increased basal corticosterone levels and basolateral amygdala immunoreactivity. Environmental enrichment and exercise buffered corticosterone elevations and basolateral amygdala hyperactivity. Protective effects of environmental enrichment and exercise may be mediated by medial prefrontal cortex and limbic structures.

Moderating effect of social support on depression and health promoting lifestyle for Chinese empty nesters: A cross-sectional study

BACKGROUND

Health promoting lifestyle (HPL) may be a facilitator for empty nesters' active aging against depression. Social support (SS) may improve their HPL. This study aimed to examine moderating effect of SS and its three sources of SS on relationship between depression and HPL among empty nesters. The compensating role of socioeconomic status (SES) for lack of SS was examined, too.

METHODS

A cross-sectional survey of empty nesters (n = 1593) was conducted in six districts of Taiyuan, China, using a stratified random cluster sampling method. Hierarchical multiple linear regression analyses were performed to assess moderation models by SS and its three sources.

RESULTS

The findings indicated that low depression (p < 0.001) and sufficient perceived SS (p < 0.001) could directly predict better HPL among empty nesters. The effect of SS on HPL declined with the raise of educational level (p < 0.001). Family support (β = 0.083, p < 0.001), friends support (β = 0.085, p < 0.001) and others support (β = 0.098, p < 0.001) expressed significant negative buffer effects on depression and HPL individually.

LIMITATIONS

There was a cross-sectional study that limited the moderating effect of SS on depression and HPL just for empty nesters in Taiyuan, China. The results cannot explain the causal relationships among the study variables.

CONCLUSIONS

SS might be a protective factor of empty nesters' health in China. Three sources of SS all showed moderating effect on the relationship between depression and HPL among empty nesters, and should be integrated to achieve maximum utility. Friends support/ others support could play complement role for lack of family support. SES expressed partial compensatory for lack of SS.

Patterns of Sedentary Behavior in the First Month After Acute Coronary Syndrome

Background Sedentary behavior is a key contributor to cardiovascular disease. Few data exist on the sedentary behavior patterns of patients with acute coronary syndrome. Methods and Results We characterized patterns of sedentary time and their correlates in 149 patients with acute coronary syndrome over the first month postdischarge, a critical period when lifestyle behaviors are formed. Sedentary time was measured by accelerometry for 28 days postdischarge. Group-based modeling at the day level was used to characterize sedentary patterns. Participants spent a mean of 9.7±2.0 hours per day sedentary during the 28 days postdischarge, with significant decreases in sedentary time observed in each consecutive week (P<0.01 for all). Three distinct sedentary patterns were identified: high (20.6% of participants), moderate (47.9%), and low (31.5%). The high and moderate sedentary groups spent a mean of 12.6±0.8 and 10.0±0.7 hours per day sedentary, respectively, and had only minimal decreases in their sedentary time (<3 minutes per day) over the 28 days. The low sedentary group spent a mean of 7.3±0.8 hours per day sedentary, with a rapid decrease in sedentary time (14 minutes per day) observed during the first week postdischarge followed by a relatively smaller decrease (≈5 minutes per day) that persisted until day 21 postdischarge. Non-Hispanic ethnicity, left ventricular ejection fraction <40%, lower physical health-related quality of life, and not having a partner were associated with an increased likelihood of being in the high sedentary group. Conclusions Survivors of acute coronary syndrome accrued high volumes of sedentary time during the first month postdischarge, with most showing little change over time. Interventions targeting reductions in sedentary time among survivors of acute coronary syndrome may be warranted, particularly for those with poor physical health and greater disease severity.

Promoting Physical Activity in a Primary Care Practice: Overcoming the Barriers

Along with proper diet and avoidance of tobacco use, physical activity is extremely important to maintain and improve overall health of the individual and population. Despite evidence for the cost-effectiveness of physical activity counseling in primary care, only one-third of patients report that they received physical activity counseling by their primary care physician (PCP). Both PCPs and patients face numerous barriers to addressing insufficient physical activity. To assist patients in overcoming their barriers to regular physical activity, the PCP should assess and address the patient's specific barriers to physical activity and counsel patients about the most common general barriers, such as lack of time, knowledge, and motivation. Numerous benefits and barriers are present, and the PCP should understand them and use the information to better counsel patients regarding the benefit of and need for regular physical activity. Brief counseling is an efficient, effective, and cost-effective means to increase physical activity and to bring considerable clinical benefits to various patient populations.

Physical Activity Attitudes, Preferences, and Experiences of Regionally-Based Australia Adults Aged 65 Years and Older

An understanding of physical activity attitudes, preferences, and experiences in older adults is important for informing interventions. Focus groups were conducted with 46 regionally-based Australian adults aged 65 years and older, who were not currently meeting activity recommendations. Content analysis revealed that participants mainly engaged in incidental activities such as gardening and household chores rather than planned exercise; however, leisure-time walking was also mentioned frequently. Although participants valued the physical and mental health benefits of physical activity, they reported being restricted by poor physical health, extreme weather, and fear of injury. Participants were interested in exercise groups and physical activity programs tailored to their existing physical health. The majority of participants reported preferring to be active with others. The findings from this study are useful in for informing future interventions specifically tailored to the needs of older adults in Australia.

Associations of physical activity with anxiety symptoms and status: results from The Irish longitudinal study on ageing

AIMS

Anxiety is debilitating and associated with numerous mental and physical comorbidities. There is a need to identify and investigate low-risk prevention and treatment strategies. Therefore, the purpose of this study was to investigate cross-sectional and longitudinal associations between different volumes of moderate-to-vigorous physical activity (PA) and anxiety symptoms and status among older adults in Ireland.

METHODS

Participants (n = 4175; 56.8% female) aged ⩾50 years completed the International PA Questionnaire (IPAQ) at baseline, and the anxiety subscale of the Hospital Anxiety and Depression Scale at baseline and follow-up (2009-2013). Participants were classified according to meeting World Health Organisation PA guidelines, and divided into IPAQ categories. Respondents without anxiety at baseline (n = 3165) were included in prospective analyses. Data were analysed in 2017.

RESULTS

Anxiety symptoms were significantly higher among females than males (p < 0.001). Models were adjusted for age, sex, waist circumference, social class, smoking status and pain. In cross-sectional analyses, meeting PA guidelines was associated with 9.3% (OR = 0.91, 95% confidence interval 0.78-1.06) lower odds of anxiety. Compared with the inactive group, the minimally- and very-active groups were associated with 8.4% (OR = 0.92, 0.76-1.10) and 18.8% (OR = 0.81, 0.67-0.98) lower odds of anxiety, respectively. In prospective analyses, meeting guidelines was associated with 6.3% (OR = 0.94, 0.63-1.40) reduced odds of anxiety. Compared with the inactive group, the minimally and very-active groups were associated with 43.5% (OR = 1.44, 0.89-2.32) increased, and 4.3% (OR = 0.96, 0.56-1.63) reduced odds of anxiety. The presence of pain, included in models as a covariate, was associated with a 108.7% (OR = 2.09, 1.80-2.42) increase in odds of prevalent anxiety, and a 109.7% (OR = 2.10, 1.41-3.11) increase in odds of incident anxiety.

CONCLUSION

High volumes of PA are cross-sectionally associated with lower anxiety symptoms and status, with a potential dose-response apparent. However, significant associations were not observed in prospective analyses. The low absolute number of incident anxiety cases (n = 109) potentially influenced these findings. Further, as older adults may tend to experience and/or report more somatic anxiety symptoms, and the HADS focuses primarily on cognitive symptoms, it is plausible that the HADS was not an optimal measure of anxiety symptoms in the current population.

Does religious involvement affect mortality in low-income Americans? A prospective cohort study

OBJECTIVE

This study aimed to evaluate the impacts of various forms of religious involvement, beyond individual socioeconomic status, lifestyle factors, emotional well-being and social support, on all-cause and cause-specific mortality in socioeconomic disadvantaged neighbourhoods.

DESIGN

This is a prospective cohort study conducted from 2002 through 2015.

SETTINGS

This study included underserved populations in the Southeastern USA.

PARTICIPANTS

A total of nearly 85 000 participants, primarily low-income American adults, were enrolled. Eligible participants were aged 40-79 years at enrolment, spoke English and were not under treatment for cancer within the prior year.

RESULTS

We found that those who attended religious service attendance >1/week had 8% reduction in all-cause death and 15% reduction in cancer death relative to those who never attended. This association was substantially attenuated by depression score, social support, and socioeconomic and lifestyle covariates, and further attenuated by other forms of religious involvement. This association with all-cause mortality was found being stronger among those with higher socioeconomic status or healthier lifestyle behaviours.

CONCLUSION

Our results indicate that the association between religious services attendance >1/week and lower mortality was moderate but robust, and could be attenuated and modified by socioeconomic or lifestyle factors in this large prospective cohort study of underserved populations in the Southeastern USA.

Physical activity correlates among older adults with probable generalized anxiety disorder: Results from The Irish Longitudinal Study on Ageing

OBJECTIVES

This study assessed physical activity (PA) correlates among 1237 (69.0% female; age ≥ 50 years) community-dwelling adults with probable-generalized anxiety disorder (GAD).

METHODS

Wave 1 data from The Irish Longitudinal Study on Ageing were analysed. PA was measured using the short-form International PA Questionnaire. Probable-GAD caseness was indicated by a score of ≥23 on the abbreviated Penn State Worry Questionnaire. Potential correlates were analysed using binomial logistic regression. Hierarchical logistic regression consisting of three blocks (sociodemographic variables; quality of life (QoL) variables; physical health and performance variables) examined the proportion of the variance for PA that was explained at each step of the regression model.

RESULTS

Five hundred thirty-five participants (43.2%) met PA guidelines. After adjustment for age and sex, younger age and being male were associated with increased likelihood of meeting PA guidelines. Significant correlates of PA were in employment, higher QoL (CASP-19), social connectedness, and grip-strength. Additionally, polypharmacy (i.e., taking ≥five medications), antidepressant use, at-risk waist circumference (i.e., Males: >94 cm; Females >80 cm), up-and-go time, and number of self-reported physical limitations were significantly negatively associated with meeting PA guidelines. Physical health and performance variables explained significant variation (8.4%) in meeting physical activity guidelines beyond that of sociodemographics, and QoL variables.

CONCLUSIONS

This study identified a range of sociodemographic, physical, and psychological variables that were associated with meeting or not meeting PA guidelines among older adults with probable-GAD.

Effects of Peer-Led Interventions for Patients With Cancer: A Meta-Analysis

PROBLEM IDENTIFICATION

To evaluate the effects of peer-led supportive interventions for patients with cancer.
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LITERATURE SEARCH

Six electronic databases (EMBASE, MEDLINE®, Google Scholar, Cochrane Library, ProQuest Medical Library, and CINAHL®) were searched for articles published from 1997 to May 2017.
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DATA EVALUATION

A total of 159 studies were identified. Eighteen (16 randomized, controlled trials [RCTs] and 2 non-RCTs) were eligible for systematic review and 16 for meta-analysis. The Cochrane risk of bias tool and Comprehensive Meta-Analysis software were used for analysis.
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SYNTHESIS

The authors synthesized the results of the effect size of each trial according to cancer symptoms, coping, emotional health, quality of life, self-efficacy, sexuality, social support, and health-related behaviors. 
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IMPLICATIONS FOR RESEARCH

The findings from this study suggest that an additional tiered evaluation that has a theoretical underpinning and high-quality methodology is required to confirm the efficacy of peer-led supportive interventions within cancer care models.

Physical activity, social support and socio-economic status amongst persons living with HIV and AIDS: a review

Physical activity can be used for the effective and comprehensive management of HIV and AIDS. Social support and socio-economic status (SES) are two factors that shape physical activity behaviours. Individuals of low SES carry a disproportionate burden of the HIV and AIDS epidemic. In addition, limited resources constitute socio-ecological barriers predisposing such individuals to physical inactivity. The purpose of this narrative review is to examine the available literature on physical activity, social support and SES and to generate recommendations for designing and implementing physical activity interventions targeting people living with HIV and AIDS (PLWHA) of low SES. The review used literature from Google, Google Scholar and PubMed on physical activity of PLWHA, social support for physical activity, and SES and physical activity. Qualitative and quantitative studies in English were included from 1970 to 2016. The results show that social support plays a major role in promoting physical activity and counteracting the barriers to PA in PLWHA of low SES. The results on the role of social support and the influence of SES are integrated to help design appropriate physical activity interventions for PLWHA of low SES. Well-designed interventions should utilise social support and be contextualised for PLWHA of low SES, whose living conditions present multiple barriers to physical activity.

Psychological and Environmental Correlates of Moderate-to-Vigorous Physical Activity and Step Counts Among Older Adults With Cognitive Decline

Promoting physical activity (PA) among older adults with cognitive decline is important for maintaining and improving their health. Identifying psychological and environmental PA correlates in this population can help develop effective strategies for PA promotion. Since past findings with healthy older adults may not generalize to those with cognitive decline, this study offers data on how self-efficacy, self-regulation, and social-environmental factors were associated with PA among a group of older adults with cognitive decline. We report secondary analysis of baseline data from a randomized control study of 262 older participants (M = 76.2 years) who showed a decline in global cognitive function as defined by Mini-Mental State Examination scores between 21 and 24. The participants' PA was measured by an accelerometer, and participants completed questionnaires measuring self-efficacy, self-regulation, social support, social network, and demographic variables. In this study, we evaluated the participants' neighborhood environment with a geographic information system and found through stepwise multiple regression analyses that self-efficacy, gender, and age were associated with PA variables, while self-regulation and environmental factors were not. Thus, perceived self-efficacy was an important psychological correlate of PA in this group of older adults with cognitive decline. PA promotion interventions for this population should attend to self-efficacy, gender, and age.

Enabling and disabling behaviors in the social environment are associated with physical Activity of older people in the Netherlands

Background

Although research clearly shows that physical activity has significant health benefits and contributes to the prevention of chronic disease onset, the vast majority of the world’s population is insufficiently physically active, and the prevalence of insufficient physical activity is greatest in the population of older adults. The social environment may play an important role in shaping health behaviors, we however, lack knowledge regarding the exact influence of the social environment on older persons’ physical activity levels. This research therefore aims to identify the relationships of physical activity to enabling and disabling behaviors in the social environment among older people in the Netherlands.

Methods

Participants were randomly sampled from the Rotterdam municipality register and stratified by age group (70–74, 75–79, 80–84, and ≥ 85 years) and neighborhood (district). Of 2798 respondents, 1280 (46%) returned filled-in questionnaires. The Perceived Social Influence on Health Behavior (PSI-HB) instrument was used to assess the degree to which individuals’ health behavior is influenced by those around them. Respondents were additionally asked about enabling and disabling behaviors in their social environments and how many days per week they were physically active. Physical activity scores ranged from 0 (not being physically active for 30 min a day at all during the week) to 7 (being physically active every day of the week). Respondents with a score of ≥5 were considered to be physically active and those with a score of < 5 as physically inactive.

Results

Results revealed that increasing age significantly contributed to physical inactivity within this older population. Lower educational level significantly decreased the odds of physical activity. After controlling for background characteristics results show enabling behaviors and utilitarian social influence significantly increased the odds of physical activity while disabling behaviour of the social environment contributed to physical inactivity. No significant associations were found with perceived social influence aspects value-expressive influence and informational influence.

Conclusion

Actual enabling and disabling behaviors of actors in older people’s social environments seem relevant for their physical activity levels, in positive and negative ways. In promoting active aging, consideration of the role of the social environment and ensuring that it is supportive of older people’s physical activity are important.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-6670-z) contains supplementary material, which is available to authorized users.