Effects of physical activity on health status in older adults. I: Observational studies

Physical activity in older adults with metastatic gastrointestinal cancer: a pilot and feasibility study

Objectives

This study determined the feasibility of delivering a 12-week structured physical activity programme during chemotherapy to older adults recently diagnosed with metastatic gastrointestinal (GI) cancer.

Methods

This study used a single-cohort design. Older adults (aged ≥65 years) diagnosed with metastatic oesophageal, gastric, pancreatic or colorectal cancer who planned to initiate chemotherapy were enrolled. The physical activity programme included a combination of aerobic, flexibility, strength and balance modalities delivered by a certified cancer exercise trainer during chemotherapy infusion appointments, then translated and sustained at home by participants. The co-primary endpoints included: (1) accrual of 20 participants in 12 months and (2) physical activity adherence of ≥50%.

Results

Between March and October 2018, 29 participants were screened, and 20 were enrolled within 12 months (recruitment rate: 69% (90% CI: 55% to 83%); p<0.001), meeting the first co-primary endpoint. The median age of participants was 73.3 years (IQR: 69.3-77.2). At week 12, 67% (90% CI: 48% to 85%) of participants adhered to ≥50% of the prescribed physical activity (p=0.079 (statistically significant)), meeting the second co-primary endpoint. From baseline to week 12, accelerometer-measured light-intensity and moderate-intensity to vigorous-intensity physical activity increased by 307.4 (95% CI: 152.6 to 462.2; p<0.001) and 25.0 min per week (95% CI: 9.9 to 40.1; p=0.001), respectively. There were no serious or unexpected adverse events. The median overall survival was 16.2 months (8.4-22.4).

Conclusion

These results establish the feasibility of a larger scale randomised controlled trial that enrols older adults with metastatic GI cancer and delivers a structured physical activity programme during chemotherapy.

Trial registration number

NCT03331406.

The relationship between socioeconomic status and depression among the older adults: The mediating role of health promoting lifestyle

BACKGROUND

Depression is the most frequent psychiatric disorder among the older adults, the purpose of this study is to explore the mediation effect of health promoting lifestyle on the relationship between Socioeconomic Status (SES) and depression, so as to provide practical reference for effectively preventing and alleviating depression of the older adults.

METHODS

A multi-stage random sampling method was conducted in Shanxi Province. A total 8526 older adults were included in the analysis. Regression analysis was used to explore the relationship between the socioeconomic status, health promoting lifestyle and depression, and the mediation effect test process was used to verify the mediating mechanism of health promoting lifestyle on this relationship.

RESULTS

62.1% of the older adults had depression symptoms in this study, and there were significant differences in depression scores among the older adults with gender, age, residence, marital status, endowment pattern, self-care ability, exercise frequency, physical examination frequency, daily diet rules(P<0.05). The results of mediating effect analysis showed that health promoting lifestyle as mediation effect between social economic status and depression was established, and the mediating effect was accounted for (a*b/c) 63.1%.

LIMITATIONS

Given the cross-sectional study, it is not possible to make causal inferences.

CONCLUSIONS

There were different degrees of depression in the older adults. The lower the SES is, the higher the risk of depression is. This result once again confirms the social causation theory. Combined with the theory of health risk behavior, the study further confirmed the applicability of lifestyle mechanism in the intermediate mechanism of the relationship between SES and depression in the elderly. Thus, in addition to providing material support and financial assistance, helping the elderly develop a healthy lifestyle is also effective measure to improve their depression.

Community science participants gain environmental awareness and contribute high quality data but improvements are needed: insights from Bumble Bee Watch

Bumble Bee Watch is a community science program where participants submit photos of bumble bees from across Canada and the United States for expert verification. The data can be used to help better understand bumble bee biology and aid in their conservation. Yet for community science programs like this to be successful and sustainable, it is important to understand the participant demographics, what motivates them, and the outcomes of their participation, as well as areas that are working well or could be improved. It is also important to understand who verifies the submissions, who uses the data and their views on the program. Of the surveyed users, most participate to contribute to scientific data collection (88%), because of a worry about bees and a desire to help save them (80%), to learn more about species in their property (63%) or region (56%), and because of a personal interest (59%). About 77% report increased awareness of species diversity, while 84% report improvement in their identification skills. We found that 81% had at least one college or university degree. There were more respondents from suburban and rural areas than urban areas, but area did not affect numbers of submissions. While half were between 45 and 64 years of age, age did not influence motivation or number of submissions. Respondents were happy with the program, particularly the website resources, the contribution to knowledge and conservation efforts, the educational values, and the ability to get identifications. Areas for improvement included app and website functionality, faster and more detailed feedback, localized resources, and more communication. Most respondents participate rarely and have submitted fewer than ten records, although about five percent are super users who participate often and submit more than fifty records. Suggested improvements to the program may increase this participation rate. Indeed, increased recruitment and retention of users in general is important, and advertising should promote the outcomes of participation. Fifteen experts responded to a separate survey and were favorable of the program although there were suggestions on how to improve the verification process and the quality of the submitted data. Suggested research questions that could be asked or answered from the data included filling knowledge gaps (species diversity, ranges, habitat, phenology, floral associations, etc.), supporting species status assessments, effecting policy and legislation, encouraging habitat restoration and management efforts, and guiding further research. However, only about half have used data from the project to date. Further promotion of Bumble Bee Watch and community science programs in general should occur amongst academia, conservationists, policy makers, and the general public. This would help to increase the number and scope of submissions, knowledge of these species, interest in conserving them, and the overall program impact.

Prevalence and related influencing factors of depressive symptoms among empty-nest elderly in Shanxi, China

BACKGROUND

In China, aging has become a serious social problem, and the number of empty-nest elderly is on the rise. The aim of this study is to clarify the prevalence of depressive symptoms among empty-nest elderly in Shanxi province and evaluate the effects of sociodemographic factors and health-promoting lifestyles so as to provide a scientific reference for preventing and intervening their depression.

METHODS

A cross-sectional study, which used a multi-stage random cluster sampling way, was conducted among 4901 empty-nest elderly in Shanxi. An independent t-test and a chi square test were used to compare the sociodemographic factors, depression scores, and health-promoting lifestyle scores of the empty-nest elderly. Multinomial logistic regression was used to analyze the potential influencing factors for depression.

RESULTS

The prevalence of depressive symptoms in the population was 64.2%. Among all participants 1,776 (36.2%) had mild depression, 1,236 (25.2%) had moderate depression, and 135 (2.8%) had severe depression. The health-promoting lifestyle of the empty nesters in this study was at the medium level (2.51 ± 0.47). Gender, education level, old-age provision model, exercise frequency, chronic disease, relationships with children, self-care ability, and health-promoting lifestyles were found to be influencing factors of depression and all variables had different effects on different degrees of depression.

LIMITATIONS

This was a cross-sectional study, so the results cannot establish causal relationships among the study variables.

CONCLUSIONS

Depression was prevalent among the empty-nest elderly in Shanxi. Maintaining good interpersonal relationships, developing extensive interests, and maintaining healthy lifestyles including good nutrition habits and regular exercises can reduce the incidence of depression among empty nesters.

A Pilot Randomized Trial of an Intervention to Enhance the Health-Promoting Effects of Older Adults' Activity Portfolios: The Engaged4Life Program

The purpose of this study was to evaluate the feasibility and outcomes of the Engaged4Life program, an intervention to encourage inactive community-dwelling older adults to embed physical activity, cognitive activity, and social interaction into their everyday lives in contexts that are personally meaningful and natural for them. Fifteen participants were randomized to the intervention group (technology-assisted self-monitoring of daily activity via pedometers and daily tablet-based surveys; psychoeducation + goal-setting via a 3-hour workshop; and peer mentoring via phone 2×/week for 2.5 weeks) and 15 to the control (technology-assisted self-monitoring only). Recruitment was shown to be feasible and efficient, but not able to reach the target for men. Retention rate was 83% and participants manifested high adherence and engagement with the intervention. Though this pilot trial was not powered to demonstrate significant differences between groups, daily steps increased by 431 (11% increase) from baseline to Week 4 for the intervention (p < .05), but decreased by 458 for the control, for a net difference of 889 steps (p < .05). Findings were sustained at Week 8 (p < .01). In a future trial, difficulties in recruiting men, barriers due to the technology-intensive design, and the optimization of secondary outcome measures should be addressed.

Self-reported major mobility disability and mortality among cancer survivors

OBJECTIVE

To quantify the prevalence of self-reported major mobility disability (SR-MMD) and its association with mortality in a nationally-representative sample of cancer survivors.

MATERIALS AND METHODS

This study included patients with a history of cancer who participated in the National Health and Nutrition Examination Survey 19992010. SR-MMD was defined as self-reported difficulty or inability to walk a quarter of a mile. Vital status through December 15, 2011 was ascertained from the United States National Center for Health Statistics. Multivariable-adjusted Cox regression models were used to quantify the hazard ratio (HR) and 95% confidence interval (CI) between SR-MMD and mortality.

RESULTS

The study included 1458 cancer survivors who averaged 67.1 years of age. At baseline, 201 (13.7%) participants had SR-MMD. During a median follow-up of 4.7 years, 434 (29.8%) participants died. SR-MMD was independently associated with a higher risk of all-cause mortality [HR: 2.15 (95% CI: 1.56-2.97); P < 0.001] and cancer-specific mortality [HR: 2.49 (95% CI: 1.53-4.07); P < 0.001]. The association between SR-MMD and all-cause mortality was not modified by age, sex, time since cancer diagnosis, body mass index, or comorbid health conditions.

CONCLUSION

SR-MMD is an easily ascertainable metric of physical function that is associated with a higher risk of mortality among cancer survivors. Integrating measures of physical function may help to guide clinical decision-making and improve long-term prognostication in this population. Interventions that prevent the development of SR-MDD, such as physical activity, should be evaluated in this population.

Mediation Effect of Physical Activity on Obesity in Black Women

BACKGROUND AND OBJECTIVE

Sociodemographic and lifestyle factors, physical activity, diet, and nutrients are important in the understanding of obesity. The possibly direct or indirect nature of the associations among these factors and the eventual link to obesity is not well understood. In this study, we assess the indirect association between socio-demographic factors and obesity.

DESIGN

A case-control study involving African American women conducted at Howard University Cancer Center.

PARTICIPANTS AND METHODS

One hundred ninety eight participants gave information on anthropometric measurements, intake of dietary supplements and nutrients, socio-demographic factors (age, marital status, income and education) and physical activity. Path analysis was utilized to assess associations between socio-demographic factors and obesity through physical activity, dietary supplements and nutrients, smoking or alcohol consumption.

MAIN RESULTS

The mean age of the participants was (55 ± 12 years), with 50% being obese (BMI ≥ 30 kg/m²). Obesity level decreased by approximately 7% for every one level increase in education via its prior effect on vigorous physical activity. Age had a significant positive indirect effect on obesity through vigorous physical activity - with obesity levels increasing by approximately 6% for every one year increase in age via its prior effect on vigorous physical activity.

CONCLUSIONS

Vigorous physical activity mediates the association between education and age on obesity.

The Relationship Between Subjective Falls-Risk Assessment Tools and Functional, Health-Related, and Body Composition Characteristics

We sought to explore the relationship between two subjective falls-risk assessment tools (Falls Efficacy Scale–International [FES-I] and Activities-Specific Balance Confidence [ABC] Scale) and functional, health-related, and body composition characteristics. A total of 245 community-dwelling people aged 60 to 88 years underwent assessments for subjective falls risk (using the FES-I and ABC Scale), health-related (cognitive; Short-Form Health Survey [SF-12]), functional (physical activity and physical function), and body composition characteristics (measured by dual X-ray absorptiometry). The FES-I and ABC Scale are strongly correlated with each other for females and males ( r = −.70, p < .001; r = −.65, p < .001), respectively. There are substantial differences between males and females when they self-assess their risk of falling as well as what characteristics contribute to explaining these self-assessments. Females are potentially more self-aware of their functional, body composition and health-related characteristics to better estimate their own risk of falling. FES-I correlates better with functional, body composition, and health-related characteristics, and thus may be more appropriate for use than the ABC in community-dwelling older adults.

Community-Based Health Coaching, Exercise, and Health Service Utilization

Objectives: The outcomes of the California Public Employees Retirement System’s Health Matters program, a replication of a health promotion and fitness program known as the Senior Wellness Program (SWP), are reported. Method: A randomized controlled design ( n = 504) was used. Eligibility included one or more qualifying chronic health conditions, age 65 or older, member of a participating health plan, and owner of a CalPERS long-term care insurance policy. Disability risk factors were measured via questionnaires and included health status, pain, exercise, depression, and social activity. Activity was compiled in project records. Results: At 12 months, Health Matters members were engaged in significantly more stretching and aerobic exercise than the controls. Depressive symptoms decreased among those with moderate or higher symptom scores. Discussion: Health Matters extends the SWP model to younger, more active, and healthier individuals with improvements in duration of exercise and stretching; use of other health promotion activities was low.

Perceived discrimination is associated with health behaviours among African-Americans in the Jackson Heart Study

BACKGROUND

Using Jackson Heart Study data, we examined associations of multiple measures of perceived discrimination with health behaviours among African-Americans (AA).

METHODS

The cross-sectional associations of everyday, lifetime and burden of discrimination with odds of smoking and mean differences in physical activity, dietary fat and sleep were examined among 4925 participants aged 35-84 years after adjustment for age and socioeconomic status (SES).

RESULTS

Men reported slightly higher levels of everyday and lifetime discrimination than women and similar levels of burden of discrimination as women. After adjustment for age and SES, everyday discrimination was associated with more smoking and a greater percentage of dietary fat in men and women (OR for smoking: 1.13, 95% CI 1.00 to 1.28 and 1.19, 95% CI 1.05 to 1.34; mean difference in dietary fat: 0.37, p<0.05 and 0.43, p<0.01, in men and women, respectively). Everyday and lifetime discrimination were associated with fewer hours of sleep in men and women (mean difference for everyday discrimination: -0.08, p<0.05 and -0.18, p<0.001, respectively; and mean difference for lifetime discrimination: -0.08, p<0.05 and -0.24, p<0.001, respectively). Burden of discrimination was associated with more smoking and fewer hours of sleep in women only.

CONCLUSIONS

Higher levels of perceived discrimination were associated with select health behaviours among men and women. Health behaviours offer a potential mechanism through which perceived discrimination affects health in AA.

Effect of age and activity level on lower extremity gait dynamics: an introductory study

Elderly adults should perform exercises that maintain or improve balance to reduce risk of injury from falls. Bone fractures secondary to falls in the elderly, particularly sedentary females, continue to pose a major health and economic problem. A greater understanding of the processes that contribute to the propensity for falling may be obtained by considering changes in gait biodynamics with age and activity level. Therefore, the purpose of this study was to quantify the relationships between age/activity level and selected biodynamic parameters of the lower extremity during normal gait. Seventeen healthy women, 9 young and 8 elderly, were divided into groups of 9 active and 8 sedentary subjects. Three-dimensional (3D) video motion and force platform kinematic and kinetic data were collected from the hip, knee, and ankle of the right lower extremity as the subjects walked at self-selected speeds. Data were analyzed as functions of age and activity level by using a 2-way analysis of variance. As expected, our results show that the elderly group had significantly greater (p < 0.05) functional and mobility limitations in their lower extremity joints than did the younger group. Significant, age-related lower-limb gait alterations were manifested primarily at the ankle, whereas activity-related alterations were manifested most prominently at the hip. The knee showed the fewest changes accompanying age or activity level. Thus, age and activity level affect gait, which may have a role in the subsequent development of a predisposition to gait-related imbalances and resultant falling and increased hip fracture risk. Strength and conditioning professionals may consider these factors related to age and activity level when individualizing exercise regimens for their older, or sedentary, clients. Prophylactic physical activities involving specific, controlled 3D body movements may help prevent abnormal lower-limb joint kinematics (and their hypothetically coupled, intrinsic postural control strategies), thereby reducing fall and fracture propensity.

The effects of weight and physical activity change over 20 years on later-life objective and self-reported disability

Background: Weight and health behaviours are known to affect physical disability; however the evidence exploring the impact of changes to these lifestyle factors over the life course on disability is inconsistent. We aimed to explore the roles of weight and activity change between mid and later life on physical disability.

Methods: Baseline and 20-year clinical follow-up data were collected from1418 men and women, aged 58–88 years at follow-up, as part of a population-based observational study based in north-west London. At clinic, behavioural data were collected by questionnaire and anthropometry measured. Disability was assessed using a performance-based locomotor function test and self-reported questionnaires on functional limitation and basic activities of daily living (ADLs).

Results: At follow-up, 39% experienced a locomotor dysfunction, 24% a functional limitation and 17% an impairment of ADLs. Weight gain of 10–20% or >20% of baseline, but not weight loss, were associated with increased odds of a functional limitation [odds ratio (OR) 1.69, 95% confidence interval (CI) 1.14-2.49 and OR 2.74, 1.55-4.83, respectively], after full adjustment for covariates. The same patterns were seen for the other disability outcomes. Increased physical activity reduced, and decreased physical activity enhanced the likelihood of disability, independent of baseline behaviours and adiposity. The adverse effects of weight gain appeared to be lessened in the presence of increased later-life physical activity.

Conclusion: Weight and activity changes between mid and later life have strong implications for physical functioning in older groups. These findings reinforce the importance of the maintenance of healthy weight and behaviour throughout the life course, and the need to promote healthy lifestyles across population groups.

Exercise at 65 and beyond

Aging is characterized by increasing muscle loss, physical inactivity and frailty. Physical inactivity is known to be associated with increased incidence of obesity and many life-threatening chronic conditions. We know that exercise, through many factors including antiinflammatory effects and enhanced fitness, can help prevent and treat many chronic diseases as well as help maintain independent living. We set out to demonstrate the utility of regular exercise in this potentially vulnerable age group in both the treatment and prevention of chronic diseases. The benefits, risks and recommendations for physical activity are discussed with an emphasis on practical advice for safe exercise in the context of established international guidelines. These guidelines typically state that 150 min per week of moderate aerobic intensity exercise should be achieved with some additional whole-body strength training and balance work. Individual risk assessment should be undertaken in a way to enable safe exercise participation to achieve maximum benefit with minimum risk. The risk assessment, subsequent advice and prescription for exercise should be personalized to reflect individual fitness and functional levels as well as patient safety. Newer and potentially exciting benefits of exercise are discussed in the areas of neuroscience and inflammation where data are suggesting positive effects of exercise in maintaining memory and cognition as well as having beneficial antiinflammatory effects.

Differences in physical fitness and subjectively rated physical health in Vietnamese and German older adults

This cross-sectional study aims to investigate the differences in physical fitness and subjectively rated physical health of Vietnamese and German older adults in a community dwelling. The Vietnamese sample was a random sample of 96 community-dwelling individuals aged 60 to 80 years; 50 % were women. Education is 0 % less than 5 years, 23.95 % 5 to 9 years, 47.91 % 10 to 12 years, and 28.12 % more than 12 years. The German sample was a random sample of 159 community-dwelling persons aged 59 to 90 years; 79.8 % were women. Education is 1.25 % less than 5 years, 40.25 % 5 to 9 years, 38.84 % 10 to 12 years, and 21.38 % more than 12 years. Senior Fitness Test and Short Form-36 were used as outcome measures. The Vietnamese sample shows significantly higher performance levels in motor abilities, i.e., aerobic fitness, strength, and flexibility. The Vietnamese sample indicates a lower difference in performance levels between age groups than the German sample. No differences in subjectively rated physical health factors were found. The higher performance levels of the Vietnamese sample might reflect a more active lifestyle throughout the life span, especially in socially mediated domains like living arrangements or labor work. Lower performance levels in the studied age groups of the German sample might lead to higher risks of cardiovascular diseases and proneness of falls. A more active lifestyle after retirement could contribute to a healthier, more capable, and more independent individual and collective aging. Subjectively rated health stated is a culturally mitigated domain and therefore might be independent of actual physical fitness levels.

The influence of health-promoting lifestyles on the quality of life of retired workers in a medium-sized city of Northeastern China

OBJECTIVES

The aim of this study was to clarify the actual state of retired workers' lifestyles and quality of life (QOL) in a medium-sized city of Northeastern China and to assess the relationship between these according to differences between gender groups.

METHODS

The Chinese version of the Health Promotion Lifestyle Profile II (HPLP-II), the World Health Organization Quality of Life-BREF (WHOQOL-BREF), and demographic variables were used to measure 343 (aged 50-79 years) retired workers' lifestyles and QOL. The results were analyzed using the t test, one-way analysis of variance, correlation analysis, and multiple linear regression analysis.

RESULTS

Among the six lifestyle subscales of HPLP-II, the highest mean score was for Interpersonal Relations (IR) and the lowest was for Health Responsibility (HR), which has not been reported previously. The youngest group (50-60 years) had higher scores for lifestyles and QOL than the other age groups. When the results were analyzed based on financial situation, the lowest income group (below ¥2000) had the poorest scores. Analysis according to gender group revealed different tendencies for the scores of lifestyle and QOL, as well as in the multiple regression analysis between variables.

CONCLUSION

Our results suggest that an effective approach to maintain a desirable lifestyle and QOL for retired workers at the regional level would be to introduce daily activities to improve HR and to maintain and enhance social support for the low-income populations. Further research is needed to understand the complex causal pathways between regional health and welfare factors, health behavior, and QOL.

Experience Corps: a dual trial to promote the health of older adults and children's academic success

BACKGROUND

As the population ages, older adults are seeking meaningful, and impactful, post-retirement roles. As a society, improving the health of people throughout longer lives is a major public health goal. This paper presents the design and rationale for an effectiveness trial of Experience Corps™, an intervention created to address both these needs. This trial evaluates (1) whether senior volunteer roles within Experience Corps™ beneficially impact children's academic achievement and classroom behavior in public elementary schools and (2) impact on the health of volunteers.

METHODS

Dual evaluations of (1) an intention-to-treat trial randomizing eligible adults 60 and older to volunteer service in Experience Corps™, or to a control arm of usual volunteering opportunities, and (2) a comparison of eligible public elementary schools receiving Experience Corps™ to matched, eligible control schools in a 1:1 control:intervention school ratio.

OUTCOMES

For older adults, the primary outcome is decreased disability in mobility and Instrumental Activities of Daily Living (IADL). Secondary outcomes are decreased frailty, falls, and memory loss; slowed loss of strength, balance, walking speed, cortical plasticity, and executive function; objective performance of IADLs; and increased social and psychological engagement. For children, primary outcomes are improved reading achievement and classroom behavior in Kindergarten through the 3rd grade; secondary outcomes are improvements in school climate, teacher morale and retention, and teacher perceptions of older adults.

SUMMARY

This trial incorporates principles and practices of community-based participatory research and evaluates the dual benefit of a single intervention, versus usual opportunities, for two generations: older adults and children.

Anticholinergic drugs and functional outcomes in older patients undergoing orthopaedic rehabilitation

BACKGROUND

Medications with anticholinergic (antimuscarinic) effects negatively affect physical and cognitive function in community-dwelling older patients. However, it is unknown if anticholinergic drugs exert detrimental effects in older patients undergoing rehabilitation.

OBJECTIVE

The purpose of our study was to assess the effect of anticholinergic drug exposure on functional outcomes in older patients undergoing rehabilitation. We speculated that higher anticholinergic drug exposure would be associated with reduced functional outcomes in this group.

METHODS

Data on clinical characteristics, full medication, anticholinergic drug exposure (total number of anticholinergic drugs [tAD] and Anticholinergic Risk Scale [ARS] score), and Barthel index (BI) score were collected on admission and discharge in a consecutive series of 117 older patients (age 79 [7] years) admitted to the orthopaedic rehabilitation unit of a teaching hospital between July 2010 and March 2011. Outcome measures were BI changes (BI on discharge - BI on admission) during rehabilitation (primary outcome) and length of stay (secondary outcome).

RESULTS

Anticholinergic drugs were prescribed in 38 patients (32.5%). Median and interquartile range for tAD = 0 (0-1); for ARS = 0 (0-1). Poisson regression showed that higher tAD (incidence rate ratio [IRR] = 0.92; 95% CI, 0.88-0.97; P = 0.003) and ARS scores (IRR = 0.97; 95% CI, 0.95-0.99; P = 0.008) on admission independently predicted lower BI changes. Being a woman (IRR = 0.87; 95% CI, 0.78-0.97; P = 0.01), lower Abbreviated Mental Test scores (IRR = 0.94; 95% CI, 0.91-0.97; P < 0.001), and lower BI on admission (IRR = 0.98; 95% CI, 0.97-0.98; P < 0.001), but not tAD or ARS scores, independently predicted increasing length of stay.

CONCLUSIONS

Higher anticholinergic drug exposure on admission independently predicts reduced functional outcomes, but not length of stay, in older patients undergoing orthopaedic rehabilitation.

Effects of disability-associated low energy expenditure deconditioning syndrome

People with neuromuscular disabilities have high rates of sedentary behavior predisposing them to severe deconditioning and significant health risk. We describe this as disability-associated low energy expenditure deconditioning syndrome and propose new approaches for promoting light-to-moderate intensity physical activity in people with disabilities.

Physical activity across adulthood and physical performance in midlife: findings from a British birth cohort

BACKGROUND

Evidence, mainly from cross-sectional studies, suggests that physical activity is a potentially important modifiable factor associated with physical performance and strength in older age. It is unclear whether the benefits of physical activity accumulate across life or whether there are sensitive periods when physical activity is more influential.

PURPOSE

To examine the associations of leisure-time physical activity across adulthood with physical performance and strength in midlife, and to test whether there are cumulative benefits of physical activity.

METHODS

Using data on approximately 2400 men and women from the UK Medical Research Council National Survey of Health and Development, followed up since birth in March 1946, the associations of physical activity levels during leisure time self-reported prospectively at ages 36, 43, and 53 years with grip strength, standing balance, and chair rise times, assessed by nurses at age 53 years (in 1999), were examined in 2010.

RESULTS

There were independent positive effects of physical activity at all three ages on chair rise performance, and at ages 43 and 53 years on standing balance performance, even after adjusting for covariates. These results were supported by evidence of cumulative effects found when using structured life course models. Physical activity and grip strength were not associated in women and, in men, only physical activity at age 53 years was associated with grip strength.

CONCLUSIONS

There are cumulative benefits of physical activity across adulthood on physical performance in midlife. Increased activity should be promoted early in adulthood to ensure the maintenance of physical performance in later life.

Do Not Go Gentle Into That Good Night: The Effect of Retirement on Subsequent Mortality of U.S. Supreme Court Justices, 1801–2006

Mortality hazard and length of time until death are widely used as health outcome measures and are themselves of fundamental demographic interest. Considerable research has asked whether labor force retirement reduces subsequent health and its mortality measures. Previous studies have reported positive, negative, and null effects of retirement on subsequent longevity and mortality hazard, but inconsistent findings are difficult to resolve because (1) nearly all data confound retirement with unemployment of older workers, and often, (2) endogeneity bias is rarely addressed analytically. To avoid these problems, albeit at loss of generalizability to the entire labor force, I examine data from an exceptional subgroup that is of interest in its own right: U.S. Supreme Court justices of 1801–2006. Using discrete-time event history methods, I estimate retirement effects on mortality hazard and years-left-alive. Some substantive and methodological considerations suggest models that specify endogenous effects estimated by instrumental variables (IV) probit, IV Tobit, and IV regression methods. Other considerations suggest estimation by endogenous switching (ES) probit and ES regression. Estimates by all these methods are consistent with the hypothesis that, on average, retirement decreases health, as indicated by elevated mortality hazard and diminished years-left-alive. These findings may apply to other occupational groups characterized by high levels of work autonomy, job satisfaction, and financial security.

The impact of physical activity level on SF-36 role-physical and bodily pain indices in midlife women

BACKGROUND

This study was done to determine whether physical activity at baseline is independently associated with musculoskeletal pain and fulfilling one's physical role over 3 subsequent years.

METHODS

Our research involved a 3-year longitudinal study of over 2400 community-dwelling, midlife women from the Study of Women's Health Across the Nation (SWAN). Measurements included baseline physical activity using the Kaiser Permanente Health Plan Activity Survey and SF-36 role-physical and bodily pain indices at each of 3 annual follow-up visits.

RESULTS

Each 1-point increase on the physical activity score was associated with a 7% greater likelihood of a high role-physical score (95% CI=1.02-1.13) and a 10% greater likelihood of a low bodily pain score (95% CI=1.04-1.17) after adjusting for age, race, menopausal status, educational level, body mass index, depressive symptoms, smoking, and chronic medical conditions. The association between physical activity level and role-physical score was eliminated in the fully adjusted model after adjustment for pain level in post hoc analysis [OR=1.04 (95% CI=0.98-1.09)].

CONCLUSION

This study demonstrates that women who are more physically active at midlife experience less bodily pain over time regardless of menopausal status, sociodemographics, and medical conditions. Higher physical activity level positively impacts fulfilling one's physical role; however, this is mediated by pain level.

Dog ownership, walking behavior, and maintained mobility in late life

OBJECTIVES

To examine dog walking among dog owners and the relationship between walking behavior of dog owners and non-dog owners and maintained gait speed over 3 years.

DESIGN

Cross-sectional and longitudinal analyses of a prospective cohort study.

SETTING

Memphis, Tennessee, and Pittsburgh, Pennsylvania.

PARTICIPANTS

Two thousand five hundred thirty-three community-dwelling adults aged 71 to 82 at 36 months of the Health, Aging and Body Composition Study.

MEASUREMENTS

Dog ownership, reported walking behavior, change in walking behavior, and usual and rapid gait speed over 3 years.

RESULTS

Of 394 dog owners, only 36% walked their dogs at least three times per week. Cross-sectionally, dog walkers were more likely to achieve 150 minutes of walking per week and had faster usual and rapid walking speeds (1.20 vs 1.14 m/s and 1.62 vs 1.52 m/s, respectively; P < .01 for both) than non-dog owners who did not walk at least three times per week and similar speeds as non-dog owners who walked at least 150 minutes per week (P > .50). Three years later, subjects who had been dog walkers at baseline were approximately twice as likely as any other group to achieve recommended walking levels, independent of covariates. Dog walkers experienced similar declines in usual and rapid walking speed as non-dog owners who walked at least three times per week but maintained their initial mobility advantage.

CONCLUSION

Although dog ownership appears to facilitate walking behavior, only a minority of older dog owners walk their dogs. The mobility advantage of dog ownership was seen only in dog walkers and was similar to that associated with any walking. Given suboptimal walking activity in older adults, examining the degree to which dog ownership promotes walking activity in persons who do little walking on their own appears worth pursuing.

Volunteering: a physical activity intervention for older adults--The Experience Corps program in Baltimore

There is compelling evidence supporting the benefits of increased regular physical activity in older adults. The Experience Corps program in Baltimore MD was designed in part as a community based approach to increasing physical activity that would also appeal to older adults who have historically not utilized health promotion programs. The Baltimore Experience Corps program places older volunteers in public elementary schools for 15 h a week in roles designed to improve the academic outcomes of children and, simultaneously, increase the physical, cognitive and social activity of volunteers. This paper reports on the change in physical activity levels among older adults associated with participation in the Baltimore Experience Corps. In a pilot randomized controlled evaluation, older adults were randomly assigned to Experience Corps (EC participants) or a waiting list control group. Ages ranged from 59-86 years, 96% were African American, 94% were women, and 84% had annual incomes less than $15,000. EC participants were required to serve >/=15 h a week. At follow-up after 4-8 months, an analysis of 113 randomized volunteers revealed 53% of the EC participants were more active than the previous year by self-report, as compared to 23% of the controls (p<0.01). When adjusted for age, gender and education, there was a trend toward increased physical activity in the EC participants as calculated by a kilocalorie per week increase of 40%, versus a 16% decrease in the controls (p=0.49). EC participants who reported "low activity" at baseline experienced an average 110% increase in their physical activity at follow-up. Among the controls who were in the "low activity" group at baseline, there was, on average, only a 12% increase in physical activity (p=0.03). Among those who were previously active, there was no significant difference (p=0.30). The pilot results suggest that a high intensity volunteer program that is designed as a health promotion intervention can lead, in the short-term, to significant improvements in the level of physical activity of previously inactive older adult volunteers.

Self-rated health and social role as predictors for 6-year total mortality among a non-disabled older Japanese population

We examined whether social role and self-rated health in an older population were predictors for 6-year total mortality among a non-disabled community-dwelling older population in Saku City, Nagano Prefecture, Japan, surveyed in 1992 and 1998. A total of 8090 men and women aged 65-99 years who reported no disability in performing activities of daily living (ADL) at the time of the survey in 1992 and provided information on their survival status at follow-up 6 years later were analyzed in this study. One dependent variable was survival status in 1998 and independent variables were various factors potentially associated with total mortality, which were obtained from a questionnaire survey at the baseline. During the 6-year interval, having poor self-rated health and poor social roles were identified as significant predictors for total mortality among both men and women. This study revealed that social role and self-rated health are independent predictors for 6-year total mortality for non-disabled Japanese aged 65 years or older.

Association between lifestyle factors and mental health measures among community-dwelling older women

OBJECTIVE

To investigate the association between potentially modifiable lifestyle factors and cognitive abilities/depressive symptoms in community-dwelling women aged 70 years and over.

METHOD

Cross-sectional study of community-dwelling women aged 70 years and over (n=278; mean age=74.6 years). Lifestyle variables assessed included smoking, alcohol consumption, physical activity, nutrition and education. The mental health measures of interest were depression, anxiety, quality of life and cognitive function, as assessed by the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), SF-36, and the Cambridge Cognitive Examination for Mental Disorders of the Elderly (CAMCOG), respectively.

RESULTS

Physically active women were half as likely to be depressed (BDI score > or =10) and anxious (BAI score > or = 8) when compared to their physically inactive counterparts (OR=0.5, 95% CI=0.3-0.8 for both, adjusted for marital status and smoking in the case of depression). Having ever smoked more than 20 cigarettes per day was associated with increased risk of depression (OR=2.8, 95% CI=1.4-5.5, adjusted for marital status and physical activity). Moderate alcohol use was associated with increased likelihood of having a CAMCOG score within the highest 50 percentile (OR=2.0, 95% CI=1.1-3.5, adjusted for age and education), as was more than minimum statutory education (OR=2.0, 95% CI=1.1-3.5, adjusted for age and alcohol consumption). There was no obvious association between vitamin B12/folate deficiency or obesity with any of the measures of interest.

CONCLUSIONS

The results of this study are consistent with the hypothesis that depression is directly associated with heavy smoking and inversely associated with physical activity. They also support the idea that non-harmful alcohol consumption is associated with better cognitive performance. Randomised clinical trials should be now designed to clarify whether management of lifestyle factors reduces the incidence of mood disorders and cognitive impairment in later life.

Adoption of Canada's Physical Activity Guide and Handbook for Older Adults: Impact on Functional Fitness and Energy Expenditure

This study investigated whether a behaviour change program, based on Canada's Physical Activity Guide and Handbook to Healthy Active Living for Older Adults (Health Canada, 1999a), would elicit greater benefits than adoption of the guide and handbook alone. Fifteen older adults received the guide and accompanying handbook and completed the 8-week behaviour change program (mean age 73.2 ± 5.2 yrs), while 14 others received only the guide and handbook (mean age 76.8 ± 10.0 yrs). Functional fitness (lower body strength/endurance, flexibility, agility/dynamic balance) (Rikli and Jones, 1999), and estimated energy expenditure (DiPietro et al., 1993) were measured at baseline and after 8 weeks. Lower body strength/endurance and agility/dynamic balance differed between groups at baseline, p <  0.05. All three functional fitness tests improved in both groups over time, p <  0.05. Estimated energy expended in physical activity increased in both groups over time, p <  0.05; however, there was a significantly greater increase in the behaviour-change group (Group × Time interaction, p <  0.05). Participant response to using the guide and handbook was positive. These results indicate that introduction to Canada's Physical Activity Guide and Handbook to Healthy Active Living for Older Adults leads to benefits, whether or not accompanied by program supports. The group receiving the behaviour change program had a greater increase in energy expenditure, which suggests that such an intervention may ultimately lead to greater health benefits. Key words: behaviour change, chair stand test, community residing, lifestyle activity

Exercise and aging

There is increasing evidence that the black box we have referred to as"biologic aging" is composed of genetic factors and many types of environmental exposures. Some of the most potentially modifiable elements of this syndrome are those attributable to disuse or insufficient exposure to certain kinds or intensities of physical stressors during the course of the life span. Beneficial adaptations to exercise once thought restricted to genetically endowed master athletes now are seen to occur just as predictably in frail elders with chronic disease, opening the door to vastly improved physical function and associated health benefits. Knowledge of the benefits of physical activity, however well substantiated, may be necessary, but it is not sufficient to change either physician-prescribing habits or the likelihood of adoption and long-term adherence to exercise on the part of patients. Ultimately, the penetration of an exercise prescription to optimize aging into the most inactive cohorts in the community,who have the most to gain from increases in levels of physical activity and fitness, will depend on a combination of clear evidence-based guidelines coupled with health professional training and behavioral programs tailored to age-specific barriers and motivational factors.

A social model for health promotion for an aging population: initial evidence on the Experience Corps model

This report evaluates whether a program for older volunteers, designed for both generativity and health promotion, leads to short-term improvements in multiple behavioral risk factors and positive effects on intermediary risk factors for disability and other morbidities. The Experience Corps(R) places older volunteers in public elementary schools in roles designed to meet schools' needs and increase the social, physical, and cognitive activity of the volunteers. This article reports on a pilot randomized trial in Baltimore, Maryland. The 128 volunteers were 60-86 years old; 95% were African American. At follow-up of 4-8 months, physical activity, strength, people one could turn to for help, and cognitive activity increased significantly, and walking speed decreased significantly less, in participants compared to controls. In this pilot trial, physical, cognitive, and social activity increased, suggesting the potential for the Experience Corps to improve health for an aging population and simultaneously improve educational outcomes for children.

Enhancing function in older adults with chronic low back pain: a pilot study of endurance training

OBJECTIVES

To assess the effectiveness of a bicycle endurance program in older adults with chronic low back pain (CLBP) and to identify correlates of exercise adherence.

DESIGN

Prospective cohort.

SETTING

Residential facilities and a tertiary care hospital.

PARTICIPANTS

Adults with CLBP aged 55 years and older. Of 29 subjects who agreed to participate, 3 (10%) were deemed ineligible at baseline. Nineteen subjects (73%) were women, and the median age was 72 years.

INTERVENTIONS

Subjects were assessed at baseline and at 6 and 12 weeks by using standardized questionnaires, physical examination, and endurance testing by a physical therapist. Subjects received a bicycle and instructions to exercise 3 times a week for 12 weeks at a set wattage. A trained rescarcher collected exercise data weekly. Main outcome measures The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), the lumbar spinal stenosis symptom severity and function scales, and kilocalories were used to assess change.

RESULTS

At baseline, subjects were moderately impaired (mean SF-36 physical function score, 52.6). Eighteen (65%) completed the trial. At 12 weeks, physical functioning (SF-36) improved by 11%, mental health (Mental Health Inventory 5-Item Questionnaire) improved by 14%, and CLBP symptoms decreased by 8%. Reasons for withdrawing included illness, family issues, and bicycle-related discomfort.

CONCLUSIONS

The bicycle program was safe and effective for improving functional status and well-being.

Barriers to and benefits of leisure time physical activity in the elderly: differences across cultures

The purpose of this study was to compare ethnic differences in attitudes toward barriers and benefits of leisure-time physical activity (LTPA) in sedentary elderly Mexican (MAs) and European Americans (EAs). An in-home, cross-sectional survey was performed on 210 community-dwelling elders from 10 primary care practices in south Texas that are part of the South Texas Ambulatory Research Network, a practice-based research network. Analytical variables included ethnicity, age, sex, income, education, marital status, and LTPA. Fisher exact test was used to analyze the 100 sedentary elders (LTPA <500 kcal/wk; 63 MAs and 37 EAs). Self-consciousness and lack of self-discipline, interest, company, enjoyment, and knowledge were found to be the predominant barriers to LTPA in both groups. Both groups held similar beliefs about benefits gained from exercise, such as improved self-esteem, mood, shape, and health, but the beliefs about the positive benefits of exercise were more prevalent in MAs. These findings remained after adjusting for age, income, education, marital status, and sex. Some might think that a major barrier lies in misconception about benefits of LTPA, but in this study, both ethnic groups were accurate in their perceived benefits of LTPA. When attempting to engage elderly in LTPA, it is important not only to consider what barriers exist but also what beliefs about the benefits exist.

Associations of aging and birth cohort with body mass index in a biethnic cohort

OBJECTIVE

To examine associations of aging and birth cohort with body mass index (BMI) in a biethnic cohort.

RESEARCH METHODS AND PROCEDURES

This was a longitudinal closed cohort study of 14,500 white and African-American men and women, 45 to 64 years of age, followed for 9 years. Aging was defined as the length of the interval in years between baseline and following visits. Birth cohort was defined by the year in which participants were born. Mixed model analyses were used to examine associations of aging, birth cohort, and BMI in four ethnicity-gender groups.

RESULTS

We found that aging was associated with an increase in BMI in white and African-American men and women. The associations between aging and BMI were stronger in the younger birth cohorts. Except for white women, younger birth cohort was associated with a higher BMI. After adjusting for aging, birth cohort was associated with an increase in BMI of 0.1 kg/m(2) [95% confidence interval (95% CI): -0.1, 0.3] among white women. The corresponding values for African-American women, white men, and African-American men are 0.5 kg/m(2) (95% CI: 0.1, 0.9), 0.6 kg/m(2) (95% CI: 0.4, 0.8), and 0.6 kg/m(2) (95% CI: 0.2, 1.0), respectively.

DISCUSSION

Our analyses show that, in all except white women, people in this age range who were born later have a higher BMI at the same attained age. In all groups, people who are born later gained more weight as they aged. In general, subjects ages 45 to 64 years gained weight as they aged 9 years.

Stressful life events among community-living older persons

OBJECTIVES

To identify the life events that older persons experience as most stressful, to evaluate older persons' perceptions of the consequences of these stressful events for their lives, and to evaluate the relationship of demographic factors and measures of health and functional status to these perceptions.

DESIGN

Cross-sectional study.

PARTICIPANTS

Seven hundred fifty-four community-living persons aged 70 years or older.

MEASURES

During a comprehensive assessment, participants identified the most stressful event that they had experienced in the past 5 years and, subsequently, rated its stressfulness and perceived consequences.

RESULTS

Six hundred three participants (80%) identified a stressful life event. Of these, 18% identified a personal illness, 42% the death of a family member or friend, 23% the illness of a family member or friend, and 17% a nonmedical event. Although participants consistently rated their events as highly stressful, they reported widely varied consequences of these events for their lives. While 27% to 59% of participants across the 4 event types reported considerable negative consequences, 17% to 36% reported positive consequences such as starting new activities that have become important to them and changing for the better how they feel about their lives. Dependence in instrumental activities of daily living and depressive symptoms were independently associated with several negative perceived consequences.

CONCLUSIONS

Older persons experience a wide array of stressful life events, with only a small minority reporting personal illnesses as the most stressful. Similar stressful events can have either negative or positive consequences for older persons' lives. This variation in response to stressful events among older persons may indicate different degrees of resilience, a potentially important factor underlying successful aging that deserves further investigation.

Exercise to prevent and treat functional disability

There are myriad ways in which optimal levels of physical activity over the course of the life span could potentially contribute to the prevention of functional disability in old age. These include direct effects of exercise to maximize physiologic capacity and prevent or delay the onset of disability-related conditions and more indirect effects, such as the modulation of psychosocial factors important in the expression of disability. Epidemiologic studies strongly suggest that functional disability is inversely related to physical activity level or physical fitness in various domains. Experimental studies confirm the benefits of exercise on correlates of disability, such as impairments of muscle strength or performance-based tests of functional limitations. However, the evidence that exercise can actually prevent disability in the long-term is not yet established by data from randomized clinical trials in the general population. Secondary prevention of disability in frail elders has been shown in a few trials. The available evidence, however, suggests that a rational exercise prescription for the prevention and treatment of disability at this time should include promotion of a physically active lifestyle and specific exercises targeting aerobic capacity, strength, and balance. Differential emphasis on specific elements of this prescription may be necessary and appropriate, depending on the etiology of the disability in specific cohorts, severity of physical impairments and functional limitations, and other individual characteristics relevant to exercise feasibility, safety, and efficacy.

Receipt of nutrition and exercise counseling among medical outpatients with psychiatric and substance use disorders

OBJECTIVE

Mentally ill persons represent a population that is potentially vulnerable to receiving a poorer quality of medical care. This study examines the relationship between mental disorders and the likelihood of receiving recommended nutrition and exercise counseling.

DESIGN

Cross-sectional study combining chart-review data and administrative database records.

SETTING

One hundred forty-seven Veterans Affairs (VA) medical centers nationwide.

PATIENTS/PARTICIPANTS

The sample included 90,240 patients with obesity and/or hypertension who had >/=3 medical outpatient visits in the previous year.

MEASUREMENTS AND MAIN RESULTS

The outcomes of interest were chart-documented receipt of nutrition counseling and receipt of exercise counseling in the past 2 years. This chart information was merged with VA inpatient and outpatient administrative databases, which were used to identify persons with diagnosed mental disorders. Most patients received nutrition counseling (90.4%), exercise counseling (88.5%), and counseling for both (85.7%) in the past 2 years. The rates of counseling differed significantly but modestly by mental health status. The lowest rates were found among patients dually diagnosed with comorbid psychiatric and substance use disorders; however, the magnitude of the disparities was small, ranging from 2% to 4% across outcomes. These results were unchanged after controlling for demographics, health status, and facility characteristics using multivariable generalized estimating equation modeling.

CONCLUSIONS

Among patients engaged in active medical treatment, rates of nutrition and exercise counseling were high at VA medical centers, and the diagnosis of mental illness was not a substantial barrier to such counseling. More work is needed to determine whether these findings generalize to non-VA settings and to understand the potential role that integrated systems such as the VA can play in reducing disparities for vulnerable populations.

Factors affecting levels of physical activity in adults

A large proportion of adults in Western cultures are physically inactive, despite several decades of warnings about the potentially negative health consequences of a sedentary lifestyle. Efforts to promote physical activity have focused on identifying its determinants and designing interventions that might effectively promote regular physical activity. The multitude of factors that induce adults to initiate and maintain programmes of physical activity have been divided into those that are invariable (age, gender, race, ethnicity) and those that are presumed to be modifiable (behavioural and personality characteristics, environmental circumstances and community settings). The lack of consistency in the design, analysis and reporting of interventions in the lives of inactive or sedentary individuals has produced equivocal results. However, several social and environmental factors have systematically emerged as determinants of physical activity in adults. In ethnic minorities, the removal of barriers such as unaffordable facilities and unavailable childcare, high crime rates, fear for personal safety and culturally inappropriate activities are of primary importance. Social support from family, peers, communities and healthcare providers has resulted in modest improvements across cultures, ages and genders in selected settings, but the definition of specific interventions and their outcomes deserve additional attention. Longitudinal studies indicate that components of physical fitness are relatively transitory, with low to modest correlations between physical activity and measures of physical fitness in childhood and adolescence and in adulthood. Attempts to explain the activity behaviour of adults by applying various theories in programmes of intervention have also produced mixed results. Successful interventions tailor programmes to individual needs, account for personal levels of fitness, allow for personal control of the activity and its outcomes, and provide for social support by family, peers and communities. The initiation and maintenance of regular physical activity in adults depends on a multitude of biological and sociocultural variables that demand attention across the lifespan.

Excess mortality or institutionalization after hip fracture: men are at greater risk than women

OBJECTIVES

To assess 2-year excess mortality or institutionalization risk associated with hip fracture in community-dwelling people aged 60 and over.

DESIGN

Cohort study.

SETTING

Auckland, New Zealand, from July 1991 to February 1996.

PARTICIPANTS

Five hundred sixty-five community-dwelling older people recently hospitalized with a hip fracture and 782 randomly selected controls, frequency matched for age and gender, living in the same catchment area as the cases.

MEASUREMENTS

Two-year mortality or institutionalization status.

RESULTS

Over half (52.1%) of male hip fracture cases and 12.4% of male controls were dead or institutionalized, compared with 39.2% of female hip fracture cases and 19.7% of female controls. The odds ratio, adjusted for baseline demographic characteristics, medical status, and physical function, for death or institutionalization was 6.89 (95% confidence interval (CI) = 2.75-17.27) for men and 1.48 (95% CI = 1.02-2.19) for women.

CONCLUSIONS

For both men and women who incur a hip fracture, the risks of dying or being institutionalized within 2 years are higher than for their peers. The independent effect of hip fracture on this outcome was significantly greater for men than women. The marked influences of prefracture health status, physical limitations, and gender on outcome have important implications for preventative strategies.

A 3-year follow-up study of social, lifestyle and health predictors of cognitive impairment in a Chinese older cohort

BACKGROUND

Longitudinal data on the older population in the Asian setting are limited. This paper reports the factors associated with the development of cognitive impairment (CI) in a cohort of Chinese elderly aged > or =70 years.

METHODS

The study cohort comprising 2030 subjects aged > or =70 years was assembled in 1991-1992 and followed for 36 months. Baseline information on cognitive function, as well as a number of social and health variables were obtained through face-to-face interview at the respondent's place of residence. The outcome variable was the development of CI among 988 cohort members who were initially free from CI, and who could be contacted at the 36-month follow-up. The instrument used to assess CI was based on the information/orientation part of the Clifton Assessment Procedure for the elderly (CAPE), using a cut-off point of 7.

RESULTS

Of the men, 6.7%, but 22.2% of women had CI at 3-year follow-up. The age-adjusted annual incidence of CI was 1.52% in men, and 6.37% in women. Multivariate logistic regression analysis showed that women had a 2.5-fold increased risk of having CI, compared with men. The risk increased by about 1.5-fold with every 5-year increase in age. Slow gait time, as assessed by the 16-foot walk, was a predictor of CI in both sexes (odds ratio [OR] = 1.03 per second increase, 95% CI : 1.0-1.07). Men residing in institutions had a 4.4-fold increased risk of having CI (95% CI : 1.7-11.1) compared with those residing in community, while the OR among women was 2.5 (95% CI : 1.3-4.9). Among women, no formal education increased the risk of having CI by 3.2-fold (95% CI : 1.8-5.5). Income dependency also increased the risk of CI by about fourfold, and no exercise at baseline was associated with a twofold increased risk of CI. Incident stroke during follow-up also increased the risk of CI (OR = 8.4, 95% CI : 1.2-59.4).

CONCLUSIONS

Older age and female sex were independent factors associated with CI. No formal education, slow gait time and institutionalization increased the risk of CI in both sexes. While education had a stronger effect in women, institutionalization had a stronger effect in men. Financial dependency, lack of exercise and incident stroke played a significant role in women.

Factors influencing participation of African American elders in exercise behavior

This study was designed to examine factors influencing exercise behavior of older African American adults. Using the Transtheoretical Stages of Change Model and focus group methodology, 103 participants were assigned to gender and stage specific groups of 5 to 12 each. The focus group discussion guide was developed to explore the meaning of health and exercise, and factors that influence exercise behavior for each stage of the model. Responses varied by stage and gender. Men and women alike described health as the ability to remain active and participate in desired activities. The meaning of exercise varied, by stage, from the ability to perform household chores to engaging in aerobic activities. Many factors such as health, social support, efficacy, and motivation influenced the desire and ability to exercise. Women were more likely than men to identify family responsibility as a barrier to participation in exercise activities. Participants identified strategies to recruit and retain African American elders in exercise programs. Findings of the study have implications for health professionals designing exercise health promotion programs for older African American adults in community settings.

Mobility difficulties are not only a problem of old age

BACKGROUND

Lower extremity mobility difficulties often result from common medical conditions and can disrupt both physical and emotional well-being.

OBJECTIVES

To assess the national prevalence of mobility difficulties among noninstitutionalized adults and to examine associations with demographic characteristics and other physical and mental health problems.

DESIGN

Cross-sectional survey using the 1994-1995 National Health Interview Survey-Disability Supplement (NHIS-D). We constructed measures of minor, moderate, and major lower extremity mobility difficulties using questions about ability to walk, climb stairs, and stand, and use of mobility aids (e.g., canes, wheelchairs). Age and gender adjustment used direct standardization methods in Software for the Statistical Analysis of Correlated Data (SUDAAN).

PARTICIPANTS

Noninstitutionalized, civilian U.S. residents aged 18 years and older. National Health Interview Survey sampling weights with SUDAAN provided nationally representative population estimates.

RESULTS

An estimated 19 million people (10.1%) reported some mobility difficulty. The mean age of those with minor, moderate, or major difficulty ranged from 59 to 67 years. Of those reporting major difficulties, 32% said their problems began at aged 50 years or younger. Adjusted problem rates were higher among women (11.8%) than men (8.8%), and higher among African American (15.0%) than whites (10.0%). Persons with mobility difficulties were more likely to be poorly educated, living alone, impoverished, obese, and having problems conducting daily activities. Among persons with major mobility difficulties, 30.6% reported being frequently depressed or anxious, compared to 3.8% for persons without mobility difficulties.

CONCLUSIONS

Reports of mobility difficulties are common, including among middle-aged adults. Associations with poor performance of daily activities, depression, anxiety, and poverty highlight the need for comprehensive care for persons with mobility problems.