Physical Activity Among Rural Older Adults With Diabetes

PURPOSE: This analysis describes physical activity levels and factors associated with physical activity in an ethnically diverse (African American, Native American, white) sample of rural older adults with diabetes. METHOD: Data were collected using a population-based, cross-sectional stratified random sample survey of 701 community-dwelling elders with diabetes completed in 2 rural North Carolina counties. Outcome measures were as follows: first, physical activity in the past year, and second, days physically active in the prior week (0-7). Potential correlates included personal and health characteristics and were evaluated for statistical significance using logistic regression models. FINDINGS: About half (52.5%) of the participants stated that they had engaged in physical activity in the past year. Among those, 42.5% stated that they had no days with at least 30 minutes of continuous physical activity in the prior week, while 21.5% reported daily physical activity. Common activities were walking and housework. Correlates of physical activity in the past year and days active in the prior week included measures of physical health and mobility. CONCLUSIONS: Physical activity in this ethnically diverse sample of rural elders with diabetes is limited. Effort must be invested to increase physical activity in these groups.     

Physical Activity Intervention Adaptation: Recommendations from Rural American Indian Older Adults

Prevention Science - Preventive interventions are critical to improving health equity among American Indian (AI) populations, yet interventions that promote physical activity (PA) among AI...     

Daily Physical Activity Predicts Frailty Development Among Community-Dwelling Older Japanese Adults

ObjectivesThis study examined the association between frailty development and physical activity including the number of steps, the time of light-intensity physical activity (LPA) with <3.0 metabolic equivalents (METs), and the time of moderate- to vigorous-intensity physical activity (MVPA) with ≥3.0 METs in community-dwelling older Japanese adults.Design, setting, and participantsStudy subjects were 401 older adults at the baseline examination (April 2000–May 2002) who participated at least once in the follow-up examination of the longitudinal study of aging. Their 1787 cumulative data points (mean number of repeat visits, 3.5) were used for analysis.MeasuresThe number of steps, time of LPA, and time of MVPA were recorded at baseline using a uniaxial accelerometer. Frailty was defined according to 5 frailty criteria: shrinking, exhaustion, low physical activity, low grip strength, and slow gait speed.ResultsThe fully adjusted odds ratio for frailty among subjects walking <5000 steps was 1.85 [95% confidence interval (CI), 1.10-3.11]. The fully adjusted odds ratio for frailty among subjects with MVPA for <7.5 minutes was 1.80 (95% CI, 1.05-3.09). No significant association was observed between frailty and LPA.Conclusions and ImplicationsThe risk for developing frailty was substantially lower in older people walking ≥5000 steps/d or exercising for at least 7.5 minutes/d at an intensity >3.0 METs. These data could be applicable to the community interventions that aim to prevent frailty.     

Assessment of Physical Activity of Hospitalised Older Adults: A Systematic Review

Background

The assessment of physical activity levels of hospitalised older people requires accurate and reliable measures. Physical activities that older people in hospital commonly engage in include exercises and walking. Measurement of physical activity levels of older inpatients is essential to evaluate the impact of interventions to improve physical activity levels and to determine associations between physical activity in hospital and other health-related outcome measures.

Objective

To determine which measures are used to measure physical activity of older people in hospital, and to describe their properties and applications.

Method

A systematic review of four databases: Medline, Embase, CINAHL and AMED was conducted for papers published from 1996 to 2016. Inclusion criteria were participants aged ≥ 65 years and studies which included measures of physical activity in the acute medical inpatient setting. Studies which specifically assessed the activity levels of surgical patients or patients with neurological conditions such as stroke or brain injury were excluded. All study designs were included in the review.

Results

18 studies were included from 127 articles selected for full review. 15 studies used objective measures to measure the physical activity of older inpatients: 11 studies used accelerometers and four used direct systematic observations. Seven accelerometers were identified including the StepWatch Activity Monitor, activPAL, GENEActiv, Kenz Lifecorder EX, Actiwatch-L, Tractivity and AugmenTech Inc. Pittsburgh accelerometer. Three studies used a subjective measure (interviews with nurses and patients) to classify patients into low, intermediate and high mobility groups. The StepWatch Activity Monitor was reported to be most accurate at step-counting in patients with slow gait speed or altered gait. The activPAL was reported to be highly accurate at classifying postures.

Conclusion

Physical activity levels of older inpatients can be measured using accelerometers. The accuracy of the accelerometers varies between devices and population-specific validation studies are needed to determine their suitability in measuring physical activity levels of hospitalised older people. Subjective measures are less accurate but can be a practical way of measuring physical activity in a larger group of patients.

     

Resilience in Rural Community-Dwelling Older Adults

ABSTRACT:  Context: Identifying ways to meet the health care needs of older adults is important because their numbers are increasing and they often have more health care issues. High resilience level may be one factor that helps older adults adjust to the hardships associated with aging. Rural community-dwelling older adults often face unique challenges such as limited access to health care resources. Purpose: To determine the resilience level of rural community-dwelling older adults and to determine if socio-demographic factors, social networks, and health status are associated with resilience. Methods: Data were collected from 106 registered voters, aged 65 years or over from a rural area in New York State using a cross- sectional design. The instruments used in the study include the Resiliency Scale, the SF-12v2, and the Lubben Social Network Scale-Revised. Findings: The mean resilience level of the sample was high. Resilience was not correlated with any of the socio-demographic factors which included gender, age, income, education, marital, and employment status. There was a weak positive correlation between social networks and resilience levels of rural older adults. Both physical and mental health status were positively correlated with resilience. In a regression model, mental health status was the strongest predictor of resilience levels. Conclusion: If low resilience levels are identified in rural community-dwelling older adults, interventions to build resilience may be helpful in promoting independence; however, further research is needed to determine this.     

Preliminary User Evaluation of a Physical Activity Smartphone App for Older Adults

Objectives: Mobile health (mHealth) delivered through smartphone apps is a viable means of improving health behaviors. Technologies can be strengthened and made more age-inclusive by involving older adults as co-designers, resulting in more accessible and effective products. This study's purpose is to describe preliminary acceptability and feasibility of a physical activity (PA) app tailored to underactive older people. Methods: Moving Up is a multi-feature app designed to increase PA and reduce sedentary behaviors in underactive older adults. The suite houses a core activity tracker and three add-on features that target correlates of inactivity: sedentary behavior, stereotypes about aging, and PA knowledge and routines. Three groups of 4–5 older adult smartphone owners were provided with and oriented to the Moving Up app activity tracker and one add-on feature. Participants beta-tested the app for two weeks, after which each cohort reconvened to discuss experiences, make recommendations for app improvements, and complete a usability questionnaire on their assigned feature. Results: Thirteen participants (median age, 71 years; iOS users, n=8; females, n=12) completed the beta-testing period and returned for follow-up. Reported usability was moderate across the features. Sentiments about app content and general impressions were mainly positive, although users made several recommendations for app improvements such as more individualized messaging and timely notifications. Conclusions: A PA app for older adults demonstrated generally good usability and acceptability. Integrating the impressions and recommendations from older adults into the design of mHealth tools will enhance overall usability and likelihood to positively influence PA behaviors long-term.     

Neighborhood Disorder and Physical Activity among Older Adults: A Longitudinal Study

Neighborhood physical disorder—the visual indications of neighborhood deterioration—may inhibit outdoor physical activity, particularly among older adults. However, few previous studies of the association between neighborhood disorder and physical activity have focused on this sensitive population group, and most have been cross-sectional. We examined the relationship between neighborhood physical disorder and physical activity, measured using the Physical Activity Scale for the Elderly (PASE), in a three-wave longitudinal study of 3497 New York City residents aged 65–75 at baseline weighted to be representative of the older adult population of New York City. We used longitudinal mixed linear regression controlling for a number of individual and neighborhood factors to estimate the association of disorder with PASE score at baseline and change in PASE score over 2 years. There were too few subjects to assess the effect of changes in disorder on activity levels. In multivariable mixed regression models accounting for individual and neighborhood factors; for missing data and for loss to follow-up, each standard deviation increase in neighborhood disorder was associated with an estimated 2.0 units (95% CI 0.3, 3.6) lower PASE score at baseline, or the equivalent of about 6 min of walking per day. However, physical disorder was not related to changes in PASE score over 2 years of follow-up. In this ethnically and socioeconomically diverse population of urban older adults, residents of more disordered neighborhoods were on average less active at baseline. Physical disorder was not associated with changes in overall physical activity over time.     

Objectively Measured Intensity-specific Physical Activity and Hippocampal Volume Among Community-dwelling Older Adults

BackgroundThe hippocampus is a brain structure important for memory and cognitive function. Physical activity may help prevent hippocampal atrophy. However, few studies have measured sedentary behavior (SB) and intensity-specific physical activity using an accelerometer. This study aimed to examine the cross-sectional associations of objectively-determined SB, light-intensity physical activity (LPA), and moderate-to-vigorous physical activity (MVPA) measured by an accelerometer with hippocampal volume among community-dwelling older adults using compositional data analysis (CoDa) approach.MethodsThis cross-sectional study was part of the Neuron to Environmental Impact across Generations (NEIGE) study. A randomly recruited sample of 485 Japanese older adults (47% male; aged 65–84 years) wore tri-axial accelerometers (Omron Healthcare) for 7 consecutive days in 2017. Hippocampal volume was measured with magnetic resonance imaging and the left and right hippocampal volumes were automatically segmented using FreeSurfer software. Associations of sedentary and physically active behaviors with hippocampal volume were examined with compositional linear regression analysis based on isometric log-ratio transformations of time use adjusted for potential confounding factors.ResultsThe relative proportion of time spent in MVPA, compared to the other two activities, was significantly positively associated with right hippocampal volume (β: 57.1, P-value = 0.027). However, no association existed between higher proportions of MVPA and left hippocampal volume, or between proportions of SB or LPA with either left or right hippocampal volumes.ConclusionThe proportion of time spent in MVPA, relative to the other two activities, was significantly positively associated with right hippocampal volume. MVPA may be beneficial for maintaining hippocampal volume.Key words: epidemiology, accelerometry, aging, hippocampus, compositional data analysis     

Physical Activity and Physical Function Improved Following a Community-based Intervention in Older Adults in Georgia Senior Centers

ABSTRACT

We evaluated a community-based physical activity intervention in Georgia senior centers. Participants were a convenience sample that completed the pre-test only (n = 592), or the pre-test, the intervention, and a post-test (n = 418, 98% aged 60 and older, mean age = 75, 83% female, 56% black). The 4-month physical activity intervention, based on the Health Belief Model, included 16 sessions that focused on educator-led chair exercises, promotion of walking, using a pedometer, and recording daily steps. Pre- and post-tests assessed physical activity and physical function, categorized as poor, moderate, or good (Short Physical Performance Battery). Following the intervention, participants improved their physical function (good physical function at pre-test vs. post-test: 16.5% vs. 25.3%, P ≤ 0.001), increased minutes of physical activity by 26% (P ≤ 0.001) and step counts by 29% (P ≤ 0.0001, sub-sample, n = 95), and decreased reports of “it's not safe” as a barrier to physical activity (P ≤ 0.05). Increased physical activity (P ≤ 0.01) was associated with improved physical function following the intervention. The results of this evaluation provide an evidence base for the effectiveness of this community intervention for improving physical activity and physical function in older adults.     

Strength Training and Light Physical Activity Reduces the Apnea-Hypopnea Index in Institutionalized Older Adults

ObjectivesTo determine the effect of 7 weeks of resistance training and walking on the apnea-hypopnea index (AHI) in institutionalized older adults compared with a usual care control group.DesignSecondary analysis of data from a randomized controlled trial.SettingTen nursing and 3 assisted living facilities in Arkansas.ParticipantsInstitutionalized older adults.InterventionsExercise group (EG) performed supervised resistance training to arm and hip extensors on 3 days a week with additional 2 days a week of light walking. Usual care group (UC) participated in the usual activities provided within their living facility.MeasurementsTwo nights of polysomnography before and following 7-week intervention.ResultsAdjusted means in the EG group showed a decrease in AHI from 20.2 (SD ±1.3) at baseline to 16.7 (SD ±0.9) at 7 weeks. Absolute strength gains were not associated with improved AHI.ConclusionSupervised resistance training and light walking reduced the severity of obstructive sleep apnea in institutionalized older adults.     

Adherence to a Mediterranean Diet Pattern,Physical Activity,and Physical Self-Concept in Spanish Older Adults

Background: The aging world population is accelerating rapidly. Physical self-concept (PSC) is one of the psychosocial factors with the greatest influence on an individual’s well-being and health. The traditional Mediterranean dietary pattern (MDP) is considered one of the healthiest dietary models, as it is nutritionally complete and easy to follow. Objective: To assess the adherence to MDP and its association with the practice of physical activity (PA) and PSC levels in the older adult Spanish population. Methods: A cross-sectional study was conducted on a representative sample of Spanish older adults (n = 342; older than 55 years old). Their PSC was assessed using a previously validated PSC questionnaire. Adherence to an MDP was assessed using a validated Mediterranean Diet Adherence Screener questionnaire. Their PA was measured using the Spanish version of the Rapid Assessment of Physical Activity Questionnaire. Data on age, sex, hypertension, cholesterol or diabetes suffered in the last 12 months, as well as weight, height, and BMI, were collected. Results: At the lowest levels of PSC, the percentage of individuals who were non-active and non-adhering to the MDP was lower compared to the highest levels (75.0% vs. 19.6; p = 0.001; Cramer’s V = 0.414, and 83.3% vs. 57.9%; p = 0.001; Cramer’s V = 0.221, respectively). This sample showed an abandonment of the most classic habits of the MDP, such as the consumption of olive oil, vegetables, fruits, nuts and fish. Conclusions: Non-adherence to the MDP and low levels of PA are associated with low levels of PSC in older adults.     

Simple Physical Activity Index Predicts Prognosis in Older Adults: Beijing Longitudinal Study of Aging

Objective

Frailty, which involves low physical activity (PA), is as a well-established factor of increased risk of hospitalization, disability, and mortality. To date, there are no specific tools to assess PA among Chinese elderly. As part of the Beijing Longitudinal Study of Aging (BLSA), we aimed to develop the BLSA Leisure-Time Physical Activity Questionnaire (BLSA-PAQ) and assess its prediction of mortality.

Design

Longitudinal study.

Setting

Community.

Participants

1810 Chinese older adults completed the BLSA-PAQ questionnaire.

Measurements

BLSA-PAQ questionnaire containing four items: walking, outdoor chores, low-intensity exercise, and moderate-intensity exercise. Physical function was assessed through the balance test, chair-stand test, and the activities of daily living (ADL), and instrumental activities of daily living (IADL). Frailty was evaluated using a modified frailty phenotype and frailty index.

Results

The following equation was obtained based on the 8-year mortality for the four BLSA-PAQ components: BLSA-PAQ index (BLSA-PAQ total score) = Walking score + Outdoor chores score + 2 × (low-intensity exercise score) + 3 × (moderate-intensity exercise score). The BLSA-PAQ index decreased with age, and was negatively related to modified frailty phenotype score and frailty index. Low PA and pre-low PA statuses were associated with poorer results in the balance and chair-stand tests, ADL dependency, IADL dependency, and frailty. After adjusting for age and gender, the 8-year mortality HRs were 1.453 (95% CI, 1.166-1.811) and 2.358 (95% CI, 1.856-2.995) for low PA and pre-low PA, respectively. Low PA defined by the BLSA-PAQ index was associated with frailty, disability, worse physical function, and higher mortality.

Conclusion

The BLSA-PAQ seems to be a reliable tool to measure PA in Chinese older adults. Further studies are needed to confirm these findings and validate the use of the BLSA-PAQ for frailty assessments of older adults.

     

Best-Practice Physical Activity Programs for Older Adults: Findings From the National Impact Study

Objectives. We assessed the impact of existing best-practice physical activity programs for older adults on physical activity participation and health-related outcomes.Methods. We used a multisite, randomized trial with 544 older adults (mean age 66 years) and measures at baseline, 5, and 10 months to test the impact of a multiple-component physical activity program compared with results for a control group that did not participate in such a program.Results. For adults who participated in a multiple-component physical activity program, we found statistically significant benefits at 5 and 10 months with regard to self-efficacy for exercise adherence over time (P < .001), adherence in the face of barriers (P = .01), increased upper- and lower-body strength (P = .02, P = .01), and exercise participation (P = .01).Conclusions. Best-practice community-based physical activity programs can measurably improve aspects of functioning that are risk factors for disability among older adults. US public policy should encourage these inexpensive health promotion programs.Moderate exercise 3 to 5 times per week for at least 30 minutes produces multiple health benefits for older adults at most levels of functional ability.¹ However, older adults are the most sedentary population in the United States,^2,3 with more than 60% failing to participate in regular physical activity.⁴A number of randomized controlled trials have tested specific exercise programs for older adults. To our knowledge, Wilcox et al. is the only study that has examined the impact of evidence-based programs adopted by community providers of physical activity programs for older adults.⁵ This study found that older adults who participated in 2 newly adopted programs experienced statistically significant benefits regarding physical activity participation, depression, stress, and body mass index. However, that study did not examine the impact of exercise programs already existing in the community. We sought to address this gap with our study.Community organizations like senior centers and YMCAs are the primary providers of physical activity programs for older adults in the United States. These providers strive to achieve a balance among the programs they offer, taking into consideration such factors as exercise science, older adults'' preferences, and real-world feasibility. In 2003, the Center for Healthy Aging of the National Council on Aging (NCOA) conducted a national competition to identify 10 best-practice physical activity programs operated by community organizations serving older adults. The competition was funded by the Robert Wood Johnson Foundation and was conducted in collaboration with the Center for Research on Health and Aging (CRHA) at the University of Illinois at Chicago. The Centers for Disease Control and Prevention''s Healthy Aging Research Network, the Active Aging Partnership, and nationally known physical activity experts helped NCOA develop best-practice criteria based on findings from the literature and expert judgment.Programs that participated in the national competition had to serve a large population of older adults, have a solid history of physical activity programming, and collect and evaluate outcomes data. The NCOA hosted application forms on its Web site, posted notices of the competition on Web sites and e-mail discussion lists, and networked with other national organizations to publicize the competition. More than 1100 competition applications were downloaded, and 83 were submitted. National experts scored the applications based on several criteria, including years of operation, numbers of clients served, types of instructors used, inservice education for instructors, and monitoring of participant attendance and outcomes. The top 29 applicants participated in telephone interviews that elicited more detailed information concerning each organization''s approach to program development and supervision, instructor training, collection and analysis of outcomes data, and sustainability. Finally, 10 programs were identified as national best-practice programs based on all of the above information. The NCOA awarded $1000 and a certificate of achievement to each of the 10 winning programs.A site visit team that included NCOA staff, researchers from the University of Illinois at Chicago, and other study partners visited the 10 best-practice sites to learn more about program elements, infrastructure support, partnership activities, and other factors that contributed to their success. During the visits, we assessed each site''s capacity to participate in the National Impact Study, which would assess the impact of site programs on participants. Based on findings from the site visits, we selected provider sites for participation in our study, recruited and enrolled study participants from those sites, and assessed the impact that participation in a multicomponent physical activity program had on those participants.     

Sexual Activity and Cognitive Decline in Older Adults

This prospective study tested whether sexual activity and emotional closeness during partnered sexual activity relate to cognitive decline (episodic memory performance) in older adulthood. In total, 6016 adults aged 50 and over (2672 men, 3344 women; M age?=?66.0?±?8.8 years) completed an episodic memory task and self-report questions related to health, sexual activity, and emotional closeness. Two years later, participants again completed the episodic memory task. After controlling for demographic and health-related lifestyle factors, more frequent sexual activity and greater emotional closeness during partnered sexual activity were associated with better memory performance. The association between sexual activity and memory performance was stronger among older participants in the sample. Memory performance worsened over 2 years, but change in memory performance was unrelated to sexual activity or emotional closeness during partnered sexual activity. These findings build on experimental research that has found sexual activity enhances episodic memory in non-human animals. Further research using longer timeframes and alternative measures of cognitive decline is recommended.