Socio-environmental exercise preferences among older adults

The Level and Limitations of Physical Activity in Elderly Patients with Diabetes

Background/Objectives: Old age and illnesses can limit physical activity (PA). We have assessed the level of PA and its limitations in older people with diabetes (DM). Methods: Cross-sectional study, period: January and June 2024, place: Diabetes Center, subjects: patients (N = 207) > 64 years with DM), Surveying using: IPAQ, Accompanying Survey (AS). The significance was assessed by: Student's t-test, Mann-Whitney U test, Pearson's test. The relationships between the IPAQ and the AS results were analyzed based on a meta-analysis model for variable effects, OR with a 95% CI. ROC curve was used to determine the threshold values for age, BMI. Correlations between selected key variables were evaluated using the PCA. Results: The median age: 72 years (65-87), BMI: 28.70 (18.61-49.69). The median PA level: 1837 MET-min/week (0-9.891). The individuals who obtained insufficient (n = 28), sufficient (n = 75), and high levels of PA (n = 53) were 17.95%, 48.08%, and 33.97%, respectively. Diseases were the main factor limiting PA (53.54%) in patient's opinion, followed by the lack of a companion or motivation. The meta-analysis found no diseases linked to insufficient PA, but those with BMI > 33.3 and over 75 years old more often had insufficient PA. PCA revealed several characteristics that predispose individuals to insufficient PA. Conclusions: People over 75 years of age tend to avoid PA more than younger seniors, leading to its insufficient level, similarly like higher BMI. The individual with DM who has an insufficient level of PA is typically a single, woman, over 75, BMI > 33.

Motivational Barriers and Facilitators for Older Adults' Engagement in Exercise during Depressive Episodes: A Network Meta-Analysis of Randomized Controlled Trials

This study aims to assess the motivational factors influencing the participation of older adults in various exercise interventions during depressive episodes and to identify which types of exercise are most effective in alleviating depressive symptoms in this population. Therefore, randomized controlled trials (RCTs) focusing on exercise interventions and their impact on depression in older adult patients, identified by the terms "exercise" AND "depression" AND "elderly" OR "geriatric", were selected from primary electronic databases to conduct this network meta-analysis (NMA). The primary outcome was the effect on depressive symptoms, while the secondary outcome was the comparison of dropout rates between the intervention groups and the usual care control groups, as a measure of sustained motivation and engagement. Standardized mean difference (SMD) values and the corresponding 95% confidence intervals (CIs) were computed for effect evaluation. This study protocol has been registered in IPLASY (INPLASY 202460035). The results of 31 RCTs with 3238 participants indicated that qigong (SMD -1.17, -2.28 to -0.06), Otago Exercise (SMD -1.15, -2.29 to -0.01), and yoga (SMD -0.88, -1.55 to -0.21) significantly alleviate depressive symptoms in older adults. Walking (SMD -0.82, -1.34 to -0.31) and strength training (SMD -0.67, -1.05 to -0.30) also showed significant effects. Aerobic, physical training, and tai chi had moderate effects, while multisport showed a weaker impact with no significant improvement. In summary, our research findings demonstrate that exercise can effectively alleviate depressive symptoms in older adults, with low dropout rates likely due to interconnected physiological, psychological, and social mechanisms. This is crucial for enhancing treatment strategies for older adults' depression.

Barriers and motivators to undertaking physical activity in adults over 70-a systematic review of the quantitative literature

BACKGROUND

Physical activity (PA) has multiple benefits for older adults (≥70 years old). Despite this many older adults do not undertake the World Health Organisation guideline recommended amount of PA. This systematic review examines barriers and motivators to PA in adults aged ≥70 years.

METHODS

We analysed the quantitative literature, including observational studies and baseline data from randomised controlled trials. Studies examining specific diseases (e.g. cognitive impairment), or care home residents were excluded. Database searches of ASSIA, CINAHL, Embase, Medline, PsycINFO and Web of Science were undertaken on 7 March 2023. Quality assessment was performed using the ROBANS tool. We synthesised the results using the socioecological model. The protocol was registered on PROSPERO (CRD42021160503).

RESULTS

We identified 37 papers, n = 26,961, age 70-101 years (median 78), 62% female. We undertook a narrative review; meta-analysis was not possible. Overall risk of bias was low. A total of 23 studies addressed barriers, seven motivators, seven both. The most cited barriers were: concern about physical health/fitness (14 studies), lack of motivation/interest (13 studies), fear of falls/history of falling (11 studies) and environmental barriers (10 studies). Key motivators were: support from family/friends (five studies), social interaction (five studies), personal benefits (five studies) and outside facilities (five studies). Results varied across gender, age, functional ability and geographical location.

DISCUSSION

To maximise PA in older adults, important modifiable factors identified in this review should be targeted: support from healthcare professionals; reducing fear of falls; and prioritising ease of access and safety of outdoor facilities. When considering future policy, a person-centred, age group appropriate approach will have the most impact.

A psychosocial investigation of exercise preferences in real and virtual environments

Three studies explored exercise preferences in real-world and virtual environments, and their relationship with social physique anxiety (SPA), social comparison, and self-presentational efficacy (SPE). In Study 1 (N = 230), real-world exercise preferences were explored. Study 2 (N = 228) measured preferences for real-world and virtual reality (VR) exercise, and Study 3 (N = 249) investigated preferences for avatar embodiment and virtual companions within VR. Results revealed that participants who preferred home-based exercise had lower exercise behaviour, more negative fitness-related social comparisons, or lower SPE expectancy and outcome value (Study 1). Individuals with lower exercise behaviour, more negative fitness-related social comparisons, lower SPE expectancy, or higher SPA were also more likely to choose VR than real-world exercise (Study 2). In a VR exercise setting, participants with higher SPA and more negative social comparisons also preferred to embody a non-human and fantasy avatar more than a realistic avatar. A heightened threat of negative social comparison when imagining exercise with a physically superior virtual companion resulted in the strongest preference to embody a fantasy avatar (Study 3). The results suggest that individuals who place high importance on self-presentation and have low belief in their capacity to project an image of competence to others, are more likely to prefer exercise contexts that minimise physique- and fitness-related evaluation. Moreover, VR may afford a less psychosocially threatening context for individuals who feel self-conscious or comparatively inferior to others during exercise.

Narrative Review of Sex Differences in Muscle Strength, Endurance, Activation, Size, Fiber Type, and Strength Training Participation Rates, Preferences, Motivations, Injuries, and Neuromuscular Adaptations

ABSTRACT

Nuzzo, JL. Narrative review of sex differences in muscle strength, endurance, activation, size, fiber type, and strength training participation rates, preferences, motivations, injuries, and neuromuscular adaptations. J Strength Cond Res 37(2): 494-536, 2023-Biological sex and its relation with exercise participation and sports performance continue to be discussed. Here, the purpose was to inform such discussions by summarizing the literature on sex differences in numerous strength training-related variables and outcomes-muscle strength and endurance, muscle mass and size, muscle fiber type, muscle twitch forces, and voluntary activation; strength training participation rates, motivations, preferences, and practices; and injuries and changes in muscle size and strength with strength training. Male subjects become notably stronger than female subjects around age 15 years. In adults, sex differences in strength are more pronounced in upper-body than lower-body muscles and in concentric than eccentric contractions. Greater male than female strength is not because of higher voluntary activation but to greater muscle mass and type II fiber areas. Men participate in strength training more frequently than women. Men are motivated more by challenge, competition, social recognition, and a desire to increase muscle size and strength. Men also have greater preference for competitive, high-intensity, and upper-body exercise. Women are motivated more by improved attractiveness, muscle "toning," and body mass management. Women have greater preference for supervised and lower-body exercise. Intrasexual competition, mate selection, and the drive for muscularity are likely fundamental causes of exercise behaviors in men and women. Men and women increase muscle size and strength after weeks of strength training, but women experience greater relative strength improvements depending on age and muscle group. Men exhibit higher strength training injury rates. No sex difference exists in strength loss and muscle soreness after muscle-damaging exercise.

Long-Term Exercise Assistance: Group and One-on-One Interactions between a Social Robot and Seniors

For older adults, regular exercises can provide both physical and mental benefits, increase their independence, and reduce the risks of diseases associated with aging. However, only a small portion of older adults regularly engage in physical activity. Therefore, it is important to promote exercise among older adults to help maintain overall health. In this paper, we present the first exploratory long-term human–robot interaction (HRI) study conducted at a local long-term care facility to investigate the benefits of one-on-one and group exercise interactions with an autonomous socially assistive robot and older adults. To provide targeted facilitation, our robot utilizes a unique emotion model that can adapt its assistive behaviors to users’ affect and track their progress towards exercise goals through repeated sessions using the Goal Attainment Scale (GAS), while also monitoring heart rate to prevent overexertion. Results of the study show that users had positive valence and high engagement towards the robot and were able to maintain their exercise performance throughout the study. Questionnaire results showed high robot acceptance for both types of interactions. However, users in the one-on-one sessions perceived the robot as more sociable and intelligent, and had more positive perception of the robot’s appearance and movements.

Meanings Attributed to Physical Activity and Changes in Self-Reported and Accelerometer-Measured Physical Activity among Recent Retirees

Retirement poses opportunities and challenges for maintaining and adopting physically active habits, which may have major implications for health and functional ability in later life. Qualitative studies suggest that a broad range of meanings of physical activity should be considered when promoting physical activity among retirees. The current study utilized the Physical Activity Relationship (PAR) approach to examine the importance of meanings attributed to physical activity and their associations with physical activity over time. A total of 230 recently retired participants (65.2 years old, 83% women) responded to a 54-item inventory assessing the importance of meanings attributed to physical activity at baseline. Eight meaning dimensions were identified through exploratory factor analysis. Differences in their importance across gender and occupational background were examined using t-tests and ANOVA. Associations between meaning dimensions and self-reported and accelerometer-measured physical activity over 12 months were examined with general linear models. Dimensions defined as Physical Fitness, Positive Mood, and Belonging were positively associated with changes in self-reported and accelerometer-measured physical activity. Additionally, the importance of several meaning dimensions varied across occupational background. In conclusion, physical activity promotion among retirees should focus on physical fitness, positive mood, and social belonging. Furthermore, meanings attributed to physical activity may vary across occupational backgrounds.

Effects of exercise intensity and frequency on improving cognitive performance in middle-aged and older adults with mild cognitive impairment: A pilot randomized controlled trial on the minimum physical activity recommendation from WHO

Background: The World Health Organization physical activity guidelines recommend adults and older adults to accumulate at least 150–300 min of moderate or 75–150 min of vigorous aerobic-type physical activity weekly for health benefits including improvements of cognitive performance. However, the optimal exercise intensity and frequency for maximizing the cognitive benefits remain unclear.

Purpose: We conducted a parallel, assessor-blinded, pilot randomized controlled trial to evaluate the effectiveness of different intensities and frequencies of the WHO-recommended minimal volume of aerobic-type physical activity on improving cognitive performance in middle-aged and older adults with mild cognitive impairment (MCI).

Methods: Participants were randomly allocated to the stretching exercise control group (CON), once-a-week and thrice-a-week moderate-intensity walking groups (M1 and M3), and once-a-week and thrice-a-week vigorous-intensity walking groups (V1 and V3). Intervention duration was 12 weeks. The primary outcome was global cognitive performance assessed by the Hong Kong version of Montreal Cognitive Assessment. Secondary outcomes were self-report and objective cognitive performances, mental health, sleep quality, and cardiorespiratory fitness.

Results: Thirty-seven participants completed the study (CON: n = 7, M1: n = 7, M3: n = 7, V1: n = 8, V3: n = 8). Participants in all four walking exercise groups demonstrated significant improvements in global cognitive performance assessed by the Hong Kong version of the Montreal Cognitive Assessment after the intervention when compared to CON (p < 0.001). The walking exercise interventions also significantly mitigated the anxiety severity (p < 0.005) and improved the cardiorespiratory fitness (p < 0.05) of the participants in the walking exercise groups.

Conclusion: 150-min moderate- or 75-min vigorous-intensity walking exercise performed once- or thrice-weekly showed similar effects on improving cognitive performance in middle-aged and older adults with MCI. The 12-week walking exercise interventions also reduced anxiety severity and improved cardiorespiratory fitness of the participants.

Clinical Trial Registration:clinicaltrials.gov, identifier NCT04515563

How the physical appearance of companions affects females with high or low social physique anxiety: a virtual reality exercise study

Technologies such as virtual reality (VR), an immersive computer-based environment that induces a feeling of mental and physical presence, are becoming increasingly popular for promoting participation in exercise. The purpose of this study was to explore changes in motivation and other psychological states when the physique of an exercise companion was altered during a VR-based exercise task, and whether trait social physique anxiety (SPA) altered these effects. Using a mixed experimental design, female participants (N = 43) categorised as high or low in SPA participated in two counterbalanced 10-min running tasks within a VR environment where the exercise companion was either overweight or in-shape. Across both running tasks, individuals with high SPA reported higher negative affect, pressure and tension, and lower perceived competencies, than those with low SPA. Pressure and tension were also higher when exercising with an in-shape companion than with an overweight companion for all participants. In addition, participants with high SPA reported a stronger preference to exercise with an overweight companion than those with low SPA in a real exercise setting, but not in a VR setting. The findings suggest that the physique of an exercise companion and the SPA of an exerciser have important, but independent, psychosocial effects during exercise. That an in-shape physique of a virtual exercise companion was not a deterrent among those with high SPA has provided preliminary evidence that VR-based exercise may be helpful among females who worry about their appearance or feel self-conscious while exercising.

Engaging older adults in an online physical activity programme to improve cognition: A qualitative study

OBJECTIVES

Maintaining physical activity is a modifiable risk factor for dementia. However, older adults do not routinely meet activity guidelines. Online interventions offer a means of engaging with this group and overcoming barriers to physical activity, particularly in the context of a global pandemic where people have become accustomed to at-home and digital living. This study explored the factors which maximise engagement in an online programme to promote physical activity.

METHODS

A qualitative study was conducted with adults aged 50 and over, recruited through the online UK PROTECT study cohort. Four focus groups (n = 21) examined key contributors to engagement with a digital programme to promote physical activity. Iterative Categorisation was utilised to identify categories and themes of the focus group data. Semi-structured interviews were also conducted (n = 5) in which participants were asked to comment on a concept-stage online intervention.

RESULTS

Four key themes emerged from focus group data: interaction at the fore, incentives as foundations, fitting around me and identity is critical. The semi-structured interviews identified key areas of programme acceptability and specific needs for enhancing engagement.

CONCLUSIONS

Older adults are open to using online physical activity programmes. Any intervention must be tailored to individual usability preferences and encompass fitness, health and lifestyle needs of older adults. The conceptual-stage intervention used in this study was found to be acceptable, with key changes needed to maximise engagement.

Tone it down or tune it out? Effects of instructor cues on body image, enjoyment, and intentions to return during group exercise for older adults

The use of appearance (versus functionality) cues in group exercise has been linked to negative body image outcomes in young women. This study examined the impact of appearance versus functionality-focused cues during an exercise class on state body image, enjoyment, and intentions to return to a future class, in older adults (60+ years). Participants (N = 107, M_age = 69 years) completed demographic and trait body image measures at a first session and attended either an appearance or functionality-focused full-body strength-based circuit class. Participants completed pre-and post-state body image measures, and measures of enjoyment and intention to return post-class. A General Linear Model approach to a repeated measures multivariate ANCOVA was used to examine pre-to-post-class differences between conditions for state body image; trait body satisfaction with appearance and functionality, BMI, and previous group exercise experience were entered as covariates. ANCOVAs were conducted to examine differences for enjoyment, (gender, BMI, and previous group exercise experience entered as covariates) and intention to return to a similar class, (previous group exercise experience as covariate). No significant differences were found across analyses (ps > .05). These findings contrast with similar studies conducted in younger populations. Future studies should continue to examine body image in aging populations.

The Contribution of Leisure Center Usage to Physical Activity in the United Kingdom: Evidence From a Large Population-Based Cohort

BACKGROUND

Physical activity (PA) levels vary across specific population groups, contributing to health inequalities. Little is known about how local authority leisure centers contribute to population PA and whether this differs by age, sex, or socioeconomic group.

METHODS

The authors calculated weekly leisure center-based moderate/vigorous PA for 20,904 registered adult users of local authority leisure facilities in Northumberland, United Kingdom, between July 2018 and June 2019, using administrative data. The authors categorized activity levels (<30, 30-149, and ≥150 min/wk) and used ordinal regression to examine predictors for activity category achieved.

RESULTS

Registered users were mainly female (58.7%), younger (23.9% of users aged 18-29 y vs 10.1% of those aged 70+ y), and from the 2 most affluent socioeconomic quintiles (53.7%). Median weekly moderate/vigorous leisure center-based activity was 55 minutes per week (interquartile range: 30-99). Being female (odds ratio: 2.09; 95% confidence interval, 1.95-2.35), older (odds ratio: 1.14; 95% confidence interval, 1.11-1.16), and using a large facility (odds ratio: 1.21; 95% confidence interval, 1.03-1.42) were positive predictors of leisure center-based PA.

CONCLUSION

Older adults and females were more likely to be active and achieve the recommended PA levels through usage of the centers. Widespread use of this novel measure of leisure center-based activity would improve the understanding of how local authority leisure centers can address physical inactivity and its associated inequalities.

The Effects of Neighborhood Built Environment on Walking for Leisure and for Purpose Among Older People

BACKGROUND AND OBJECTIVES

Characteristics of a neighborhood's built environment affect the walking behavior of older people, yet studies typically rely on small nonrepresentative samples that use either subjective reports or aggregate indicators from administrative sources to represent neighborhood characteristics. Our analyses examine the usefulness of a novel method for observing neighborhoods-virtual observations-and assess the extent to which virtual-based observations predict walking among older adults.

RESEARCH DESIGN AND METHODS

Using Google Street View, we observed the neighborhoods of 2,224 older people and examined how characteristics of the neighborhood built environments are associated with the amount of time older people spend walking for leisure and purpose.

RESULTS

Multilevel model analyses revealed that sidewalk characteristics had significant associations with both walking for purpose and leisure. Land use, including the presence of multifamily dwellings, commercial businesses, and parking lots were positively associated with walking for purpose and single-family detached homes were negatively associated with walking for purpose, but none of these characteristics were associated with leisure walking. Gardens/flowers were associated with walking for leisure but not purpose. Garbage/litter was not associated with either type of walking behavior.

DISCUSSION AND IMPLICATIONS

Virtual observations are a useful method that provides meaningful information about neighborhoods. Findings demonstrate how neighborhood characteristics assessed virtually differentially impact walking for leisure and purpose among older adults and are interpreted within a social-ecological model.

Is Promotion of Mobility in Older Patients Hospitalized for Medical Illness a Physician's Job?-An Interview Study with Physicians in Denmark

: The aim of this study was to identify the most common barriers and facilitators physicians perceive regarding their role in the promotion of mobility in older adults hospitalized for medical illness as part of on an intervention to promote mobility. Twelve physicians at two medical departments were interviewed face-to-face using semi-structed interviews based on the Theoretical Domains Framework. The physicians' perceived barriers to promoting mobility were: the patients being too ill, the department's interior does not fit with mobility, a culture of bedrest, mobility not being part their job, lack of time and resources and unwillingness to accept an extra workload. The facilitators for encouraging mobility were enhanced cross-professional cooperation focusing on mobility, physician encouragement of mobility and patient independence in e.g., picking up beverages and clothes. The identified barriers and facilitators reflected both individual and social influences on physicians' behaviors to achieve increased mobility in hospitalized older medical patients and suggest that targeting multiple levels is necessary to influence physicians' propensity to promote mobility.

Impact of Daily Physical Activity as Measured by Commonly Available Wearables on Mealtime Glucose Control in Type 1 Diabetes

Objective: In contrast with exercise, or structured physical activity (PA), glycemic disturbances due to daily unstructured PA in patients with type 1 diabetes (T1D) is largely underresearched, with limited information on treatment recommendations. We present results from retrospective analysis of data collected under patients' free-living conditions that illuminate the association between PA, as measured by an off-the-shelf activity tracker, and postprandial blood glucose control. Research Design and Methods: Data from 37 patients with T1D during two clinical studies with identical data collection protocols were analyzed retrospectively: 4 weeks of continuous glucose monitoring, carbohydrate intake, insulin injections, and PA (assessed through wearable activity tracker) were collected in free-living conditions. Five-hour glucose area under curves (GAUCs) following the last-bolused meal of every day were computed to assess postprandial glucose excursions, and their relation with corresponding antecedent PA was analyzed using linear mixed-effects regression models, accounting for meal, insulin, and current glycemic state. Results: Datasets yielded 845 days of data from 37 subjects (22.8 ± 11.6 days/subject); postmeal GAUC was negatively associated with total daily PA measured by step count (P = 0.025), and total time spent performing higher than light-intensity PA (P = 0.042). Patients with higher median total daily PA exhibited lower average postprandial GAUC (P < 0.01). Additional analyses indicated that daily PA likely presents an immediate and delayed impact on glucose control. Conclusion: Daily PA assessed by commonly available sensors is significantly associated with glycemic exposure after an evening meal, indicating that quantitative assessment of PA may be useful in mealtime treatment decisions.

Percepção de barreiras e facilitadores dos usuários para participação em programas de promoção da atividade física

Resumo: No Brasil, a atividade física é eixo prioritário das ações de promoção da saúde no Sistema Único de Saúde (SUS). O presente estudo tem como objetivo descrever o perfil dos usuários, as barreiras e os facilitadores para participação em programas para promoção de atividades físicas na atenção básica à saúde. Trata-se de um estudo transversal com abrangência estadual realizado nos municípios de Pernambuco. Foram entrevistados de 2 a 21 indivíduos, por município, por meio de instrumento previamente testado e validado nas dimensões: sociodemográfica; estado de saúde; participação; informações sobre o programa; motivos de participação; facilitadores para a prática; barreiras para a prática e preferência de atividades. Foram realizadas análises descritivas e inferenciais (qui-quadrado). A amostra foi de 1.153 usuários, sendo 35,9% com idade entre 41-59 anos; 90,1% residentes em áreas urbanas; 58,2% dos usuários participavam das atividades há, pelo menos, um ano. A frequência semanal de 3-4 dias foi de 44,9%, e 71,1% praticavam atividades de uma hora ou mais. Observou-se que 40% das barreiras para a participação nos programas de atividade física e 77,5% dos facilitadores relatados foram de domínio intrapessoal. A barreira mais prevalente foi “condição atual de saúde”, e o facilitador foi “ter uma condição melhor de saúde”. As mulheres percebem mais barreiras do que os homens. Conclui-se que as barreiras e os facilitadores de domínio intrapessoal, relacionados com a saúde, são os fatores envolvidos na manutenção e no engajamento dos usuários dos programas e intervenções para promoção da atividade física desenvolvidos pela atenção básica à saúde do Estado de Pernambuco.

A systematic review of barriers and motivators to physical activity in elderly adults in Iran and worldwide

OBJECTIVES

This study was conducted to identify and characterize the barriers and motivations to physical activity (PA) for elderly adults in Iran and other countries.

METHODS

We searched 6 databases (PubMed, Embase, Scopus, Web of Science, Magiran, and the Scientific Information Database) from 2000 to the November 2017, using "aged 60 and over," "physical activity" or "exercise," and "motivator" and "barrier" as keywords. Two reviewers independently performed the search, screening, and quality assessment of the studies.

RESULTS

In total, 34 papers were finally included in the study. The most important barriers, based on the frequency of factors, included physical problems, having no companions, and physical barriers to walking. The motivators included improving one's physical condition, being social, and suitability of the physical environment.

CONCLUSIONS

Important motivators and barriers to PA were more closely related to intrapersonal factors than to the interpersonal and environmental domains. The barriers and motivators to PA in the elderly were not markedly different between Iran and other countries. Therefore, a general strategy could be designed to improve PA in the elderly.

Factors influencing women in physical activity programs in Malaysia

The majority of research on factors associated with women participation in physical activity (PA) has been in developed countries with limited research in developing countries. Few women in Malaysia are active at the recommended levels for health, and activity rates are less than developed countries. Little research has focused specially on physically active Malaysian women and the factors that contribute to them becoming and staying active in PA programs. This lack of knowledge hinders the tailored development and implementation of PA programs to meet their needs. The aim of this study was to identify the factors of participation in PA programs for Malaysian women. The social-ecological model was used to investigate and theme the factors. Focus group discussion was conducted with participants in six PA programs targeted specifically to women. Thirty-seven women were involved in the focus group discussion, with ages ranging from 19 to 82 years. Inductive and deductive content analysis was conducted from verbatim transcripts using NVivo. Inductive content analysis allowed raw data and second-order themes to emerge. Findings revealed social support structures, tailored programs for women, and location were key contributors that encouraged women to participate in these programs. The similarity in contributors between women in non-western and western countries signifies a prime opportunity for bi-lateral relationships to be formed to enable the enhancement of program development relevant to different ethnicities and cultures within or across countries.

Physical Activity Preferences Among Older Adults: A Systematic Review

The objective of this study was to identify preferences for physical activity among adults aged 65 years and over. A systematic review was conducted. A search strategy without language and date restriction (up until March 31, 2017) was developed for PubMed, CINAHL, PsycINFO, ERIC, and SPORTDiscus. Study selection and data extraction were performed independently by two reviewers. A total of 21 independent primary studies were included in the systematic review. Irrespective of the methodologies used and samples, a majority of older adults prefer to walk and engage in physical activity continuously for about 30 min. These findings are mainly generalizable to White females from the United States. Two-thirds of the studies were at high risk of selection bias, which suggests additional caution when interpreting the review findings. Nonetheless, policymakers, community organizations, and healthcare providers should consider walkability in their efforts to promote physical activity in older adults.

Stay active for life: physical activity across life stages

Purpose

This paper concerns participation of Poles aged 15+ years in leisure time and transport-related physical activity (PA) with a special focus on the life stages. The purpose of the paper was to analyze types of exercises, current and future behavior concerning PA, availability of sport and recreation facilities, and factors having the strongest relation with undertaking PA at a sufficient level according to pro-health recommendations of World Health Organization (WHO).

Patients and methods

A survey was carried out on the representative sample (n=2,000). Respondents were classified in accordance to their life stages with a two-step cluster analysis. Relationships between meeting the dose of PA required for health recommendations and a membership in groups of life stages were evaluated using log-linear analysis. The strength of this relationship was expressed by the odds ratio. In order to capture relationships between meeting WHO recommendations and a set of explanatory variables, a predictive model was built.

Results

Life stages and various related events have a significant relation with a decrease of PA. Among groups of a particular risk, there are professionally active and unemployed people aged 50–64 years without children as well as retirees aged 65+ years who do not meet WHO recommendations (45.3; 50.4% and 47.6%). The unemployed and retirees more frequently (p<0.0001) do not or cannot practice sport and do not think that a change of their situation is expected soon. However, 35% of professionally active people aged 50–64 years without children and 18.2% of unemployed people declare that they are currently not active but if they had the possibility, they would start practicing sport.

Conclusion

Campaigns promoting PA should be targeted at groups of a particular risk. Any attempts of increasing PA or changing tendencies of its decrease should consider life conditions of these persons, as well as their needs, motivations, and barriers.

Nutritional and physical exercise programs for older people: program format preferences and (dis)incentives to participate

Purpose

A growing number of studies in older people have been examining the beneficial effects of non-pharmacological interventions, such as physical exercise (PE) and nutritional supplementation, to target age-related syndromes such as sarcopenia and frailty. This study evaluated interpersonal, intrapersonal, and community (dis)incentives, concepts of motivation, and preferred program formats toward a PE or nutritional program in older people, with or without frailty or risk of sarcopenia.

Methods

A questionnaire was developed and filled in by 115 community-dwelling older adults (≥65 years of age) after content (n=7 experts) and face validation (n=8 older adults). We assessed 1) the agreement with a statement (a statement with which ≥70% of the participants agree or strongly agree is considered as a common statement), 2) concepts of motivation by an exploratory factor analysis, and 3) program preferences by nonparametric Wilcoxon or Friedman’s analysis of variance and post hoc Wilcoxon signed-rank tests.

Results

Intrapersonal motivators (eg, health benefits) were the most common motivators to participate in a PE or nutritional program. Identified concepts to participate in a PE intervention were intrinsic health beliefs, fear of falling or injuries, influence of significant others and environment, and (para)medical encouragement (Cronbach’s alpha: 0.75; 72% variance explained). Intrinsic health beliefs, influence of significant others and (para)medical encouragement were identified as concepts that motivate older people to participate in a nutritional intervention (Cronbach’s alpha: 0.77; 78% variance explained). No favorability of exercise location was identified; however, older people preferred protein supplement intake in a tablet form compared to liquid or powder form and in a pulsed timing compared with a spread intake.

Conclusion

Program preferences of older people toward nutritional interventions need to be taken into account in future clinical trials and implementation programs, to increase recruitment and adherence to interventions.

The Influence of Older Adults' Beliefs and Attitudes on Adopting Fall Prevention Behaviors

Among Americans aged 65 years and older, falls are the leading cause of injury death and disability, and finding effective methods to prevent older adult falls has become a public health priority. While research has identified effective interventions delivered in community and clinical settings, persuading older adults to adopt these interventions has been challenging. Older adults often do not acknowledge or recognize their fall risk. Many see falls as an inevitable consequence of aging. Health care providers can play an important role by identifying older adults who are likely to fall and providing clinical interventions to help reduce fall risks. Many older people respect the information and advice they receive from their providers. Health care practitioners can encourage patients to adopt effective fall prevention strategies by helping them understand and acknowledge their fall risk while emphasizing the positive benefits of fall prevention such as remaining independent. To help clinicians integrate fall prevention into their practice, the Centers for Disease Control and Prevention launched the STEADI (Stopping Elderly Accidents, Deaths, and Injuries) initiative. It provides health care providers in primary care settings with resources to help them screen older adult patients, assess their fall risk, and provide effective interventions.

Exercise gaming - a motivational approach for older adults with vestibular dysfunction

Purpose The purpose of the study was to identify possible reasons for a modest level of exercise compliance during computer-assisted training for vestibular rehabilitation. Method Qualitative design and analysis of 14 semi-structured interviews with seven participants before and after a period with computer-assisted home training. The interviews evolved around themes, such as the elderly participants' self-efficacy, motivation and acceptance of the technology. Results Age was not an excuse for the modest exercise compliance. The participants were basically self-efficient and accepted the technology, but their knowledge and understanding of the training programme were insufficient. The participants asked for a greater variation in the exercises and asked for closer contact with the physiotherapist. When Mitii is used for vestibular rehabilitation, the system has some limitations. Conclusions The modest level of exercise compliance can be explained by (1) missing variety of exercise speed and duration and lack of introducing new exercises, (2) insufficient interaction with the physiotherapist regarding the participants' performance and lack of social contact with other patients and (3) desire for a deeper understanding of the training programme with supplying information on the parts of the vestibular system addressed by the training. Implications for Rehabilitation Computer-assisted technologies should generate feedback on the quality of user performance and inform the patient of the relevance of the exercise. The technology should support social contact among patients with the same diagnosis and establish contact with the physiotherapist at the hospital advice and feedback. Varity and adjustments to exercises are necessary to maintain motivation and exercise compliance.

Task-Oriented Exercise to Reduce Activities of Daily Living Disability in Vulnerable Older Adults: A Feasibility Study of the 3-Step Workout for Life

The purpose of this feasibility study was to evaluate the 3-Step Workout for Life program, a 10-week exercise program that included moderate-intensity muscle strength training followed by task-oriented training. Fourteen participants completed the program (mean age = 73 years; SD = 6.83). The Box and Block test (Z = -2.24, p = .03) and the 30-s chair stand test (Z = -2.21, p = .03) indicate improved physical functioning of the upper and lower extremities. More importantly, results of the function component from the Late-Life Function and Disability Instrument (Z = -2.04, p = .04) and motor skills scale from the Assessment of Motor and Process Skills (Z = -2.97, p = .003) indicate subjective and objective improvements on performing activities of daily living. Supplementing moderate-intensity muscle strength exercise with task-oriented training components is feasible. Preliminary data support the effectiveness of 3-Step Workout for Life in reducing late-life disability.

Dance as Prevention of Late Life Functional Decline Among Nursing Home Residents

Late life deterioration of functional status is associated with adverse health outcomes and increased cost of care. This trial was conducted to determine whether dance-based intervention could reverse functional decline among nursing home (NH) residents. A total of 189 residents of seven NHs in the Czech Republic were randomly assigned to intervention and control groups. More detailed data were collected in a subsample of 52 participants. Intervention consisted of 3-month dance-based exercise. Functional status was assessed by the get-up-and-go test, basic activities of daily living (ADL), instrumental activities of daily living (IADL), and senior fitness tests (SFTs). Participants in the control group experienced a significant decline in get-up-and-go test, IADL, and in four of the six SFTs. The intervention proved to be effective in preventing this deterioration and improved chair stand test and chair sit-and-reach test. The findings indicate that a relatively simple dance-based exercise can slow down deterioration of functional status in NH residents.

Distance to parks and non-residential destinations influences physical activity of older people, but crime doesn't: a cross-sectional study in a southern European city

BACKGROUND

Physical activity (PA) has numerous health benefits, but older adults live mostly sedentary lifestyles. The physical and social neighborhood environment may encourage/dissuade PA. In particular, neighborhood crime may lead to feeling unsafe and affect older adults' willingness to be physically active. Yet, research on this topic is still inconclusive. Older population, probably the age group most influenced by the neighborhood environment, has been understudied, especially in Southern Europe. In this study, we aimed to analyze the association between leisure-time physical activity (LTPA) in older adults and objective crime, alongside other neighborhood characteristics.

METHODS

We obtained data from a population-based cohort from Porto (2005-2008) to assess LTPA. Only adults aged 65 years or more were included (n = 532). A Geographic Information System was used to measure neighborhood characteristics. Neighborhood crime was expressed as crime rates by category (incivilities, criminal offenses with and without violence and traffic crime). Neighborhood characteristics such as socioeconomic deprivation, land gradient, street density, transportation network, distance to parks, non-residential destinations and sport spaces were also included. Generalized Additive Models were fitted to estimate the association between neighborhood characteristics and the participation (being active vs. inactive) and frequency (min/day) of LTPA.

RESULTS

Forty-six percent of the men and 61 % of the women did not engage in any kind of LTPA. Among the active participants, men spent on average 50.5 (35.2 Standard Deviation, SD) min/day in LTPA, whereas the average among women was 36.9 (35.1 SD) min/day (p < 0.001). Neighborhood crime was unrelated to the participation in, or frequency of, LTPA. On the other hand, two neighborhood characteristics - distance to the nearest park (β = -0.0262, p = 0.029) and to the nearest non-residential destination (β = -0.0735, p = 0.019) - were associated with time spent on LTPA, but only among active older women. No neighborhood characteristic was related to participation in LTPA.

CONCLUSIONS

From a public health point of view, the provision of parks and non-residential destinations (shops, schools, cultural and worship places) might contribute to elevate PA levels of already active older women. On the other hand, in this setting, crime was not a big issue.

Computer-assisted training as a complement in rehabilitation of patients with chronic vestibular dizziness--a randomized controlled trial

OBJECTIVE

To compare a computer-assisted home exercise program with conservative home-training following printed instructions in the rehabilitation of elderly patients with vestibular dysfunction.

DESIGN

Single-blind, randomized, controlled trial.

SETTING

Geriatric department of a university hospital.

PARTICIPANTS

Patients with chronic dizziness due to vestibular dysfunction (N=63) were randomly assigned to either rehabilitation in the clinic followed by computer-assisted home exercises (intervention group: n=32) or rehabilitation in the clinic followed by home exercises according to printed instructions (control group: n=31).

INTERVENTIONS

Patients in the intervention group received assisted rehabilitation by a computer program.

MAIN OUTCOME MEASURES

Measurements at baseline and at 8 and 16 weeks were compared. These included the One Leg Stand Test, Dynamic Gait Index, Chair Stand Test, Motion Sensitivity Test, Short Form-12, Dizziness Handicap Inventory, and visual analog scale.

RESULTS

Both groups improved significantly during 16 weeks of rehabilitation. However, neither t tests nor repeated-measures analysis of variance demonstrated any significant differences between the 2 groups. The overall compliance rate to computer program exercises during 16 weeks was 57%.

CONCLUSIONS

A computer-assisted program to support the home training of elderly patients with vestibular dysfunction did not improve rehabilitation more than did printed instructions.

Physical activity program preferences and perspectives of older adults with and without cognitive impairment

INTRODUCTION

There is increasing evidence to support the benefits of physical activity on cognition in older adults. This paper describes (i) the attitudes, beliefs and barriers towards physical activity of older adults with and without cognitive impairment and (ii) their opinion of the attributes of the ideal physical activity program.

METHODS

Thematic analysis of focus groups and individual interviews with 50 older adults with no cognitive impairment, subjective memory complaints, mild cognitive impairment and Alzheimer's disease was performed.

RESULTS

Consistent with previous research in cognitively intact older adults, most participants, irrespective of cognitive status, had a positive attitude towards physical activity and believed it was beneficial both generally and for cognition. There was a preference for physical activity programs to be suggested by advertising and general practitioners (GPs), undertaken in a group setting, and beliefs that they should be tailored to individual's needs and preferences, and should be affordable according to their income. Participants with cognitive impairment cited specific barriers including "memory" and "lack of companion" as well as preferring "accessible" settings and "simple/light/safe" activities.

DISCUSSION

These findings provide useful data, particularly from participants with cognitive impairment, with whom there has been little research to date. This could contribute to efforts to translate the growing research evidence of the benefits of physical activity for brain health into effective community programs.

Preventing falls with Tai Ji Quan: A public health perspective

Falls among people aged 65 and older are a significant public health problem and one that is expected to increase as the population ages. Randomized controlled trials have demonstrated that Tai Ji Quan can reduce falls and associated injuries among older adults. In this paper, we describe how Tai Ji Quan community programs are being utilized by public health and aging services organizations to reduce older adult falls. We conclude that, to have a population-level impact on reducing falls and improving the health of older adults, Tai Ji Quan interventions must be translated into community programs that meet the needs and abilities of older adults. These programs must be adapted to fit into existing community structures, disseminated through multiple delivery channels, adopted and implemented broadly by organizations, and institutionalized to ensure sustainability.

Physical activity-friendly neighbourhood among older adults from a medium size urban setting in Southern Europe

OBJECTIVE

In this cross-sectional study, we examined the relationship between socio-environmental characteristics of neighborhood of residence and the frequency of leisure-time physical activity (LTPA) among older adults from Porto (Portugal).

METHOD

Data from EpiPorto - a prospective adult cohort study from Porto (Portugal) - were used. Only adults aged ≥ 65 at baseline (1999-2003) were included (n=580). We used a Geographic Information System to objectively measure the neighborhood characteristics and Generalized Additive Models to estimate their effect on participation in LTPA (none vs. some reported) and frequency of LTPA (min/day).

RESULTS

62% of the participants reported no LTPA. Active elderly spent on average 38 (women) and 67 (men) minutes per day exercising. Neighborhood characteristics were unrelated to whether older people exercised or not. However, among active individuals, distance to the nearest destination (β=-0.154, p=0.016), in women, and distance to the nearest park, in men (-0.030, 0.050), were predictors of LTPA frequency.

CONCLUSION

There was almost no association between neighborhood characteristics and whether older adults engaged in LTPA or not, but among those that did engage, neighborhood characteristics were associated with increased frequency of LTPA. The promotion of well distributed destinations and parks might improve physical activity levels among the elderly.

Differences in Effectiveness of the Active Living Every Day Program for Older Adults With Arthritis

Objective:

The authors explored whether demographic and psychosocial variables predicted differences in physical activity for participants with arthritis in a trial of Active Living Every Day (ALED).

Method:

Participants (N = 280) from 17 community sites were randomized into ALED or usual care. The authors assessed participant demographic characteristics, self-efficacy, outcome expectations, pain, fatigue, and depressive symptoms at baseline and physical activity frequency at 20-wk follow-up. They conducted linear regression with interaction terms (Baseline Characteristic × Randomization Group).

Results:

Being female (p ≤ .05), less depressed (p ≤ .05), or younger (p ≤ .10) was associated with more frequent posttest physical activity for ALED participants than for those with usual care. Higher education was associated with more physical activity for both ALED and usual-care groups.

Discussion:

ALED was particularly effective for female, younger, and less depressed participants. Further research should determine whether modifications could produce better outcomes in other subgroups.

Fatores motivacionais de idosos praticantes de exercícios físicos: um estudo baseado na teoria da autodeterminação

Objetivou-se analisar os fatores e índices motivacionais de idosos participantes de um programa de exercícios físicos e a sua relação com o tempo de participação. Participaram 140 idosos. Para a coleta dos dados utilizou-se o Inventário de Motivação para a Prática Regular de Atividades Físicas, duas perguntas abertas sobre o motivo de adesão e permanência no referido programa e ficha de identificação do idoso. Os dados foram analisados com auxílio da estatística descritiva e o teste de Mann-Whitney (p < 0,05). Verificou-se que a recomendação médica e o prazer foram os principais fatores de permanência no programa. O tempo de prática mostrou-se um fator diferencial para a mudança nas causas da motivação, possivelmente advindas da satisfação das necessidades psicológicas básicas. Destaca-se a importância de conhecer os fatores motivacionais de idosos participantes dos programas de exercícios físicos bem como da realização de atividades que auxiliem no desenvolvimento de aspectos da motivação intrínseca.

Location, Timing, and Social Structure Patterns Related to Physical Activity Participation in Weight Loss Programs

Less than half of the adults in the United States meet national guidelines for physical activity. Physical activity programs can induce short-term improvements in physical activity. To develop effective interventions, researchers and practitioners should consider the timing, location, and social structure patterns of participants. Using a pretest, posttest study design, 329 adults in a weight loss program completed surveys on their patterns and physical activity participation. Men preferred weight lifting, cycling, and jogging, whereas women preferred walking and aerobics. Black participants preferred being active in the home. Additionally, participating in a mix of group and individual activities compared with individual-only activities was predictive of posttest moderate-to-vigorous intensity and total physical activity. Providing a variety of activities for adults in both location and social structure may lead to sustained physical activity participation.

Attitudes and expectations regarding exercise in the hospital of hospitalized older adults: a qualitative study

OBJECTIVES

To describe expectations of, and perceived motivators and barriers to, in-hospital exercise of hospitalized older adults.

DESIGN

Qualitative study using the framework theory.

SETTING

Public hospital general medical wards.

PARTICIPANTS

Twenty-eight English- or Spanish-speaking inpatients aged 65 to 103.

MEASUREMENTS

Semistructured interviews were conducted at the bedside. Questions explored attitudes and expectations regarding in-hospital exercise. Interviews were tape recorded and transcribed, and content analysis was performed to identify major themes.

RESULTS

For most participants (71%), exercise in the hospital meant walking. Only 29% of participants expected to be exercising in the hospital, although three-quarters perceived it to be appropriate. Major themes included motivating factors and barriers to in-hospital exercise. Motivating factors included avoiding the negative effects of prolonged bed rest, promoting a sense of well-being, promoting functional recovery, and being asked to exercise. Barriers included symptoms related to one's illness, institutional barriers, and fear of injury. Most respondents (85%) felt that if the physician suggested exercise, it would influence their decision to do so, yet few (27%) reported that they had spoken to their physician about exercise.

CONCLUSION

Hospitalized older adults have positive perceptions about in-hospital exercise, although they must overcome significant barriers to do so. Medical professionals have a strong influence over the exercise behavior of elderly adults in the hospital yet infrequently address the issue. Incorporating motivating factors and removing barriers may increase the effectiveness of in-hospital exercise programs.

Measuring enjoyment of physical activity in older adults: invariance of the physical activity enjoyment scale (paces) across groups and time

The purpose of this study was to validate the Physical Activity Enjoyment Scale (PACES) in a sample of older adults. Participants within two different exercise groups were assessed at two time points, 6 months apart. Group and longitudinal invariance was established for a novel, 8-item version of the PACES. The shortened, psychometrically sound measure provides researchers and practitioners an expedited and reliable instrument for assessing the enjoyment of physical activity.

Motivators and barriers for physical activity in the oldest old: a systematic review

Worldwide, people engage insufficiently in physical activity, particularly subjects aged 80 years and over. For optimal life-style campaigns, knowledge of motivators and barriers for physical activity is mandatory. Given their specific needs, it is conceivable that these would be different for the oldest old compared to younger subjects. Pubmed, Web of Science and Psychinfo were systematically screened for articles reporting motivators and barriers for physical activity. Papers were excluded if data regarding elderly aged >79 years were absent. Forty-four relevant articles were included, involving a total of 28,583 subjects. Sixty one motivators and 59 barriers for physical activity in the elderly were identified, including those who are relevant for persons aged 80 years and over. Based on the results of our literature review, we recommend that when promoting physical activity in the oldest old, special attention is paid to the health benefits of physical activity, to the subject's fears, individual preferences and social support, and to constraints related to the physical environment. However, no studies were found exclusively describing people aged 80 years and over, and future research is necessary to differentiate the barriers or motivators that are specific for the oldest old from those of younger elderly.

Exercise preferences are different after stroke

Objective. To explore exercise preferences in stroke survivors and controls. Methods. A novel scale—the Exercise Preference Questionnaire—was developed for this study. This questionnaire, together with established assessments of physical activities, mood, and quality of life, was completed in a single assessment session. Results. Twenty-three adult stroke survivors (mean age 63, 65% male) and 41 healthy controls (mean age 61, 66% male) participated. The groups differed on 4 of the 5 a priori exercise preference factors: relative to controls, stroke survivors preferred exercise to be more structured, in a group, at a gym or fitness centre, and for exercises to be demonstrated. Factor analysis yielded 6 data-driven factors, and these factors also differentiated stroke and control groups. There was evidence that group differences were diminished when activity levels and psychological wellbeing were accounted for. Individual variability in exercise preferences and reported barriers to exercise are outlined. Conclusion. Stroke survivors have different exercise preferences, and a better understanding of these preferences can be used to inform rehabilitation programs and increase adherence.

Biomechanical properties of the triceps surae muscle-tendon unit in young and postmenopausal women

BACKGROUND

Insufficient and excessive stiffness may increase the risk of soft tissue and bone injuries, respectively, while the resonance frequency seems to be related with energy expenditure and stiffness. With aging and menopause muscle weakness, physical fragility and mobility limitations are also expected. Therefore this study addresses the differences of biomechanical properties of the triceps surae muscle-tendon unit between young and postmenopausal women.

METHODS

39 young and 37 postmenopausal women participated. The biomechanical properties of the triceps surae muscle-tendon unit were assessed in vivo using a free oscillation technique involving 30% of the maximal voluntary isometric contraction load.

FINDINGS

The postmenopausal women in this study show significant higher values in the damped natural frequency of oscillation (young 3.84Hz vs. postmenopausal 4.68Hz, P<0.001), muscle-tendon unit stiffness (young 16,446N/m vs. postmenopausal 23,229N/m, P<0.001), and muscle-tendon unit stiffness normalized by mass (young 286.3N/m vs. postmenopausal 325.1N/m, P<0.05). The postmenopausal study group shows significant lower values in the damping ratio (young 0.190 vs. postmenopausal 0.150, P<0.01) than young women.

INTERPRETATION

The postmenopausal subjects may not be able to take advantage of resonance as the young subjects, or, the relationship between these frequencies is adjusted according to the musculoskeletal characteristics of each group. The decrease in damping properties and the increase in muscle-tendon unit stiffness suggest that postmenopausal women might be at a greater risk of injury.

Self-reported physical activity preferences in individuals with prediabetes

PURPOSE

The primary objective of this study was to determine the physical activity (PA) preferences in a sample of individuals with prediabetes.

METHODS

Individuals with prediabetes (N = 232) residing in Northern Alberta, Canada completed a mailed questionnaire that assessed demographic and health variables, self-reported PA (Godin Leisure-Time Exercise Questionnaire), and PA preferences.

RESULTS

Respondents indicated they would like to be counseled about PA (75%), were physically able to participate (96%), were interested in a PA program for individuals with prediabetes (86%), and were most interested in walking (71%). Activity status, number of comorbidities, level of employment, marital status, body mass index, and time since diagnosis with prediabetes all demonstrated significant influence on different PA preference variables.

CONCLUSIONS

There is a demand for PA-related programs for individuals with prediabetes. Incorporating identified PA preferences of those with prediabetes might aid in the development of relevant intervention tools, programs, and strategies to support PA.

Physical activity preferences and type 2 diabetes: exploring demographic, cognitive, and behavioral differences

PURPOSE

The purpose of this study was to examine physical activity counseling and program preferences in a sample of adults with type 2 diabetes. Specifically, the objectives were to determine physical activity preferences (objective 1), and whether there were any significant differences between age and/or sex groups for these preferences (objective 1a). A subsidiary objective was to explore potential associations of key social-cognitive constructs (ie, self-efficacy and social support) with physical activity preferences (objective 2).

METHODS

This exploratory study consisted of a quantitative, secondary analysis of survey data from a national sample of adults with type 2 diabetes (N = 244). A qualitative follow-up employing telephone interviews was conducted with 14 individuals.

RESULTS

Consistent with hypotheses, walking was the most preferred physical activity behavior and there was a preference for engaging in physical activity with others. There were significant (P values < .05) differences in counseling and program preferences between demographic (age and sex), and physical activity cognitive scores. For example, a significantly (P < .05) higher physical activity intensity preference was found in men and younger participants.

CONCLUSIONS

Tailoring interventions and physical activity programs to the specific preferences of individuals is an important component for health professionals and researchers in facilitating this behavior.

Processes associated with participation and adherence to a 12-month exercise programme for adults aged 70 and older

This study investigated the processes associated with the engagement of adults aged 70 years and older in a 12-month long research-based structured exercise programme. A sample of 21 participants (Mean age (SD) 75.8 (3.9); 14 females) and six exercise class leaders or researchers involved in the programme participated in individual semi-structured interviews. Transcripts were analysed with the principles of interpretive qualitative analysis. Our findings suggest that a programme that runs locally, provides individual attention/tailoring, delivers meaningful benefits, offers a staged approach to efficacy building, creates a sense of ownership, and provides intergenerational support and opportunities for social interaction, facilitates exercise engagement in later life.

Triceps-surae musculotendinous stiffness: relative differences between obese and non-obese postmenopausal women

BACKGROUND

There is a lack of research into the relationship between obesity and muscle-tendon unit stiffness in postmenopausal women. Muscle-tendon unit stiffness appears to affect human motion performance and excessive and insufficient stiffness can increase the risk of bone and soft tissue injuries, respectively. The aim of this study was to investigate the relationship between muscle-tendon unit stiffness and obesity in postmenopausal women.

METHODS

105 postmenopausal women (58 [SD 5.5] years) participated. Four groups (normal weight, pre-obese, obesity class I and obesity class II) were defined according World Health Organization classification of body mass index. The ankle muscle-tendon unit stiffness was assessed in vivo with a free oscillation technique using a load of 30% of maximal voluntary isometric contraction.

FINDINGS

ANOVA shows significant difference in muscle-tendon unit stiffness among the groups defined (P<0.001). Post hoc analysis reveals significant differences between the following groups: normal weight-pre-obese; normal weight-obesity class I and normal weight-obesity class II. The normal weight group had stiffness of 15789 (SD 2969) N/m, pre-obese of 19971 (SD 3678) N/m, obesity class I of 21435 (SD 4295) N/m, and obesity class II of 23497 (SD 1776) N/m.

INTERPRETATION

Obese subjects may have increased muscle-tendon unit stiffness because of fat infiltration in leg skeletal muscles, range of motion restrictions and stability/posture reasons and might be more predisposed to develop musculoskeletal injuries. Normal weight group had identical stiffness values to those reported in studies where subjects were not yet menopausal, suggesting that stiffness might not be influenced by menopause.

Influence of an early recovery telehealth intervention on physical activity and functioning after coronary artery bypass surgery among older adults with high disease burden

OBJECTIVE

Older adults with poor functioning preoperatively are at risk for delayed recovery and more impaired outcomes after coronary artery bypass surgery (CABS). The study objective was to determine whether a 6-week early recovery telehealth intervention, designed to improve self-efficacy and management related to symptoms after CABS, was effective in improving outcomes (physical activity, physiologic, and psychologic functioning) for older adults (aged > 65 years) with higher disease burden.

METHODS

A descriptive, repeated-measures experimental design was used. Follow-up data were collected at 3 and 6 weeks and 3 months after CABS. Subjects were drawn from a larger randomized clinical trial. Parent study subjects who had high disease burden preoperatively (physical component score of < 50 on the Medical Outcome Study Short Form-36 and RISKO score of > 6) were included (N = 55), with 23 subjects in the early recovery intervention group and 31 subjects in the usual care group (n = 31). Subjects ranged in age from 65 to 85 years (M = 71.6 + 5.1 years).

RESULTS

There was a significant main effect by group (F[1,209] = 4.66, P < .05). The intervention group had a least square means of 27.9 kcal/kg/d of energy expenditure compared with the usual care group of 26.6 kcal/kg/d per the RT3 accelerometer (Stayhealthy, Inc, Monrovia, CA). Both groups had significantly improved physical (F[2,171] = 3.26, P < .05) and role-physical (F[2,171] = 6.64, P < .005) functioning over time.

CONCLUSION

The subgroup of subjects undergoing CABS with high disease burden were responsive to an early recovery telehealth intervention. Improving patients' physical activity and functioning can reduce morbidity and mortality associated with poor functioning after cardiac events.