Regular group exercise contributes to balanced health in older adults in Japan: a qualitative study

Negotiating a physically active life in tune with ageing: a grounded theory study of older persons' experiences of participating in high-intensity interval training

BACKGROUND

Physical activity and exercise are promoted worldwide as effective interventions for healthy ageing. Various exercise initiatives have been developed and evaluated for their efficacy and effectiveness among older populations. However, a deeper understanding of participants' experiences with these initiatives is crucial to foster long-term activity and exercise among older persons.

METHODS

A constructivist grounded theory study was conducted to explore the experiences of older persons participating in a supervised group supramaximal high-intensity training (HIT) programme. Four focus groups were held, involving 28 persons aged 65 to 78. The focus groups were analysed inductively, followed by an iterative process of abstraction, abduction, and theory generation using a constant comparative method. A conceptual framework comprising three theoretical concepts-stereotype embodiment, ageist practices, and self-efficacy-was employed during the abductive phase as an analytical lens.

RESULTS

The core category of our grounded theory, Negotiating a physically active life in tune with ageing, encapsulates the complex processes and actions influencing older persons as they engage in physical activities in their daily lives and in relation to HIT. This core category was created from the conceptual framework and the four categories: Grit in the moment and overall life, Empowered by the training group, Navigating one's physically active self, and Committing to exercise for duty and pleasure. Participants reported feeling invigorated by the exercise, enjoying the challenge, and valuing the group setup for its social connectedness and structure. The generated theory illustrates how participants' engagement with physical activity and exercise is shaped by various perspectives accumulated over their lifespan. The findings provide a plausible explanation of how participation in HIT groups can challenge negative age stereotypes and ageist practices while enhancing self-efficacy for high-intensity exercise.

CONCLUSIONS

Our grounded theory underscores that physical activity and exercise should be regarded as multifaceted processes, which must be considered when promoting physical activity initiatives for older persons. By considering the older person and societal norms and values, we can gather knowledge to design physical exercise interventions that are not only effective but also enjoyable and capable of transforming how individuals perceive themselves as exercising persons.

A qualitative study on the impact and participation in the AGELESS multidomain intervention: Insights from older adults with cognitive frailty and their caregivers

BACKGROUND

Cognitive frailty (CF) is a major precursor to dementia, and multidomain interventions have the potential to delay, prevent or reverse its early onset. However, the successful translation and sustainability of such interventions in real-life settings remain uncertain. In this study, we aimed to explore the insights of older adults with CF and their caregivers regarding the impact and participation in the AGELESS multidomain intervention.

METHODS

This qualitative study was conducted following the completion of AGELESS multidomain intervention. Semi-structured interviews covering domains such as perceptions, benefits, barriers, facilitators, and program preferences were conducted among 17 older adults with CF and 10 caregivers following the completion of the intervention. The data obtained were transcribed verbatim and analyzed using thematic analysis. Each transcript was reviewed and coded to identify prevailing themes derived from the interview data.

RESULTS

The analysis revealed five distinct themes: (1) impact of the program, (2) facilitators enhancing participation, (3) barriers hindering participation, (4) suggestions for improving participation and (5) challenges to adopt digital platforms. Based on the findings, the AGELESS multidomain intervention had a positive impact on the participants and their caregivers. It was noted that they showed preference for in-person sessions over virtual ones. The study highlighted key factors critical for successful participation, including diversity and inclusivity. It emphasized incorporating a multi-component, group-based approach with social aspects. The intervention should be people-centered, dignified, affordable, and customized to meet the unique needs of each participant.

CONCLUSIONS

The AGELESS multidomain intervention was well received by older adults with CF and their caregivers who participated in this study. Moving forward, it is recommended that future initiatives focus on identifying opportunities to implement existing evidence-based programs on a larger scale for the prevention of dementia in older adults.

Feasibility of Using Rebound Exercise in Community-Dwelling Adults With Neurological Disorders

Rebound exercise (RE) increases mobility in hospitalized adults with neurological disorders (AwND), but its feasibility in community settings remains largely unexplored. This study evaluates the practicality of implementing RE in the community, particularly for AwND. The feasibility study involved 53 community-dwelling AwND engaging in RE sessions for 30 min, once- or twice-weekly, over 12 weeks. Feasibility was assessed through recruitment rates, adherence, attrition, and participant feedback. The study measured blood pressure (BP), walking speed (WS), and physical activity level (PAL) at baseline, 6 weeks, and 12 weeks. Repeated measures ANOVA and the Friedman tests were used to test for significant differences across the time points. The study demonstrated high recruitment (70.59%) and retention (98.1%) rates, with most participants (76.9%) preferring once-weekly sessions due to time constraints. There were no reported injuries or adverse events. Most participants were older adults (50%), females (67.3%), and retired (55.8%). Significantly lower resting BP (p < 0.001), higher WS (p < 0.001), and PAL (p = 0.000) were observed after 12 weeks of RE. In conclusion, RE is a feasible, safe, and acceptable intervention for supervised community-dwelling AwND and could be a valuable tool for promoting PAL in this population.

Physical activity trajectories and their determinants in older adults with subjective cognitive decline: Results from a national cohort study

OBJECTIVES

This study aims to investigate the trajectories of physical activity among older adults with subjective cognitive decline and explore the determinants influencing these trajectories within a national cohort.

DESIGN

Cohort study.

METHODS

We used data from a national cohort called the China Health and Retirement Longitudinal Study and included 1063 participants. The short international physical activity questionnaire was used to measure the moderate-to-vigorous physical activity, and group-based trajectory modeling was applied to explore the moderate-to-vigorous physical activity trajectories. The predictors were selected based on the social-ecological model. Multinomial logistic regression was conducted to identify the predictors of physical activity trajectories.

RESULTS

Our findings reveal three trajectories of physical activity among older adults with subjective cognitive decline: the rapid decline group (10.35 %), stable inactive group (80.62 %), and rapid growth group (9.03 %). Several determinants emerged as significant predictors influencing these trajectories, including age, smoking status, body mass index, number of comorbidities, mobility activities of daily life, marital status, family size, frequency of social activities, and residence.

CONCLUSIONS

Our study highlights the predominance of the stable inactive group among older adults with subjective cognitive decline, emphasizing the need for targeted interventions. Addressing some modified determinants, such as smoking status, body mass index, number of comorbidities, mobility activities of daily life, family size, frequency of social activities, and residence is crucial for promoting physical activity in this population.

Perceived health outcomes of recreation and happiness: exploring the mediating role of resilience

Introduction

Previous research has shown that leisure activities can positively influence perceived health outcomes by increasing individuals' levels of physical activity. Yet, little has been discovered about the mechanisms that are driving this association. This study was conducted with the aim of examining the relationship between perceived health outcomes of recreation and happiness as well as the mediating effect of resilience.

Methods

The study comprised a total of 451 adult individuals residing in seven different geographical regions of Turkey, who were included using a convenience sampling method, and the data were collected between March and June 2023. Respondents completed assessments utilizing the Perceived Health Outcomes of Recreation, Brief Resilience Scale, and The Oxford Happiness Questionnaire-Short Form. Data analysis was executed employing the PROCESS macro for SPSS.

Results

The study's findings revealed that perceived health outcomes of recreation had a positive effect on both happiness (β = 0.146, [95% CI: 0.106, 0.186]) and resilience (β = 0.156, [95% CI: 0.107, 0.205]). Resilience had a positive effect on happiness (β = 0.435, [95% CI: 0.362, 0.507]). Furthermore, the relationship between perceived health outcomes of recreation and happiness was partially mediated by resilience (β = 0.068, [95% CI: 0.042, 0.096]).

Conclusion

As a result, participating in leisure activities has been found to have a positive impact on perceived health outcomes, which in turn positively affects both happiness and resilience. Additionally, psychological resilience can be said to partially mediate the relationship between perceived health outcomes of recreation and happiness.

Prepandemic Feasibility of Tele-Exercise as an Alternative Delivery Mode for an Evidence-Based, Tai Ji Quan Fall-Prevention Intervention for Older Adults

There is a critical need for fall-prevention interventions to reach medically underserved, hard-to-reach, rural older adults. The evidence-based Tai Ji Quan: Moving for Better Balance (TJQMBB) program reduces falls in older adults. This pre-COVID-19 pandemic study assessed the feasibility and impact of a 16-week tele-TJQMBB intervention in older adults. Instructors led six tele-TJQMBB classes via Zoom for 52 older adults (mean age ± SD 68.5 ± 7.7 years) at one academic and four community sites. Nearly all (97%) planned sessions were delivered. Average attendance was 61%. There were no adverse events. Fidelity was fair to good (mean 67%). Forty-one percent of sessions experienced technical disruptions. Participants improved their gait speed, balance, lower-extremity strength, and body mass index. Tele-TJQMBB was feasible with a positive impact on outcomes. This study was the first step toward establishing an additional delivery mode that could potentially expand TJQMBB's reach and maintenance.

Guideline-based exercise management for hip and knee osteoarthritis: a cross-sectional comparison of healthcare professional and patient beliefs in Ireland

OBJECTIVES

To identify within-stakeholder agreement and between-stakeholder differences in beliefs regarding exercise for osteoarthritis among general practitioners (GPs), physiotherapists (PTs) and people with hip and knee osteoarthritis (PwOA). A secondary objective was to explore the association between referral patterns and beliefs of PwOA.

DESIGN

Cross-sectional.

SETTING

Online surveys administered to GPs, PTs and PwOA in Ireland via social media and healthcare networks.

PARTICIPANTS

421 valid responses (n=161 GPs, n=163 PTs, n=97 PwOA).

PRIMARY AND SECONDARY OUTCOME MEASURES

Nine belief statements related to exercise effectiveness, safety and delivery were rated on a 5-point Likert scale and analysed for within-stakeholder consensus. χ2 tests assessed differences in agreement between groups. Multivariable linear regression models tested associations between beliefs in PwOA and referral to/attendance at physiotherapy.

RESULTS

Positive within-stakeholder consensus (>75% agreement) was reached for most statements (7/9 GPs, 6/9 PTs, 5/9 PwOA). However, beliefs of PwOA were significantly less positive compared with healthcare professionals for six statements. All stakeholders disagreed that exercise is effective regardless of the level of pain. Attendance at physiotherapy (49% of PwOA), rather than referral to physiotherapy from a GP only, was associated with positive exercise beliefs for PwOA (β=0.287 (95% CI 0.299 to 1.821)).

CONCLUSIONS

Beliefs about exercise therapy for osteoarthritis are predominantly positive across all stakeholders, although less positive in PwOA. PwOA are more likely to have positive beliefs if they have seen a PT for their osteoarthritis. Knowledge translation should highlight the effectiveness of exercise for all levels of pain and osteoarthritis disease.

Effects of dual-task resistance exercise on cognition, mood, depression, functional fitness, and activities of daily living in older adults with cognitive impairment: a single-blinded, randomized controlled trial

BACKGROUND

Regular exercise is emphasized for the improvement of functional capacity and independence of older adults. This study aimed to compare the effects of a dual-task resistance exercise program and resistance exercise on cognition, mood, depression, physical function, and activities of daily living (ADL) in older adults with cognitive impairment.

METHODS

A total of 44 older adults participated in the study. Participants were randomly allocated to an experimental group (n = 22) performing a dual-task resistance exercise program for cognitive function improvement and a control group (n = 22) performing a resistance exercise program. Both groups performed the exercise for 40 min per session, three times a week, for 6 weeks (18 sessions). Cognition, mood, depression, functional fitness, and ADL were quantified before and after the intervention using the Mini-Mental State Examination (MMSE), profile of mood states (POMS), geriatric depression scale (GDS), senior fitness test (SFT), and Korean version of ADL, respectively.

RESULTS

There was a significant time and group interaction on the MMSE (p = 0.044). There were no significant time and group interactions in the POMS, GDS, SFT, or ADL. Cognitive function (p < 0.001), mood (p < 0.001), depression (p < 0.001), functional fitness (p < 0.001), and ADL (p < 0.001) significantly improved after dual-task resistance exercise, and cognitive function (p < 0.001), mood (p < 0.001), depression (p < 0.001), functional fitness (p < 0.001), and ADL (p < 0.001) significantly improved after resistance exercise.

CONCLUSIONS

Dual-task resistance exercise is more effective than resistance exercise in improving cognitive function in older adults with cognitive impairment. Both dual-task resistance exercise and resistance exercise improves mood, depression, functional fitness, and ADL after the intervention. We propose using dual-task resistance exercises for cognitive and physical health management in the older adults with cognitive impairment.

TRIAL REGISTRATION

This study was registered with the Clinical Research Information Service (WHO International Clinical Trials Registry Platform) (Registration ID, KCT0005389; Registration date, 09/09/2020).

Physical Activity and Neuropsychological Functioning in Older Adults

Research has identified a positive relationship between physical activity and neuropsychological functioning across the lifespan. The present study further examined the relationship between physical activity, depression, anxiety, and cognitive functioning in community-dwelling older adults (ages 65-96) who completed an outpatient neuropsychological evaluation (N = 526). Psychometrically sound and validated measures were used to assess depression, anxiety, and cognitive functioning. Analyses of covariance (ANCOVA) were conducted to examine differences between individuals who reported regularly engaging in physical activity and those who did not, after adjusting for demographic variables (age, education, and gender). Results indicated that physical activity was associated with better scores on measures of depression, anxiety, and cognitive functioning. Effect sizes for total scores on all measures were large, but there was a sizeable range of effect sizes (from small to large) for various cognitive domains. Smallest effect sizes were observed for subtests measuring language skills and visuospatial abilities, whereas largest effect sizes were seen in processing speed and memory. Results suggest that engaging in physical activity may be a beneficial non-pharmacological intervention for older adults. These findings underscore the importance of integrating physical activity programs in community and healthcare settings to foster mental and cognitive health in older populations.

"It's not time for us to sit down yet": how group exercise programs can motivate physical activity and overcome barriers in inactive older adults

PURPOSE

Physical activity and exercise are critical for older adults' physical and mental health. The purpose of this qualitative study was to richly capture the motivators of and barriers to engaging in physical activity in previously inactive older adults who participated in a three-arm randomized controlled trial (RCT) of eight-week group exercise interventions.

METHODS

We conducted a qualitative content analysis of individual interviews with fifteen participants-five from each study arm: strength training, walking, and inactive control. Participants included nine females and six males ranging from 60 to 86 years of age.

RESULTS

Key motivators of physical activity included perceived improvements in physical and mental health, positive social influences, observed health deterioration in others, and the desire to spend time with and take care of family members. Barriers to physical activity included existing health conditions, fear of getting hurt, negative social influences, perceived lack of time and motivation, inconvenient times and locations, and monetary cost.

CONCLUSIONS

Our findings add to the body of literature identifying factors that motivate and stand in the way of older adults' engagement in physical activity. These factors influence older adults' self-efficacy and should be incorporated into the design of new and existing programs to encourage initiation and maintenance of physical activity.

Enhancing Physical and Psychosocial Health of Older Adults in Saudi Arabia through Walking: Comparison between Supervised Group-Based and Non-Supervised Individual-Based Walking

Walking is widely recognized as one of the most common and effective forms of physical activity, particularly for older adults. This study examined the comparative effects of two types of walking interventions, including supervised group-based intervention (SGBI) and non-supervised individual-based intervention (NSIBI), on frailty syndrome, cognitive functions or skills, and health-related quality of life among sedentary older Saudi individuals. A 15-week double-blinded, randomized controlled trial (RCT) including three groups (two were intervention groups while the other was the control group) was conducted among older adults who were inactive to examine the effect of different forms of walking interventions on frailty syndrome, cognitive functions, and health-related quality of life. A total of 107 participants, including 65 males and 42 females, were divided into three groups, which include SGBI, NSIBI, and the control group. Frailty syndrome was measured using the physical performance test (PPT), while cognitive function and health-related quality of life were assessed using the Mini-mental State Examination (MMSE) and the Short Form 36 (SF 36) health survey questionnaire. One-way repeated measures analysis of variance (ANOVA) and one-way analysis of covariance (ANCOVA) with the pre- and post-tests were performed for within- and between-group differences. while post-test data for the control group participants were absent due to the change in elderly center regulation, and they were excluded from the analysis. Hence, the comparison was stated only between the intervention groups. Both of the intervention groups (SGBI and NSIBI) showed significant within-subject differences in the Physical Function subscale of the health-related quality of life scale only, with F(1,20) = 23.03, p < 0.001, and F(1,18) = 27.22, p < 0.001, respectively. On the other hand, the Physical Performance Test revealed significant [F(2,51) = 9.21, p < 0.001] between-group differences in the post-test based on the baseline values. In addition, the average step count of older adults was increased from 4000 steps per session to around 7000 steps per session in the intervention group. The average heart rate of the NSIBI group did not show a visible change, and the resting heart rate of both groups showed a slightly declining trend throughout the intervention period. The walking intervention significantly increased participants' physical function, which is a component of health-related quality of life and physical performance (frailty level), along with average daily step counts for older adults in Saudi Arabia. Regular engagement in the recommended level of walking is strongly advisable for Saudi Arabian older adults to maintain their overall quality of life at this stage.

Optimizing outdoor fitness equipment training for older adults: Benefits and future directions for healthy aging

Regular physical activity is vital for the health and disease prevention of older adults. Outdoor fitness equipment has gained popularity for natural exercise spaces among middle-aged and older individuals. This narrative review demonstrates that these programs have the potential to improve cardiovascular health, muscle strength, flexibility, balance, and reduce falls, while also enhancing quality of life, alleviating depression and anxiety, and boosting self-esteem. However, our understanding is hindered by limited rigorous experimental studies. Future directions include implementing standardized measurements, conducting long-term studies, and addressing equipment limitations to enable better adjustment of training intensity and promote correct postures on machines. New, more rigorous research is needed to comprehensively understand the psychophysiological and social effects on health. Additionally, suggested modifications could render the machines more effective and safer. The primary objective is to enhance this type of machinery to encourage its use in outdoor spaces, thus aiding adults and older individuals in achieving overall health and enjoying a healthy aging process.

The effects of walking on frailty, cognitive function and quality of life among inactive older adults in Saudi Arabia: a study protocol of randomized control trial by comparing supervised group-based intervention and non-supervised individual-based intervention

BACKGROUND

Kingdom of Saudi Arabia (KSA) demographics are also changing with the increase in life expectancy in the country and the rise in the number of older Saudi Arabians. Saudi Arabia has a higher rate of physically inactive people, and most of them are between the ages of 55-64. Walking is one of the most prevalent forms of physical activity in Saudi Arabia and the study showed that most people prefer walking for recreational and health benefits. Therefore, the purpose of the proposed study is to compare the effects of supervised group-based walking and non-supervised individual-based walking interventions on frailty, cognitive function and quality of life among inactive older adults in Saudi Arabia.

METHOD

This study will apply a three-group (2 intervention groups and 1 control group), double-blinded, randomized controlled trial (RCT) to examine the effect of different forms of walking interventions on Saudi Arabia older adults' frailty, cognitive function and quality of life immediately after a 16-week intervention, as well as the residual effects 12 weeks after completion of the interventions.

DISCUSSION

This study aims to determine whether supervised group walking and non-supervised individual walking lead to different effects. Given the limited evidence in the literature regarding Saudi Arabia older adults' physical fitness and health, it is worthwhile to explore the effect of walking, as well as the forms of walking on improving the overall physical fitness and psychological status of older adults in Saudi Arabia. The findings of the current study could also create awareness of the government and the general public in Saudi Arabia of the ageing problems and the effective ways of achieving better intervention results.

TRIAL REGISTRATION

The trial is registered at the ClinicalTrials.gov PRS (Trial ID: NCT05151575; Date of first posted: 12/07/2021).

Positive impact of social relationships fostered by physical and/or cognitive group activity on older people's quality of life: PRISMA systematic review

Introduction

This review identified and examined the research literature on the effect of participating in physical and/or cognitive activities on older people's quality of life, to establish whether the social relationships fostered by these activities can be a vector of better physical, mental and social quality of life.

Method

A systematic review of the literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched four databases (MEDLINE, APA PsycArticles/PsycInfo, PubMed, and Web of Science) for articles published between 1975 and 2022 using search terms related to psychosocial, population, and intervention topics. Studies were eligible if they involved older adults, participation in at least one activity (physical or cognitive), and at least one quality of life related outcome measure.

Results

We selected 20 articles published between 1990 and 2021, the majority concerning studies conducted in English-speaking countries. Ten studies were interventional (introduction of program of activities), and 10 studies were observational (60% quantitative, 40% qualitative). Overall, results revealed a positive impact of the activities on every aspect of quality of life (i.e., cognitive, physical, social, psychological, and quality of life in general).

Conclusion

The present review confirmed the beneficial impact of practicing physical and/or cognitive group activities on older people's quality of life, but the contribution of social factors and social relationships remains underestimated and not well defined in researches.

Community arts engagement supports perceptions of personal growth in older adults

PURPOSE

The effects of arts engagement on older adults have been well-documented. However, the ways older adults overcome common situational and dispositional barriers to enhance personal growth and well-being are less known.

METHODS

Fifty-six community dwelling older adults (71.3 ± 4.6 years) took part in dance, music, or a control workshop two times/week for ten weeks. Participants' personal growth was examined through focus groups and surveys in this mixed-methods study.

RESULTS

Focus group and survey results revealed participants experienced personal growth through engaging in the dance and music arms of the experiment. Participants, especially those in arts workshops, described personal growth experiences aligning with four themes: increased social connections, developed new skills, utilized a growth mindset, and used creativity to overcome situational and dispositional barriers to participation. The barriers included musculoskeletal challenges, hearing impairments, and difficulty retaining new information.

CONCLUSIONS

The study yielded high adherence and retention rates, and participants reported increased engagement within their communities. Our observations provide avenues for future practitioners and facilitators to create programming that empowers older adults and utilizes participants' ongoing feedback to support access, inclusion, and sense of community.

Participants Characteristics of a Park-Based Physical Activity Intervention in an Urban Context-A Cross-Sectional Study in Bologna, Italy

Physical inactivity, a leading risk factor for chronic diseases and premature death, is prevalent worldwide. This study focuses on participant profiles and factors influencing continued participation and physical activity (PA) levels in the "Moving Parks" PA intervention in Bologna, Italy. This intervention offers free group activities in city parks during the summer. A questionnaire was administered to participants in 2022, gathering data on socio-demographic information, chronic diseases, participation in previous iterations, and PA levels. Out of 596 respondents, 85% were women, and the average age was 50. About 56% held a university degree, and 73% exercised regularly in the winter. Continuous participation was linked to older age, higher education, and chronic conditions. Prior participation predicted higher winter PA levels. Notably, the majority of participants were educated, physically active women. While the project continually engages individuals with higher education and chronic conditions, it needs further tailoring to reach less represented populations.

Relationships among Square Dance, Group Cohesion, Perceived Social Support, and Psychological Capital in 2721 Middle-Aged and Older Adults in China

(1) Background: Aging is a global phenomenon, and China's aging is extensive and rapid and already at the middle to upper level worldwide. Promoting social interaction and increasing positive psychological qualities in individuals are key components in helping people adapt to the physical and mental changes of the aging process. Among them, how middle-aged and older adults improve their physical and mental health through physical activity is of great concern. (2) Methods: This study measured the physical activity of 2721 middle-aged and elderly square dance participants across China, and structural equation modeling was applied to explore the relationship between square dance exercise and group cohesion as well as the role of perceived social support and psychological capital. (3) Results: The results showed that (a) square dance exercise positively predicts group cohesion among middle-aged and older adults. (b) Perceived social support and psychological capital mediate the relationship between square dance exercise and group cohesion, and the mediating role consists of three pathways: perceived social support alone, psychological capital alone, and perceived social support-psychological capital chain mediation. (c) The mediating effect of psychological capital alone is greater than the mediating effect of perceived social support alone and the mediating effect of the perceived social support-psychological capital chain. (4) Conclusions: This study provides support for the theory and practice of square dance exercise and intervention guidance for increasing positive psychological qualities and group dynamic levels in middle-aged and older adults.

A scalable 12-week exercise and education programme reduces symptoms and improves function and wellbeing in people with hip and knee osteoarthritis

Introduction

Osteoarthritis is a chronic musculoskeletal condition that impacts more than 300 million people worldwide, with 43 million people experiencing moderate to severe disability due to the disease. This service evaluation provides the results from a tailored blended model of care on joint health, physical function, and personal wellbeing.

Methods

1,593 adult participants with osteoarthritis completed the Nuffield Health Joint Pain Programme between February 2019 and May 2022. The 12-week programme included two 40-min exercise sessions per week. All exercise sessions were conducted face-to-face and were followed by 20 min of education to provide information and advice on managing osteoarthritis.

Results

The 12-week joint pain programme significantly improved Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) global scores (Week 0: 37.5 [17.2]; Week 12: 24.0 [16.6]; p < 0.001), as well as subscales for pain (Week 0: 7.6 [3.7]; Week 12: 4.9 [3.7]; p < 0.001), function (Week 0: 26.0 [13.0]; Week 12: 16.3 [12.4]; p < 0.001), and stiffness (Week 0: 3.9 [1.6]; Week 12: 2.8 [1.7]; p < 0.001). Significant improvements in health-related outcomes including systolic and diastolic blood pressure (Week 0: 139 [18] mmHg; Week 12: 134 [17] mmHg, and Week 0: 82 [11] mmHg; Week 12: 79 [19] mmHg; both p < 0.001), body mass index (Week 0: 29.0 [4.5] kg/m2; Week 12: 28.6 [4.4] kg/m2; p < 0.001), waist to hip ratio (Week 0: 0.92 [0.23]; Week 12: 0.90 [0.11], p < 0.01) and timed up and go (Week 0: 10.8 s [2.9]; Week 12: 8.1 s [2.0]; p < 0.001) were also observed. On completion of the joint pain programme, participants also reported significant improvements in all assessed aspects of self-reported wellbeing (all p < 0.001).

Discussion

With reductions in physical symptoms of osteoarthritis and improvements in personal wellbeing, the joint pain programme delivered by personal trainers in a gym-setting offers a nationally scalable, non-pharmacological treatment pathway for osteoarthritis.

Developing online fall prevention program: Older adult recommendations`

Falls are a critical public health problem for older adults making expanded access of evidence-based fall prevention programs to this population a priority. Online delivery could improve the reach of these needed programs, however associated benefits and challenges remain poorly explored. This focus group study was undertaken to gather older adults' perceptions regarding the transition of face-to-face fall prevention programs to online formats. Content analysis was used to identify their opinions and suggestions. Older adults had concerns related to technology, engagement, and interaction with peers that they valued during face-to-face programs. They provided suggestions they felt would improve the success of online fall prevention programs, especially including synchronous sessions and getting input during program development from older adults.

Protocols and Features of Goal-Setting-Based Intervention for Frail Older Adults in Community Exercise Facilities

Appropriate goal setting for frail older adults is important because it drives effective rehabilitation. However, more insights into the types and degrees of frailty and goal-setting trends should be obtained. We conducted a multicenter prospective study to qualitatively examine the relation between each frailty domain (physical, social, and cognitive) and the goals of 201 subjects (median age: 79, 43.8% male) who began rehabilitation at a long-term care prevention facility. Goal setting was determined by the specific, measurable, achievable, relevant, and time to goal (SMART) framework up to three months, categorized according to the International Classification of Functioning, Disability, and Health. The results showed that approximately 90% of the subjects had frailty in at least one domain, and about half had frailties in two or more domains. In total, 176 (87.6%) subjects had goals corresponding to activities and participation. The tendency to set goals to improve mobility was confirmed when the number of overlapping frailties was high, especially those in the physical and social domains. Those with milder frailties were more likely to establish goals targeting improvements in community, social, and civic life. These findings will lead to the development of practical goal-setting guidelines for frail older adults.

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].

Short Multicomponent Group Exercise Intervention Promotes Long-Term Physical Activity Habits among Community-Dwelling Older Adults during COVID-19 Restrictions: A Cohort Study

This study investigated whether strength, balance, body mass index, falls self-efficacy, activity levels, self-rated health, and participation in a multicomponent exercise intervention could predict physical activity levels after 5 months of self-quarantine due to the COVID-19 pandemic. This study included baseline data of 200 community-dwelling older adults (79% women, 21% men) with a mean age of 72 years who participated in a randomized controlled trial investigating a multicomponent exercise program, with 7-month follow-up survey data of their physical activity levels. The results showed significant associations with the activity levels at the 7-month follow-up. The activity levels (odds ratio (OR): 2.83, 95% CI: 1.20-6.71), the self-rated health score (2.80, 1.42-5.53), and being allocated to a specific multicomponent group-based exercise program (2.04, 1.04-4.00) showed a significant association with the activity habits at the 7-month follow-up. As this study suggests, besides the physical activity levels and the self-rated health score, participation in a high challenge multicomponent exercise program was significantly associated with physical activity levels at the 7-month follow-up. This study indicates that a relatively short multicomponent group exercise program (6-9 weeks) can motivate individuals to sustain their own training and activity levels even several months after the program has been paused or terminated. Identifying older adults' physical activity levels and self-rated health scores and prescribing multicomponent group-based exercise programs to promote sustained physical activity habits may be a successful alternative to provide for older adults in the future.

Physical activity and subjective well-being of older adults during COVID-19 prevention and control normalization: Mediating role of outdoor exercise environment and regulating role of exercise form

Since the outbreak of the COVID-19 pandemic, the physical and mental health of older adults has been threatened. Promoting physical and mental health through physical activity has therefore become a strategy for healthy aging. In order to better understand the impact of the participation of older adults in physical activity, this paper selects different types of physical activity, and examines the relationship between them and subjective well-being through the analysis of the mediation effect of outdoor exercise environment and the regulating effect of exercise form. In this cross-sectional study, a questionnaire survey was conducted in mainland China. The main data come from 903 older adults in five urban areas in Chengdu, Sichuan Province. The surveys were carried out using the Physical Activity Rating Scale, Newfoundland Subjective Well-Being Scale, Exercise Environment Scale, and Exercise Form Scale. SPSS was used for statistical analysis, linear regression analysis was adopted for processing data, and AMOS was used to establish a mediation model. The mediating variable is the outdoor exercise environment, and the moderating variable is exercise form; gender, age, education level, and monthly income were used as control variables. The study results showed that different physical activities (tai chi; health qigong; walking and jogging) were significantly, positively correlated with the subjective well-being of older adults (tai chi: R = 0.351, p < 0.01; health qigong: R = 0.340, p < 0.01; walking and jogging: R = 0.245, p < 0.01); among the activities, tai chi had the strongest effect on the subjective well-being of older adults (R = 0.351, p < 0.01). Outdoor exercise environment played a mediating role between different physical activity types and subjective well-being of older adults [tai chi: β = 0.030, 95% CI (0.005, 0.031); health qigong: β = 0.018, 95% CI (0.000, 0.021); walking and jogging: β = 0.034, 95% CI (0.008, 0.035)]. Exercise form moderated the subjective well-being of older adults in different physical activities (tai chi: 0.006, p < 0.05; health qigong: 0.006, p < 0.05; walking and jogging: 0.009, p < 0.001). The results of this study demonstrate that the outdoor exercise environment plays a mediating role between different physical activities and the subjective well-being of older adults, and the form of exercise can also moderate the impact of different physical activities on the subjective well-being of older adults. This study has enlightening significance for psychological intervention with older adults facing stress, anxiety and depression.

Determinants of new participation in sports groups among community-dwelling older adults: Analysis of a prospective cohort from The Otassha Study

Participation in sports groups has health benefits for older adults, such as preventing functional limitations and social isolation. Encouraging participation in sports groups may be an important means of health promotion in older adults. However, there is insufficient research on the determinants of new participation in sports groups to consider effective interventions to promote participation in these groups. We investigated this using data from a 1-year prospective study. Data were obtained from "The Otassha Study" that assessed a cohort of community-dwelling older adults living in an urban area of Japan. Of 769 older adults who participated in a baseline health survey in 2018, 557 participated in a follow-up survey in 2019. We excluded 184 individuals who already participated in sports groups at baseline and 36 with missing data. Participation in sports groups was defined as that occurring more than once a week. Logistic regression analysis was used to identify the determinants of new participation in sports groups, with sociodemographic factors, lifestyle habits, physical functions, cognitive functions, psychological factors, and social factors as independent variables. Forty-one (12.2%) individuals participated in sports groups at follow-up. In the multiple adjusted logistic regression model, new participation in sports groups was significantly associated with female sex (odds ratio [OR] = 5.57, 95% confidence interval [CI]: 1.61‒19.26), engagement in regular exercise (OR = 2.23, 95%CI: 1.03‒4.84), and having a large social network (OR = 1.12, 95%CI: 1.04‒1.20). Physical functions were not associated with new participation. Determinants of new participation were lifestyle habits and social factors, rather than physical functions. Intervention through social networks may be effective in encouraging new participation in sports groups, which, in turn, may facilitate healthy aging.

Neighbourhood environmental influences on older adults' physical activities and social participation in Singapore: A photovoice study

Physical activities and social participation have vast health benefits for older adults and are also known to influence each other in everyday lives of older adults. In the quest for healthy ageing in place, it is vital to investigate the role of neighbourhood environmental factors in maintaining and/or initiating physical activities and social participation in older adults. Using the photovoice method, this qualitative research aims to examine how the physical and social neighbourhood environment influences physical activities, social participation, and instances where they occur together among 30 older adults in three Singapore neighbourhoods. A thematic analysis of 820 photographs, their descriptions, and 21 semi-structured individual and group interviews reveals that participants' physical activities and social participation are influenced by neighbourhood features during everyday movements (themes related to walking trips and resting places), and at destination nodes (themes on destinations and events where people often met and/or accessed amenities and services). Environmental qualities grounded in the local context affect older adults' outdoor activities. Physical activities and social participation in older adults may be planned or spontaneous, occurring independently, simultaneously or one after another in supportive neighbourhood environments.

The effect of dance on physical health and cognition in community dwelling older adults: a systematic review and meta-analysis

BACKGROUND

Dancing is an attractive form of exercise among older adults and may positively influence physical and psychosocial health. The aim of this systematic review was to synthesize the evidence examining the dance prescription and effectiveness of dance in community dwelling older adults.

METHODS

Eight databases were searched to identify randomized controlled trials that evaluated the effectiveness of dance programs on community-dwelling older adults from 2007 to December 2020. Data regarding participants, dance programs and outcomes of interest were extracted and narratively synthesized. A meta-analysis was performed on the outcome data where possible.

RESULTS

Twenty-two studies met the inclusion criteria, of those 15 were deemed to be fair quality and 7 high quality using the PEDro scale. Nineteen studies included in the meta-analysis found that dancing can improve mobility and endurance compared to no intervention and afforded equivalent outcomes compared to other exercise programs.

CONCLUSION

The findings suggest that dance is an effective, safe and viable activity for community-dwelling older adults..

High Challenge Exercise and Learning Safe Landing Strategies among Community-Dwelling Older Adults: A Randomized Controlled Trial

There is limited research on optimal exercise programs that effectively decrease falls and fall-related injuries in older populations. This randomized controlled trial (RCT) aimed to explore the effects of a 12-week Judo4Balance program on falling techniques, physical and psychological functions, health status, and physical activity levels among 200 community-dwelling older adults (79% women and 21% men) with a mean age of 72 years. The 200 participants were randomly allocated for the Judo4Balce program (n = 100) or control group (n = 100). The RCT intervention started in mid-January 2020 and was abruptly interrupted because of the COVID-19 pandemic. A restart of the RCT was initiated in September 2021, and the 12-week intervention was offered to two groups. This study reports the results from three points of assessment: baseline, 20-month follow-up, and 12-week postintervention. At 20 months follow-up, the control group had significantly decreased physical activity levels (summer p = 0.002 and winter p = 0.003); similar changes were not seen in the exercise group. In the exercise group, learning falling techniques in 6−9 weeks led to sustained fall competence at 20 months follow-up. Further, significant improvements in physical function (exercise group p = 0.009 and control group p < 0.001) and learning falling techniques (p < 0.001 for both groups) were noted in both groups after the 12-week intervention. This effective, supervised, group-based, high-challenge multicomponent exercise program needs to be further evaluated for possible impact on falls and fall-related injuries.

Effects of traditional Chinese medicine-based exercises on cognitive function in older people with mild cognitive impairment: A systematic review and meta-analysis

This study evaluated the effects of traditional Chinese medicine based exercise (TCE) on cognitive outcomes for patients with mild cognitive impairment (MCI), and tried to identify the most effective TCE modality. A systematic review and meta-analysis of randomized controlled trials were conducted. Ten studies met the inclusion criteria. TCE interventions were classified into three types: (a) Tai Chi, (b) Baduanjin, and (c) Qigong. The pooled analysis showed that, overall, TCE had beneficial effects on global cognition and memory. Subgroup analysis further demonstrated that Baduanjin had a larger effect size on global cognition than the other TCE modalities. By contrast, Tai Chi had a larger effect size on memory than the other modalities. This study implied that TCE is a promising exercise option for improving cognition in MCI. However, further studies with a more rigorous study design are warranted to support or falsify the findings of the present review.

'It is designed for everybody to find their own level and to improve themselves'; views of older people and instructors of the Falls Management Exercise (FaME) programme

BACKGROUND

Older adults are at increased risk of falls due to ageing, decreased muscle strength and impaired balance. Clinical trials have demonstrated the efficacy and effectiveness of the Falls Management Exercise (FaME) programme in improving functioning and preventing falls. However, programme completion is often low, impacting the potential benefits of FaME.

OBJECTIVE

To explore the barriers and facilitators for participation and completion of the FaME programme from an instructor and participant perspective.

METHODS

Semi-structured interviews were conducted with 20 FaME users and seven Postural Stability Instructors from the East Midlands region of England, UK. Interviews were conducted using a topic guide and explored their views of the programme, intended benefits, reasons for participating, instructor's approach and venue facilities. Data were transcribed verbatim and analysed using thematic analysis. Written informed consent was obtained from all participants and instructors.

RESULTS

Common themes identified by participants and instructors for adherence related to perceived health benefits, psychological well-being, intervention characteristics, cost, instructors' qualities, opportunity to socialise, venue accessibility and facilities. Further factors such as maintaining independence, discipline, relationship with peers and caring responsibilities influenced participants' engagement with the programme. Instructor factors such as progression were also reported as important predictors.

CONCLUSIONS

Instructor and participant factors influence uptake, attendance and adherence of FaME. The findings from this study can inform the development and improvement of additional falls-prevention programmes. It can also guide marketing strategies to promote uptake of exercise-based falls-prevention programmes among older adults.

Perceptions of physical activity and technology enabled exercise interventions among people with advanced chronic kidney disease: a qualitative study

BACKGROUND

Exercise improves health outcomes and quality of life in persons with chronic kidney disease (CKD). The numbers of persons with advanced CKD meeting physical activity guidelines however is low. We undertook a qualitative study of men and women aged 36-74 from various race/ethnic populations with advanced CKD not requiring dialysis to describe their experiences and opinions around prior physical activity, motivating factors for and barriers to exercise, and perceptions of exercise-promoting technology and group-based programming designed to improve physical activity levels.

METHODS

Nineteen persons with advanced CKD not requiring dialysis were interviewed at two high volume nephrology clinics enriched with racial/ethnic minority patients (Emory University and Santa Clara Valley Medical Center). We used thematic analysis to identify dominant themes (n = 4) and subthemes (n = 19) around exercise experience, barriers, motivators, views, and preferences.

RESULTS

Four dominant themes and 19 subthemes were identified. The most common motivators to exercise included physical and mental health benefits, appearance, improvement in energy levels, and potential social interaction in group-based programs. Common barriers included health concerns, particularly complications related to other co-morbidities, as well as time and transportation constraints. Participants were skeptical of exercise programs solely reliant on technology.

CONCLUSIONS

The use of group-based exercise programs may motivate persons with CKD to increase exercise levels, while programs entirely based on technology may be less effective.

Long-term effect of a 24-week multicomponent intervention on physical performance and frailty in community-dwelling older adults

Introduction

Multicomponent interventions improve physical function and frailty in older adults, but their long-term benefit remains uncertain.

Methods

This prospective non-randomised study was conducted in 383 older Koreans (mean age, 76.8 years; female 72.3%) who were living alone or receiving medical aid. Of these, 187 individuals chose to receive a 24-week intervention that consisted of group exercise, nutritional supplements, depression management, deprescribing and home hazard reduction. The remaining 196 individuals received usual care. We compared the short physical performance battery (SPPB) score (0–12 points), frailty phenotype scale (0–5 points) and deficit-accumulation frailty index (0–1) at baseline, 6, 18 and 30 months.

Results

After 1:1 propensity score matching (n = 117 per group), the mean SPPB scores for the intervention and comparison groups were 7.6 versus 7.6 at baseline, 10.7 versus 7.1 at 6 months (mean difference, 3.5; 95% confidence interval [CI], 2.8–4.2), 9.1 versus 7.8 at 18 months (1.3; 95% CI, 0.6–2.0) and 8.6 versus 7.5 at 30 months (1.1; 95% CI, 0.4–1.8). The intervention group had lower frailty phenotype scale (1.1 versus 1.8; difference, −0.7; 95% CI −1.0 to −0.3) and frailty index (0.22 versus 0.27; difference, −0.04; −0.06 to −0.02) at 6 months, but similar scores at 18 and 30 months. The 30-month mean institutionalisation-free survival time was 28.5 months in the intervention group versus 23.3 months in the comparison group (difference, 5.2 months; 95% CI, 3.1–7.4).

Conclusions

The 24-week multicomponent intervention showed sustained improvement in physical function, temporary reduction in frailty and longer institutionalisation-free survival over 30 months.

The impact of the COVID-19 pandemic on the wellbeing of Irish Men's Shed members

COVID-19 disproportionately affects males especially those who are older and more socio-economically disadvantaged. This study assessed wellbeing outcomes among men’s shed members (Shedders) in Ireland at baseline (T1), 3 (T2), 6 (T3) and 12 months (T4) in response to a 10-week health promotion program ‘Sheds for Life’ (SFL). Two cohorts participated in SFL commencing in March and September 2019. This study compares the T3 findings from one cohort carried out during the COVID-19 pandemic [COVID cohort (n = 185)] with T3 findings from a comparator cohort [pre-COVID cohort (n = 195)], completed pre-COVID-19. Questionnaires assessing wellbeing [life satisfaction, mental health, loneliness, physical activity (PA), self-rated health and other lifestyle measures] were analyzed in both cohorts T1, T2 and T3. Self-rated Health and life satisfaction decreased in the COVID cohort at T3 (p < 0.001), while loneliness scores increased (p < 0.0005). Higher loneliness scores were correlated with lower health ratings, life satisfaction and PA during COVID-19 (p < 0.001). Days PA decreased in the COVID cluster at T3 from T2 (p < 0.01) with those in urban areas reporting lower activity levels than rural areas (p < 0.05). Those sufficiently active at baseline managed to maintain PA during COVID-19 while those not meeting guidelines were more likely to report decreases (p < 0.001). Shedders experiencing COVID-19 restrictions are at an increased risk of poorer wellbeing and increased levels of loneliness. Support and guidance are needed to safely encourage this cohort back into men’s sheds, settings that protect against loneliness and positively promote health and wellbeing.

Lay summary

The COVID-19 pandemic will have wide-reaching implications on wellbeing, particularly on those who are older and more vulnerable. Evidence also suggests that COVID-19 disproportionately affects males. This study aimed to understand the impact that COVID-19 has had on men in the setting of Men’s Sheds in Ireland. Two cohorts of men who were participating in a 10-week health and wellbeing program (Sheds for Life) at different stages were followed over time. At 6 months follow-up the first Cohort had not experienced COVID-19 whereas the second cohort was actively experiencing the COVID-19 pandemic. We measured wellbeing using questionnaires, comparing both groups of men for differences. We found that the men who were experiencing COVID-19 had lower self-rated health, physical activity and life satisfaction as well as higher rates of loneliness, with those who were more lonely reporting lower wellbeing scores. We also found that men in rural areas were more physically active during COVID-19 and that those were not active were more likely to become more inactive during COVID-19. This study suggests that support and guidance is needed to safely encourage this cohort back into Men’s Sheds, settings that protect against loneliness and positively promote health and wellbeing.

A community-wide intervention to promote physical activity: A five-year quasi-experimental study

Evidence on the effects of a community-wide intervention (CWI) on population-level physical activity (PA), especially in the long term, is limited. Therefore, we evaluated the five-year effect of CWI on promoting PA through information dissemination, education, and community support primarily targeting older adults, by incorporating Japanese guidelines, in Fujisawa City, from 2013. To assess the effect of the whole-city intervention, we distributed questionnaires in 2013, 2015, and 2018 to three independent random samples of 3,000 community-dwelling adults (aged ≥ 20 years) using a quasi-experimental study design. Three separate samples responded to the survey (41% at baseline, 46% at the two-year mark, and 48% at the five-year follow-up). The primary outcome was change in PA participation. At the five-year follow-up, PA (median: 120 minutes/day) was significantly higher than at baseline (86 minutes/day) and the two-year follow-up (90 minutes/day). The results of the multivariate analysis indicated that PA among older adults-the primary target population of the CWI-increased significantly at the five-year follow-up, compared to those aged 20-64 (mean difference of change between groups: 14.7 minutes/day, P= 0.029). Among older adults, PA was significantly lower in those with poorer perceived economic status than in their more well-off counterparts at the two-year follow-up (P= 0.003); however, there was no significant difference at the five-year follow-up (P= 1.000). There was a positive interaction between group and period (mean difference of change between groups: 40.9 minutes/day, P= 0.001). In conclusion, the five-year CWI targeting older adults, incorporating national guidelines, improved population-level PA.

Predict the exercise behavior intention of the older adults in Taipei City to promote exercise behavior

The purpose of this study employed the theory of planned behavior as a research framework to analyze the explanatory power of exercise attitude, subjective norms, and perceived behavioral control on exercise intention among older adults and to obtain insight on exercise behavior among older adults. The study used Ajzen's theory of planning behavior as a basis to compile the "Exercise Behavior Intention Questionnaire of the Older Adults." Results showed that there were significant differences were detected in the exercise intentions of older adults with different subjective norms and perceived behavioral control. This indicated that older adults of greater age have a greater need for companionship from family members and stronger subjective norms. In addition, exercise attitude, subjective norms, and perceived behavioral control explained the variance in exercise intention among older adults, verifying the positive explanatory power of these variables on exercise intention in older adults. The study concluded that the theory of planned behavior, improving older adults' exercise attitude alone was insufficient for increasing their exercise behavior intention. In particular, older adults of greater age had greater needs for social support from the main groups, and they required encouragement to enhance their self-efficacy and confidence.

Group-based physical activity as a means to reduce social isolation and loneliness among older adults

Social isolation and loneliness are critical health epidemics among older adults. The present manuscript aimed to underscore group-based physical activity (GBPA) as an approach to prevent and/or reduce social isolation and loneliness among older adults and, therefore, avoid its negative health consequences. We compiled evidence from the literature to answer the following question: would GBPA be a better approach to prevent/reduce social isolation and loneliness among older adults compared to individual physical activity? There is evidence demonstrating that older adults participating in GBPA not only acquire the well-known physical benefits of physical activity but also experience improvements in social connectedness, due to the fact that individuals exercising with others. To this end, beyond providing physical health benefits, GBPA for older adults may have the potential to help prevent social isolation and loneliness by improving levels of social connectedness in this age group. Further research is much needed, as the literature seems to be scarce. This would help devise tailored exercise programs for those reporting to be isolated or feeling lonely.

Thai Older People's Willingness (Intention) to Participate in a Care Prevention, Community Group Exercise Program: An Assessment before Implementing an Intervention Trial in Chiang Mai, Northern Thailand

BACKGROUND

Sustainability of a current family-based long-term care model in Thailand has been challenged by demographic aging, and the rising burden of non-communicable diseases and age-related morbidities. In order to overcome these challenges, a community-integrated intermediary care (CIIC) service model, including functional training as one of the interventions, was introduced. To increase program uptake and adherence, it is vital to understand the facilitators and barriers for joining this group exercise. Therefore, we aimed to explore the determinants of older adults' willingness to participate in it.

METHODS

A total of 1509 participants from an intervention arm of a cluster randomized trial were interviewed with a structured questionnaire. A descriptive analysis and binary logistic regression were applied.

RESULTS

More than half of participants (51.4%) were willing to join community-based care prevention, functional training exercise program. Significant associated motivators were being of younger age, female, married, working seniors, original community residents, having (regular and irregular) exercise habits, history of a fall in the last six months, needs for walking aids and secondary caregivers.

CONCLUSION

Our findings highlighted both personal and social factors motivated old people to access health promotion activities. It might help design or implement effective programs to promote healthy aging among community-dwelling seniors in Thailand. This research is analysis of baseline results from a Community Integrated Intermediary Care project. TCTR20190412004.

Exergaming Platform for Older Adults Residing in Long-Term Care Homes: User-Centered Design, Development, and Usability Study

Background

Older adults (OAs) residing in long-term care (LTC) homes are often unable to engage in adequate amounts of physical activity because of multiple comorbidities, including frailty and severe cognitive impairments. This level of physical inactivity is associated with declines in cognitive and functional abilities and can be further compounded by social isolation. Exergaming, defined as a combination of exercise and gaming, has the potential to engage OAs in exercise and encourage social interaction. However, previously used systems such as the Nintendo Wii are no longer commercially available, and the physical design of other exergames is not suitable for OAs (ie, fall risks, accessibility issues, and games geared toward a younger population) with diverse physical and cognitive impairments.

Objective

This study aims to design and develop a novel, user-centered, evidence-based exergaming system for use among OAs in LTC homes. In addition, we aim to identify facilitators and barriers to the implementation of our exergaming intervention, the MouvMat, into LTC homes according to staff input.

Methods

This study used a user-centered design (UCD) process that consisted of 4 rounds of usability testing. The exergame was developed and finalized based on existing evidence, end user and stakeholder input, and user testing. Semistructured interviews and standardized and validated scales were used iteratively to evaluate the acceptability, usability, and physical activity enjoyment of the MouvMat.

Results

A total of 28 participants, 13 LTC residents, and 15 staff and family members participated in the UCD process for over 18 months to design and develop the novel exergaming intervention, the MouvMat. The iterative use of validated scales (System Usability Scale, 8-item Physical Activity Enjoyment Scale, and modified Treatment Evaluation Inventory) indicated an upward trend in the acceptability, usability, and enjoyment scores of MouvMat over 4 rounds of usability testing, suggesting that identified areas for refinement and improvement were appropriately addressed by the team. A qualitative analysis of semistructured interview data found that residents enjoyed engaging with the prototype and appreciated the opportunity to increase their PA. In addition, staff and stakeholders were drawn to MouvMat’s ability to increase residents’ autonomous PA. The intended and perceived benefits of MouvMat use, that is, improved physical and cognitive health, were the most common facilitators of its use identified by study participants.

Conclusions

This study was successful in applying UCD to collaborate with LTC residents, despite the high number of physical and sensory impairments that this population experiences. By following a UCD process, an exergaming intervention that meets diverse requirements (ie, hardware design features and motivation) and considers environmental barriers and residents’ physical and cognitive needs was developed. The effectiveness of MouvMat in improving physical and cognitive abilities should be explored in future multisite randomized controlled trials.

Group Dance and Motivational Coaching for Walking: A Physical Activity Program for South Asian Indian Immigrant Women Residing in the United States

BACKGROUND

South Asian Indian immigrants residing in the United States are at high risk of cardiovascular disease (prevalence ≥35%), diabetes (prevalence 45.4%), and stroke (prevalence 26.5%). This study examined the effect of culturally relevant physical activity interventions on the improvement of physiological measures and average daily steps in at-risk midlife South Asian Indian immigrant women.

METHODS

In this 2-arm interventional research design, the dance (n = 25) and the motivational phone calls group (n = 25), attended social cognitive theory-based motivational workshops every 2 weeks for the first 12 weeks. Data for weight, waist circumference, blood pressure, blood sugar, cholesterol level, and 12-lead electrocardiogram were collected at the baseline, 12 weeks, and 24 weeks.

RESULTS

Significant differences were seen in body weight (F2,94 = 4.826, P = .024; ηp2=.093), waist circumference (F2,92 = 7.496, P = .001; ηp2=.140), systolic blood pressure (F2,94 = 19.865, P = .000; ηp2=.2970), triglyceride (F2,94 = 11.111, P = .000; ηp2=.191), cholesterol (F2,94 = 8.925, P = .001; ηp2=.160), blood sugar level (F2,94 = 8.851, P = .000; ηp2=.158), and average daily steps across both intervention groups over time (F2,96 = 30.94, P = .000; ηp2=.392).

CONCLUSION

Culturally relevant motivational workshops with Indian dance and walking are an innovative approach to increasing lifestyle physical activity among South Asian Indian immigrant women.

The role and attitude of senior leaders in promoting group-based community physical activity: a qualitative study

Background

In the context of worldwide public health, it is very important to promote physical activity among the older people. This study explored the roles and attitudes of senior leaders in promoting group-based exercise in their local communities, specifically to determine the level and extent to which to elderly participation was encouraged.

Methods

This study conducted semi-structured face-to-face in-depth interviews and employed a subsequent thematic analysis. Participants included 10 club leaders and five sub-leaders who were working at senior clubs in Fujisawa-city, Kanagawa, Japan, from July to September 2018.

Results

Four themes emerged from the interview responses, including “unwavering attitude/conviction in relation to the vision,” “leaders must set an example,” “a search for balance in delegating responsibilities to members,” and “creating and fostering culture and environment of mutual help.” Further, each participant outlined several aims, including “achieving healthy longevity for the entire local community,” “having older people promote healthy activities among the older people,” and “creating a pro-health town.”

Conclusions

Findings indicate that policymakers, public health workers, and healthcare providers should recognize the pivotal roles that senior group leaders play in promoting healthy activities for the older people. These efforts should be strongly considered when developing policies and strategies designed to promote overall healthy longevity from a general community perspective.

Approaches to the diagnosis and prevention of frailty

An individual who is living with frailty has impairments in homeostasis across several body systems and is more vulnerable to stressors that may ultimately predispose them to negative health-related outcomes, disability and increased healthcare use. Approximately a quarter of individuals aged > 85 years are living with frailty and as such the identification of those who are frail is a public health priority. Given that the syndrome of frailty is defined by progressive and gradual loss of physiological reserves there is much scope to attempt to modify the trajectory of the frailty syndrome via physical activity and nutritional interventions. In this review we give an up to date account on the identification of frailty in clinical practice and offer insights into physical activity and nutritional strategies that may be beneficial to modify or reverse the frailty syndrome.

Older Adults' Perspective towards Participation in a Multicomponent Frailty Prevention Program: A Qualitative Study

OBJECTIVES

This study aimed to explore pre-frail and frail older Chinese people's perspectives on a multi-component, group-based frailty prevention program in Hong Kong, along with their views regarding factors determining participation and sustainability of such program.

DESIGN

Seven focus groups were conducted.

SETTING

Community elderly centres.

PARTICIPANTS

A total of 38 community-dwelling older people aged 54 - 84 (mean age, 64.9 years; female, 58%; married, 68%; retired, 97%) screened with pre-frailty or frailty completing a 12-week multi-component (involving physical, cognitive, and social activities), group-based frailty prevention program were interviewed.

MEASUREMENTS

Thematic analysis was conducted.

RESULTS

Using thematic analysis, perceived health benefits, peer support and social networking were identified as key motivators concerning intention to participate in the frailty prevention program; whereas perceived health benefits, socializing, sense of connectedness, expert guidance and sense of dignity were identified as key motivators concerning program adherence.

CONCLUSION

Majority of participants provided positive feedbacks about the multi-component intervention program in regards to their physical health, psychological well-being and social life. These findings highlighted several important factors for consideration in future design of frailty interventions regarding the needs of pre-frail and frail older adults, which could help to motivate and sustain their participation in community-based frailty prevention programs.

Promoting adherence to organised physical activity among socially disadvantaged older people

Group-based physical activity (PA) in community-based settings represents a promising avenue for promoting healthy ageing, however, lower levels of adherence have been found to be associated with aspects of social disadvantage. Providers are in a key position to provide important insights about strategies to improve adherence, however, few studies have examined their perspectives. In this study, 30 community service providers were interviewed, and 42 older people participated in focus groups to identify actions perceived as effective for promoting adherence to organised PA, with a focus on factors relevant to older people experiencing socio-economic disadvantage, social isolation, living with a disability or from culturally and linguistically diverse backgrounds. Data were analysed thematically. Adherence barriers included deteriorating health, lack of belonging and loss of motivation. Helpful strategies for addressing deteriorating health included maintaining programme flexibility, facilitating access to health and other services, and supporting participants to adapt to acquired limitations. Belonging can be fostered by creating positive and inclusive experiences, ensuring safe and stigma-free environments, providing opportunities to forge personal connections and demonstrating care. Motivation may be enhanced by ensuring activities are of interest and functional benefit, programme settings are suitable and appealing, and enjoyment is prioritised. In conclusion, a range of strategies is likely to be necessary to mitigate risks to adherence and support continued participation in organised PA among socially disadvantaged older people.

The Effects of Group and Home-Based Exercise Programs in Elderly with Sarcopenia: A Randomized Controlled Trial

Physical exercise is effective for sarcopenic elderly but evidence for the most effective mode of exercise is conflicting. The objective of this study was to investigate the effects of a three-month group-based versus home-based exercise program on muscular, functional/physical performance and quality of life (QoL) across elderly with sarcopenia. 54 elderly (47 women, 7 men aged 72.87 ± 7 years) were randomly assigned to one of three interventions: supervised group (n = 18), individualized home-based exercise (n = 18) and control group (n = 18). Body composition was determined by bioelectrical impedance analysis, calf measurement with inelastic tape and strength assessments (grip and knee muscle strength) via hand-held and isokinetic dynamometers. Functional assessments included four-meter (4 m), Τimed-Up and Go (TUG) and chair stand (CS) tests. QoL was assessed with Greek Sarcopenia Quality of Life (SarQol_GR) questionnaire. Outcomes were assessed at baseline, immediately post-intervention (week 12), and 3 months post-intervention (week 24). Significant group x time interactions (p < 0.001) were observed in QoL, calf circumference, TUG, CS, and 4 m tests, grip and knee muscle strength. Group-based compared to home-based exercise yielded significant improvements (p < 0.05) in muscle mass index, CS and 4 m tests, calf circumference, muscle strength at 12 weeks. Most improvements at 24 weeks were reported with grouped exercise. No changes were found across the control group. Results suggest group-based exercise was more effective than home-based for improving functional performance.