A Motivational Physical Activity Intervention for Improving Mobility in Older Korean Americans

Behavioral change interventions, theories, and techniques to reduce physical inactivity and sedentary behavior in the general population: a scoping review

BACKGROUND

Worldwide, physical inactivity (PIA) and sedentary behavior (SB) are recognized as significant challenges hindering the achievement of the United Nations (UN) sustainable development goals (SDGs). PIA and SB are responsible for 1.6 million deaths attributed to non-communicable diseases (NCDs). The World Health Organization (WHO) has urged governments to implement interventions informed by behavioral theories aimed at reducing PIA and SB. However, limited attention has been given to the range of theories, techniques, and contextual conditions underlying the design of behavioral theories. To this end, we set out to map these interventions, their levels of action, their mode of delivery, and how extensively they apply behavioral theories, constructs, and techniques.

METHODS

Following the scoping review methodology of Arksey and O'Malley (2005), we included peer-reviewed articles on behavioral theories interventions centered on PIA and SB, published between 2010 and 2023 in Arabic, French, and English in four databases (Scopus, Web of Science [WoS], PubMed, and Google Scholar). We adopted a framework thematic analysis based on the upper-level ontology of behavior theories interventions, Behavioral theories taxonomies, and the first version (V1) taxonomy of behavior change techniques(BCTs).

RESULTS

We included 29 studies out of 1,173 that were initially screened/searched. The majority of interventions were individually focused (n = 15). Few studies have addressed interpersonal levels (n = 6) or organizational levels (n = 6). Only two interventions can be described as systemic (i.e., addressing the individual, interpersonal, organizational, and institutional factors)(n = 2). Most behavior change interventions use four theories: The Social cognitive theory (SCT), the socioecological model (SEM), SDT, and the transtheoretical model (TTM). Most behavior change interventions (BCIS) involve goal setting, social support, and action planning with various degrees of theoretical use (intensive [n = 15], moderate [n = 11], or low [n = 3]).

DISCUSSION AND CONCLUSION

Our review suggests the need to develop systemic and complementary interventions that entail the micro-, meso- and macro-level barriers to behavioral changes. Theory informed BCI need to integrate synergistic BCTs into models that use micro-, meso- and macro-level theories to determine behavioral change. Future interventions need to appropriately use a mix of behavioral theories and BCTs to address the systemic nature of behavioral change as well as the heterogeneity of contexts and targeted populations.

The Role of Family Social Networks in Cardiovascular Health Behaviors Among Asian Americans, Native Hawaiians, and Pacific Islanders

Asian American, Native Hawaiians, and Other Pacific Islander (AANHPI) populations experience significant disparities in cardiovascular health. AANHPI populations also have strong, family-centered social relationships and networks. Since social networks may influence health behaviors, this review aimed to summarize research on the relationship between family social networks and cardiovascular health behaviors among AANHPI individuals. Current evidence suggests that family social network structures may play a particularly important role in smoking, dietary pattern, and physical activity behaviors among AANHPI individuals. Family networks may hinder or promote healthy behaviors through several social network mechanisms including social support, social influence, and social control. These effects vary across different AANHPI subgroups. Recommendations for future research on the role of social networks in health behaviors among AANHPI individuals are provided. Drawing on methodological advances and interventions that leverage social networks in AANHPI populations may be an avenue to improve health and reduce disparities.

Interventions simultaneously promoting social participation and physical activity in community living older adults: A systematic review

Background

In recent years, there has been a global trend toward an increase in life expectancy and the proportion of elderly people among the population. In this regard, it becomes important to promote active and healthy aging. Physical inactivity and social isolation are both risk factors of many chronic illnesses and highly prevalent in older adults. This challenges communities to develop interventions that reduce these risk factors among elderly populations. The main aims of this study were to summarize community-based interventions that aim to simultaneously promote social participation and physical activity in older adults and to examine their effects.

Methods

We performed a systematic review based on the PRISMA standards. Literature searches were conducted in six scientific databases in July 2021. Articles were included if they had an interventional design, focused on older adults living in the community and measured social participation and physical activity as an outcome. The data were summarized narratively due to the heterogeneity of studies and the variety of outcome measures.

Results

Overall, 46 articles published in English were included. The studies were grouped in (1) interventions with main focus on physical activity promotion; (2) social activities that included a physical activity component; (3) health behavior interventions/ health education interventions; (4) multicomponent interventions; (5) environmental interventions. The majority of the reviewed studies reported positive effects of interventions on physical activity and/or social participation. No study reported negative effects. Analysis of quantitative studies showed that multicomponent interventions have great positive effects on both outcomes. In qualitative studies positive effects were found regardless of intervention type.

Conclusion

This review summarizes the evidence about the effects of community-based interventions that aim to promote social participation and physical activity in older adults. Multicomponent interventions seem to be most suitable for simultaneous promotion of physical activity and social participation. However, high variability in measurement methods used to assess both social participation and physical activity in the included studies made it difficult to compare studies and to indicate the most effective.

Systematic review registration

www.crd.york.ac.uk, identifier: PROSPERO [CRD42021268270].

Benefits of sustained physical activity from middle age to early old age on quality of life in early old age

This study aimed to examine changes in physical activity (PA) over time (2009-2017) in the same participants and to determine an association between changes in PA and health-related quality of life (HRQoL) in early older adults (n = 994) using data from the Korea Health Panel Survey. HRQoL was measured using the EuroQol system, and the amount of PA was grouped into four activity levels: remained inactive, became inactive, became active, and remained active. The association of changes in PA over 8 years with HRQoL was examined using logistic regression analysis while controlling for socioeconomic and behavioral factors. Total PA decreased from 1859.72 ± 1760.01 MET-minutes in 2009 to 1264.80 ± 1251.14 MET-minutes in 2017 (P < 0.001). In 2017, 142 (14.3%) remained inactive, whereas 419 (42.2%) remained active. Participants who remained inactive in early old age were more likely to be in the lowest 10% HRQoL of the sample (odds ratio = 1.95, 95% confidence interval = 1.09-3.48). These findings indicate that health education and promotion must be prioritized for middle-aged adults, who are relatively inactive, so that they increase their current PA and improve their HRQoL to maximize the benefits of PA in old age.

Engaging community-dwelling older adults as co-developers in a public outdoor exercise facilities-based physical activity education intervention: A mixed-method participatory study in Hong Kong

In Hong Kong, an increasing number of outdoor exercise facilities have been established in public open spaces to promote physical activity (PA) in older adults. However, no intervention is dedicated in educating the public on how to make use of these resources to fulfil the PA guidelines based on behavioural change theory. This study has two phases, phase one aims to describe the participatory development of the intervention, and phase two is the evaluation of a public outdoor exercise facilities-based PA education intervention for community-dwelling older adults. A mixed-methods participatory design was used to evaluate the impact of the intervention. PA behaviour was assessed as the fulfilment of the PA recommendations by World Health Organization, and the Rapid Assessment of Physical Activity (RAPA) scale at baseline, immediately, and 3 and 6 months post-intervention. Psychosocial constructs and physical assessments were carried out at both pre- and post-intervention. Individual in-depth interviews were conducted at post-intervention. Forty-seven participants were enrolled in the intervention. The average adherence rate was 90.87%. PA significantly increased after the intervention and remained elevated for the following 6 months. Post-intervention, the qualitative findings supported the quantitative findings at both the individual and social levels. However, findings regarding the change in participants' usage of environmental resources were divergent. The intervention was well-received by the participating older adults, as reflected by the high adherence rate. Both quantitative and qualitative data demonstrated the overall impacts of the intervention for creating sustainable changes in PA behaviour.

Behaviour change interventions to promote health and well-being among older migrants: A systematic review

Background

Whether behaviour change interventions are effective for the maintenance of older migrants’ health and well-being is uncertain. A systematic review was conducted to assess evidence for the capacity of behaviour change techniques (BCTs) to promote the health and well-being of older migrants.

Methods

Electronic databases (Cochrane CENTRAL, Embase, Ovid MEDLINE and Web of Science) were searched systematically to identify relevant randomised controlled trials, pre–post studies and quasi-experimental studies published before March 2021. Additional articles were identified through citation tracking. Studies examining BCTs used to promote the health and/or well-being of older migrants were eligible. Two independent reviewers used the Behaviour Change Technique Taxonomy version 1 to extract data on BCTs. Data on intervention functions (IFs) and cultural adaption strategies were also extracted. Intervention contents (BCTs, IFs, culture adaption strategies) were compared across effective and ineffective interventions according to health and well-being outcome clusters (anthropometrics, health behaviour, physical functioning, mental health and cognitive functioning, social functioning and generic health and well-being).

Results

Forty-three studies (23 randomised controlled trials, 13 pre–post studies and 7 quasi-experimental studies) reporting on 39 interventions met the inclusion criteria. Thirteen BCTs were identified as promising for at least one outcome cluster: goal-setting (behaviour), problem-solving, behavioural contract, self-monitoring of behaviour, social support (unspecified), instruction on how to perform the behaviour, information about health consequences, information about social and environmental consequences, demonstration of the behaviour, social comparison, behavioural practice/rehearsal, generalisation of a target behaviour and addition of objects to the environment. Three BCTs (instruction on how to perform the behaviour, demonstration of the behaviour, and social comparison) and two IFs (modelling and training) were identified as promising for all outcome clusters.

Conclusions

Thirteen distinct BCTs are promising for use in future interventions to optimise health and well-being among older migrants. Future research should focus on the effectiveness of these BCTs (combinations) in various contexts and among different subgroups of older migrants, as well as the mechanisms through which they act. Given the scarcity of interventions in which cultural adaption has been taken into account, future behavioural change interventions should consider cultural appropriateness for various older migrant (sub)groups.

Trial registration

PROSPERO CRD42018112859.

A Technology-Enhanced Physical Activity Intervention: A Feasibility Study

Using a single-group, pre-posttest design, we evaluated feasibility and acceptability of a technology-enhanced physical activity intervention in 43 midlife (aged 35-64) first-generation Korean American adults who were physically inactive. The intervention consisted of bi-weekly education sessions for 4 weeks, monthly small group walks for the following 8 weeks, and weekly reminder text messages during the entire intervention period. A 100% retention rate, 93% adherence, and 88.4% satisfaction supported the feasibility and acceptability of the intervention. Paired t-tests revealed the intervention was successful and effective as demonstrating a significant increase in self-efficacy and moderate physical activity and improved cardiometabolic health. This easy and motivation enhancing intervention has a wide potential applicability for other ethnic groups. Further intervention research is suggested in a large sample, multisite, for a longer-term with a randomized controlled trial design, which may lead us to narrow the gap in physical activity engagement and cardiometabolic health disparities.

Pilot randomized controlled trial of the Yoga for HEART intervention in community-dwelling older adults

Physical activity reduces cardiovascular risk; however, many older adults do not engage in recommended levels. Theory-based interventions supporting motivation for physical activity are limited. This pilot study evaluated the feasibility of Yoga for Health Empowerment and Realizing Transformation (HEART), a theory-based intervention combining motivation and yoga-based physical activity. Feasibility was addressed as acceptability, demand, implementation fidelity, and limited efficacy in promoting physical activity, cardiovascular health, and mechanisms of action. Sedentary older adults (m = 65 years old, sd = 8.5) were randomized to Yoga for HEART (n=8) or Active Control (n=7) conditions. Yoga for HEART was: (a) acceptable, (b) retention 73%, (c) implemented as planned. A significant main effect for body mass index (BMI) was found in Yoga for HEART participants (p = .02). No significant effects were found for physical activity, other cardiovascular outcomes, or mechanisms of action. Yoga for HEART is feasible and recommended for further testing.

Physical activity interventions among culturally and linguistically diverse populations: a systematic review

OBJECTIVES

To systematically review physical activity interventions among culturally and linguistically diverse (CALD) populations and explore the strategies used to recruit CALD populations, the cultural adaptations made in these interventions, and the cultural adaptations used among successful interventions.

DESIGN

Four electronic databases (Embase, MEDLINE, CENTRAL, and CINAHL) was searched in March 2017 and re-run in January 2018. Manual screening of the reference lists of the included studies was also conducted. Eligibility criteria for inclusion in the systematic review were: intervention studies (e.g. controlled and non-controlled studies), physical activity as primary outcome and as the only health behaviour targeted, culturally and linguistically diverse population of interest, published in English, and targeted adult populations (i.e. aged ≥18).

RESULTS

A total of 19 articles were included in this review, comprising 15 unique studies. Most studies targeted Latino populations, published in the United States, and targeted women. An array of recruitment strategies were used, such as recruiting from religious establishments or religious and cultural events, and community organisations and events. The majority of studies made cultural adaptations to their intervention to suit the CALD population of interest, however, the level of detail of reported adjustments was limited. Successful interventions were those that generally included community consultation to inform their intervention, language adjustments, community health workers/bilingual/bicultural personnel for intervention delivery, recruitment, and data-collection, and using culturally-relevant intervention material.

CONCLUSIONS

Although many studies included in this review reported increases in physical activity at follow-up, the results need to be interpreted with caution due to the lower level of methodological quality and reporting on study methodology. Future interventions designed for CALD populations should be of greater methodological quality and also provide a greater level of transparency in terms of the cultural adaptations that have been made to the intervention.

Interventions for reducing sedentary behaviour in community-dwelling older adults

BACKGROUND

Older adults are the most sedentary segment of society, often spending in excess of 8.5 hours a day sitting. Large amounts of time spent sedentary, defined as time spend sitting or in a reclining posture without spending energy, has been linked to an increased risk of chronic diseases, frailty, loss of function, disablement, social isolation, and premature death.

OBJECTIVES

To evaluate the effectiveness of interventions aimed at reducing sedentary behaviour amongst older adults living independently in the community compared to control conditions involving either no intervention or interventions that do not target sedentary behaviour.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, PsycINFO, PEDro, EPPI-Centre databases (Trials Register of Promoting Health Interventions (TRoPHI) and the Obesity and Sedentary behaviour Database), WHO ICTRP, and ClinicalTrials.gov up to 18 January 2021. We also screened the reference lists of included articles and contacted authors to identify additional studies.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) and cluster-RCTs. We included interventions purposefully designed to reduce sedentary time in older adults (aged 60 or over) living independently in the community. We included studies if some of the participants had multiple comorbidities, but excluded interventions that recruited clinical populations specifically (e.g. stroke survivors).

DATA COLLECTION AND ANALYSIS

Two review authors independently screened titles and abstracts and full-text articles to determine study eligibility. Two review authors independently extracted data and assessed risk of bias. We contacted authors for additional data where required. Any disagreements in study screening or data extraction were settled by a third review author.

MAIN RESULTS

We included seven studies in the review, six RCTs and one cluster-RCT, with a total of 397 participants. The majority of participants were female (n = 284), white, and highly educated. All trials were conducted in high-income countries. All studies evaluated individually based behaviour change interventions using a combination of behaviour change techniques such as goal setting, education, and behaviour monitoring or feedback. Four of the seven studies also measured secondary outcomes. The main sources of bias were related to selection bias (N = 2), performance bias (N = 6), blinding of outcome assessment (N = 2), and incomplete outcome data (N = 2) and selective reporting (N=1). The overall risk of bias was judged as unclear. Primary outcomes The evidence suggests that interventions to change sedentary behaviour in community-dwelling older adults may reduce sedentary time (mean difference (MD) -44.91 min/day, 95% confidence interval (CI) -93.13 to 3.32; 397 participants; 7 studies; I2 = 73%; low-certainty evidence). We could not pool evidence on the effect of interventions on breaks in sedentary behaviour or time spent in specific domains such as TV time, as data from only one study were available for these outcomes. Secondary outcomes We are uncertain whether interventions to reduce sedentary behaviour have any impact on the physical or mental health outcomes of community-dwelling older adults. We were able to pool change data for the following outcomes. • Physical function (MD 0.14 Short Physical Performance Battery (SPPB) score, 95% CI -0.38 to 0.66; higher score is favourable; 98 participants; 2 studies; I2 = 26%; low-certainty evidence). • Waist circumference (MD 1.14 cm, 95% CI -1.64 to 3.93; 100 participants; 2 studies; I2 = 0%; low-certainty evidence). • Fitness (MD -5.16 m in the 6-minute walk test, 95% CI -36.49 to 26.17; higher score is favourable; 80 participants; 2 studies; I2 = 29%; low-certainty evidence). • Blood pressure: systolic (MD -3.91 mmHg, 95% CI -10.95 to 3.13; 138 participants; 3 studies; I2 = 73%; very low-certainty evidence) and diastolic (MD -0.06 mmHg, 95% CI -5.72 to 5.60; 138 participants; 3 studies; I2 = 97%; very low-certainty evidence). • Glucose blood levels (MD 2.20 mg/dL, 95% CI -6.46 to 10.86; 100 participants; 2 studies; I2 = 0%; low-certainty evidence). No data were available on cognitive function, cost-effectiveness or adverse effects.

AUTHORS' CONCLUSIONS

It is not clear whether interventions to reduce sedentary behaviour are effective at reducing sedentary time in community-dwelling older adults. We are uncertain if these interventions have any impact on the physical or mental health of community-dwelling older adults. There were few studies, and the certainty of the evidence is very low to low, mainly due to inconsistency in findings and imprecision. Future studies should consider interventions aimed at modifying the environment, policy, and social and cultural norms. Future studies should also use device-based measures of sedentary time, recruit larger samples, and gather information about quality of life, cost-effectiveness, and adverse event data.

The Use of Smartphone Fitness Applications: The Role of Self-Efficacy and Self-Regulation

With the popularity of the health and wellness trend in recent years, smartphone fitness applications have become more and more popular. Thus, this study explored factors affecting the behavioral intention to use and the actual usage behavior of smartphone fitness apps from technical, health, and social perspectives by integrating the Social Cognitive Theory (SCT) and Unified Theory of Acceptance and Use of Technology (UTAUT). We examined whether perceived usefulness, perceived ease-of-use, social influence, self-efficacy, goal-setting, and self-monitoring predict usage behavior. Based on the survey responses of 1066 smartphone fitness apps users, we revealed that all of the variables, except for self-monitoring, significantly influence usage behavior, while behavioral intention acts as a total mediator between perceived usefulness, perceived ease-of-use and usage behavior. Drawing on the research findings, we suggest that influencing behavioral intention to use a fitness app can be an effective method to increase its adoption. Therefore, app developers need to pay attention to interventions that seek to enhance the usefulness of the app, provide professional counseling, as well as an opportunity for effortless goal setting features.

Older adults' social network and support and its association with physical activity

The purpose of this study was to describe older adults' social network and support during a physical activity intervention and its association with physical activity. Mixed methods were used for this secondary analysis of existing data from a physical activity intervention. Seventy-three participants who completed a session by telephone on using support comprised the sample. Participants reported on average approximately eight individuals in their social network. Half reported support for physical activity from a spouse/partner, adult child, or friend. Those who perceived support for self-reported physical activity tended to have greater improvements on average from baseline for mean daily minutes of physical activity than those with no perceived support. Four-fifths developed a plan for a spouse/partner, friend, adult child, or sibling to provide physical activity support. Participants reported that the session was helpful and increased their confidence in using support; over one-quarter intended to use support after the intervention ended.

Examining Potential Psychosocial Mediators in a Physical Activity Intervention for Older Adults

The purpose of this study was to examine psychosocial constructs targeted as potential mediators in a prior physical activity (PA) intervention study. This secondary analysis used data from 102 older adults randomized to one of four conditions-within a 2 (Interpersonal Strategies: yes, no) x 2 (Intrapersonal Strategies: yes, no) factorial design. We tested intervention effects on social support, self-efficacy, self-regulation, and goal attainment, and whether these constructs mediated intervention effects on PA. Participants who received interventions with interpersonal strategies, compared to those who did not, increased their readiness (post-intervention), the self-regulation subscale of self-assessment, and goal attainment (post-intervention, 6-months). Participants who received interventions with intrapersonal strategies, compared to those who did not, increased their social support from family (post-intervention). There was no statistically significant mediation. To understand mechanisms through which interventions increase older adults' PA and to improve intervention effectiveness, researchers should continue to examine potential psychosocial mediators.Clinical Trial Registry: NCT02433249.

ReadySteady intervention to promote physical activity in older adults with Parkinson's disease: Study design and methods

The main motor impairments of gait and balance experienced by people with Parkinson's disease (PD) contribute to a sedentary lifestyle, resulting in poor physical conditioning, loss of functional independence, and reduced quality of life. Despite the known benefits of physical activity in PD, the majority of older adults with PD are insufficiently active. Few studies incorporate behavioral change approaches to promoting physical activity in PD. The main goal of this research is to foster community mobility in older adults with PD by promoting physical activity and improving gait patterns using a theory-based behavioral change intervention. The ReadySteady intervention combines wellness motivation theory with polestriding physical activity, which has been shown to be beneficial for people with PD. The intervention will be tested using a randomized controlled design, including inactive older adults diagnosed with PD. Participants will be randomly assigned the 12-week ReadySteady intervention, 12-week polestriding, and education intervention, or 12-week education intervention. Thirty-six older adults with PD will participate in each of the interventions. Level of physical activity, clinical scores, quantitative measures of gait and balance control, and motivational variables for each intervention will be measured at three time points: pre-intervention, post-intervention (12 weeks), and follow-up (24 weeks). If the intervention is beneficial, it may serve as a sustainable addition to current practice in health promotion efforts serving the PD population.

A Systematic Review of Culturally Specific Interventions to Increase Physical Activity for Older Asian Americans

BACKGROUND

Physical activity (PA) is a significant modifiable risk factor for cardiovascular disease. For older adults, engaging in PA is shown to improve cardiac status, reduce cognitive, and functional decline, and improve overall quality of life. However, only 17% of Asian American adults meet the 2008 federal recommended guidelines for aerobic and muscle strengthening activity; and there is a paucity of data reporting on older Asian Americans - a rapidly growing, underserved group. While data pertaining to Asian Americans is frequently reported at the aggregate level, this masks differences (eg, language, culture, income) among Asian ethnic subgroups that may impact health behaviors. The purpose of this review was to identify intervention, and cultural adaptation strategies in studies promoting PA for older Asian Americans.

METHODS

A comprehensive literature search was performed to identify interventions published between 1996-2016 focused on improving PA among older Asian Americans (> 60 years old). Data were abstracted to examine intervention study designs, cultural adaptation strategies, theoretical frameworks, and physical activity measures.

RESULTS

Nine studies met the review's inclusion criteria. Community-based recruitment approaches were widely used, and all studies employed cultural adaptation to varying degrees. Most studies reported improvements in PA outcomes, focused on Chinese Americans, and relied on self-reports of PA, while few aimed to increase PA using a multi-component approach.

CONCLUSIONS

Future studies would benefit from larger sample sizes, a wider representation of Asian ethnic subgroups, and concentrated efforts to implement deep level adaptations that may increase the salience and sustainability of these interventions.

Implementation of motivational interviewing in a fall prevention exercise program: experiences from a randomized controlled trial

Objective

The elderly population over 65 is increasing globally, and interventions promoting health and preventive work, especially fall prevention, will constitute a large part of physiotherapists’ duties in the near future. To address the challenges of promoting effective and sustainable health behavior changes among older persons, physiotherapists need support when it comes to how to apply behavior change strategies, especially in fall prevention. Therefore, the aim of this study was to describe implementation of motivational interviewing in a fall prevention exercise program. This study is a side product of another project.

Results

Data from a recently performed three-armed randomized controlled trial were used to describe the implementation of motivational interviewing in the exercise group (n = 58). Level of motivation (priorities) and self-efficacy for both the physiotherapist and the participant in treatment, and to use a guide targeted towards the planned treatment are recommended actions. Regular meetings and follow ups as well as updates of motivational interviewing skills during a treatment period, should also be considered to achieve treatment fidelity.

Trial registration NCT01778972, Retrospectively registered January 29, 2013

Assessing the Effects of Interpersonal and Intrapersonal Behavior Change Strategies on Physical Activity in Older Adults: a Factorial Experiment

BACKGROUND

Little is known about which behavior change strategies motivate older adults to increase their physical activity.

PURPOSE

The purpose of this study was to assess the relative effects of two sets of behavior change strategies to motivate increased physical activity among older adults: interpersonal and intrapersonal.

METHODS

Community-dwelling older adults (N = 102, mean age = 79) were randomized in a 2 × 2 factorial experiment to receive interpersonal (e.g., social support, friendly social comparison; no, yes) and /or intrapersonal (e.g., goal setting, barriers management; no, yes) behavior change strategies, combined with an evidence-based, physical activity protocol (Otago exercise program) and a physical activity monitor (Fitbit One™).

RESULTS

Based on monitor data, participants who received interpersonal strategies, compared to those who did not, increased their average minutes of total physical activity (light, moderate, vigorous) per week, immediately (p = .006) and 6 months (p = .048) post-intervention. Similar, increases were observed on measures of functional strength and balance, immediately (p = .012) and 6 months (p = .003) post-intervention. The intrapersonal strategies did not elicit a significant increase in physical activity or functional strength and balance.

CONCLUSIONS

Findings suggest a set of interpersonally oriented behavior change strategies combined with an evidence-based physical activity protocol can elicit modest, but statistically and clinically significant, increases in older adults' physical activity and functional strength and balance. Future research should replicate these findings and investigate the sustained quantity of physical activity elicited by these strategies and their impact on older adults' quality of life and falls. Trial Registration The ClinicalTrials.gov registration identifier is NCT02433249.

Development and testing of a goals of care intervention in advanced heart failure

AIM

The purpose of this paper is to describe the conceptual framework for a goals of care (GoC) intervention, elements, and findings of intervention feasibility, acceptability, and benefits from both patients with heart failure (HF) and their providers.

BACKGROUND

Receiving care at a mechanical circulatory support center for advanced HF offers new opportunities for treatment, making the implementation of a GoC intervention timely and crucial in helping patients determine next steps in HF treatment.

METHODS

The GoC intervention was designed using a self-management framework, incorporating the concepts of self-efficacy, patient activation, and patient motivation. At the conclusion of the study, open-ended exit interviews were conducted with patients and providers. Content analysis was used to derive the feasibility, acceptability, and benefits of the intervention.

RESULTS

Forty-one patients with HF, with average age 58.2±11.3years, LVEF=30.3±9.7%, and New York Heart Association Functional Class (NYHA FC)=2.4±0.8, and nine HF providers participated in the study. Patient benefits from the intervention included enhanced communication with their provider and family members, increased confidence to have a conversation with the provider, and refreshed HF knowledge. Provider benefits from the intervention were facilitating a conversation with the patient and learning new information about the patient's goals and values.

CONCLUSION

The GoC intervention provides an avenue to align patient goals and values with treatment choices in the context of advanced heart failure, so that patient quality of life is enhanced and costs of care can be reduced.

The association between social support and physical activity in older adults: a systematic review

BACKGROUND

The promotion of active and healthy ageing is becoming increasingly important as the population ages. Physical activity (PA) significantly reduces all-cause mortality and contributes to the prevention of many chronic illnesses. However, the proportion of people globally who are active enough to gain these health benefits is low and decreases with age. Social support (SS) is a social determinant of health that may improve PA in older adults, but the association has not been systematically reviewed. This review had three aims: 1) Systematically review and summarise studies examining the association between SS, or loneliness, and PA in older adults; 2) clarify if specific types of SS are positively associated with PA; and 3) investigate whether the association between SS and PA differs between PA domains.

METHODS

Quantitative studies examining a relationship between SS, or loneliness, and PA levels in healthy, older adults over 60 were identified using MEDLINE, PSYCInfo, SportDiscus, CINAHL and PubMed, and through reference lists of included studies. Quality of these studies was rated.

RESULTS

This review included 27 papers, of which 22 were cross sectional studies, three were prospective/longitudinal and two were intervention studies. Overall, the study quality was moderate. Four articles examined the relation of PA with general SS, 17 with SS specific to PA (SSPA), and six with loneliness. The results suggest that there is a positive association between SSPA and PA levels in older adults, especially when it comes from family members. No clear associations were identified between general SS, SSPA from friends, or loneliness and PA levels. When measured separately, leisure time PA (LTPA) was associated with SS in a greater percentage of studies than when a number of PA domains were measured together.

CONCLUSIONS

The evidence surrounding the relationship between SS, or loneliness, and PA in older adults suggests that people with greater SS for PA are more likely to do LTPA, especially when the SS comes from family members. However, high variability in measurement methods used to assess both SS and PA in included studies made it difficult to compare studies.

Combining Motivational and Physical Intervention Components to Promote Fall-Reducing Physical Activity Among Community-Dwelling Older Adults: A Feasibility Study

PURPOSE

To assess the feasibility of a new intervention, Ready~Steady, in terms of demand, acceptability, implementation, and limited efficacy.

DESIGN

Randomized controlled trial; repeated measures.

SETTING

Two rural communities in Itasca County, Minnesota.

SUBJECTS

Thirty participants were randomized to an intervention (n = 16) or attention-control (n = 14) group.

INTERVENTION

Ready~Steady combined two components: (1) motivational (motivational support, social network support, empowering education), and (2) fall-reducing physical activities (PAs; guidance to practice leg-strengthening, balance, and flexibility activities and walking).

MEASURES

Acceptability questionnaire and Indices of Procedural Consistency (investigator developed), Community Health Activity Model Program for Seniors Questionnaire (confirmed with accelerometry), Short Physical Performance Battery, Perceived Environmental Support Scale, Social Support for Exercise Questionnaire, Goal Attainment Scale, Index of Readiness, and Index of Self-Regulation.

ANALYSIS

Descriptive statistics and a marginal approach to repeated-measures analysis of variance, using mixed-model procedures.

RESULTS

Attrition was 7% and mean attendance was 7.2 of 8 sessions, participants evaluated Ready~Steady as acceptable, and implementation fidelity was good. The intervention group improved significantly more than the attention-control group in PA behavior, F_1,27 = 11.92, p = .002; fall risk (functional balance and strength), F_1,27 = 14.89, p = .001; support for exercise from friends, F_1,27 = 11.44, p = .002; and self-regulation, F_1,26 = 38.82, p < .005.

CONCLUSION

The Ready~Steady intervention was feasible as evidenced by low attrition and good attendance and implementation, as well as positive effects on targeted outcomes and theoretical mechanisms of change.