Benefits of Exercise for Older Adults: A Review of Existing Evidence and Current Recommendations for the General Population

Effect of aquatic resistance interval training and dietary education program on physical and psychological health in older women: Randomized controlled trial

Due to demographic changes, the world’s population is progressively aging. The physiological deterioration of the older adult may lead to reduced balance capacity and increased risk of falls, among others, due to the prevalence of degenerative diseases. Physical exercise can be effective in reducing the risk of disease and slowing functional decline in older people. The aim of the research is to test the effects of aquatic resistance training and dietary education on health indicators, strength, balance, functional autonomy, perception of satisfaction with life. Thirty-four participants aged 69 ± 4 years were randomly assigned into two groups: experimental (aquatic resistance interval training) and control group (no intervention). The intervention consisted of resistance training in an aquatic environment carried out for 14 weeks (three sessions per week: 60 min each). All variables were analyzed twice; pre - post intervention. Aquatic resistance training has positive effects on strength (p < 0.001), functional self-sufficiency (p < 0.001) and aerobic capacity (p < 0.001), however, no significant differences were observed in the perception of satisfaction with life and balance. Research results suggest that older women who engage in regular, scheduled aquatic resistance training have greater autonomy in performing activities of daily living, agility, gait control, and body composition variables (lower fat compartment and greater muscle mass).

Objective and subjective measures of sleep in men with Muscular Dystrophy

Purpose

Despite poor sleep quality being recognised in Duchenne Muscular Dystrophy, reports from milder forms of Muscular Dystrophy (MD), and accompanied associations with quality of life (QoL), pain and fatigue, remain limited however.

Methods

Adult males (n = 15 Beckers MD (BMD), n = 12 Limb-Girdle MD (LGMD), n = 12 Fascioscapulohumeral (FSHD), n = 14 non-MD (CTRL)) completed assessments of body composition (Bio-electrical impedance), sleep (7-day 24-hour tri-axial accelerometer, Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index, QoL (SF36-v2), pain (Visual analogue scale), fatigue (Modified Fatigue Index Scale) and functional assessments (Brookes and Vignos).

Results

FSHD and BMD reported worse sleep than CTRL on the PSQI. FSHD scored worse than CTRL on the Insomnia Severity Index (P<0.05). 25–63% and 50–81% of adults with MD reported poor sleep quality using the Insomnia Severity Index and PSQI, respectively. Accelerometery identified no difference in sleep quality between groups. Associations were identified between sleep measures (PSQI global and insomnia severity) with mental or physical QoL in LGMD, BMD and FSHD. Multiple regression identified associations between sleep impairment and fatigue severity (all MDs), body composition (BMD & LGMD), upper and lower limb function (LGMD, FSHD) and age (FSHD).

Conclusions

25–81% of men with MD, depending on classification, experience sleep impairment, using self-report sleep measures. Whilst BMD and FSHD showed worse sleep outcomes than CTRL, no group difference was observed between LGMD and CTRL, however all groups showed associations with sleep impairment and higher levels of fatigue. These findings, and associations with measures of health and wellbeing, highlight an area for further research which could impact QoL in adults with MD.

Gameful Design of an Application for Patients in Rehabilitation

The design process of any interactive application is an important part of its lifecycle, since it largely defines its structure, means of interaction with the users and its actual content. In the case of applications related to medical uses and self-help, it is even more important, given the aims of the application, the diversity of target users and the urgent need for increased retention. In this article, we present a gameful design process for a mobile application targeted toward patients in rehabilitation, implementing concepts related to increasing user rapport and motivation through gamification, and means to offer guidance and personalized services to improve user experience. Both gamification and personalization build on narrative concepts, by putting patients in the place of a “hero”, offering them the opportunity to overcome “challenges” and receive a clear view of their progress (a.k.a. a “hero's journey”), both in terms of physical and mental condition. Finally, we discuss measurable indicators used to evaluate the application in terms of the progress that patients showed, their motivation and interest, and degree of adherence to the exercise plans.

The Effects of Exercise on Aging-Induced Exaggerated Cytokine Responses: An Interdisciplinary Discussion

Aging is generally known to be associated with dynamic biological changes, physiological dysfunction, and environmental and psychological decline. Several studies have suggested that aging is associated with increased inflammatory cytokines, causing several diseases. However, the effect of exercise on aging has been less delineated, and the relationships between cytokine activation, aging, and exercise also need further study. Here, we discuss some ideas about the effect of exercise on aging-induced exaggerated cytokine responses and discuss the possible roles of the aging-induced exaggerated cytokine response following exercise. Evidence from these findings suggests that exercise is a beneficially applicable model to use in studies on the mechanisms underlying the age-associated gradated cytokine response, and these results may provide guidelines for health professionals with diverse backgrounds.

What intensity of exercise is most suitable for the elderly in China? A propensity score matching analysis

BACKGROUND

The strategy of successful ageing is an important means to deal with the challenges of the current ageing society. This paper aims to explore the effects of different intensities of physical activity on the successful ageing of the elderly.

METHODS

Our data were from wave 4 of the China Health and Retirement Longitudinal Survey (CHARLS), involving 9026 residents aged 60 years and older. The intensity of physical activity was divided into three levels: vigorous, moderate and mild. The concept of successful ageing adopted a four-dimensional model of life satisfaction added to the theoretical model of Rowe and Kahn's. Propensity score matching (PSM) with controlling nine confounding factors were used to analyse the effects of different intensities of physical activity.

RESULTS

The percentage of successful ageing was 1.88% among all subjects. Among them, 30.26, 29.57 and 29.40% of the elderly often participated in vigorous, moderate and mild physical activity, respectively. The results of PSM showed that participation in moderate activity increased the probability of successful ageing of the elderly by 0.76-0.78% (P < 0.001), while participation in vigorous and mild physical activity had no significant effect on successful ageing (P > 0.05). Moderate physical activity had statistically significant effects on four components of successful aging, including major disease, physical function, life satisfaction, and social participation (P < 0.05).

CONCLUSION

Moderate-intensity physical activity was most beneficial to the successful ageing of the elderly and should be promoted in the elderly population.

Considerations in Planning Physical Activity for Older Adults in Hot Climates: A Narrative Review

Regular physical activity has multiple health benefits for both the prevention and management of disease, including for older adults. However, additional precautions are needed with ageing given physiological changes and the increasing prevalence of comorbidities. Hot ambient temperatures increase the risks of exercise at any age, but are particularly important given thermoregulatory changes in older people. This narrative review informs planning of physical activity programs for older people living in rural areas with very hot climates for a period of the year. A multi-database search of peer-reviewed literature was undertaken with attention to its relevance to Australia, starting with definitions and standard advice in relation to physical activity programming and the incremental limitations imposed by age, rurality, and extreme heat. The enablers of and barriers to increasing physical activities in older adults and how they can be modified for those living in extreme hot climates is described. We describe multiple considerations in program design to improve safety, adherence and sustaining physical activity, including supervision, simple instructions, provision of reminders, social support, encouraging self-efficacy. Group-based activities may be preferred by some and can accommodate special populations, cultural considerations. Risk management is an important consideration and recommendations are provided to assist program planning.

Effect of the Auricular Acupoint Associated with Physical Exercise in Elderly People: A Randomized Clinical Test

OBJECTIVE

To analyze the effect of auricular acupoint associated with physical exercise on balance, mobility, and fear of falling in the elderly.

METHOD

The study is characterized as a clinical, controlled, and randomized trial with 22 elderly people divided into two groups: kinesiotherapy group (n = 11) and kinesiotherapy/auriculotherapy group (n = 11). The instruments used for evaluation were Falls Efficacy Scale International; Berg Balance Scale, and Timed up and Go Test. The intervention was performed with frequency 2×/week for 8 weeks. In the kinesiotherapy/auriculotherapy group, in addition to kinesiotherapy, auriculotherapy was applied in specific acupoints. The Shapiro-Wilk test was used to determine the normality of the data, and for comparison, analysis of variance was used for repeated measures of two factors.

RESULTS

There was a significant intragroup reduction for the Timed up and Go Test (p = 0.00) and Falls Efficacy Scale International (p = 0.00), and significant intragroup Berg Balance Scale (p = 0.00) for both groups.

CONCLUSION

The auricular acupoint did not influence the balance, mobility, and fear of falling in the elderly studied.

Older Adults' Acceptance of Activity Trackers

OBJECTIVE

To assess the usability and acceptance of activity tracking technologies by older adults.

METHOD

First in our multimethod approach, we conducted heuristic evaluations of two activity trackers that revealed potential usability barriers to acceptance. Next, questionnaires and interviews were administered to 16 older adults ( Mage = 70, SDage = 3.09, rangeage = 65-75) before and after a 28-day field study to understand facilitators and additional barriers to acceptance. These measurements were supplemented with diary and usage data and assessed whether and why users overcame usability issues.

RESULTS

The heuristic evaluation revealed usability barriers in System Status Visibility, Error Prevention, and Consistency and Standards. The field study revealed additional barriers (e.g., accuracy, format) and acceptance-facilitators (e.g., goal tracking, usefulness, encouragement).

DISCUSSION

The acceptance of wellness management technologies, such as activity trackers, may be increased by addressing acceptance-barriers during deployment (e.g., providing tutorials on features that were challenging, communicating usefulness).

Tai Chi and Low Impact Exercise: Effects on the Physical Functioning and Psychological Well-Being of Older People

The effects of tai chi (TC) and low impact exercise (LIE) interventions on physical functioning and psychological well-being of sedentary older people were contrasted. Participants were randomized to TC, LIE, or non-exercise control groups with interventions running for 12 weeks. Post-intervention assessments with 72 participants who completed the study revealed that participants in both exercise groups improved with respect to upper body strength, balance, cardiovascular endurance, lower body strength, sleep disturbances, and anxiety. Participants in the LIE group reported better functional ability while those in the TC group reported better subjective health. Findings suggest that tai chi and low impact exercise are safe, cost-effective ways to improve both physical and psychological functioning of older people.

Older Adults' Changes in Intent to Adopt Wellness Management Technologies

Individuals are becoming more involved in managing their own health. Health self-management technologies have the potential to help older adults remain well by promoting exercise and a good diet. However, older adults may or may not decide to adopt wellness management technologies. Adoption is a process and the intent to adopt may change over time. Sixteen older adults (8 females; M age=70.06, SD=3.09; range=65-75) used one of two wellness management technologies (the Fitbit One or myfitnesspal.com) over a 28-day period. Initially, all participants were open or neutral to adopting their technologies. After 28 days, 12 participants intended to adopt and 4 participants did not intend to adopt. The diary data revealed that over time, adopters made more positive comments than non-adopters. Both adopters and non-adopters mentioned perceived ease of use praises and complaints, whereas only adopters mentioned praises regarding usefulness. Results are interpreted within the frameworks of the unified theory of acceptance and use of technology (Venkatesh et al., 2003) and the diffusion of innovation (Rogers, 2003). Changes in intent to adopt suggest that experience is important in the adoption decision. Adoption of wellness management technologies by older adults may increase if designers attend to the perceived ease of use and perceived usefulness factors identified in this study.

The effect of exercise on behavioral and psychological symptoms of dementia: towards a research agenda

BACKGROUND

Behavioral and psychological symptoms of dementia (BPSD) are common and are core symptoms of the condition. They cause considerable distress to the person with dementia and their carers and predict early institutionalization and death. Historically, these symptoms have been managed with anxiolytic and antipsychotic medication. Although potentially effective, such medication has been used too widely and is associated with serious adverse side-effects and increased mortality. Consequently, there is a need to evaluate non-pharmacological therapies for behavioral and psychological symptoms in this population. One such therapy is physical activity, which has widespread health benefits. The aim of this review is to summarize the current findings of the efficacy of physical activity on BPSD.

METHOD

Published articles were identified using electronic and manual searches. Rather than systematically aggregating data, this review adopted a rapid critical interpretive approach to synthesize the literature.

RESULTS

Exercise appears to be beneficial in reducing some BPSD, especially depressed mood, agitation, and wandering, and may also improve night-time sleep. Evidence of the efficacy of exercise on improving other symptoms such as anxiety, apathy, and repetitive behaviors is currently weak or lacking.

CONCLUSION

The beneficial effect of exercise type, its duration, and frequency is unclear although some studies suggest that walking for at least 30 minutes, several times a week, may enhance outcome. The methodological shortcomings of current work in this area are substantial. The research and clinical implications of current findings are discussed.

Benefits of home-based rocking-chair exercise for physical performance in community-dwelling elderly women: a randomized controlled trial

BACKGROUND AND AIMS

Home-based exercise is a viable alternative for older adults with difficulties in exercise opportunities outside the home. The aim of this study was to investigate the benefits of home-based rocking-chair training, and its effects on the physical performance of elderly women.

METHODS

Community- dwelling women (n=51) aged 73-87 years were randomly assigned to the rocking-chair group (RCG, n=26) or control group (CG, n=25) by drawing lots. Baseline and outcome measurements were hand grip strength, maximal isometric knee extension, maximal walking speed over 10 meters, rising from a chair five times, and the Berg Balance Scale (BBS). The RCG carried out a six-week rocking-chair training program at home, involving ten sessions per week, twice a day for 15 minutes per session, and ten different movements. The CG continued their usual daily lives. After three months, the RCG responded to a mail questionnaire.

RESULTS

After the intervention, the RCG improved and the CG declined. The data showed significant interactions of group by time in the BBS score (p=0.001), maximal knee extension strength (p=0.006) and maximal walking speed (p=0.046), which indicates that the change between groups during the follow-up period was significant. Adherence to the training protocol was high (96%). After three months, the exercise program had become a regular home exercise habit for 88.5% of the subjects.

CONCLUSIONS

Results indicate that home-based elderly women benefit from this easily implemented rocking-chair exercise program. The subjects became motivated to participate in training and continued the exercises. This is a promising alternative exercise method for maintaining physical activity and leads to improvements in physical performance.

First Steps towards Evidence-Based Preventive Home Visits: Experiences Gathered in a Swedish Municipality

The purpose of preventive home visits is to promote overall health and wellbeing in old age. The aim of this paper was to describe the process of the development of evidence-based preventive home visits, targeting independent community-living older persons. The evidence base was generated from published studies and practical experiences. The results demonstrate that preventive home visits should be directed to persons 80 years old and older and involve various professional competences. The visits should be personalized, lead to concrete interventions, and be followed up. The health areas assessed should derive from a broad perspective and include social, psychological, and medical aspects. Core components in the protocol developed in this study captured physical, medical, psychosocial, and environmental aspects. Results of a pilot study showed that the protocol validly identified health risks among older people with different levels of ADL dependence.

Feasibility of an Intensive Trial of Modern Dance for Adults with Parkinson Disease

Although preliminary evidence supports the psychophysical benefits of dance for adults with Parkinson disease, guidelines for community-based dance programs await further scrutiny for safety and efficacy. This pilot study was designed to assess the feasibility of an intensive trial of group-delivered modern dance for 11 adults with early-to-middle stage Parkinson’s. The Timed ‘‘Up and Go’’ test and the Fullerton Advanced Balance scale were administered to assess balance safety and re-administered at closure along with a self-reported feedback questionnaire. Video recordings were analyzed for qualitative behavioral change. Pre/posttest comparisons from the Timed ‘‘Up and Go’’ test were not significant, while those from the Fullerton Advanced Balance Scale were significant at the .05 level for the group as a whole (p = .01) with an average score change of +3.1 points. Although qualitative results generally concurred with the social benefits associated with an enjoyable form of expressive exercise, important indicators surfaced bearing on future research and community program designs. These include need for more rigorous stratification of participants and adapting dance class structure to address specific group needs to promote motor learning for sustained functional gains.

MS, exercise, and the potential for older adults

Multiple Sclerosis (MS) is an autoimmune disorder of the central nervous system. The average onset of the disease is 30 years of age, and it afflicts women more often than men (ratio of approximately 2:1). The symptoms of the disease include fatigue, motor weakness, heat sensitivity, reduced mobility, abnormal gait mechanics, and poor balance. These symptoms decrease cognitive and physical functional capacity of an individual and tend to result in sedentary lifestyle behaviors. A sedentary lifestyle among individuals with MS increases the risk of secondary diseases such as coronary heart disease and obesity, particularly as one ages. The effect of exercise in treating symptoms of MS has been under explored, perhaps due to the fact that exercise was thought to magnify MS-related fatigue and other symptoms. Recent research has challenged this notion, advocating exercise as an effective therapy for the management of MS, as well as maintaining overall fitness and improving quality-of-life measures. While the research shows clear benefits, the barriers to exercise participation among MS patients are significant. Recommendations for various forms of exercise are provided, along with strategies for overcoming barriers to participation.

Programa de atenção particularizada ao idoso em unidades básicas de saúde

INTRODUÇÃO: Envelhecer é um processo de mudanças irreversíveis na estrutura e no funcionamento de um organismo, que ocorre como resultado da passagem do tempo. Segundo a OMS, programas voltados à saúde dos idosos devem promover, estimular e potencializar situações que os levem a organizar sua rotina de acordo com o próprio planejamento e metas pessoais. No Brasil, a população de idosos aumenta significativamente; estima-se que representará 12,5% em 2020. Nesse contexto, justifica-se a criação de programas de saúde particularizados a esse grupo populacional. OBJETIVO: Elaborar programa de saúde para o idoso aplicável em Unidades Básicas de Saúde. METODOLOGIA: O projeto foi aplicado no Centro de Saúde Escola Barra Funda "Dr. Alexandre Vranjac". Com revisão bibliográfica, conhecimento da população local e das demandas regionais quanto a novas atividades e mapeamento das atividades existentes no terrritório, formulou-se uma apostila direcionada aos profissionais da saúde visando elucidar dúvidas e orientar o manejo do paciente idoso. RESULTADOS: A Unidade é referência na organização dos projetos existentes em sua área de abrangência; muitos, atualmente, com potencial subutilizado. Foram encontrados diversos centros que oferecem atividades aos idosos, no entanto há necessidade de aprimorar a divulgação desses projetos através de meios que atinjam efetivamente essa população. Elaborou-se apostila composta de revisão bibliográfica, fluxograma de atendimento médico, roteiro para personalizar o atendimento do idoso, banco de dados com os principais projetos da região e calendário com as atividades existentes permitindo centralizar informações e torná-las acessíveis, para que atividades específicas a cada paciente possam ser indicadas de maneira objetiva.

Effects of a low-frequency sound wave therapy programme on functional capacity, blood circulation and bone metabolism in frail old men and women

Objective: To evaluate the effects of a low-frequency sound wave therapy programme on functional capacity, blood circulation and bone metabolism of the frail elderly.

Design: Single-blind, randomized, controlled trial.

Setting: Two senior service centres.

Subjects: Forty-nine volunteers (14 males and 35 females) aged 62—93 years with up to 12 diagnosed diseases were allocated in either the intervention group (n = 30) or control group (n = 19).

Intervention: The intervention group underwent sound wave therapy, 3—5 times a week for 30 minutes per session over a period of 6 months. The control group received no intervention.

Main measurements: Blood pressure, functional capacity, mobility, bone density, biochemical markers, isometric muscle strength, balance, and skin surface temperature.

Results: Compared with the control group, the intervention group’s mobility and the amount of self-reported kilometres walked per week increased by 3 km (P<0.05), while levels of cholesterol (4.97 (0.72) to 4.52 (0.65) mmol/L, P =0.019), low-density lipoprotein (2.82 (0.72) to 2.45 (0.61) mmol/L, P =0.022), bone markers of total osteocalcin (11.0 (6.5) to 10.3 (5.9) ng/mL, P =0.048)) and tartrate-resistant acid phosphatase isoform 5b (2.50 (1.0) to 2.41 (1.1) IU/L, P =0.021)) decreased. The average skin surface temperature was significantly higher during active sessions at the end of the intervention than in the beginning (P = 0.004). No change was found during placebo sessions.

Conclusions: Low-frequency sound wave therapy may have the potential to promote well-being of frail elderly subjects via improved functional capacity, especially in subjects who are too frail to undertake exercise.

Physician-based physical activity counseling for middle-aged and older adults: a randomized trial

Sedentary behavior among older adults increases risk for chronic diseases. Physicians in a primary care setting can play an important role in promoting physical activity adoption among their older patients. The Physically Active for Life (PAL) project was a randomized, controlled trial comparing the efficacy of brief physician-delivered physical activity counseling to usual care on self-reported physical activity levels. The physical activity counseling was based on the Transtheoretical Model of Change and social learning theory. Twenty-four community-based primary care medical practices were recruited into the study; 12 were randomized to the Intervention condition and 12 to the Control condition. Physicians in the Intervention practices received training in the delivery of brief physical activity counseling. Subjects in the Intervention practices (n=181) received brief activity counseling matched to their stage of motivational readiness for physical activity, a patient manual, a follow-up appointment with their physician to discuss activity counseling, and newsletter mailings. Subjects in the Control practices (n=174) received standard care. Measures of motivational readiness for physical activity and the Physical Activity Scale for the Elderly (PASE) were administered to subjects in both conditions at baseline, 6 weeks following their initial appointment, and at 8 months. Results showed that at the 6-week follow-up, subjects in the Intervention condition were more likely to be in more advanced stages of motivational readiness for physical activity than subjects in the Control condition. This effect was not maintained at the 8 month follow-up and the intervention did not produce significant changes in PASE scores. Results suggest that more intensive, sustained interventions may be necessary to promote the adoption of physical activity among sedentary, middle-aged, and older adults in primary care medical practices.

Equilíbrio, coordenação e agilidade de idosos submetidos à prática de exercícios físicos resistidos

OBJETIVOS: Avaliar o equilíbrio, a coordenação e a agilidade dos idosos submetidos a exercícios físicos. MÉTODOS: 61 idosos do gênero masculino, com idades entre os 60-75 anos, designados aleatoriamente para um grupo de exercícios resistidos com carga progressiva (n=39) ou para um controle submetido a exercícios sem carga (n=22). O grupo exercício resistido participou de um programa de 24 semanas, com 3 visitas por semana, em dias não consecutivos. Foram avaliados após o término do treinamento, pela Escala de Equilíbrio de Berg, do Teste de Tinetti e do Timed UP & GO. RESULTADOS: Comparando-se os dois grupos verificou-se um melhor desempenho estatisticamente significativo para o grupo experimental em relação ao controle para os testes Timed "Up & Go". (p=0,02) e para o Tinetti Total (p=0.046) e para o Tinetti marcha (p=0.029). Desta forma, não encontramos diferença na Escala de Equilíbrio de Berg e no teste de Tinetti equilíbrio. CONCLUSÃO: O programa de treinamento de força durante 24 semanas mostrou-se favorável na melhora dos desempenhos funcional e motores de idosos.

Motor plasticity in a juggling task in older adults-a developmental study

OBJECTIVE

to examine the plasticity of motor performance in old age. Older adults were instructed and trained in a juggling task and their performances were compared, first, within the group of older adults and, second, with the performances of children, youths and younger adults.

SUBJECTS

older adults, children, youths and younger adults (n = 1,206, range 6-89 years).

METHODS

participants were asked to learn a juggling task. Performance was tested before semantic instruction (pre-test 1), after semantic instruction (pre-test 2) and after 6 days of juggling practice (post-test). None of the participants had prior experiences in juggling. Results were analysed using repeated measure analysis of variance (ANOVA).

RESULTS

older adults showed a clear improvement in juggling performance after instruction and after six training sessions. On average, they reached performances comparable with those of children aged between 10 and 14 years, and with those of younger adults aged between 30 and 59 years. Only youths and younger adults aged between 15 and 29 years showed significantly higher performances at baseline, after instruction and after training.

CONCLUSIONS

older adults exhibit high reserve capacity, that is, a potential for learning 'new' motor skills.

Is physical activity counseling effective for older people? A cluster randomized, controlled trial in primary care

OBJECTIVES

To establish the effectiveness of the Green Prescription physical activity counseling program in increasing activity and quality of life in older community-dwelling people.

DESIGN

Post hoc subgroup analysis of a large cluster randomized, controlled trial.

SETTING

One hundred seventeen doctors in 42 primary care practices (74% participation rate) in the Waikato region of New Zealand.

PARTICIPANTS

Two hundred seventy sedentary primary healthcare patients aged 65 and older (67% participation rate).

INTERVENTION

Patients in intervention practices prompted their primary care doctors or practice nurse to deliver brief activity counseling. A "Green Prescription" was written involving the negotiation of activity goals. Trained exercise specialists from a regional sports foundation gave follow-up telephone support over 3 months.

MEASUREMENTS

Leisure moderate and vigorous physical activity, total energy expenditure, systolic and diastolic blood pressure, health-related quality of life, musculoskeletal injuries, falls, and hospitalizations.

RESULTS

After 12 months of follow-up, leisure time moderate activity increased by 0.67 h/wk more in the intervention group than the control group (95% confidence interval (CI)=0.17-1.17) and energy expenditure increased by 2.67 kcal/kg per week (95% CI=0.87-4.47) more. For intervention group participants, vitality and general health scales of the 36-item Short Form showed statistically and clinically relevant improvements, and there was a decrease in hospitalizations (P<.03). There were no observable changes in blood pressure, injuries, or falls as a result of the Green Prescription program.

CONCLUSION

This physical activity intervention improved activity, energy expenditure, health-related quality of life, and hospitalizations for older primary care patients. Systematic inclusion of the Green Prescription in routine primary health care will probably lead to health gain for older people.

Cortical reorganization in the aging brain

Aging exerts major reorganization and remodeling at all levels of brain structure and function. Studies in aged animals and in human elderly individuals demonstrate that sensorimotor cortical representational maps undergo significant alterations. Because cortical reorganization is paralleled by a decline in perceptual and behavioral performance, this type of cortical remodeling differs from the plastic reorganization observed during learning processes in young individuals where map changes are associated with a gain in performance. It is now clear that brain plasticity is operational into old age; therefore, protocols for interventions such as training, exercising, practicing, and stimulation, which make use of neuroplasticity principles, are effective to ameliorate some forms of cortical and behavioral age-related changes, indicating that aging effects are not irreversible but treatable. However, old individuals cannot be rejuvenated, but restoration of function is possible through the emergence of new processing strategies. This implies that cortical reorganization in the aging brain occurs twice: during aging, and during treatment of age-related changes.

Work, retirement and physical activity: cross-sectional analyses from the Whitehall II study

BACKGROUND

To explore the relationship between work, retirement and physical activity.

METHODS

Cross-sectional analyses of data from self-completed questionnaires by 6224 civil servants aged 45-69 years participating in phase 5 of the Whitehall II longitudinal study.

RESULTS

There appeared to be a dose-response relationship between hours worked and the prevalence of physical activity, with a lower prevalence of recommended physical activity amongst participants working full time (> or =30 h/week), higher prevalence rates amongst those working part time (<30 h/week), and the highest rates amongst participants who were not working at all. Physical activity rates did not increase greatly amongst study participants who had retired from the Civil Service but had gone on to do further full-time work, however, the higher physical activity rates of participants working part time, or not at all, were further enhanced amongst those who had also retired.

CONCLUSIONS

These findings suggest that full-time work is associated with lower rates of recommended physical activity levels in this cohort of middle-aged white-collar office workers. Lower grade occupations are also less likely to meet the recommended physical activity levels. While retirement is associated with higher rates of recommended physical activity levels, this benefit is evident amongst those who work part time, or not at all, during their retirement, for whom the benefits of retirement and lower working hours on rates of physical activity appear additive. The frequency of different types of physical activity is associated with different occupational grades, with more sport and gardening being done by the higher occupational grades.

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

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

Effectiveness of a community-based Tai Chi program and implications for public health initiatives

OBJECTIVES

To establish whether the reported beneficial physiologic effects of Tai Chi when performed under stringent experimental conditions can be generalized to the community.

DESIGN

Phase 1: pre-post comparison in a group inexperienced in Tai Chi. Phase 2: baseline comparison between inexperienced and experienced Tai Chi groups.

SETTING

A community in Hong Kong.

PARTICIPANTS

Phase 1: 51 subjects inexperienced in Tai Chi (novice group) participated in the program. Phase 2: baseline measures of the novice group were compared with those of an experienced group (n=49) who had practiced Tai Chi for at least 6 months.

INTERVENTION

A Cheng 119 style program was taught by a Tai Chi master for 1.5 hours, 3 times weekly, for 12 weeks.

MAIN OUTCOME MEASURES

Lung function and physical activity evaluated before and after the completion of the program. Resting heart rate, blood pressure, oxygen saturation, handgrip strength, flexibility, and balance measured at the program commencement, 6 weeks, and 12 weeks.

RESULTS

Phase 1: after the program, the novice group had increased handgrip strength, flexibility, and peak expiratory flow rate. Phase 2: the experienced group had greater flexibility, lower resting heart rate but higher diastolic blood pressure than the novice group prior to training.

CONCLUSIONS

A community-based Tai Chi program produces beneficial effects comparable to those reported from experimental laboratory trials of Tai Chi; therefore, it should be considered as a public health strategy.

Do Poor Health Behaviors Affect Health-related Quality of Life and Healthcare Utilization Among Veterans?

The impact of health behaviors on Health-Related Quality of Life (HRQoL) and HealthCare Utilization (HCU) was examined in a sample of male veterans. We examined the relationship between health behaviors (cigarette smoking, alcohol use, exercise, seat belt use, cholesterol level, and body mass index [BMI]), and HRQoL and HCU, among Veterans Health Study participants providing complete baseline (t0) and 12-month follow-up (t12) data. (Respective sample sizes were 1242 and 1397.) HRQoL measures were derived from the SF-36, expressed as physical component summary (PCS) and mental component summary (MCS) scores. Prospective 12-month outpatient and inpatient utilization data were obtained from a VA administrative database. Exercise and BMI were significant PCS predictors at t0 and t12, adjusting for age, social supports, education, employment status, and comorbidities. Smoker status was negatively associated with PCS only at t0. Nonproblem (no abuse) alcohol users had significantly higher t0 PCS scores than nonusers. Only current problem alcohol use was associated with lower MCS at t0 and t12 in multivariate analyses. Regarding HCU, current smokers had fewer medical visits than never smokers; alcohol nonusers had more medical visits than current alcohol users, current problem users, and former problem users. No behaviors were associated with mental health visits or inpatient stays. HRQoL is negatively affected by poor health behaviors. HRQoL and physical health may be improved by practitioners targeting these behaviors for preventive interventions. This study did not support an association between poor health behaviors and higher HCU. Future research should consider the effect of moderating variables on this relationship.

Análise de taxa metabólica basal e composição corporal de idosos do sexo masculino antes e seis meses após exercícios de resistência

O objetivo deste trabalho foi o de comparar a taxa metabólica basal e a composição corporal antes e após um programa de exercício de resistência. Foram selecionados 46 voluntários do sexo masculino com idade entre 60 e 75 (66,97 ± 4,80 anos), que foram distribuídos aleatoriamente em dois grupos: 1) grupo controle, que foi orientado a não alterar seus hábitos rotineiros e não se engajar em nenhum programa de exercício físico; e 2) grupo experimental, que participou de um programa de exercícios em cicloergômetro três vezes por semana (60 minutos) em dias alternados por seis meses, com intensidade prescrita referente à freqüência cardíaca do limiar ventilatório 1 (LV-1). Os voluntários foram submetidos a avaliação da composição corporal (DEXA); calorimetria indireta, análise sanguínea e teste ergoespirométrico. Após o período de estudo, foram observados decréscimo significativo nos hormônios tireoidianos e mudanças no metabolismo basal em ambos os grupos, mas não foram constatadas alterações na composição corporal. No entanto, o grupo experimental apresentou aumento significativo no consumo de oxigênio pico e na carga de trabalho referente à intensidade do LV-1. Os dados sugerem que um programa de exercícios aeróbios na intensidade do LV-1 não é suficiente para provocar alterações favoráveis no metabolismo basal e composição corporal de idosos, embora promova benefícios cardiovasculares.

Treating the aging brain: cortical reorganization and behavior

Aging comprises many physiological modifications, including structural and metabolic changes, yet little is known about how aging affects the way in which neurons process and integrate sensory information from the environments. Here the framework of "modified use" as a determinant of cortical reorganization was applied for the investigation of age-related modifications of cortical maps and processing, and of associated changes of behavior. The age-related changes of walking behavior in rats were contrasted with the parallel changes of sensorimotor processing developing at the cortical level. Based on the regional specificity of these changes attempts are made to separate age-related changes arising as a consequence of degeneration from a result of adaptable processes following reduced use at high age. Finally, findings from long-term treatment with the Ca2+-blocker nimodipine, or from housing animals under enriched environmental conditions to ameliorate aging effects were described. Combined, these results show the general treatability of age-related changes. The data imply that age-related changes can be reversed by short periods of training and stimulation schedules even if they have developed. Clearly, the development of specific measures to delay aging processes and to rehabilitate aged brains depends on future progress in understanding mechanisms and effects of aging.

Health promotion practices of older adults: model testing

The purpose of this study was to describe the primary and secondary health promotion activities of a group of older adults living independently in a continuing care retirement community. Primary and secondary health promotion activities were described and compared among the young old (ages 65-80), the old (ages 81-85), and the old-old (ages 86-101). Model testing of the factors that influence participation in health-promoting activities was also completed. This descriptive study included 206 of 210 residents who participated in a single face-to-face interview. The majority of the participants were female (79%), white (99%), and cognitively intact. Those in the old-old age group were less likely than the old and young-old groups to have: (1) their stools checked for occult blood; (2) their skin checked for lesions; or (3) a recent mammogram, Pap test, or prostate exam. Model testing found that age, chronic illnesses, degree of physical and mental health, and cognitive status directly or indirectly influenced older adults' participation in primary and secondary health behaviors.

Physician Advice to the Elderly about Physical Activity

Lack of physical activity is an increasing public-health problem. Physicians should counsel elderly patients to maintain regular physical activity in order to retain functionality and quality of life. This study examined the patterns of physician advice about physical activity in an elderly population. A homogeneous group of older adults living in public housing (N= 146) was surveyed to determine the extent to which they received such advice. Their mean age was 77.9 ± 7 years, 74% were women, 70.5% were White, and 53.4% had high school education or less. We assessed the association between physician counseling practices and the participants’ demographic characteristics, overweight status, and type of physical activity performed. The prevalence rate of physician counseling was 61.6%. Elderly men who were married and those who were overweight were most likely to receive advice. Routine physician counseling of elderly patients regardless of overweight status could contribute to improving their quality of life.

Health promotion practices of older adults: testing an individualized approach

The world's population is getting older. Consequently, the World Health Organization has focused efforts on health promotion activities for these individuals. The purpose of this study was to explore the factors that influence health promotion behaviours and to describe the impact of an individualized approach to decision-making with regard to health promotion activities in a group of older adults living in a continuing care retirement community. The study used a single group pre- and post-test design that included a total of 134 residents. Descriptive statistics were used to describe the sample. A McNemar test was used to compare health promotion activities pre- and postintervention. Regression analysis was used to consider the factors that influenced health promotion activities in these individuals. The survey included questions about health promotion activities and both mental and physical health status. In the year between baseline and follow-up testing a geriatric nurse practitioner provided both formal and informal education about health promotion activities. With the exception of monitoring dietary fat intake, there was not a statistically significant difference in primary and secondary health promotion behaviours pre- and post-testing. There was, however, a decline in smoking and alcohol use, an increase in physical activity and a slight decline in the percentage of older adults who engaged in cancer screenings. An individualized approach may be a useful way to help older adults make health decisions and engage in those health promotion activities that will increase their quality of life.

Modification of brain aging and neurodegenerative disorders by genes, diet, and behavior

Multiple molecular, cellular, structural, and functional changes occur in the brain during aging. Neural cells may respond to these changes adaptively, or they may succumb to neurodegenerative cascades that result in disorders such as Alzheimer's and Parkinson's diseases. Multiple mechanisms are employed to maintain the integrity of nerve cell circuits and to facilitate responses to environmental demands and promote recovery of function after injury. The mechanisms include production of neurotrophic factors and cytokines, expression of various cell survival-promoting proteins (e.g., protein chaperones, antioxidant enzymes, Bcl-2 and inhibitor of apoptosis proteins), preservation of genomic integrity by telomerase and DNA repair proteins, and mobilization of neural stem cells to replace damaged neurons and glia. The aging process challenges such neuroprotective and neurorestorative mechanisms. Genetic and environmental factors superimposed upon the aging process can determine whether brain aging is successful or unsuccessful. Mutations in genes that cause inherited forms of Alzheimer's disease (amyloid precursor protein and presenilins), Parkinson's disease (alpha-synuclein and Parkin), and trinucleotide repeat disorders (huntingtin, androgen receptor, ataxin, and others) overwhelm endogenous neuroprotective mechanisms; other genes, such as those encoding apolipoprotein E(4), have more subtle effects on brain aging. On the other hand, neuroprotective mechanisms can be bolstered by dietary (caloric restriction and folate and antioxidant supplementation) and behavioral (intellectual and physical activities) modifications. At the cellular and molecular levels, successful brain aging can be facilitated by activating a hormesis response in which neurons increase production of neurotrophic factors and stress proteins. Neural stem cells that reside in the adult brain are also responsive to environmental demands and appear capable of replacing lost or dysfunctional neurons and glial cells, perhaps even in the aging brain. The recent application of modern methods of molecular and cellular biology to the problem of brain aging is revealing a remarkable capacity within brain cells for adaptation to aging and resistance to disease.

The effect of social support on exercise behavior in older adults

The purpose of this study was to test the relationship among social supports related to exercise (family, friends, and expert support), self-efficacy expectations, outcome expectations, and exercise behavior in a sample of older adults living in a continuing care retirement community. The sample included 74 older adults with a mean age of 85.6 +/- 5.5. Path analysis using Amos 4.0 was done. The model fit the data (chi-square = 4.6, df = 3, p = .21, normed fit index of .99, relative fit index of .98, and root mean square error of approximation of .08) and explained 53% of the variance in exercise behavior. Five of the seven hypothesized paths in the model were statistically significant. Friend support indirectly influenced exercise through self-efficacy and outcome expectations. This suggests interventions to improve exercise behavior in older adults should incorporate social supports to strengthen self-efficacy and outcome expectations related to exercise.

Recreational physical activity levels in healthy older women: the importance of fear of falling

OBJECTIVES

To examine whether fear of falling is a probable cause of reduced recreational physical activity levels in healthy older women.

DESIGN

Cross-sectional analysis of baseline data from a longitudinal study.

PARTICIPANTS

One thousand five hundred older, ambulatory women (aged 70-85), selected at random from the electoral roll.

MEASUREMENTS

Self-reported recreational physical activity levels and fear of falling, demographic variables, anthropometric variables and measures of disability, and physical and cognitive function.

RESULTS

The study subjects had low levels of physical and cognitive impairments; 24.1% of the group was obese (body mass index> 30). Twenty-six percent of the women did not participate in recreational physical activity; 39% participated in sufficient activity to gain probable health benefits. Although the women who did not participate in recreational activities were most likely to report fear of falling (45.2%), it was common in the group as a whole (33.9%), including the most active women (27.0%). Independent risk factors for nonparticipation in physical activity were fear of falling (odds ratio (OR)=0.70, 95% confidence interval (CI)=0.54-0.90, P=.006), obesity (OR=0.50, 95% CI=0.38-0.66, P=.001), and slower times on the timed up-and-go test (OR=0.88, 95% CI=0.84-0.92, P=.001). Fear of falling was also independently associated with lower recreational physical activity levels in women who were active (beta=-0.09, P=.003). Subgroup analysis suggested that fear of falls affected activity levels at a predisability stage in women with mildly impaired mobility.

CONCLUSIONS

Fear of falling is common in healthy, high-functioning older women and is independently associated with reduced levels of participation in recreational physical activity. Fear of falling is an important psychological barrier that may need to be overcome in programs attempting to improve activity levels in older women.

A Prospective Evaluation of the Effects of a 12-Week Outpatient Exercise Program on Clinical and Behavioral Outcomes in Patients with Epilepsy

Purpose. We hypothesized that patients randomized to an exercise program would demonstrate a measurable improvement in behavioral outcomes with no adverse clinical outcomes, as compared with control patients.Methods. This randomized, prospective, parallel, and controlled study spanned 12 weeks. Twenty-eight patients were randomized either to participate in a supervised exercise program (Exercise) or to continue their current level of activity with no planned intervention (Control). The Exercise group worked with an exercise physiologist three times per week. At specific intervals, behavioral (QOLIE-89, POMS, PSDQ, Self-Esteem) and clinical (seizure activity, antiepileptic drug (AED) concentrations) outcomes were measured.Results. Twenty-three patients completed the study (Exercise n = 14, Control n = 9). Of the four patients in the Exercise group with active seizures, two had no change, one had an increase, and one had a decrease in seizure activity. Of the three patients in the Control group with active seizures, one had no change, one had an increase, and one had a decrease in seizure activity. In all patients, there was <26% coefficient of variation in AED concentrations over the 12-week study, suggesting little or no impact of the exercise intervention. The overall quality of life and two domain scores improved from baseline to Week 12 in the Exercise group (P = 0.031), while the Control group score did not change (P = 0.943). In the Exercise group, there were several measures of physical self-concept and vigor that improved and total mood disturbance decreased from the beginning to the end of the program.Conclusion. This is the first randomized, controlled study of exercise in patients with epilepsy. Behavioral outcomes are positively influenced by moderate exercise and there is no impact on seizure frequency. This suggests that exercise should not be discouraged in the care of epilepsy patients. The ability to offer an exercise program adds a health promotion component to the current plan of care provided by our comprehensive epilepsy program.

Validation of the functional fitness age (FFA) index in older Japanese women

Functional fitness age (FFA), which we previously described, is a measure of functional age that reflects a person's overall physical ability to complete daily tasks such as preparing meals and performing various household chores. The purpose of this study was to validate FFA in two elderly populations: 1) older subjects from different communities, and 2) older subjects participating in an exercise intervention program. FFA was calculated from 4 performance tests: performing arm curls; moving beans with chopsticks; demonstrating functional reach; and sitting and walking around two cones. The first study group was selected from 4 different communities (N=127), and was subdivided into a less active group (N=87) and an active group (N=40). The results of the 4 tests for the less active group were not significantly different from those for the original validation group used in developing the FFA equation. The FFA of the less active group (71.1+/-7.7 yrs) was not different from their chronological age (70.4+/-6.6 yrs). In the active group, except for the arm curls, test scores were significantly higher than those of the original validation group. The FFA of the active group (66.2+/-5.1 yrs) was significantly younger than their chronological age (70.9+/-4.2 yrs). Another group of 14 older women (79.5+/-3.9 yrs) was recruited for pre- and post-training testing. After the 3-month exercise program, they showed significant improvements in sitting and walking around two cones and functional reach; their FFA decreased significantly from 81.5+/-5.0 yrs to 78.3+/-4.5 yrs. The control group selected from the same community (N=16, 79.8+/-5.3 yrs) showed no significant changes in the 4 performance tests, and their FFA remained unchanged. These results indicate that our FFA is highly cross-validated for different Japanese communities, and is sensitive to changes associated with participation in an exercise intervention program.

Interventions to promote physical activity by older adults

Physical inactivity has been established to be an independent risk factor for a range of chronic diseases and conditions that threaten the health of the nation. However, only a minority of the population is currently meeting the recommended levels of regular physical activity, which have been linked with important health and quality-of-life benefits. Older adults are at particular risk for leading sedentary lifestyles. This article provides an overview of factors associated with physical activity for older adults and also describes potentially promising interventions for promoting regular physical activity in this growing population segment. Examples of interventions undertaken at personal and interpersonal as well as broader levels of analysis (e.g., environmental) are provided. Major issues currently facing the field are discussed, including the ongoing challenge of developing assessment tools that are sensitive to the more moderate-intensity physical activities favored by older adults and the formidable task of combining clinical approaches with environmental and policy strategies aimed at combating this public health problem.

Relationships between physical activity, obesity and diabetes mellitus in a French elderly population: the POLA study. Pathologies Oculaires lieés á l' Age

OBJECTIVE

To analyse the relationships between body mass index, waist circumference, waist-to-hip ratio, physical activity and the risk of type 2 diabetes in a French elderly population.

DESIGN AND SUBJECTS

We conducted a cross-sectional study on 1113 men and 1419 women aged 60 y or more, participating in the POLA Study.

RESULTS

The prevalence of diabetes was two-fold higher in men than in women (19.1% and 9.3%, respectively). The anthropometric variables studied-body mass index (BMI), waist circumference (WC) and the waist/hip ratio (WHR)-were all positively related to the prevalence of type 2 diabetes. The strongest relationships were found for BMI in men and WHR in women. In both genders, sport activity and diabetes were inversely linked whereas no relationship was shown between the amount of household activity and diabetes mellitus.

CONCLUSION

In the elderly, overall obesity in men and abdominal fat accumulation in women appeared strongly related to diabetes. Sport activity was negatively and independently associated with the prevalence of diabetes mellitus.

Promoting health in older adults: a four-year analysis

PURPOSE

The purpose of this study was to consider the influence of selected health promotion and disease prevention interventions in elderly residents of a continuing care retirement community (CCRC) over a four-year period by comparing actual health promotion practices of the residents.

DATA SOURCES

Original research using a descriptive design, face-to-face interviews of residents (N = 176-200), chart reviews, and administration of a mini-mental state exam (MMSE) and health survey administered annually.

CONCLUSIONS

In each year the mean age of the residents was at least 85, the majority were female, Caucasian, and unmarried. With the exception of checking stools for occult blood, there was a statistically significant change in all health promotion behaviors over the four-year period. The most significant change was in the area of exercise behavior, which increased from 24% of the residents participating in regular exercise in year one to 61% by year four.

IMPLICATIONS FOR PRACTICE

The purpose of health promotion and disease prevention in older adults is to reduce the potential years of life lost in premature mortality and ensure better quality of remaining life. In addition to regularly scheduled interventions (group education, on-site administration of pneumonia and flu vaccines, on-site exercise room and walking group), individualized counseling regarding the pros and cons of health-promotion activities was provided to help residents make an educated decision about engaging in these activities. These interventions can be used to help facilitate participation in health promotion activities as appropriate and desired for each older adult.

Physical inactivity in the Baltic countries

BACKGROUND

Physical inactivity is a known risk factor for heart disease and obesity, two major health problems in the Baltic Republics. This study examined patterns of physical activity level in these countries, and correlates of leisure-time sedentary behavior.

METHODS

Data from three national surveys of adults conducted in Estonia, Latvia, and Lithuania in 1997 were used. Respondents who provided information on their activity level were included in this study (Estonia: n = 2,018; Latvia: n = 2,303; Lithuania: n = 2,140).

RESULTS

One in three Estonians and one in five Latvians and Lithuanians had a low physical activity level at work. Half the respondents (Lithuania: 60%, Latvia: 52%, Estonia: 43%) participated only in sedentary activities during their leisure time. Leisure-time sedentarity was inversely related to education level in men and women and with income in men. It was also associated with smoking in men and with inadequate vegetable intake in men and women.

CONCLUSIONS

Sedentary behavior during leisure time should be a public health issue in the Baltic Republics. Health promotion strategies aiming at increasing leisure-time physical activity level will need to target the general population, but particularly individuals from lower socioeconomic strata.