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See L, Rasiah RL, Laing R, Thompson SC. Considerations in Planning Physical Activity for Older Adults in Hot Climates: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031331. [PMID: 33540584 PMCID: PMC7908220 DOI: 10.3390/ijerph18031331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 01/26/2021] [Indexed: 12/25/2022]
Abstract
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.
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Affiliation(s)
- Lydia See
- Western Australian Centre for Rural Health, School of Population and Global Health, University of Western Australia, Crawley 6009, Australia; (R.L.R.); (R.L.); (S.C.T.)
- Oral Health Centre of Western Australia, School of Dentistry, University of Western Australia, Nedlands 6009, Australia
- Correspondence: ; Tel.: +61-8-6457-4400
| | - Rohan L. Rasiah
- Western Australian Centre for Rural Health, School of Population and Global Health, University of Western Australia, Crawley 6009, Australia; (R.L.R.); (R.L.); (S.C.T.)
| | - Rachael Laing
- Western Australian Centre for Rural Health, School of Population and Global Health, University of Western Australia, Crawley 6009, Australia; (R.L.R.); (R.L.); (S.C.T.)
| | - Sandra C. Thompson
- Western Australian Centre for Rural Health, School of Population and Global Health, University of Western Australia, Crawley 6009, Australia; (R.L.R.); (R.L.); (S.C.T.)
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Harris T, Kerry S, Victor C, Iliffe S, Ussher M, Fox-Rushby J, Whincup P, Ekelund U, Furness C, Limb E, Anokye N, Ibison J, DeWilde S, David L, Howard E, Dale R, Smith J, Normansell R, Beighton C, Morgan K, Wahlich C, Sanghera S, Cook D. A pedometer-based walking intervention in 45- to 75-year-olds, with and without practice nurse support: the PACE-UP three-arm cluster RCT. Health Technol Assess 2019; 22:1-274. [PMID: 29961442 DOI: 10.3310/hta22370] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Guidelines recommend walking to increase moderate to vigorous physical activity (MVPA) for health benefits. OBJECTIVES To assess the effectiveness, cost-effectiveness and acceptability of a pedometer-based walking intervention in inactive adults, delivered postally or through dedicated practice nurse physical activity (PA) consultations. DESIGN Parallel three-arm trial, cluster randomised by household. SETTING Seven London-based general practices. PARTICIPANTS A total of 11,015 people without PA contraindications, aged 45-75 years, randomly selected from practices, were invited. A total of 6399 people were non-responders, and 548 people self-reporting achieving PA guidelines were excluded. A total of 1023 people from 922 households were randomised to usual care (n = 338), postal intervention (n = 339) or nurse support (n = 346). The recruitment rate was 10% (1023/10,467). A total of 956 participants (93%) provided outcome data. INTERVENTIONS Intervention groups received pedometers, 12-week walking programmes advising participants to gradually add '3000 steps in 30 minutes' most days weekly and PA diaries. The nurse group was offered three dedicated PA consultations. MAIN OUTCOME MEASURES The primary and main secondary outcomes were changes from baseline to 12 months in average daily step counts and time in MVPA (in ≥ 10-minute bouts), respectively, from 7-day accelerometry. Individual resource-use data informed the within-trial economic evaluation and the Markov model for simulating long-term cost-effectiveness. Qualitative evaluations assessed nurse and participant views. A 3-year follow-up was conducted. RESULTS Baseline average daily step count was 7479 [standard deviation (SD) 2671], average minutes per week in MVPA bouts was 94 minutes (SD 102 minutes) for those randomised. PA increased significantly at 12 months in both intervention groups compared with the control group, with no difference between interventions; additional steps per day were 642 steps [95% confidence interval (CI) 329 to 955 steps] for the postal group and 677 steps (95% CI 365 to 989 steps) for nurse support, and additional MVPA in bouts (minutes per week) was 33 minutes per week (95% CI 17 to 49 minutes per week) for the postal group and 35 minutes per week (95% CI 19 to 51 minutes per week) for nurse support. Intervention groups showed no increase in adverse events. Incremental cost per step was 19p and £3.61 per minute in a ≥ 10-minute MVPA bout for nurse support, whereas the postal group took more steps and cost less than the control group. The postal group had a 50% chance of being cost-effective at a £20,000 per quality-adjusted life-year (QALY) threshold within 1 year and had both lower costs [-£11M (95% CI -£12M to -£10M) per 100,000 population] and more QALYs [759 QALYs gained (95% CI 400 to 1247 QALYs)] than the nurse support and control groups in the long term. Participants and nurses found the interventions acceptable and enjoyable. Three-year follow-up data showed persistent intervention effects (nurse support plus postal vs. control) on steps per day [648 steps (95% CI 272 to 1024 steps)] and MVPA bouts [26 minutes per week (95% CI 8 to 44 minutes per week)]. LIMITATIONS The 10% recruitment level, with lower levels in Asian and socioeconomically deprived participants, limits the generalisability of the findings. Assessors were unmasked to the group. CONCLUSIONS A primary care pedometer-based walking intervention in 45- to 75-year-olds increased 12-month step counts by around one-tenth, and time in MVPA bouts by around one-third, with similar effects for the nurse support and postal groups, and persistent 3-year effects. The postal intervention provides cost-effective, long-term quality-of-life benefits. A primary care pedometer intervention delivered by post could help address the public health physical inactivity challenge. FUTURE WORK Exploring different recruitment strategies to increase uptake. Integrating the Pedometer And Consultation Evaluation-UP (PACE-UP) trial with evolving PA monitoring technologies. TRIAL REGISTRATION Current Controlled Trials ISRCTN98538934. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 37. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Tess Harris
- Population Health Research Institute, St George's, University of London, London, UK
| | - Sally Kerry
- Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK
| | - Christina Victor
- Gerontology and Health Services Research Unit, Brunel University London, London, UK
| | - Steve Iliffe
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Michael Ussher
- Population Health Research Institute, St George's, University of London, London, UK
| | - Julia Fox-Rushby
- Health Economics Research Group, Brunel University London, London, UK
| | - Peter Whincup
- Population Health Research Institute, St George's, University of London, London, UK
| | - Ulf Ekelund
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway.,Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Cheryl Furness
- Population Health Research Institute, St George's, University of London, London, UK
| | - Elizabeth Limb
- Population Health Research Institute, St George's, University of London, London, UK
| | - Nana Anokye
- Health Economics Research Group, Brunel University London, London, UK
| | - Judith Ibison
- Population Health Research Institute, St George's, University of London, London, UK
| | - Stephen DeWilde
- Population Health Research Institute, St George's, University of London, London, UK
| | - Lee David
- 10 Minute CBT, Devonshire Business Centre, Letchworth Garden City, UK
| | - Emma Howard
- Population Health Research Institute, St George's, University of London, London, UK
| | - Rebecca Dale
- Population Health Research Institute, St George's, University of London, London, UK
| | - Jaime Smith
- Population Health Research Institute, St George's, University of London, London, UK
| | - Rebecca Normansell
- Population Health Research Institute, St George's, University of London, London, UK
| | - Carole Beighton
- Population Health Research Institute, St George's, University of London, London, UK
| | - Katy Morgan
- Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK
| | - Charlotte Wahlich
- Population Health Research Institute, St George's, University of London, London, UK
| | - Sabina Sanghera
- Health Economics Research Group, Brunel University London, London, UK
| | - Derek Cook
- Population Health Research Institute, St George's, University of London, London, UK
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Petrella AFM, Gill DP, Petrella RJ. Evaluation of the Get Active Questionnaire in community-dwelling older adults. Appl Physiol Nutr Metab 2018; 43:587-594. [PMID: 29342366 DOI: 10.1139/apnm-2017-0489] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Physical activity screening prior to starting a physical activity program is important to identify if there are any underlying health conditions. However, many older adults do not complete such assessments prior to beginning their physical activity program. This project compared the Canadian Society for Exercise Physiology's newly developed Get Active Questionnaire (GAQ) to a standardized exercise stress test in terms of screening out versus screening in false-positive GAQ tests. A convenience sample of community-dwelling adults (male n = 58, female n = 54) aged 75 ± 7 years from London, Ontario, Canada, was used. Participants completed a physical exam and physical activity screening session (i.e., stress test and GAQ) at a research laboratory that routinely conducts community-based referrals. One week after the initial visit, participants returned to the study site, completed the GAQ, and were asked questions about their perceptions of physical activity screening by a research assistant. The GAQ "screened in" participants, but it did not provide the same precision of "screening out" at-risk individuals as an exercise stress test; the GAQ reduced false-positives versus the stress test, yet there was a large proportion of high false-negative results reported. The GAQ shows promise in physical activity screening in older adults to engage in exercise safely. However, the lack of precision in physical-activity screening out of at-risk populations requires further evaluation. Questionnaires such as the GAQ should be evaluated in a larger study population at various time points to further assess the validity and reliability of physical activity screening tools.
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Affiliation(s)
- Andrea F M Petrella
- a Faculty of Health Sciences, School of Kinesiology, University of Western Ontario, London, ON N6A 3K7, Canada
| | - Dawn P Gill
- b Centre for Studies in Family Medicine, Department of Family Medicine, University of Western Ontario, London, ON N6G 2M1, Canada.,c Faculty of Health Sciences, School of Health Studies, University of Western Ontario, London, ON N6A 2B7, Canada
| | - Robert J Petrella
- a Faculty of Health Sciences, School of Kinesiology, University of Western Ontario, London, ON N6A 3K7, Canada.,b Centre for Studies in Family Medicine, Department of Family Medicine, University of Western Ontario, London, ON N6G 2M1, Canada
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Batsis JA, Germain CM, Vásquez E, Zbehlik AJ, Bartels SJ. Physical Activity Predicts Higher Physical Function in Older Adults: The Osteoarthritis Initiative. J Phys Act Health 2016; 13:6-16. [PMID: 25831551 PMCID: PMC4596795 DOI: 10.1123/jpah.2014-0531] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Physical activity reduces mobility impairments in elders. We examined the association of physical activity on risk of subjective and objective physical function in adults with and at risk for osteoarthritis (OA). METHODS Adults aged ≥ 60 years from the longitudinal Osteoarthritis Initiative, a prospective observational study of knee OA, were classified by sex-specific quartiles of Physical Activity Score for the Elderly scores. Using linear mixed models, we assessed 6-year data on self-reported health, gait speed, Late-Life Function and Disability Index (LLFDI) and chair stand. RESULTS Of 2252 subjects, mean age ranged from 66 to 70 years. Within each quartile, physical component (PCS) of the Short Form-12 and gait speed decreased from baseline to follow-up in both sexes (all P < .001), yet the overall changes across PASE quartiles between these 2 time points were no different (P = .40 and .69, males and females, respectively). Decline in PCS occurred in the younger age group, but rates of change between quartiles over time were no different in any outcomes in either sex. LLFDI scores declined in the 70+ age group. Adjusting for knee extensor strength reduced the strength of association. CONCLUSIONS Higher physical activity is associated with maintained physical function and is mediated by muscle strength, highlighting the importance of encouraging physical activity in older adults with and at risk for OA.
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Affiliation(s)
- John A Batsis
- Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH
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Australian and New Zealand Society for Geriatric Medicine: Position Statement--Exercise guidelines for older adults. Australas J Ageing 2015; 33:287-94. [PMID: 25471747 DOI: 10.1111/ajag.12194] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Hinrichs T, Bücker B, Wilm S, Klaaßen-Mielke R, Brach M, Platen P, Moschny A. Adverse events in mobility-limited and chronically ill elderly adults participating in an exercise intervention study supported by general practitioner practices. J Am Geriatr Soc 2015; 63:258-69. [PMID: 25688602 DOI: 10.1111/jgs.13253] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To present detailed adverse event (AE) data from a randomized controlled trial (RCT) of a home-based exercise program delivered to an elderly high-risk population by an exercise therapist after medical clearance from a general practitioner (GP). DESIGN Randomized controlled trial. SETTING General practitioner practices and participant homes. PARTICIPANTS Community-dwelling, chronically ill, mobility-limited individuals aged 70 and older (mean 80 ± 5) participating in a RCT of an exercise program (HOMEfit; ISRCTN17727272) (N = 209; n = 106 experimental, n = 103 control; 74% female). INTERVENTION A 12-week multidimensional home-based exercise program (experimental) versus baseline physical activity counseling (control). An exercise therapist delivered both interventions to participants during counseling sessions at the GP's practice and on the telephone. MEASUREMENTS Adverse events were documented at least at every counseling session and assessed by the GP and an AE manager. RESULTS One hundred fifty-one AEs were reported in 47% (n = 99) of all participants. Twenty-one (14%) events were classified as serious. In six events (4%; n = 4 experimental, n = 2 control), participation in the study had to be discontinued immediately. In 25 events (17%; n = 9 experimental, n = 16 control), the intervention had to be suspended. The intervention was determined to have caused two events (both nonserious and in the experimental group). CONCLUSION Even though the program appears to be safe, high morbidity unrelated to exercise can constitute a critical challenge for sustained exercise participation.
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Affiliation(s)
- Timo Hinrichs
- Swiss Paraplegic Research, Nottwil, Switzerland; Department of Sports Medicine and Sports Nutrition, Ruhr University Bochum, Bochum, Germany; Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
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Rombaldi AJ, Silva MCD, Barbosa MT, Pinto RC, Azevedo MR, Hallal PC, Siqueira FV. Prevalência e fatores associados à ocorrência de lesões durante a prática de atividade física. REV BRAS MED ESPORTE 2014. [DOI: 10.1590/1517-86922014200301709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: Embora estudos demonstrem a importância da atividade física na prevenção e manutenção de um padrão de vida saudável, a prática pode determinar um aumento no risco da ocorrência de lesões entre aqueles praticantes de atividades desportivas.OBJETIVO: Determinar a prevalência e os fatores associados à ocorrência de lesões durante a prática de atividade física no tempo de lazer na cidade de Pelotas, RS, Brasil.MÉTODOS: Estudo transversal de base populacional realizado na área urbana do município de Pelotas, RS, Brasil. Uma amostra levando em consideração os diversos conglomerados foi selecionada. Características sociodemográficas, econômicas, comportamentais, nutricionais e relacionadas à ocorrência de lesões durante a prática de atividade física foram coletadas por meio de questionário padronizado e pré-codificado.RESULTADOS: O percentual de lesões em sujeitos praticantes de atividade física no lazer foi de 21,9% (IC95% 18,3 - 25,9). As lesões mais prevalentes foram contusões (39,6%), luxações (30,2%) e distensões (11,3%) e a prática de futebol e musculação foram as atividades onde mais ocorreram lesões. As lesões estiveram associadas ao sexo masculino, idades mais jovens e a indivíduos de cor da pele preta e parda.CONCLUSÃO: Embora a prevalência de lesões entre praticantes seja importante, os benefícios decorrentes de um estilo de vida ativo superam os riscos.
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Harris T, Kerry SM, Victor CR, Shah SM, Iliffe S, Ussher M, Ekelund U, Fox-Rushby J, Whincup P, David L, Brewin D, Ibison J, DeWilde S, Limb E, Anokye N, Furness C, Howard E, Dale R, Cook DG. PACE-UP (Pedometer and consultation evaluation--UP)--a pedometer-based walking intervention with and without practice nurse support in primary care patients aged 45-75 years: study protocol for a randomised controlled trial. Trials 2013; 14:418. [PMID: 24304838 PMCID: PMC4235020 DOI: 10.1186/1745-6215-14-418] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 11/20/2013] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Most adults do not achieve the 150 minutes weekly of at least moderate intensity activity recommended for health. Adults' most common physical activity (PA) is walking, light intensity if strolling, moderate if brisker. Pedometers can increase walking; however, most trials have been short-term, have combined pedometer and support effects, and have not reported PA intensity. This trial will investigate whether pedometers, with or without nurse support, can help less active 45-75 year olds to increase their PA over 12 months. METHODS/DESIGN DESIGN Primary care-based 3-arm randomized controlled trial with 12-month follow-up and health economic and qualitative evaluations. PARTICIPANTS Less active 45-75 year olds (n = 993) will be recruited by post from six South West London general practices, maximum of two per household and households randomised into three groups. Step-count and time spent at different PA intensities will be assessed for 7 days at baseline, 3 and 12 months by accelerometer. Questionnaires and anthropometric assessments will be completed. INTERVENTION The pedometer-alone group will be posted a pedometer (Yamax Digi-Walker SW-200), handbook and diary detailing a 12-week pedometer-based walking programme, using targets from their baseline assessment. The pedometer-plus-support group will additionally receive three practice nurse PA consultations. The handbook, diary and consultations include behaviour change techniques (e.g., self-monitoring, goal-setting, relapse prevention planning). The control group will receive usual care. OUTCOMES Changes in average daily step-count (primary outcome), time spent sedentary and in at least moderate intensity PA weekly at 12 months, measured by accelerometry. Other outcomes include change in body mass index, body fat, self-reported PA, quality of life, mood and adverse events. Cost-effectiveness will be assessed by the incremental cost of the intervention to the National Health Service and incremental cost per change in step-count and per quality adjusted life year. Qualitative evaluations will explore reasons for trial non-participation and the interventions' acceptability. DISCUSSION The PACE-UP trial will determine the effectiveness and cost-effectiveness of a pedometer-based walking intervention delivered by post or practice nurse to less active primary care patients aged 45-75 years old. Approaches to minimise bias and challenges anticipated in delivery will be discussed. TRIAL REGISTRATION ISRCTN98538934.
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Affiliation(s)
- Tess Harris
- Population Health Research Centre, St George’s University of London, London SW17 ORE, UK
| | - Sally M Kerry
- Pragmatic Clinical Trials Unit, Queen Mary’s University of London, London E12AT, UK
| | - Christina R Victor
- Gerontology and Health Services Research Unit, Brunel University, London UB8 3PH, UK
| | - Sunil M Shah
- Population Health Research Centre, St George’s University of London, London SW17 ORE, UK
| | - Steve Iliffe
- Department of Population Health Sciences, University College, London NW3 2PF, UK
| | - Michael Ussher
- Population Health Research Centre, St George’s University of London, London SW17 ORE, UK
| | - Ulf Ekelund
- MRC Epidemiology Unit, University of Cambridge, Cambridge CB2 OQQ, UK
- Department of Sport Medicine, Norwegian School of Sport Sciences, PO Box 4014, 0806 Oslo, Norway
| | - Julia Fox-Rushby
- Health Economics Research Group, Brunel University, London UB83PH, UK
| | - Peter Whincup
- Population Health Research Centre, St George’s University of London, London SW17 ORE, UK
| | - Lee David
- 10 Minute CBT, Devonshire Business Centre, Letchworth Garden City, Herts SG61GJ, UK
| | - Debbie Brewin
- 10 Minute CBT, Devonshire Business Centre, Letchworth Garden City, Herts SG61GJ, UK
| | - Judith Ibison
- Population Health Research Centre, St George’s University of London, London SW17 ORE, UK
| | - Stephen DeWilde
- Population Health Research Centre, St George’s University of London, London SW17 ORE, UK
| | - Elizabeth Limb
- Population Health Research Centre, St George’s University of London, London SW17 ORE, UK
| | - Nana Anokye
- Health Economics Research Group, Brunel University, London UB83PH, UK
| | - Cheryl Furness
- Population Health Research Centre, St George’s University of London, London SW17 ORE, UK
| | - Emma Howard
- Population Health Research Centre, St George’s University of London, London SW17 ORE, UK
| | - Rebecca Dale
- Population Health Research Centre, St George’s University of London, London SW17 ORE, UK
| | - Derek G Cook
- Population Health Research Centre, St George’s University of London, London SW17 ORE, UK
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Harris T, Kerry S, Victor C, Ekelund U, Woodcock A, Iliffe S, Whincup P, Beighton C, Ussher M, David L, Brewin D, Adams F, Rogers A, Cook D. Randomised controlled trial of a complex intervention by primary care nurses to increase walking in patients aged 60-74 years: protocol of the PACE-Lift (Pedometer Accelerometer Consultation Evaluation - Lift) trial. BMC Public Health 2013; 13:5. [PMID: 23289648 PMCID: PMC3543841 DOI: 10.1186/1471-2458-13-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 01/03/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physical activity is essential for older peoples' physical and mental health and for maintaining independence. Guidelines recommend at least 150 minutes weekly, of at least moderate intensity physical activity, with activity on most days. Older people's most common physical activity is walking, light intensity if strolling, moderate if brisker. Less than 20% of United Kingdom 65-74 year olds report achieving the guidelines, despite most being able to. Effective behaviour change techniques include strategies such as goal setting, self-monitoring, building self-efficacy and relapse prevention. Primary care physical activity consultations allow individual tailoring of advice. Pedometers measure step-counts and accelerometers measure physical activity intensity. This protocol describes an innovative intervention to increase walking in older people, incorporating pedometer and accelerometer feedback within a primary care nurse physical activity consultation, using behaviour change techniques. METHODS/DESIGN DESIGN Randomised controlled trial with intervention and control (usual care) arms plus process and qualitative evaluations. PARTICIPANTS 300 people aged 60-74 years registered with 3 general practices within Oxfordshire and Berkshire West primary care trusts, able to walk outside and with no restrictions to increasing their physical activity. INTERVENTION 3 month pedometer and accelerometer based intervention supported by practice nurse physical activity consultations. Four consultations based on behaviour change techniques, physical activity diary, pedometer average daily steps and accelerometer feedback on physical activity intensity. Individual physical activity plans based on increasing walking and other existing physical activity will be produced. OUTCOMES Change in average daily steps (primary outcome) and average time spent in at least moderate intensity physical activity weekly (secondary outcome) at 3 months and 12 months, assessed by accelerometry. Other outcomes include quality of life, mood, exercise self-efficacy, injuries. Qualitative evaluations will explore reasons for trial non-participation, the intervention's acceptability to patients and nurses and factors enhancing or acting as barriers for older people in increasing their physical activity levels. DISCUSSION The PACE-Lift trial will determine the feasibility and efficacy of an intervention for increasing physical activity among older primary care patients. Steps taken to minimise bias and the challenges anticipated will be discussed. Word count 341. TRIAL REGISTRATION NUMBER ISRCTN42122561.
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Affiliation(s)
- Tess Harris
- Population Health Research Centre, St George's University of London, UK.
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Chodzko-Zajko WJ, Resnick B, Ory MG. Beyond screening: tailoring physical activity options with the EASY tool. Transl Behav Med 2012; 2:244-8. [PMID: 24073117 PMCID: PMC3717896 DOI: 10.1007/s13142-012-0134-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
The development and dissemination of the EASY tool provides a resource to facilitate access to information about physical activity for older adults, particularly with regard to specific physical activity recommendations for individuals with chronic medical conditions. Health care providers and older adults can use the EASY tool to provide a flexible, tailored approach to screening. This approach will better inform both older adults and their health care providers about safe physical activity programs with appropriate injury management strategies. The identification of a broad range of activities appropriate for different health circumstances and situations will enable a greater number of older adults to engage in physical activity/exercises that will improve their health and functioning.
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Affiliation(s)
- Wojtek J Chodzko-Zajko
- />Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Louise Freer Hall, 906 S. Goodwin Avenue, Urbana, IL 61801 USA
| | - Barbara Resnick
- />University of Maryland School of Nursing, Baltimore, MD USA
| | - Marcia G Ory
- />The Texas A&M University System, College Station, TX USA
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Hinrichs T, Bucchi C, Brach M, Wilm S, Endres HG, Burghaus I, Trampisch HJ, Platen P. Feasibility of a multidimensional home-based exercise programme for the elderly with structured support given by the general practitioner's surgery: study protocol of a single arm trial preparing an RCT [ISRCTN58562962]. BMC Geriatr 2009; 9:37. [PMID: 19686587 PMCID: PMC2753322 DOI: 10.1186/1471-2318-9-37] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2009] [Accepted: 08/17/2009] [Indexed: 12/31/2022] Open
Abstract
Background Physical activity programmes can help to prevent functional decline in the elderly. Until now, such programmes use to target either on healthy community-dwelling seniors or on elderly living in special residences or care institutions. Sedentary or frail people, however, are difficult to reach when they live in their own homes. The general practitioner's (GP) practice offers a unique opportunity to acquire these people for participation in activity programmes. We conceptualised a multidimensional home-based exercise programme that shall be delivered to the target group through cooperation between GPs and exercise therapists. In order to prepare a randomised controlled trial (RCT), a feasibility study is being conducted. Methods The study is designed as a single arm interventional trial. We plan to recruit 90 patients aged 70 years and above through their GPs. The intervention lasts 12 weeks and consists of physical activity counselling, a home-exercise programme, and exercise consultations provided by an exercise therapist in the GP's practice and via telephone. The exercise programme consists of two main components: 1. a combination of home-exercises to improve strength, flexibility and balance, 2. walking for exercise to improve aerobic capacity. Primary outcome measures are: appraisal by GP, undesirable events, drop-outs, adherence. Secondary outcome measures are: effects (a. motor tests: timed-up-and-go, chair rising, grip strength, tandem stand, tandem walk, sit-and-reach; b. telephone interview: PRISCUS-Physical Activity Questionnaire, Short Form-8 Health Survey, three month recall of frequency of falls, Falls Efficacy Scale), appraisal by participant, exercise performance, focus group discussion. Data analyses will focus on: 1. decision-making concerning the conduction of a RCT, 2. estimation of the effects of the programme, detection of shortcomings and identification of subgroups with contrary results, 3. feedback to participants and to GPs. Conclusion A new cooperation between GPs and exercise therapists to approach community-dwelling seniors and to deliver a home-exercise programme is object of research with regard to feasibility and acceptance. In case of success, an RCT should examine the effects of the programme. A future implementation within primary medical care may take advantage from the flexibility of the programme. Trial registration Current Controlled Trials ISRCTN58562962.
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Affiliation(s)
- Timo Hinrichs
- Department of Sports Medicine and Sports Nutrition, Ruhr-University Bochum, 44780 Bochum, Germany.
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Springer JB, Eickhoff-Shemek JM, Zuberbuehler EJ. An investigation of pre-activity cardiovascular screening procedures in health/fitness facilities--part II: rationale for low adherence with national standards. PREVENTIVE CARDIOLOGY 2009; 12:176-183. [PMID: 19751481 DOI: 10.1111/j.1751-7141.2009.00029.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The purpose of this study was to explore the rationale provided by program directors and general managers of health/fitness facilities for low adherence to nationally accepted standards related to pre-activity cardiovascular screening procedures (PACSPs) for members and clients of personal trainers. Qualitative interviews were conducted with the directors/managers in a Midwest region representing 76 facilities who indicated they did not conduct PACSPs for members and clients of personal trainers. Analysis of the rationale provided revealed 6 major clusters: (1) Purpose or need for screening; (2) time and staffing; (3) barrier to participation; (4) personal responsibility for health and actions; (5) legal issues; and (6) company or franchise policy that categorized the reasons for low adherence to PACSPs. These findings highlight the need to increase awareness of the relevance of PACSPs among health/fitness managers, staff members, and current exercise science students as well as engage those in risk management for informed dialogue for consistent application of the standard of care.
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A proposal for a new screening paradigm and tool called Exercise Assessment and Screening for You (EASY). J Aging Phys Act 2008; 16:215-33. [PMID: 18483443 DOI: 10.1123/japa.16.2.215] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The Exercise Assessment and Screening for You (EASY) is a tool developed to help older individuals, their health care providers, and exercise professionals identify different types of exercise and physical activity regimens that can be tailored to meet the existing health conditions, illnesses, or disabilities of older adults. The EASY tool includes 6 screening questions that were developed based on an expert roundtable and follow-up panel activities. The philosophy behind the EASY is that screening should be a dynamic process in which participants learn to appreciate the importance of engaging in regular exercise, attending to health changes, recognizing a full range of signs and symptoms that might indicate potentially harmful events, and becoming familiar with simple safety tips for initiating and progressively increasing physical activity patterns. Representing a paradigm shift from traditional screening approaches that focus on potential risks of exercising, this tool emphasizes the benefits of exercise and physical activity for all individuals.
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Resnick B, Ory M, Coday M, Riebe D. Professional perspectives on physical activity screening practices: Shifting the paradigm. CRITICAL PUBLIC HEALTH 2008. [DOI: 10.1080/09581590701771717] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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15
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Conn VS, Hafdahl AR, Brown SA, Brown LM. Meta-analysis of patient education interventions to increase physical activity among chronically ill adults. PATIENT EDUCATION AND COUNSELING 2008; 70:157-72. [PMID: 18023128 PMCID: PMC2324068 DOI: 10.1016/j.pec.2007.10.004] [Citation(s) in RCA: 178] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2007] [Revised: 09/24/2007] [Accepted: 10/06/2007] [Indexed: 05/25/2023]
Abstract
OBJECTIVE This meta-analysis integrates primary research testing the effect of patient education to increase physical activity (PA) on behavior outcomes among adults with diverse chronic illnesses. METHODS Extensive literature searching strategies located published and unpublished intervention studies that measured PA behavior outcomes. Primary study results were coded. Fixed- and random-effects meta-analytic procedures included moderator analyses. RESULTS Data were synthesized across 22,527 subjects from 213 samples in 163 reports. The overall mean weighted effect size for two-group comparisons was 0.45 (higher mean for treatment than control). This effect size is consistent with a difference of 48 min of PA per week or 945 steps per day. Preliminary moderator analyses suggest interventions were most effective when they targeted only PA behavior, used behavioral strategies (versus cognitive strategies), and encouraged PA self-monitoring. Differences among chronic illnesses were documented. Individual strategies unrelated to PA outcomes included supervised exercise sessions, exercise prescription, fitness testing, goal setting, contracting, problem solving, barriers management, and stimulus/cues. PA outcomes were unrelated to gender, age, ethnicity, or socioeconomic distribution among samples. CONCLUSION These findings suggest that some patient education interventions to increase PA are effective, despite considerable heterogeneity in the magnitude of intervention effect. PRACTICE IMPLICATIONS Moderator analyses are preliminary and provide suggestive evidence for further testing of interventions to inform practice.
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Affiliation(s)
- Vicki S Conn
- S317 School of Nursing, University of Missouri, Columbia, MO 65211, USA.
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16
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Abstract
PURPOSE The purpose of this article is to present strategies to improve the effectiveness of physical activity counseling for adults in primary care settings. Adoption of physical activity can be part of a healthy lifestyle to prevent or manage many chronic and debilitating conditions, including cardiovascular disease, diabetes, hypertension, and obesity. DATA SOURCES Original research articles reporting results from descriptive studies and clinical trials testing the effectiveness of physical activity counseling in primary care. Journal articles and Web sites are cited as patient and professional resources. CONCLUSIONS Despite conflicting research findings on the effectiveness of physical activity counseling in primary care, the importance of an active lifestyle in promoting health and well-being is well known. Yet, only one third of all Americans attain adequate daily physical activity. Implementing physical activity counseling in primary care is one method to promote active lifestyles. Some strategies to promote physical activity counseling in primary care settings are identified, including use of the Five A's approach and printed materials. Suggestions to manage the barriers primary care providers experience with physical activity counseling include brief counseling sessions involving all members of the health team. IMPLICATIONS FOR PRACTICE The implementation of a brief physical activity counseling intervention in primary care settings is presented as a promising method to promote physical activity in adults. Nurse practitioners can deliver this counseling in a succinct, well-planned session to promote physical activity and reduce the potential devastating consequences associated with a sedentary lifestyle.
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Goodrich DE, Larkin AR, Lowery JC, Holleman RG, Richardson CR. Adverse events among high-risk participants in a home-based walking study: a descriptive study. Int J Behav Nutr Phys Act 2007; 4:20. [PMID: 17521443 PMCID: PMC1891313 DOI: 10.1186/1479-5868-4-20] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2007] [Accepted: 05/23/2007] [Indexed: 11/10/2022] Open
Abstract
Background For high-risk individuals and their healthcare providers, finding the right balance between promoting physical activity and minimizing the risk of adverse events can be difficult. More information on the prevalence and influence of adverse events is needed to improve providers' ability to prescribe effective and safe exercise programs for their patients. Methods This study describes the type and severity of adverse events reported by participants with cardiovascular disease or at-risk for cardiovascular disease that occurred during an unsupervised, home-based walking study. This multi-site, randomized controlled trial tested the feasibility of a diet and lifestyle activity intervention over 1.5 years. At month 13, 274 eligible participants (male veterans) were recruited who were ambulatory, BMI > 28, and reporting one or more cardiovascular disease risk factors. All participants attended five, face-to-face dietitian-delivered counseling sessions during the six-month intervention. Participants were randomized to three study arms: 1) time-based walking goals, 2) simple pedometer-based walking goals, and 3) enhanced pedometer-based walking goals with Internet-mediated feedback. Two physicians verified adverse event symptom coding. Results Enrolled participants had an average of five medical comorbidities. During 1110 person months of observation, 87 of 274 participants reported 121 adverse events. One serious study-related adverse event (atrial fibrillation) was reported; the individual resumed study participation within three days. Non-serious, study related adverse events made up 12% of all symptoms – predominantly minor musculoskeletal events. Serious, non-study related adverse events represented 32% of all symptoms while non-serious, non-study related adverse events made up 56% of symptoms. Cardiovascular disease events represented over half of the non-study related adverse event symptoms followed by musculoskeletal complaints. Adverse events caused 50 temporary suspensions averaging 26 days in duration before physician medical clearance was obtained to resume walking. Conclusion Men at high risk for adverse cardiovascular events can safely be advised to start a progressive walking program. Results suggest that minor to serious medical problems unrelated to exercise are a major barrier to walking adherence. Helping individuals with chronic illness return to physical activity quickly but safely after an adverse event is an important component of any physical activity intervention targeting this population.
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Affiliation(s)
- David E Goodrich
- HSR&D Center for Excellence, VA Health Care Medical Center, P.O. Box 130170, Ann Arbor, MI 48113-0170, USA
- Department of Family Medicine, University of Michigan, 1018 Fuller St. SPC: 5708, Ann Arbor, MI 48109-5708, USA
| | - Angela R Larkin
- HSR&D Center for Excellence, VA Health Care Medical Center, P.O. Box 130170, Ann Arbor, MI 48113-0170, USA
| | - Julie C Lowery
- HSR&D Center for Excellence, VA Health Care Medical Center, P.O. Box 130170, Ann Arbor, MI 48113-0170, USA
| | - Robert G Holleman
- HSR&D Center for Excellence, VA Health Care Medical Center, P.O. Box 130170, Ann Arbor, MI 48113-0170, USA
- Department of Family Medicine, University of Michigan, 1018 Fuller St. SPC: 5708, Ann Arbor, MI 48109-5708, USA
| | - Caroline R Richardson
- HSR&D Center for Excellence, VA Health Care Medical Center, P.O. Box 130170, Ann Arbor, MI 48113-0170, USA
- Department of Family Medicine, University of Michigan, 1018 Fuller St. SPC: 5708, Ann Arbor, MI 48109-5708, USA
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Morey MC, Ekelund C, Pearson M, Crowley G, Peterson M, Sloane R, Pieper C, McConnell E, Bosworth H. Project LIFE: a partnership to increase physical activity in elders with multiple chronic illnesses. J Aging Phys Act 2006; 14:324-43. [PMID: 17090809 DOI: 10.1123/japa.14.3.324] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The authors describe a medical center-based randomized trial aimed at determining the feasibility and effectiveness of partnering patients and primary-care providers with an exercise health counselor. Study participants included 165 veterans age 70 years and older. The primary end point was change in physical activity at 3 and 6 months comparing patients receiving high-intensity physical activity counseling, attention control counseling, and usual care after receiving standardized clinic-based counseling. We noted a significant Group x Time interaction (p = .041) for physical activity frequency and a similar effect for caloric expenditure (p = .054). Participants receiving high-intensity counseling and usual care increased physical activity over the short term, but those with usual care returned to baseline by the end of the study. The intervention was well received by practitioners and patients. We conclude that partnering primary-care providers with specialized exercise counselors for age- and health-appropriate physical activity counseling is effective.
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Affiliation(s)
- Miriam C Morey
- Geriatric Research, Education and Clinical Center, Durham VA Medical Center, Durham, NC, USA
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Abstract
OBJECTIVES To compare the national prevalence of reported receipt of clinician exercise counseling across four age groups of women (50-64, 65-74, 75-84, and > or =85) and to determine whether age or health are barriers to reported receipt of exercise counseling. DESIGN 2000 National Health Interview Survey (NHIS). SETTING United States. PARTICIPANTS Six thousand three hundred eighty-five women aged 50 and older who responded to the 2000 NHIS, representing an estimated 34.5 million noninstitutionalized women nationally. MEASUREMENTS Exercise counseling, disease burden, functional dependency, and physical inactivity were assessed by questionnaire. RESULTS Of the 6,385 women, 52.2% were aged 50 to 64, 24.8% were aged 65 to 74, 18.0% were age 75 to 84, and 5.1% were aged 85 and older. Overall, 28.3% reported that a clinician had recommended that they begin or continue to perform any type of exercise or physical activity during the previous year: 31.4% of women aged 50 to 64, 29.2% of women aged 65 to 74, 21.6% of women aged 75 to 84, and 14.4% of women aged 85 and older. Women aged 75 to 84 (adjusted odds ratio (AOR)=0.8, 95% confidence interval (CI)=0.6-1.0) and women aged 85 and older (AOR=0.6, 95% CI=0.4-0.9) were substantially less likely to report clinician counseling about exercise, before and after adjustment. Further adjustment for illness burden and functional dependency did not attenuate the effect of receipt of exercise counseling. CONCLUSION Reported receipt of exercise counseling by older women is low nationally. Despite known benefits of late-life exercise, women aged 75 and older are less likely to report receiving exercise counseling from their clinicians than women aged 50 to 64. Interventions should be aimed at increasing clinician counseling about exercise, especially to older women.
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Affiliation(s)
- Mara A Schonberg
- Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA.
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Abstract
Since the effects of tobacco smoke are so detrimental to health, growing consideration has been given to the development of harm reduction strategies for those smokers who are unable or unwilling to stop using tobacco. The term harm reduction refers to a policy, strategy, or particular intervention that assumes continued use of an undesired behavior and aspires to lower the risk of adverse consequences associated with the continuation of this addictive behavior. Up to this point, tobacco harm reduction interventions have focused on reducing tobacco-related harm through the utilization of innovative tobacco products, reduced tobacco consumption, and pharmaceutical medications. With the possible exception of medicinal nicotine products, these strategies remain unproven and thus far no scientific or medical literature exists to suggest these harm reduction strategies reduce tobacco-related exposure, morbidity, or mortality. Consequently, a need exists for broadening the range of potentially effective harm reduction strategies. This preliminary review suggests that physical activity has the potential to become one such strategy. Of the eight principles that characterize a harm reduction strategy, all are at least partially satisfied by physical activity. Further, emerging evidence indicates that physical activity may delay the occurrence of disease and premature death initiated by tobacco consumption. Significant concerns remain regarding the practicality of physical activity as a harm reduction strategy and the extent to which participation in physical activity may be used to justify continued smoking.
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Resnick B, Ory M, Coday M, Riebe D. Older adults' perspectives on screening prior to initiating an exercise program. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2006; 6:203-11. [PMID: 16044209 DOI: 10.1007/s11121-005-0011-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The purpose of this study was to explore the experiences of older adults with screening prior to starting an exercise program (structured or unstructured), and the impact this had on their willingness to engage in physical activity. This was a qualitative study using a focus group methodology. Focus groups were conducted in regionally dispersed sites in which exercise programs were ongoing or had been offered. A total of 122 older adults were included in this study, the majority of whom were African American (72%) with ages ranging from 50s to the 80s. An interview guide was used to facilitate each of the focus groups. Seventeen codes were identified and were reduced to 4 major themes: (1) Description of screening experienced; (2) Perception of purpose or need for screening; (3) Benefits of screening; and (4) Screening as a barrier to exercise. The participants indicated that there were some benefits associated with screening, such as safety assurances, although screening was also noted to be a barrier to exercising. Older adults who were already active, or had regular health care, believed that "screening" was not necessary. Pre-activity screening has different meanings for older adults depending on their own personal situations, resulting in potentially different motivational implications for adopting more active lives. For many, screening increased their sense of confidence and served as a positive motivator. Others felt that screening was irrelevant and actually hindered one's ability to join an activity group. We conclude with recommendations for refocusing future screening guidelines and suggestions for future research.
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Affiliation(s)
- Barbara Resnick
- University of Maryland-Baltimore, Columbia, Maryland, 21045, USA.
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Ory M, Resnick B, Jordan PJ, Coday M, Riebe D, Ewing Garber C, Pruitt L, Bazzarre T. Screening, safety, and adverse events in physical activity interventions: Collaborative experiences from the behavior change consortium. Ann Behav Med 2005; 29 Suppl:20-8. [PMID: 15921486 DOI: 10.1207/s15324796abm2902s_5] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Researchers who conduct physical activity (PA) intervention studies provide an invaluable opportunity to further the prevention science knowledge base for implementing and delivering PA programs. Despite recommendations that screening is important to increase patient safety, the specific screening criteria best suited for different community applications are unknown. To add to the limited knowledge base, we examined the screening procedures and the occurrence of adverse events among more than 5,500 participants from 11 diverse PA interventions participating in a trans-National Institutes of Health (NIH) collaborative known as the Behavior Change Consortium (BCC). Numerous adverse events occur in sedentary, chronically ill, or older populations, although few are attributed to activity/exercise interventions. No serious study-related adverse events (SRAEs) were reported across different screening practices, interventions, and/or populations. Relatively few minor SRAEs were reported (primarily musculoskeletal injuries), emphasizing the need to be aware of potential musculoskeletal sequelae during exercise interventions. One common characteristic of these studies is that they recommended "start low and go slow" strategies, with moderate intensity PA as the goal behavior. Recommendations to reframe the meaning and use of screening criteria to initiate PA in the community are discussed. Although we were unable to conduct generalizable quantitative analyses from our data, the combined experience of the BCC studies provides a unique opportunity to examine PA-related screening and safety issues across diverse populations, settings, and intervention programs.
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Affiliation(s)
- Marcia Ory
- School of Rural Public Health, Texas A&M University System, College Station, TX 77840, USA.
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Abstract
Congestive heart failure (CHF) is a chronic medical problem commonly found in older adults. Management of CHF ideally should combine lifestyle modifications and medication management. Exercise prescriptions and encouraging patients with CHF to exercise can have a significant impact on management of symptoms as well as exacerbation of further disease. The recommended exercise program should ideally incorporate 10 to 15 minutes of warm-up with exercise durations of 20 to 30 minutes and a cool-down period generally repeating the warm up exercises. Exercise should be done at least 3 to 5 days per week and should include a combination of aerobic and resistance exercise. The HEART approach provides a useful guide to help motivate older adults with CHF to exercise regularly. In so doing, older adults with CHF will be helped to improve and maintain cardiac status, decrease the symptoms of CHF, and improve overall quality of life.
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