Physical activity and physical function improved following a community-based intervention in older adults in Georgia senior centers

Development of a frailty prevention program including nutrition and exercise interventions for older adults in senior daycare centers in South Korea using a mixed methods research design

BACKGROUND/OBJECTIVES

The growing aging population has led to an increased utilization of senior daycare centers. This study was conducted to design a program to enhance the health of older adults in senior daycare centers in Chuncheon City, South Korea.

SUBJECTS/METHODS

The study explored the health conditions and dietary patterns of older adults in senior daycare centers. Participants included staff and older adults from senior daycare centers in Chuncheon City. A mixed methods research design was used to obtain both qualitative and quantitative data. Qualitative insights were obtained through in-depth interviews with 26 staff members and older adults, coupled with observations made at 10 senior daycare centers. The quantitative component comprised structured questionnaires and physical measurements of 204 older adults at these centers.

RESULTS

Many of the older adults relied on the meals provided by the center due to their limited cooking abilities. Dental health issues and dysphagia were common. Interviews highlighted the budgetary constraints of the centers in providing wholesome meals and the need for government support to alleviate meal expenses and enhance quality. A structured survey of older adults showed that the average age was 83.3 yrs, with an average of 2 chronic conditions per participant. Frailty analysis of the participants revealed that 56.2% were prefrail and 32.0% were frail. Almost half of the participants (47.0%) used dentures. Based on these findings, a preventive intervention program was proposed, addressing the specific needs and challenges of older adults while promoting overall well-being and preventing frailty.

CONCLUSION

Tailored health promotion strategies are crucial in senior daycare centers. Recommended interventions include staff nutrition education, improved dietary plans, and cost-effective strength training programs. These interventions aim to reduce frailty and enhance the quality of life of older adults in the community via interventions in daycare centers.

Development and Evaluation of a Community Health Program to Promote Physical Activity Among Vulnerable Community-Dwelling Older Adults: Protocol for a Prospective Cohort Study

BACKGROUND

Vulnerable older adults have a high risk of morbidity and mortality. Regular physical activity (PA) can have a positive effect on the health and health-related behavior of this specific target group. However, evidence of the impact and feasibility of community-based PA promotion interventions for vulnerable older adults is still limited.

OBJECTIVE

The BeTaSen (Bewegungs-Tandems in den Lebenswelten Chemnitzer Seniorinnen und Senioren: ein Beitrag zur kommunalen Gesundheitsförderung) study aims to evaluate the (1) impact as well as the (2) feasibility, acceptance, and usefulness of a 12-month low-threshold PA intervention program for community-dwelling vulnerable older adults.

METHODS

For our population-based prospective observational cohort study, a total of 120 vulnerable older adults (aged 75 years or older) in the area of Chemnitz (Germany) will be recruited to participate in (1) weekly neighborhood-based low-threshold PA meetings with trained mentors (activity tandems) and (2) monthly exercise meetings led by trained exercise instructors. Within the intervention, participants will be encouraged to perform the PA independently. Participants will complete assessments, which will include questionnaires as well as objective measurements of their physical, cognitive, and psychosocial health at 3 different time points (baseline, 6 months after the start, and 6 months after the end of the intervention). Additionally, a process evaluation will be performed, including questionnaires and qualitative interviews, involving the participants, mentors, and municipal project partner representatives.

RESULTS

The BeTaSen project process began in October 2021, with the start of data collection and intervention in August 2022 in the first neighborhoods of the city of Chemnitz. A total of 86 participants were recruited at the time of submission of the manuscript. Longitudinal results are expected by 2025.

CONCLUSIONS

This study's results will provide insights on (1) the PA behavior of vulnerable older adults as well as the impact of PA interventions on health-related outcomes such as cognitive, physical, and psychosocial health, and (2) the feasible and useful components of community-based PA interventions. Thus, this pilot study contributes to future recommendations and provides a basis for further research, such as the development of feasible and sustainable target group-specific interventions in community settings.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/51462.

Using Travel Diaries to Examine the Extent to Which Older Adult Centres Are a Focal Point for Recreation and Social Activities

This study aimed to better understand the extent to which older adult centres are a focal point for recreation and social activities for their members. Travel diaries completed by 261 members of 12 older adult centres across Ontario provided comprehensive and real-time (24-hour) data over two consecutive weeks concerning time away from home, trip purposes, and modes of travel. The data showed that nearly one-third of their trips included a stop at their older adult centre. Three-quarters also went to other community venues over the study period, possibly to access amenities (e.g., pools) not available at their centre. Notwithstanding, their local older adult centre was still a focal point in out-of-home travel, particularly for potentially more vulnerable older adults, including those who were non-drivers, had less education, and felt lonelier. The diaries also substantiated the importance of time spent socializing with peers and staff at the centre, apart from formal program participation.

Impact of Activity Tracker Usage in Combination with a Physical Activity Intervention on Physical and Cognitive Parameters in Healthy Adults Aged 60+: A Randomized Controlled Trial

Regular physical activity (PA) is of central importance for healthy aging and has a well-known impact on helping older adults maintain their cognitive and physical health. Thus, we aimed to compare the effectiveness of two physical activity interventions primarily conducted at home (print-based or web-based vs. web-based plus the use of an activity tracker) on cognitive and physical health parameters in older adults. Data of participants (n = 551, 60–80 years) were analyzed after being randomly allocated to a waitlist control group (CG), a web-based or print-based intervention group (IG) or a web-based intervention group that also included the use of an activity tracker (AG). Measured parameters were grip strength, endurance (two-minute step test), gait speed (four-meter walk test), cognition (Simon task; balanced integration score (BIS), reaction time and accuracy) and physical self-concept (Physical Self-Description Questionnaire (PSDQ)). We found the highest effect sizes in all measured dimensions for AG (grip strength, endurance, gait speed, reaction time, physical self-concept), followed by IG (endurance, gait speed, reaction time, physical self-concept) and CG (endurance, gait speed, BIS). Findings suggest that a combined web-based and activity tracker intervention may improve physical functions, physical self-concept, and cognition in community-dwelling older adults.

Early postoperative physical activity and function: a descriptive case series study of 53 patients after lumbar spine surgery

BACKGROUND

The purpose of this prospective case series study was to compare changes in early postoperative physical activity and physical function between 6 weeks and 3 and 6 months after lumbar spine surgery.

METHODS

Fifty-three patients (mean [95% confidence interval; CI] age = 59.2 [56.2, 62.3] years, 64% female) who underwent spine surgery for a degenerative lumbar condition were assessed at 6 weeks and 3- and 6-months after surgery. The outcomes were objectively-measured physical activity (accelerometry) and patient-reported and objective physical function. Physical activity was assessed using mean steps/day and time spent in moderate to vigorous physical activity (MVPA) over a week. Physical function measures included Oswestry Disability Index (ODI), 12-item Short Form Health Survey (SF-12), Timed Up and Go (TUG), and 10-Meter Walk (10 MW). We compared changes over time in physical activity and function using generalized estimating equations with robust estimator and first-order autoregressive covariance structure. Proportion of patients who engaged in meaningful physical activity (e.g., walked at least 4400 and 6000 steps/day or engaged in at least 150 min/week in MVPA) and achieved clinically meaningful changes in physical function were compared at 3 and 6 months.

RESULTS

After surgery, 72% of patients initiated physical therapy (mean [95%CI] sessions =8.5 [6.6, 10.4]) between 6 weeks and 3 months. Compared to 6 weeks post-surgery, no change in steps/day or time in MVPA/week was observed at 3 or 6 months. From 21 to 23% and 9 to 11% of participants walked at least 4400 and 6000 steps/day at 3 and 6 months, respectively, while none of the participants spent at least 150 min/week in MVPA at these same time points. Significant improvements were observed on ODI, SF-12, TUG and 10 MW (p <  0.05), with over 43 to 68% and 62 to 87% achieving clinically meaningful improvements on these measures at 3 and 6 months, respectively.

CONCLUSION

Limited improvement was observed in objectively-measured physical activity from 6 weeks to 6 months after spine surgery, despite moderate to large function gains. Early postoperative physical therapy interventions targeting physical activity may be needed.

Custom-Made Daily Routine Increases the Number of Steps Taken by Frail Older Adults

This study examined whether the number of steps taken by frail older adults increased after two types of interventions (custom-made daily routine [CDR] vs. exercise) were conducted over 12 weeks. The participants were 36 frail older adults aged 84.5 ± 6.0 years who attended a day-care center. They were assigned to one of three groups: CDR (n = 13), home-based exercise (HE, n = 10), or control (CON, n = 13). A wrist-worn accelerometer was used to measure their step count in 24 hr for 6 days. The CDR group demonstrated a daily step count change of approximately 25%, which was significantly higher than that of the CON group (effect size [r] = .51, p = .040). There were no significant changes in the HE group. Thus, a CDR might be useful for increasing the number of steps in frail older adults.

Effectiveness of a Disability Preventive Intervention for Minority and Immigrant Elders: The Positive Minds-Strong Bodies Randomized Clinical Trial

OBJECTIVE

To test the acceptability and effectiveness of a disability prevention intervention, Positive Minds-Strong Bodies (PMSB), offered by paraprofessionals to mostly immigrant elders in four languages.

DESIGN

Randomized trial of 307 participants, equally randomized into intervention or enhanced usual care.

SETTING

Community-based organizations in Massachusetts, New York, Florida, and Puerto Rico serving minority elders. Data collected at baseline, 2, 6, and 12 months, between May 2015 and March 2019.

PARTICIPANTS

English-, Spanish-, Mandarin-, or Cantonese-speaking adults, age 60+, not seeking disability prevention services, but eligible per elevated mood symptoms and minor to moderate physical dysfunction.

INTERVENTIONS

Ten individual sessions of cognitive behavioral therapy (PM) concurrently offered with 36 group sessions of strengthening exercise training (SB) over 6 months compared to enhanced usual care.

MEASUREMENTS

Acceptability defined as satisfaction and attendance to >50% of sessions. Effectiveness determined by changes in mood symptoms (HSCL-25 and GAD-7), functional performance (SPPB), self-reported disability (LLFDI), and disability days (WHODAS 2.0).

RESULTS

Around 77.6% of intervention participants attended over half of PM Sessions; 53.4% attended over half of SB sessions. Intent-to-treat analyses at 6 months showed significant intervention effects: improved functioning per SPPB and LLFDI, and lowered mood symptoms per HSCL-25. Intent-to-treat analyses at 12 months showed that effects remained significant for LLFDI and HSCL-25, and disability days (per WHODAS 2.0) significantly decreased 6-month after the intervention.

CONCLUSIONS

PMSB offered by paraprofessionals in community-based organizations demonstrates good acceptability and seems to improve functioning, with a compliance-benefit effect showing compliance as an important determinant of the intervention response.

Age at natural menopause and physical functioning in postmenopausal women: the Canadian Longitudinal Study on Aging

OBJECTIVE

The aim of this study was to evaluate the association between categories of age at natural menopause (ANM) and gait speed (slowness) and grip strength (weakness), common measures of physical functioning in older women.

METHODS

We analyzed data from the Canadian Longitudinal Study on Aging, which included participants from seven cities across Canada collected in 2012. The sample was restricted to women who reported to have entered menopause (N = 9,920). Women who had a hysterectomy before menopause were excluded since the age at which this surgical procedure was performed was not available. ANM was categorized into five groups: less than 40 (premature), 40 to 44 (early), 45 to 49, 50 to 54, and more than 54. We conducted linear regressions to assess the association between ANM and gait speed (m/s) and grip strength (kg) adjusting for participant age, education, body mass index, smoking, use of hormone therapy, height, and province of residence.

RESULTS

Mean ANM was 49.8 (95% confidence interval [CI]: 49.7-50.0), with 3.8% of women having a premature menopause; the average gait speed was 0.98 m/s (standard deviation: 0.22), the average grip strength was 26.6 kg (standard deviation: 6.39). Compared to women with ANM of 50 to 54, women with premature menopause had 0.054 m/s (95% CI -0.083, -0.026) lower gait speed when adjusting for age and study site. In the fully adjusted model, the association was attenuated, 0.032 m/s (95% CI -0.060, -0.004). ANM was not associated with grip strength.

CONCLUSION

Our study suggests that premature menopause (<40 years) may be associated with lower gait speed (slowness) among Canadian women. No association was observed between ANM and grip strength. Future studies should include a life course approach to evaluate whether social and biological pathways modify the association between age at menopause and physical function in populations from different contexts.

Positive Effects of a Short-Term Intense Elastic Resistance Training Program on Body Composition and Physical Functioning in Overweight Older Women

The aim of this study was to investigate the effects of a resistance training program (RTP) in older overweight women (OOW) using two different types of elastic devices.

METHODS

This study was a randomized controlled trial with pre- and postintervention measures. Participants included OOW, aged 60-85 years, with no medical history of disease that would preclude them from engaging in physical exercise. Participants were randomly divided into the following groups: elastic tubes with handles group (ETG; n = 22), traditional elastic bands group ( n = 21), and control group (CG; n = 20). Exercise groups (EGs) performed the following supervised RTP: 8 weeks, twice weekly, six overall body exercises, and 3-4 sets of 10 repetitions at a rate of perceived exertion (RPE) of 7-9 on the OMNI-Resistance Exercise Scale of perceived exertion. The controls did not change their usual lifestyle. Outcome measures included body composition (BC; total and regional percentage of fat mass [FM] and fat-free mass [FFM]) and physical performance (PP; dynamic and isometric strength, flexibility, agility/dynamic balance, and endurance).

RESULTS

Both EGs exhibited significantly reduced FM in the upper limbs (ULs) and trunk and increased FFM in the UL, while the ETG exhibited a significantly increased trunk FFM. Both EGs improved in PP, and there were no intergroup differences. Trunk FM and FFM and meters walked differed significantly between the ETG and CG. The CG did not exhibit any significant changes.

CONCLUSION

Training with elastic devices at a moderate-high RPE produces short-term improvements in BC and PP in OOW.

Cost-Effectiveness of a Community Exercise and Nutrition Program for Older Adults: Texercise Select

The wide-spread dissemination of evidence-based programs that can improve health outcomes among older populations often requires an understanding of factors influencing community adoption of such programs. One such program is Texercise Select, a community-based health promotion program previously shown to improve functional health, physical activity, nutritional habits and quality of the life among older adults. This paper assesses the cost-effectiveness of Texercise Select in the context of supportive environments to facilitate its delivery and statewide sustainability. Participants were surveyed using self-reported instruments distributed at program baseline and conclusion. Program costs were based on actual direct costs of program implementation and included costs of recruitment and outreach, personnel costs and participant incentives. Program effectiveness was measured using quality-adjusted life year (QALY) gained, as well as health outcomes, such as healthy days, weekly physical activity and Timed Up-and-Go (TUG) test scores. Preference-based EuroQol (EQ-5D) scores were estimated from the number of healthy days reported by participants and converted into QALYs. There was a significant increase in the number of healthy days (p < 0.05) over the 12-week program. Cost-effectiveness ratios ranged from $1374 to $1452 per QALY gained. The reported cost-effective ratios are well within the common cost-effectiveness threshold of $50,000 for a gained QALY. Some sociodemographic differences were also observed in program impact and cost. Non-Hispanic whites experienced significant improvements in healthy days from baseline to the follow-up period and had higher cost-effectiveness ratios. Results indicate that the Texercise Select program is a cost-effective strategy for increasing physical activity and improving healthy dietary practices among older adults as compared to similar health promotion interventions. In line with the significant improvement in healthy days, physical activity and nutrition-related outcomes among participants, this study supports the use of Texercise Select as an intervention with substantial health and cost benefits.

Impact of universal interventions on social inequalities in physical activity among older adults: an equity-focused systematic review

Background

Physical activity is one of the most important contributors to healthy aging. Public health strategies aiming to promote physical activity among older adults are increasingly being implemented. However, little is known about their impact on social inequalities. Purpose of the study was to analyze whether and how studies of interventions consider effects on social inequalities in physical activity among older adults.

Methods

Nine electronic databases were searched to identify quantitative studies evaluating the effects of interventions on self-reported or objectively measured physical activity among the general population of older adults (≥50 years). English and German language peer-reviewed journal articles published between 2005 and 2015 were included. Using the PROGRESS-Plus framework, data on whether and how social factors were considered both for describing participants’ baseline characteristics and for measuring intervention effects were systematically extracted. Studies examining differential intervention effects by at least one PROGRESS-Plus factor were quality assessed. Results were presented in narrative synthesis.

Results

Fifty-nine studies were included. Beside age and sex, 44 studies used at least 1 further PROGRESS-Plus factor for the description of participants’ baseline characteristics. When measuring intervention effects, 22 studies considered PROGRESS-Plus factors as control variables. Eleven studies reported having analyzed potential effects on inequalities by testing interaction effects, stratifying effect analyses, or exploring associations between PROGRESS-Plus factors and increases in physical activity following an intervention. Effects were most often analyzed by gender/sex (n = 9) and age (n = 9), followed by education (n = 3), marital status (n = 2), and race/ethnicity (n = 2). Five studies pointed to gender/sex- or age-specific intervention effects, indicating that some interventions affect males and females, and younger and older individuals differently.

Conclusions

Many studies evaluating the effects of interventions on physical activity among older adults have not exploited the potential for assessing effects on social inequalities so far. There is an urgent need for systematic application of appropriate methodological approaches and transparent reporting of social inequalities-related findings which can provide important indications for the design of those interventions most likely to be effective across all social groups of older adults.

Trial registration

PROSPERO registration number: CRD42015025066

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-017-0472-4) contains supplementary material, which is available to authorized users.

Is leisure beneficial for older Korean immigrants? An interpretative phenomenological analysis

Leisure is an important quality of life factor for older Korean immigrants. The purpose of this study was to explore leisure benefits associated with health among older Korean immigrants. A total of 18 individuals participated in the study. Using interpretative phenomenological analysis (IPA), three themes emerged from participants' personal statements and experiences: (a) experiencing psychological benefits, (b) strengthening social connections, and (c) coping with acculturative stress. The findings indicate that leisure provided a context in which older Korean immigrants created an emotional and social support system that helped them to experience psychological and social benefits. This research suggested that older Korean immigrants used leisure as a coping mechanism that results in health and well-being.

Improving physical fitness and health status perception in community-dwelling older adults through a structured program for physical activity promotion in the city of Naples, Italy: A randomized controlled trial

AIM

To evaluate the efficacy and feasibility of a physical activity promotion intervention in community-dwelling older adults based on a free program of exercise adapted for older adults aged ≥60 years managed by trainees from the Movement Sciences degree course.

METHODS

A total of 160 adults aged 60-82 years were randomly allocated into the intervention and control group. The exercise program consisted of 1-h sessions carried out twice a week for a year. Control participants received recommendations about an active lifestyle from their physicians. Senior Fitness Tests and the 12-item Short Form Health Survey were used to assess six functional fitness domains of participants and perception of their health status, respectively. Body mass index was also evaluated.

RESULTS

A total of 62 participants completed the exercise path. At the end of the intervention, they showed a significant body mass index decrease (from 27.9 ± 1.6 to 25.1 ± 1.8 kg/m² , P < 0.01), and a significant improvement in functional domains, mainly aerobic fitness (+33.9%, P < 0.01) and agility (+24.2%, P < 0.01), and in good health status perception (+38.7%, P < 0.05). Similar variations were not observed in the control group (P > 0.05). A high acceptance of the intervention was registered among participants (>88.7%); staff competence and gratuitousness were the most appreciated features (>85.5%).

CONCLUSIONS

The structured program represented a useful opportunity to promote physical activity among participants, and it was effective in improving their physical fitness and health status perception. Similar interventions are required to sensitize the whole older population, and experts in Movement Sciences might represent a key figure in this context. Geriatr Gerontol Int 2017; 17: 1421-1428.

Challenges in the Management of Geriatric Obesity in High Risk Populations

The global prevalence of obesity in the older adult population is growing, an increasing concern in both the developed and developing countries of the world. The study of geriatric obesity and its management is a relatively new area of research, especially pertaining to those with elevated health risks. This review characterizes the state of science for this “fat and frail” population and identifies the many gaps in knowledge where future study is urgently needed. In community dwelling older adults, opportunities to improve both body weight and nutritional status are hampered by inadequate programs to identify and treat obesity, but where support programs exist, there are proven benefits. Nutritional status of the hospitalized older adult should be optimized to overcome the stressors of chronic disease, acute illness, and/or surgery. The least restrictive diets tailored to individual preferences while meeting each patient’s nutritional needs will facilitate the energy required for mobility, respiratory sufficiency, immunocompentence, and wound healing. Complications of care due to obesity in the nursing home setting, especially in those with advanced physical and mental disabilities, are becoming more ubiquitous; in almost all of these situations, weight stability is advocated, as some evidence links weight loss with increased mortality. High quality interdisciplinary studies in a variety of settings are needed to identify standards of care and effective treatments for the most vulnerable obese older adults.

A Comparison of Objective Physical Activity, Muscle Strength, and Depression among Community-dwelling Older Women Living in Sloped Versus Non-sloped Environments

OBJECTIVE

To examine the relationship between the living location and outcomes of physical activity level and physical and psychological functioning in older women. The specific aim was to understand the association between living in a sloped versus non-sloped environment and these outcomes.

DESIGN

Cross-sectional study.

SETTING AND PARTICIPANTS

108 older women aged 65 years or older who resided in Nagasaki prefecture participated.

MEASUREMENTS

Physical activity, lung function, muscle strength (hand grip and quadriceps force) and depressive symptoms were assessed objectively.

RESULTS

In logistic regression, activity counts per day (OR 0.779, 95%CI 0.715-0.841, p<0.01), activity times per day (OR 0.821, 95%CI 0.801-0.913, p<0.01), hand grip force (OR 0.666, 95%CI 0.558-0.796, p<0.001), and depressed (Center for Epidemiological Studies Depression Scale score ≥16) (OR 1.093, 95%CI 1.019-1.427, p<0.05) showed statistically significant inverse associations with living in a sloped ground.

CONCLUSIONS

Since dwelling on sloped ground was associated with negative (lower physical activity levels, lower grip strength, and more depression) outcomes, a comprehensive geriatric assessment, related to all aspects of older women, is recommended. Planning of home exercise programs for the elderly should take such environmental factors into consideration.

Eating behaviors, mental health, and food intake are associated with obesity in older congregate meal participants

The relationship between eating behaviors, food intake, and mental health and the occurrence of obesity in older adults has rarely been investigated. Therefore, the objective of this study was to establish the associative links of these factors with two measures of obesity: class I obesity as indicated by body mass index (OB-BMI; BMI ≥ 30 kg/m²) and class I obesity as indicated by waist circumference (OB-WC; WC ≥ 43 inches for men and ≥ 42 inches for women). Older adults participating in the Older American's Act congregate meal program (N = 113, mean age = 74 years, 74% female, 45% African American) were assessed. Eating behaviors (cognitive restraint, uncontrolled eating, and emotional eating), food group choices (sweets, salty snacks, and fruits), and mental health indices (depression, anxiety, and stress) were recorded by questionnaire and related to measured occurrence of OB-BMI and OB-WC. In a series of multivariate logistical regression models, we found cognitive restraint to be consistently and robustly associated with both measures of obesity. In the fully adjusted model, cognitive restraint, consumption of sweets, anxiety, and lack of depression were associated with OB-WC. In summary, we found an association of obesity with abnormal eating behaviors, certain food group intakes, and mental health symptoms in this population. These findings may guide the development of future weight management interventions in a congregate meal setting.

The combined effects of tai chi, resistance training, and diet on physical function and body composition in obese older women

Obesity is a major health problem in the USA, especially in minority populations over the age of 60 years, and the aging process can cause adverse effects on physical function. Previous research has shown that Tai Chi, resistance training (RT), and diet result in overall health improvements. However, the combination of these specific interventions has yet to be translated to obese older women in an urban setting. The purpose of this study was to examine a combined intervention on the primary outcomes of physical function and body composition. Using a nonrandomized design, 26 obese women (65.2 ± 8.1 years) completed a 12-week intervention; participants were assigned to an intervention (EXD) group or a control (CON) group. The EXD group (n = 17) participated in Tai Chi, RT, and a dietary session. The CON group (n = 9) was asked to continue their normal lifestyle. Timed up and go (TUG) time was reduced by 0.64 ± 2.1 seconds (P = 0.04) in the EXD group while the CON group saw a borderline significant increase of 0.71 sec (P = 0.051). The combined intervention helped improve performance on TUG time, but there were no significant increases in other body composition or function measures.

Association of diabetic peripheral arterial disease and objectively-measured physical activity: NHANES 2003-2004

Background

Although much is known about the management of peripheral arterial disease among adults in the general population, the management of this disease among those with diabetes, and the effects of diabetic-induced peripheral arterial disease on objectively-measured physical activity, is unclear. Here, we examined the association between accelerometer-assessed physical activity and peripheral arterial disease among a national sample of U.S. adults with diabetes.

Methods

Data from the 2003–2004 National Health and Nutrition Examination Survey were used. Physical activity was measured using an accelerometer in 254 adults with diabetes. Peripheral arterial disease was assessed via ankle brachial index. Negative binomial regression analysis was used to examine the association between physical activity and peripheral arterial disease.

Results

Results were adjusted for age, gender, race-ethnicity, comorbidity index, smoking, HgbA1C, C-reactive protein, homocysteine, glomerular filtration rate, microalbuminuria, peripheral neuropathy, physical functioning, and medication use. After adjustments, participants with peripheral arterial disease engaged in 23% less physical activity (RR = 0.77, 95% CI: 0.62-0.96) than those without peripheral arterial disease.

Conclusions

These findings demonstrate an inverse association between accelerometer-assessed physical activity and peripheral arterial disease in a national sample of U.S adults with diabetes.

Effectiveness of an oral health educational program on community-dwelling older people with xerostomia

AIM

The purpose of the present study was to evaluate the changes in oral health and function through an oral health educational program for the independent older people with xerostomia.

METHODS

Community-dwelling older people with xerostomia aged over 65 years who participated in a preliminary comprehensive health survey in 2011 were recruited for the educational program. A total of 47 participants were randomly assigned into two groups, the intervention group (n = 26) and the control group (n = 21). The intervention group attended a 90-min oral health education program every 2 weeks for 3 months. The program consisted of oral hygiene instruction, facial and tongue muscle exercise, and salivary gland massage. The control group was provided only general information about oral health. The assessments of oral function, such as oral diadochokinesis of articulation, swallowing, taste threshold and salivary flow rate, were carried out before and after 3 months with or without intervention.

RESULTS

A total of 38 participants (21 of intervention group and 17 of control group) completed the study protocol. In the intervention group, resting salivation significantly improved after the program. The second and third cumulated Repetitive Saliva Swallowing Test times significantly improved in the intervention group. The threshold for bitterness significantly lowered in the intervention group, whereas the sour threshold significantly heightened in the control group after 3 months (P < 0.05).

CONCLUSIONS

The present study suggests that the educational program targeting oral function improvement is effective among the independent older population.

Implementation cost analysis of a community-based exercise program for seniors in South Florida

The objective of the study was to measure the costs of implementing the EnhanceFitness program to elderly residents of South Florida. The Health Foundation of South Florida's Healthy Aging Regional Collaborative implemented EnhanceFitness as part of their initiative to make evidence-based healthy aging programs available to South Florida seniors. Cost data were collected from agencies participating in the delivery of EnhanceFitness classes in South Florida. Cost questionnaires were e-mailed to program coordinators from agencies participating in the delivery of EnhanceFitness classes. Program coordinators worked with accounting staff to complete the questionnaires. Questionnaires were returned via e-mail. Costs were presented from the perspective of participating agencies. Total costs were divided by the number of classes being offered by each agency to determine cost per class per month. Average monthly costs per class were $1,713 during the first year of implementation and $873 during the second year of implementation. The cost measurements, combined with information from the literature on cost savings attributable to EnhanceFitness participation, suggest that EnhanceFitness has the potential to generate a net societal cost savings among program participants. The results are useful for community agencies considering implementing EnhanceFitness for their populations.

Community-based intervention to improve dietary habits and promote physical activity among older adults: a cluster randomized trial

Background

The fastest growing age group globally is older adults, and preventing the need for long-term nursing care in this group is important for social and financial reasons. A population approach to diet and physical activity through the use of social services can play an important role in prevention. This study examined the effectiveness of a social health program for community-dwelling older adults aimed at introducing and promoting physical activity in the home at each individual’s pace, helping participants maintain good dietary habits by keeping self-check sheets, and determining whether long-standing unhealthy or less-than-ideal physical and dietary habits can be changed.

Method

This cluster randomized trial conducted at 6 community centers in an urban community involved 92 community-dwelling older adults aged 65–90 years. The intervention group (3 community centers; n = 57) participated in the social health program “Sumida TAKE10!” which is an educational program incorporating the “TAKE10!® for Older Adults” program, once every 2 weeks for 3 months. The control group (3 community centers; n=35) was subsequently provided with the same program as a crossover intervention group. The main outcome measures were changes in food intake frequency, food frequency score (FFS), dietary variety score (DVS), and frequency of walking and exercise. The secondary outcome measures were changes in self-rated health, appetite, and the Tokyo Metropolitan Institute of Gerontology (TMIG) Index of Competence score.

Results

Compared to baseline, post-intervention food intake frequency for 6 of 10 food groups (meat, fish/shellfish, eggs, potatoes, fruits, and seaweed), FFS, and DVS were significantly increased in the intervention group, and interaction effects of FFS and DVS were seen between the two groups. No significant differences were observed between baseline and post-intervention in the control group. Frequency of walking and exercise remained unchanged in both groups, and no significant difference in improvement rate was seen between the groups. Self-rated health was significantly increased in the intervention group. Appetite and TMIG Index of Competence score were unchanged in both groups.

Conclusions

The social health program resulted in improved dietary habits, as measured by food intake frequency, FFS, and DVS, and may improve self-rated health among community-dwelling older adults.

Trial registration number

UMIN000007357

Evaluation of an intervention using a self-regulatory counselling aid: pre- and post- intervention results of the OPTIMAHL 60plus study

OBJECTIVES

The study covers development and evaluation of an innovative counselling aid in an intervention study. The main purpose of the study was to establish whether improvements in nutrition and physical activity behaviour according to standard recommendations can be demonstrated.

METHODS

OPTIMAHL 60plus is a quasi-experimental study in which participants were assigned in clusters to an intervention or control group. The study was conducted in low socio-economic-status districts in Bremen, Germany. 423 elderly participated at baseline and 369 after 3 months intervention. Face-to-face interviews (24-h recall and frequency questionnaire) were conducted at T0 and T1. χ (2)-tests, sign-test and logistic regression were used for statistical analyses.

RESULTS

No significant differences could be shown when comparing the intervention versus control group at T1. Significant changes from T0 to T1 in the intervention group were identified for daily fruit and vegetable (χ (2)-test, p = 0.04), and for weekly fish consumption (χ (2)-test, p = 0.04). However, similar results could also be shown for the control group.

CONCLUSIONS

A practical counselling aid for elderly was developed and evaluated. Changes in the health behaviour of elderly were identified, but effects could not be clearly traced to the intervention.

Resistance Training in Older Adults

Sarcopenia is associated with substantial health and economic consequences and is emerging as a major public health problem in the older population. The effects of sarcopenia may increase the risk for adverse health outcomes in older adults, and strategies need to be developed to maintain healthy aging. Although several intervention strategies have been proposed, resistance training (RT) has been suggested as the most effective stimulus for optimizing improvements in physical function and body composition with age. Although RT has been established as a safe and efficacious intervention for the prevention and treatment of sarcopenia, very few older adults regularly participate in RT programs. Community-based RT programs may be a feasible strategy because of their accessibility, cost-effectiveness, and lower-intensity training stimuli. However, the effects of these interventions on health outcomes in older adults have not been adequately reviewed. This report will describe the health effects associated with sarcopenia and summarize the major findings from community-based RT interventions on different health outcomes in older adults. Finally, it is suggested that all older adults who demonstrate the ability to safely participate in RT comply with the guidelines recommended by the American College of Sports Medicine.

Promoting walking among older adults living in retirement communities

The authors tested the feasibility and acceptability, and explored the outcomes, of 2 walking interventions based on ecological models among older adults living in retirement communities. An enhanced intervention (EI) was compared with a standard walking intervention (SI) among residents in 4 retirement facilities (N = 87 at baseline; mean age = 84.1 yr). All participants received a walking intervention including pedometers, printed materials, and biweekly group sessions. EI participants also received phone counseling and environmental-awareness components. Measures included pedometer step counts, activities of daily living, environment-related variables, physical function, depression, cognitive function, satisfaction, and adherence. Results indicated improvements among the total sample for step counts, neighborhood barriers, cognitive function, and satisfaction with walking opportunities. Satisfaction and adherence were high. Both walking interventions were feasible to implement among facility-dwelling older adults. Future studies can build on this multilevel approach.

Changes in physical functioning in the Active Living Every Day program of the Active for Life Initiative®

BACKGROUND

Physical activity can prevent or delay the onset of physical functional limitations in older adults. There are limited data that evidence-based physical activity interventions can be successfully translated into community programs and result in similar benefits for physical functioning.

PURPOSE

The purpose of this study is to measure the effects of the Active Living Every Day program on physical functioning and physical functional limitations in a diverse sample of older adults.

METHODS

As a part of the Active for Life initiative, the Council on Aging of Southwestern Ohio implemented Active Living Every Day (ALED), a group-based lifestyle behavior change program designed to increase physical activity. Performance-based physical functioning tests (30-s Chair Stand Test, eight Foot Up-and-Go Test, Chair Sit-and-Reach Test, 30-Foot Walk Test) were administered to participants at baseline and posttest. Baseline to post-program changes in physical functioning and impairment status were examined with repeated measures analysis of covariance. Interactions tested whether change over time differed according to race/ethnicity, body mass index (BMI), and baseline impairment status.

RESULTS

Participants significantly increased their performance in all four physical functioning tests. The percentage of participants classified as "impaired" according to normative data significantly decreased over time. Physical functioning improved regardless of BMI, race/ethnicity, or baseline impairment status.

CONCLUSIONS

ALED is an example of an evidenced-based physical activity program that can be successfully translated into community programs and result in significant and clinically meaningful improvements in performance-based measures of physical functioning.

The effects of diet education plus light resistance training on coronary heart disease risk factors in community-dwelling older adults

OBJECTIVES

To examine the effects of diet education (DE) plus light resistance training (RT) on coronary heart disease risk (CHD) factors, specifically dietary quality, blood lipid and C-Reactive protein (CRP) concentrations in overweight and obese older adults in a community setting.

DESIGN

Community outreach intervention with a quasi-experimental design.

PARTICIPANTS AND SETTING

A total of 96 subjects, 16 males and 80 females, aged 69.2 ± 6.2 years, community-dwelling, and from one of four senior centers in Rhode Island.

INTERVENTION

Subjects participated in 30 minutes of DE (once per week) and ~80 minutes of RT (two separate sessions per week) for eight weeks. The DE sessions were led by a registered dietitian.

MEASUREMENTS

Anthropometrics (height, weight, waist circumference, hip circumference, and body composition), clinical (blood pressure), biochemical (lipid profile, glucose, and CRP concentrations), and diet quality measured by the Dietary Screening Tool (DST).

RESULTS

A significant change was seen in DST risk categories from baseline to post-intervention, χ² (2)=20.43, p < 0.01. Significant differences were seen in triacylglycerol (p=0.028) as well as in systolic and diastolic blood pressures, weight, waist circumference, hip circumference, percent body fat, fat mass, and body mass index (all p<0.05).

CONCLUSION

This intervention effectively decreased CHD risk in overweight and obese older adults. Future research is needed to examine the effects of longer DE plus RT interventions with greater weight loss on the lipid profile and CRP concentrations in overweight and obese older adults at risk for CHD.

A cognitive-behavioral plus exercise intervention for older adults with chronic back pain: race/ethnicity effect?

This pilot study examined the feasibility and potential efficacy of a self-management program for seniors with chronic back pain and assessed for possible race/ethnicity differences in program impact. Sixty-nine seniors (24 African Americans, 25 Hispanics, and 20 non-Hispanic Whites) enrolled in the 8-wk community-based program. Efficacy outcomes included pain-related disability as measured by the Roland Morris Disability Questionnaire (RMDQ), pain intensity, pain self-efficacy, depressive symptoms, social activity, and functional status. Eighty percent of enrollees completed the program. Clinically important decreases in RMDQ scores were found for non-Hispanic White (adjusted change score = -3.53), African American (-3.89), and Hispanic (-8.45) participants. Improvements in all other outcomes were observed, but only for Hispanic participants. Results confirm that implementation of the protocol in urban senior centers is feasible, and the program shows potential efficacy. The race/ethnicity differences observed in the current study merit further investigation.

Improved physical function and physical activity in older adults following a community-based intervention: Relationships with a history of depression

The purpose of this study was to explore the relationship of a history of depression with moderate physical activity and physical function before and after a physical activity intervention of congregate meal participants in senior centers from all 12 Georgia Area Agencies on Aging (AAA). Participants were a convenience sample of older adults (n=376, mean age=76 years, 82% female, 64% Caucasian, 36% African American, 22% a history of depression). The physical activity intervention included educator-led chair exercises that incorporated balls and bands. Pre- and post-tests assessed moderate physical activity and physical function. At the pre-test, a history of depression was not related to moderate physical activity or physical function. Following the intervention there were significant increases in both moderate physical activity and physical function, but a history of depression was a negative predictor of improvements in physical activity when controlled for site, demographics, and health-related conditions. These results provide an evidence base for the effectiveness of this intervention in improving moderate physical activity and physical function in a community setting, but additional efforts may be needed to improve the impact of this type of intervention among older adults with a history of depression.

How many steps/day are enough? For older adults and special populations

Older adults and special populations (living with disability and/or chronic illness that may limit mobility and/or physical endurance) can benefit from practicing a more physically active lifestyle, typically by increasing ambulatory activity. Step counting devices (accelerometers and pedometers) offer an opportunity to monitor daily ambulatory activity; however, an appropriate translation of public health guidelines in terms of steps/day is unknown. Therefore this review was conducted to translate public health recommendations in terms of steps/day. Normative data indicates that 1) healthy older adults average 2,000-9,000 steps/day, and 2) special populations average 1,200-8,800 steps/day. Pedometer-based interventions in older adults and special populations elicit a weighted increase of approximately 775 steps/day (or an effect size of 0.26) and 2,215 steps/day (or an effect size of 0.67), respectively. There is no evidence to inform a moderate intensity cadence (i.e., steps/minute) in older adults at this time. However, using the adult cadence of 100 steps/minute to demark the lower end of an absolutely-defined moderate intensity (i.e., 3 METs), and multiplying this by 30 minutes produces a reasonable heuristic (i.e., guiding) value of 3,000 steps. However, this cadence may be unattainable in some frail/diseased populations. Regardless, to truly translate public health guidelines, these steps should be taken over and above activities performed in the course of daily living, be of at least moderate intensity accumulated in minimally 10 minute bouts, and add up to at least 150 minutes over the week. Considering a daily background of 5,000 steps/day (which may actually be too high for some older adults and/or special populations), a computed translation approximates 8,000 steps on days that include a target of achieving 30 minutes of moderate-to-vigorous physical activity (MVPA), and approximately 7,100 steps/day if averaged over a week. Measured directly and including these background activities, the evidence suggests that 30 minutes of daily MVPA accumulated in addition to habitual daily activities in healthy older adults is equivalent to taking approximately 7,000-10,000 steps/day. Those living with disability and/or chronic illness (that limits mobility and or/physical endurance) display lower levels of background daily activity, and this will affect whole-day estimates of recommended physical activity.

Maintaining functionality in later years: a review of nutrition and physical activity interventions in postmenopausal women

Independence and quality of life of postmenopausal women are influenced by functional status. Nutrition and physical activity impact functional changes through changes in body composition. The article presents a narrative review of the literature to identify interventions that improve the functionality of community-dwelling postmenopausal women. The authors used the Evidence Analysis Approach developed by the American Dietetic Association to appraise current research. Strong evidence does exist that interventions that incorporate both physical activity and nutrition can improve physical function of older women. However, research focusing on functional status and quality of life, in addition to nutrition and exercise, is extremely limited.

Food insecurity, food and nutrition programs, and aging: experiences from Georgia

Food insecurity and hunger are real and growing problems in the United States. Among older adults, the prevalence of food insecurity is at a 14-year high and occurred in more than 8% of households with older adults in 2008 according to USDA. However, the rate is at least 10% higher when less severe degrees of food insecurity are considered. Emerging research suggests that several segments of the older adult population are particularly vulnerable to food insecurity, including those receiving or requesting congregate meals, home-delivered meals, and other community-based services. Thus, national and state estimates of food insecurity may obscure problems in specific subgroups of older adults. Older adults are at high risk of chronic health problems that can be exacerbated by food insecurity, poor nutritional status, and low physical activity. To help improve targeting of food and nutrition programs to those most in need because of food insecurity and/or nutrition-related chronic health problems, the purposes of this review are (1) to define the prevalence and consequences of food insecurity; (2) to discuss the outcomes of some food, nutrition, disease prevention, and health promotion programs targeted to older adults in Georgia, the state with the 3rd highest prevalence of food insecurity; and (3) to make recommendations for research, service, and advocacy related to monitoring and alleviating food insecurity and related health problems in older adults.

Physical limitations contribute to food insecurity and the food insecurity-obesity paradox in older adults at senior centers in Georgia

The purpose of this study was to explore the relationship of obesity and physical limitations with food insecurity among Georgians participating in the Older Americans Act (OAA) congregate meal-site program (N = 621, median age = 76 years, 83% female, 36% Black, and 64% White, convenience sample). Food insecurity was assessed using the modified 6-item US Household Food Security Survey Module; obesity was defined as Body Mass Index (BMI) or waist circumference (WC) class I or II obesity; and physical limitations (arthritis, joint pain, poor physical function, weight-related disability) were based on the Disablement Process. A series of multivariate logistic regression models found weight-related disability and obesity (WC class II) may be potential risk factors for food insecurity. Thus, obesity and weight-related disability may be risk factors to consider when assessing the risk of food insecurity and the need for food assistance in this vulnerable subgroup of older adults.

High BMI and waist circumference are associated with a high prevalence of comorbidities in older Americans Act programs in Georgia senior centers

OBJECTIVE

This study characterized the relationship of body mass index (BMI) and high waist circumference (WC) with the prevalence of selected comorbidities among older adults receiving nutrition and wellness services from Georgia's Older Americans Act programs at senior centers.

METHODS

Participants were a convenience sample (N = 759, mean age = 75 years, 81% female, 63% white, 36% black). Correction factors were applied to measured WC and to measured and self-reported height and weight.

RESULTS

The prevalence of several comorbidities showed striking relationships with WC and BMI, independent of age, gender, and race.

CONCLUSION

The health burden of overweight/obesity is very high in these older adults creating an urgent need for evidence-based nutrition, physical activity programs, and therapeutic lifestyle counseling to prevent and manage weight-related comorbidities.

Correction: Expected values for pedometer-determined physical activity in older populations

Correction to Tudor-Locke C, Hart TL, Washington TL: Expected values for pedometer-determined physical activity in older populations. International Journal of Behavioral Nutrition and Physical Activity 2009, 6:59

Fruit and vegetable intake and knowledge increased following a community-based intervention in older adults in Georgia senior centers

Our purpose was to evaluate a community-based fruit and vegetable intervention conducted in rural and urban areas of Georgia. Participants were a convenience sample from Georgia senior centers that completed a pre-test, the intervention, and a post-test (N = 558, mean age = 75, 83% female, 47% white, 53% black). The 4-month intervention had eight sessions focused on practical ways to increase intake of fruits and vegetables at meals and snacks and included physical activity. Pre- and post-tests examined self-reported intakes of fruits and vegetables at breakfast, lunch, the evening meal, and snacks, knowledge of recommended intakes, and barriers to intake. Following the intervention, the number of participants reporting consumption of at least 7 servings of fruits and vegetables daily increased by 21-percentage points (P < or = 0.001), knowledge that 7 to 10 servings of fruits and vegetables are recommended daily (for 1,600 to 2,200 calories) increased from 7% to 57% (P < or = 0.001), and three barriers to fruit and vegetable intake decreased (P < or = 0.05): "difficulties with digestion," "too many are recommended," and "too much trouble." Regression analyses indicated that increased intake following the intervention was independently associated with living in more urban rather than rural areas, improved knowledge of intake recommendations, decrease in perception of cost as a barrier, and increase in digestive problems as a barrier (P < or = 0.05). These results provide an evidence base for the effectiveness of this community intervention for improving knowledge and intake and decreasing barriers to fruit and vegetable intake in older adults.