Effects of A "Modified" Otago Exercise Program on the Functional Abilities and Social Participation of Older Adults Living in the Community-The AGA@4life Model

The Relationship of Exercise, Psychosocial Factors, and Social Participation Among Adults Aging With Long-Term Physical Disability: A Cross-Sectional Study

PURPOSE

This study investigated the relationships among exercise engagement, psychosocial factors, and social participation for adults aging with physical disabilities (AAwPD).

DESIGN

A cross-sectional study within a community-based cohort study of participation among AAwPD was conducted.

SETTING

A comprehensive survey was administered online or via telephone.

PARTICIPANTS

Participants were 474 individuals between the ages of 45-65, primarily living in the Midwestern United States, who reported living with a physical disability for at least 5 years.

METHOD

Survey questions created based on prior consolidation of activity domains assessed exercise engagement. Psychosocial health and social participation were measured using the Patient Reported Outcomes Measurement Information System. Chi-square tests, t-tests, and a general linear model were used to examine differences between exercisers and non-exercisers.

RESULTS

Participants who exercised reported less pain (P < .001), fatigue (P < .001), and depression (P < .001) and greater self-efficacy for management of chronic conditions (P = .002), satisfaction with participation in social roles and activities (P < .001), and ability to participate in social roles and activities (P < .001) compared with non-exercising participants.

CONCLUSIONS

AAwPD who exercised reported fewer secondary conditions and greater social participation. Although causal relationships cannot be drawn, and the frequency, duration, and intensity of exercise were not examined, this study lays important groundwork for future research to determine the health and participation benefits of exercise for AAwPD. Future studies should also focus on the development of exercise interventions to support successful aging with disability.

Age-Friendly Community Interventions for Health and Social Outcomes: A Scoping Review

To address the numerous challenges associated with aging, increased attention has been given to the development of age-friendly cities and communities (AFCC) to promote healthy aging and social participation. However, limited evidence exists for addressing both health and social needs through the AFCC framework. We address this gap by conducting a scoping review of the interventions that target both health and social outcomes within the purview of the AFCC framework. The results showed that many of the successful interventions used a partnership model and behavioral change theories to inform the program design and implementation. The results also indicated that social participation and engagement played a key role in making the interventions successful. However, the results revealed that the literature is dominated by person-focused approaches. Future research should focus more on evaluating environmental-focused interventions and develop a holistic framework that combines both person- and environment-based approaches to healthy aging.

Effects of Modified-Otago Exercise Program on Four Components of Actual Balance and Perceived Balance in Healthy Older Adults

Falls are a serious problem for older adults, leading to adverse injuries and decreased quality of life. Balance impairment is a key factor in falls. The Otago Exercise Program (OEP) is a promising intervention for preventing falls, thereby improving balance and gait. Previous studies reported improved effects on balance using the OEP conducted in a group setting, and recommended additional walking. Walking is a feasible exercise that benefits both fall-related physical and physiological functions. This study aims to investigate the effects of a modified-Otago Exercise Program (modified-OEP) on four components of actual balance (static, dynamic, proactive, and reactive balance) and perceived balance in healthy older adults, by conducting the modified-OEP in a groupsetting, and including additional walking in one session to gain better efficacy. Participants aged 60–85 years old were randomly assigned to the modified-OEP group or the control group (CT). The modified-OEP consisted of 60 min sessions made up of 30 min of OEP and 30 min of walking, three times a week for 12 weeks, while no intervention was assigned to the control group. The modified-OEP group showed significant improvement in the four components of actual balance and in perceived balance. Furthermore, the modified-OEP group outperformed the control group in all parameters except for dynamic balance, after 12 weeks. The present study highlights the beneficial effects of a modified-OEP on all balance components. Additionally, this study is the first to demonstrate the measurement of all actual balance components as well as perceived balance.

Effect of a multicomponent exercise program and cognitive stimulation (VIVIFRAIL-COGN) on falls in frail community older persons with high risk of falls: study protocol for a randomized multicenter control trial

BACKGROUND

Falls represent important drivers of intrinsic capacity losses, functional limitations and reduced quality of life in the growing older adult's population, especially among those presenting with frailty. Despite exercise- and cognitive training-based interventions have shown effectiveness for reducing fall rates, evidence around their putative cumulative effects on falls and fall-related complications (such as fractures, reduced quality of life and functional limitations) in frail individuals remains scarce. The main aim of this study is to explore the effectiveness program combining an individualized exercise program and an executive function-based cognitive training (VIVIFRAIL-COGN) compared to usual care in the prevention of falls and fall-related outcomes over a 1-year follow-up.

METHODS

This study is designed as a four-center randomized clinical trial with a 12-week intervention period and an additional 1-year follow-up. Three hundred twenty frail or pre-frail (≥ 1 criteria of the Frailty Phenotype) older adults (≥ 75 years) with high risk of falling (defined by fall history and gait performance) will be recruited in the Falls Units of the participating centers. They will be randomized in a 1:1 ratio to the intervention group (IG) or the control group (CG). The IG will participate in a home-based intervention combining the individualized Vivifrail multicomponent (aerobic, resistance, gait and balance and flexibility) exercise program and a personalized executive function-based cognitive training (VIVIFRAIL-COGN). The CG group will receive usual care delivered in the Falls Units, including the Otago Exercise Program. Primary outcome will be the incidence of falls (event rate/year) and will be ascertained by self-report during three visits (at baseline, and 6 and 12 weeks) and telephone-based contacts at 6, 9 and 12 months after randomization. Secondarily, effects on measures of physical and cognitive function, quality of life, nutritional, muscle quality and psychological status will be evaluated.

DISCUSSION

This trial will provide new evidence about the effectiveness of an individualized multidomain intervention by studying the effect of additive effects of cognitive training and physical exercise to prevent falls in older frail persons with high risk of falling. Compared to usual care, the combined intervention is expected to show additive effects in the reduction of the incidence of falls and associated adverse outcomes.

TRIAL REGISTRATION

NCT04911179 02/06/2021.

Effectiveness and Usability of a Novel Kinect-Based Tailored Interactive Fall Intervention System for Fall Prevention in Older People: A Preliminary Study

Falls are prevalent among older people and can lead to serious health problems. We newly developed a novel Kinect-based tailored interactive fall intervention system, which seamlessly integrates multifactorial fall risk assessment and tailored intervention programs to prevent falls in older people. This preliminary study aimed to examine the effectiveness and usability of this developed system for fall prevention in older people. Thirty community-dwelling older women participated in this experiment; they were allocated to an intervention group (IG) or a control group (CG) for a quasi-randomized trial (15 people each). Participants in IG followed an 8-week tailored intervention (40 min/session × 2 sessions/week × 8 weeks) using the Kinect-based interactive fall intervention system, while participants in CG maintained their habitual activities. Various outcome measures were evaluated at baseline (Week 0), interim (Week 4), and post-intervention (Week 8). Experimental results showed that IG led to significant improvements in TUG-Timed Up and Go (p = 0.010), BBS-Berg Balance Scale (p = 0.011), and Montreal Cognitive Assessment-MoCA (p = 0.022) between baseline and post-intervention. In comparison to the baseline, TUG and BBS were even significantly improved at interim (p = 0.004 and 0.047, respectively). There were no significant changes in static balance-related performance outcomes and the Short Falls Efficacy Scale-SFES after the intervention. Whereas in CG, most performance measures did not show significant changes during the 8-week period, TUG completion time became significantly longer at post-intervention in comparison to interim (p = 0.028) and fear of falling was also significantly higher at post-intervention than baseline (p = 0.021). These findings suggest that the Kinect-based 8-week tailored interactive fall interventions effectively improved older people's physical and cognitive abilities. Regarding the usability of the developed system, the average System Usability Scale (SUS) score was 83.5 out of 100, indicating excellent system usability. The overall mean Computer Literacy Scale (CLS) score was 2.5 out of 26, showing that older participants in this study had very limited experience with computers. No significant correlation between SUS and CLS scores demonstrated that newly developed Kinect-based tailored interactive fall intervention system was easy to use for older people, regardless of their computer experience. This novel system should help health professionals and older people proactively manage the risk of falls.

The effect that the Otago Exercise Programme had on fear of falling in community dwellers aged 65-80 and associated factors

BACKGROUND

Falls are a major public health problem. Fear of falling is highly prevalent amongst community-dwelling older adults who have already fallen and it is also a risk factor for recurrent falls. There has been limited research about the impact that exercises programs have on the fear of falling. The aim of this study was to evaluate whether the Otago Exercise Programme (OEP) reduced the fear of falling in non-institutionalised people aged 65-80 years in Spain. It also evaluated the factors associated with the fear of falling.

METHODS

This was a quasi-experimental study that focused on people aged 65-80 who attended 21 primary healthcare centres, lived in the community, were able to walk independently and provided written, informed consent. They were recruited from September 2017 to December 2019. The OEP sessions took place at the primary healthcare centres and were provided on an individual or group basis by trained OEP instructors. The participants attended five weekly sessions, where they were given exercises to develop their strength, balance and endurance. They then continued the programme at home. The subjects were followed up 12 months after baseline and the analyses included a bivariate analysis and a multivariate analysis with logistic regression.

RESULTS

We enroled 498 patients (67.07% female) with an average age of 71.81 years. More than two-thirds (65.06%) lived with a partner and 42.37% were overweight. Significant reductions were observed in the mean level of fear of falling between baseline and 12 months (p = 0.000). A number of factors associated with fear of falling also showed significant differences. These were: age (p = 0.033), sex (p = 0.000), living alone (p = 0.000), body mass index (p = 0.003) and whether psychotropic drugs were used (p = 0.000). The multivariate analysis showed a moderate to high fear of falling amongst participants who were female (p = 0.000), 72-80 years of age (p = 0.017), obese (p = 0.045) and used psychotropic drugs (p = 0.021).

CONCLUSIONS

Taking part in the OEP reduced the overall fear of falling. There were significant associations between fear of falling and being female, taking psychotic drugs and having a history of falls. This study is a quasi-experimental sign nested an experimental study (randomized controlled trial previously published and registered on ClinicalTrials.org (NCT03320668)). Retrospectively registered on 25/10/2017.

Effects of physical activity in muscle ultrasound evaluation of an older adult population – a pilot study

INTRODUCTION: Population aging has become an increasing challenge in society and inactive aging populations are especially challenging. OBJECTIVE: The main aim of this study is to conduct ultrasound evaluation of the effects of an intervention program on muscle architecture in older adults. METHODS: A total of thirty-four individuals of both sexes aged over 60 years were divided into two groups as follows: an intervention group (n = 18), who took part in a physical activity program for 8 weeks, three sessions per week, lasting approximately 20 min on each occasion, and a control group, whose members were encouraged to maintain their usual daily routines (outdoor aerobic exercise) (n = 16). Only six of the 18 participants from the intervention group were available for a second evaluation session. All the participants were submitted to bilateral quadriceps muscle ultrasound evaluations; thickness and echo-intensity of muscles were analyzed. RESULTS: Muscle thickness showed a significant negative correlation with age and echo-intensity showed a significant positive correlation with age. Echo-intensity showed a significant negative correlation with muscle thickness. Comparing the groups at the baseline evaluation, there were no significant differences between them (p < 0.05) for either measurement. CONCLUSIONS: We can highlight three points regarding post-intervention status in the intervention group: 1. There were significant differences in echo-intensity. It is therefore essential to establish early strategies to promote active aging, thus preventing dependence and inactivity in the older adult population; 2. Ultrasound is a good method for evaluating the musculoskeletal system and its changes in response to aging and physical activities; 3 Physical activities are important to maintain the muscles healthy and the older adult population independent.