Adherence, Adhesion, and Dropout Reasons of a Physical Activity Program in a High Social Vulnerability Context

Multivariable Prediction Model Development and Validation for Dropout in Community-Based Going-Out Program for Older Adults

BACKGROUND

We aimed to develop and validate a multivariable model for predicting dropout from a community-based going-out program for older adults.

METHODS

The National Center for Geriatric and Gerontology's Study of Geriatric Syndromes, with a prospective cohort of general older adults, was employed. A total of 5905 older adults who were independent in their activities of daily living were recruited and randomly allocated into training, validation, and testing data sets in a 6:2:2 ratio. An outcome was defined as dropping out of a community-based going-out program within 180 days. An extreme gradient boosting algorithm was used to develop the predictive model using training and validation data sets and to identify feature importance. The model's discrimination and calibration were evaluated in the test data set.

RESULTS

The area under the curve for the receiver operating characteristic ( 95% CI) was 0.701 (0.670-0.732). Sensitivity, specificity, positive predictive value, and negative predictive value and their 95% CIs were 0.253 (0.226-0.277), 0.915 (0.899-0.931), 0.588 (0.560-0.612), and 0.718 (0.692-0.743), respectively, and the slope of the calibration plot was 1.046 (0.909-1.182). Cognitive and physical functions and willingness to engage in exercise/sport activities were selected as the most important features.

CONCLUSIONS

The predictive model reliably indicates whether a participant will drop out when classified as negative but not when classified as positive. Physical and cognitive functions and willingness to engage in physical activity may be primary predictors.

Adherence to a telehealth program for older adults with dementia and their caregivers: A mixed-methods study

The objectives were to analyze the association between the cognitive performance of older adults/caregivers, adherence to a telehealth program and investigate reasons for dropouts, retention and adherence. A mixed-methods study was conducted involving 41 older adults diagnosed with dementia who participated in a 12-week telehealth program that offered physical exercises for the older adults and psychoeducation for the caregivers. Cognitive performance, adherence rates, benefits and reasons for withdrawal, retention and adherence were determined with the aid of questionnaires, field records, and focus groups. No significant association was found between the adherence rate and cognitive performance. The main reason for dropouts was the occurrence of illness during the intervention. The reasons for adherence were the convenience of the online program and the fact that the program was free of cost. The benefits were improvements in the wellbeing, mood of the older adults and the mitigation of progressive symptoms of dementia.

Intensity of a Physical Exercise Programme Executed through Immersive Virtual Reality

Evidence suggests that moderate to vigorous physical activity (MVPA) is necessary for health benefits. Immersive virtual reality is a technology that uses images, sounds, and tactile sensations from a simulated world to encourage healthy behaviours and physical activity. The aims of this research are (1) to determine the duration and intensity of physical activity performed through immersive virtual reality; (2) to determine differences in physical activity intensity according to gender.

METHODS

A nonprobabilistic convenience sample composed of 39 university students of physical education pedagogy, who performed, through immersive virtual reality, a physical activity programme composed of three levels that progressively increased in complexity. Physical activity intensity was measured using accelerometers.

RESULTS

Of the three levels, the most complex was not the one that produced the most minutes of MVPA. The three levels added up to 08:53 min of MVPA. No significant differences were found when comparing them by sex.

CONCLUSIONS

The results of this study suggest that an exercise programme delivered through immersive virtual reality generates MVPA levels, with no major differences between sexes. Further research is needed to confirm the contribution of immersive virtual reality to physical activity.

A Critical Review on New Approaches for Chronic Disease Prevention in Brazil and Canada: From Wholistic Dietary Guidelines to Physical Activity Security

In light of new evidence on the prevention of chronic diseases and the elevated rates of overweight and obesity in Brazil and Canada, this critical review aims to interpret and synthesize current aspects regarding dietary and physical activity initiatives in both countries and make future recommendations. The pioneering work presented in the last Brazilian dietary guidelines has been called a model that can be applied globally, given its conceptualization of healthy eating that translates easily to practical guidance. The new Canadian Food Guide has incorporated similar aspects, also putting the country as a leader in dietary guidance. With these new recommendations, citizens in both Brazil and Canada have access to impactful evidence-informed nutritional guidelines. Both documents propose eating patterns that focus not only on health benefits, such as chronic disease prevention, but also incorporate well-being concerning cultural, economic, sociodemographic, biological, and ecological dimensions. A similar approach is required for physical activity to allow individuals to have attainable health and life goals and thereby fully enjoy their lives, regardless of geographical location, health status, and socioeconomic condition, a concept recently described as physical activity security. The wholistic dietary guidelines from both countries represent a change in paradigm in public health. Likewise, national evidence-based policies are warranted to reduce disparities in physical activity, allowing healthier and more active lifestyles for everyone.

Supervised training in primary care units but not self-directed physical activity lowered cardiovascular risk in Brazilian low-income patients: a controlled trial

BACKGROUND

Public health strategies to increase physical activity in low-income communities may reduce cardiovascular risk in these populations. This controlled trial compared the cardiovascular risk estimated by the Framingham Risk Score (FRS) over 12 months in formally active (FA), declared active (DA), and physically inactive (PI) patients attended by the 'Family Health Strategy' in low-income communities at Rio de Janeiro City, Brazil (known as 'favelas').

METHODS

Patients were matched for age and assigned into three groups: a) FA (supervised training, n = 53; 60.5 ± 7.7 yrs); b) DA (self-reported, n = 43; 57.0 ± 11.2 yrs); c) PI (n = 48; 57.0 ± 10.7 yrs). FA performed twice a week a 50-min exercise circuit including strength and aerobic exercises, complemented with 30-min brisk walking on the third day, whereas DA declared to perform self-directed physical activity twice a week. Comparisons were adjusted by sex, chronological age, body mass index, and use of anti-hypertensive/statin medications.

RESULTS

At baseline, groups were similar in regards to body mass, body mass index, triglycerides, and LDL-C, as well to FRS and most of its components (age, blood pressure, hypertension prevalence, smoking, HDL-C, and total cholesterol; P > 0.05). However, diabetes prevalence was 10-15% lower in DA vs. FA and PI (P < 0.05). Intention-to-treat analysis showed significant reductions after intervention (P < 0.05) in FA for total cholesterol (~ 10%), LDL-C (~ 15%), triglycerides (~ 10%), systolic blood pressure (~ 8%), and diastolic blood pressure (~ 9%). In DA, only LDL-C decreased (~ 10%, P < 0.05). Significant increases were found in PI (P < 0.05) for total cholesterol (~ 15%), LDL-C (~ 12%), triglycerides (~ 15%), and systolic blood pressure (~ 5%). FRS lowered 35% in FA (intention-to-treat, P < 0.05), remained stable in DA (P > 0.05), and increased by 20% in PI (P < 0.05).

CONCLUSIONS

A supervised multi-modal exercise training developed at primary care health units reduced the cardiovascular risk in adults living in very low-income communities. The risk remained stable in patients practicing self-directed physical activity and increased among individuals who remained physically inactive. These promising results should be considered within public health strategies to prevent cardiovascular disease in communities with limited resources.

TRIAL REGISTRATION

TCTR20181221002 (retrospectively registered). Registered December 21, 2018.

Inspiratory threshold loading reduces lipoperoxidation in obese and normal-weight subjects

Obesity is related to increased oxidative stress. Although low-intensity physical exercise reduces oxidative stress, obese subjects may show exercise intolerance. For these subjects, inspiratory threshold loading could be an alternative tool to reduce oxidative stress. We investigated the effects of inspiratory threshold loading on biomarkers of oxidative stress in obese and normal-weight subjects. Twenty obese (31.4 ± 6 years old, 10 men and 10 women, 37.5 ± 4.7 kg/m²) and 20 normal-weight (29.4 ± 8 years old, 10 men and 10 women, 23.2 ± 1.5 kg/m²) subjects matched for age and gender participated in the study. Maximal inspiratory pressure (MIP) was assessed by a pressure transducer. Blood sampling was performed before and after loading and control protocols to assess thiobarbituric acid reactive substances (TBARS), protein carbonylation, and reduced glutathione. Inspiratory threshold loading was performed at 60% MIP and maintained until task failure. The 30-min control protocol was performed at 0 cmH₂O. Our results demonstrated that inspiratory threshold loading reduced TBARS across time in obese (6.21 ± 2.03 to 4.91 ± 2.14 nmol MDA/ml) and normal-weight subjects (5.60 ± 3.58 to 4.69 ± 2.80 nmol MDA/ml; p = 0.007), but no change was observed in protein carbonyls and glutathione in both groups. The control protocol showed no significant changes in TBARS and protein carbonyls. However, reduced glutathione was increased across time in both groups (obese: from 0.50 ± 0.37 to 0.56 ± 0.35 μmol GSH/ml; normal-weight: from 0.61 ± 0.11 to 0.81 ± 0.23 μmol GSH/ml; p = 0.002). These findings suggest that inspiratory threshold loading could be potentially used as an alternative tool to reduce oxidative stress in both normal-weight and obese individuals.