Change in self-efficacy following a single strength training session predicts sedentary older adults' subsequent motivation to join a strength training program

PURPOSE. To determine whether performance accomplishment and perceived exertion predict change in self-efficacy following a single strength training session and whether change in self-efficacy predicts subsequent motivation to join a strength training program. METHODS. Fifty-nine sedentary older adults participated in a single strength training session at a seniors' exercise center, completed measures of perceived exertion and self-efficacy, and received a voucher for a free fitness consultation. RESULTS. Regression analyses indicated that perceived exertion predicted change in self-efficacy. In turn, greater change in self-efficacy was associated with a greater likelihood of using the voucher for a fitness consultation. DISCUSSION. Sedentary older adults can be motivated toward joining a strength training program after an initial strength training session that required low exertion. Practitioners could increase strength training initiation by providing such experiences.     

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.     

Internet-based interventions have potential to affect short-term mediators and indicators of dietary behavior of young adults

ObjectiveEvaluate a theory-based, Internet-delivered nutrition education module.DesignRandomized, treatment-control design with pre-post intervention assessments.Setting and ParticipantsConvenience sample of 160 young adults (aged 18-24) recruited by community educators in 4 states. Study completers (n = 96) included a mix of racial/ethnic groups and family demographics, but were predominately white females without children.InterventionA Transtheoretical Model (TTM)-based, stage-tailored Internet program, F&;V (Fruit &; Vegetable) Express Bites, was delivered to treatment group participants; controls received nontailored messages in a comparable format.Main Outcome Measures and AnalysisTTM constructs at baseline, immediately postviewing, and at 30-day follow-up were compared via chi-square, McNemar's test, and logistic regression. Qualitative use and acceptability indicators were collected postviewing (treatment only).ResultsOf baseline respondents, 86.5% completed the study. At follow-up, self-efficacy, decisional balance, and selected processes improved for both groups, with only marginal advantages for the theory-based version. Fruit and vegetable consumption changes were similar for both groups. Qualitative measures of knowledge, confidence, and motivation improved (not measured for controls). Favorable ratings of treatment program acceptability and personal relevance were reported.Conclusions and ImplicationsThe Internet is a favorable option for reaching young adults with nutrition messages. This study did not identify strong advantages of theory-based tailoring, especially for fruit consumption, which had weaker barriers than vegetable consumption among this target audience.     

Whole Grain Nutrition Education Program Improves Whole Grain Knowledge and Behaviors Among Community-Residing Older Adults

U.S. older adults are not meeting the recommendation for whole grain (WG) intake. This pilot study determined the influence that a WG nutrition education program for community-residing adults aged 60?+?years has on WG knowledge and behaviors. The program included WG education and discussion, participation in hands-on activities and taste testing. Participants were mostly white, females. Total grain and WG dietary intake frequencies (WG frequency; p?≤?0.001), and “knowledge score” increased from PRE to POST (p?≤?0.001). Participants in PowerPoint-based classes had a higher “knowledge scores” at POST (p?=?0.002). Nearly all (n?=?139, 88.5%) intended to eat more WG foods, with almost two-thirds (n?=?93, 59.3%) reporting a “strong” intention to do so. There was a positive association between strength of intention to eat WG foods and “WG frequency” at POST (r?=?0.435, p?≤?0.001). Results suggest that this WG program is an effective strategy for improving WG knowledge and behaviors among older adults.     

Predicting long-term maintenance of physical activity in older adults

BACKGROUND: Considerable research has established that self-efficacy is a consistent correlate of physical activity. Additional factors, such as exercise-induced affect, social support, and value judgments, have also been identified as having the potential to influence adherence to activity. This study examined the utility of such variables in predicting the long-term exercise behavior of older adults. METHOD: In the context of a 6-month randomized controlled trial with an 18-month follow-up, we tested the extent to which adherence during the trial, affective responses to exercise, exercise value, and social support from the exercise group had either a direct or indirect effect through the mediation of exercise self-efficacy on physical activity levels at 6- and 18-month follow-up in a sample (N=174) of older adults (M age, 66 years). Structural equation modeling tested several models of exercise prediction. RESULTS: The best fitting model indicated significant paths from social support, affect, and exercise frequency to efficacy at the end of the program. Efficacy, in turn, was related to physical activity at 6- and 18-month follow-up. The model accounted for 40% of the variance in 18-month activity levels. CONCLUSION: This prospective study provides support for the inclusion of social cognitive variables in models of exercise adherence and highlights the pivotal role of self-efficacy in long-term exercise behavior. Subsequent trials are called for to replicate and extend these findings.     

Non-Exercise Estimated Cardiorespiratory Fitness: Associations with Brain Structure, Cognition, and Memory Complaints in Older Adults

There is increasing evidence that cardiorespiratory fitness (CRF) is associated with brain structure and function, and improvements in CRF through exercise training have been associated with neural and cognitive functioning in older adults. The objectives of this study were to validate the use of a non-exercise estimate of CRF, and to examine its association with cognitive function, brain structure and subjective memory complaints. Low active, older adults (N = 86; Mage = 65.14) completed a physician-supervised maximal exercise test, a 1-mile timed walk, several measures of cognitive function, and a 3 T structural MRI. Fitness was also calculated from an equation derived by Jurca et al. (2005) based on age, sex, body mass index, resting heart rate, and self-reported physical activity level. Analyses indicated that all three measures of CRF were significantly correlated with one another. In addition, measures of cognitive function, hippocampus volume, and memory complaints were significantly correlated with each measure of fitness. These findings have implications for using a low-risk, low-cost, non-exercise estimate of CRF in determining fitness associations with brain structure and cognitive function in older adults. As such, this measure may have utility for larger population based studies. Further validation is required, as is determination of whether such relationships hold over the course of exercise interventions.     

Self-Reported Barriers to Colorectal Cancer Screening in a Racially Diverse, Low-Income Study Population

Colorectal cancer (CRC) screening is underutilized, especially in low income, high minority populations. We examined the effect test-specific barriers have on colonoscopy and fecal immunochemical test (FIT) completion, what rationales are given for non-completion, and what “switch” patterns exist when participants are allowed to switch from one test to another. Low income adults who were not up-to-date with CRC screening guidelines were recruited from safety-net clinics and offered colonoscopy or FIT (n = 418). Follow up telephone surveys assessed test-specific barriers. Test completion was determined from patient medical records. For subjects who desired colonoscopy at baseline, finding a time to come in and transportation applied more to non-completers than completers (p = 0.001 and p < 0.001, respectively). For participants who initially wanted FIT, keeping track of cards, never putting stool on cards, and not remembering to mail cards back applied more to non-completers than completers (p = 0.003, p = 0.006, and p < 0.001, respectively). The most common rationale given for not completing screening was a desire for the other screening modality: 7 % of patients who initially preferred screening by FIT completed colonoscopy, while 8 % of patients who initially preferred screening by colonoscopy completed FIT. We conclude that test-specific barriers apply more to subjects who did not complete CRC screening. As a common rationale for test non-completion is a desire to receive a different screening modality, our findings suggest screening rates could be increased by giving patients the opportunity to switch tests after an initial choice is made.     

The FABS trial: A randomised control trial of the effects of a 6-month physical activity intervention on adherence and long-term physical activity and self-efficacy in older adults with memory complaints

Objective

The aim of this study is to assess in older adults with memory complaints, the effects of a 6-month home-based physical activity (PA) intervention on short-term adherence, short and long-term self-efficacy and the predictors of adherence.

Methods

Participants with memory complaints with or without mild cognitive impairment (MCI) were recruited from Perth, Western Australia between May 2004 and July 2006 and randomly assigned to a control or an intervention group. The intervention group received a 6-month PA programme and recorded sessions on a diary. Pedometer readings, questionnaires, and physical and cognitive measures were completed at 0, 6, 12 and 18 months.

Results

One hundred and seventy participants started the study. Retention rates were similar for both groups at all time-points however retention was higher for men than women (P < 0.01). Adherence to the prescribed PA was 72.8% (95% CI, 70.8 74.9%). Men had higher adherence rate than women (P < 0.001). Those with and without MCI had similar adherence. Compared to controls self-efficacy was higher in the intervention group after 6 months only (P < 0.01).

Conclusions

Older adults with memory complaints, with or without MCI, can successfully participate in and enjoy home-based PA programmes. Long-term adherence to such interventions may require continued support and increased self-efficacy. (Trial registration: ACTRN012605000136606.)     

Peripheral Blood T Cell Gene Expression Responses to Exercise and HMB in Sarcopenia

Background: Sarcopenia is a major health problem in older adults. Exercise and nutrient supplementation have been shown to be effective interventions but there are limited studies to investigate their effects on the management of sarcopenia and its possible underlying mechanisms. Here, we studied T cell gene expression responses to interventions in sarcopenia. Methods: The results of this study were part of a completed trial examining the effectiveness of a 12-week intervention with exercise and nutrition supplementation in community-dwelling Chinese older adults with sarcopenia, based on the available blood samples at baseline and 12 weeks from 46 randomized participants from three study groups, namely: exercise program alone (n = 11), combined-exercise program and nutrition supplement (n = 23), and waitlist control group (n = 12). T cell gene expression was evaluated, with emphasis on inflammation-related genes. Real-time PCR (RT-PCR) was performed on CD3 T cells in 38 selected genes. Correlation analysis was performed to relate the results of gene expression analysis with lower limb muscle strength performance, measured using leg extension tests. Results: Our results showed a significant improvement in leg extension for both the exercise program alone and the combined groups (p < 0.001). Nine genes showed significant pre- and post-difference in gene expression over 12 weeks of intervention in the combined group. Seven genes (RASGRP1, BIN1, LEF1, ANXA6, IL-7R, LRRN3, and PRKCQ) showed an interaction effect between intervention and gene expression levels on leg extension in the confirmatory analysis, with confounder variables controlled and FDR correction. Conclusions: Our findings showed that T cell-specific inflammatory gene expression was changed significantly after 12 weeks of intervention with combined exercise and HMB supplementation in sarcopenia, and that this was associated with lower limb muscle strength performance.     

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.     

Perceived benefits and barriers to exercise among persons with physical disabilities or chronic health conditions within action or maintenance stages of exercise

BackgroundInformation regarding factors that affect the initial step to exercise behavior change among persons with physical disabilities or chronic health conditions is available in the literature but much less is known regarding perceived benefits and barriers to exercise among those who are regularly active.ObjectiveThe purpose of this study was to examine the perceived benefits and barriers to exercise among persons with physical disabilities or chronic health conditions within action or maintenance stages of exercise.MethodsParticipants (n = 152) completed the Exercise Benefits and Barriers Scale (EBBS). For data analyses, disabilities and health conditions were grouped as neuromuscular, orthopedic, cardiovascular/pulmonary, or multiple conditions. Multivariate analysis of variance (MANOVA) was conducted to determine if mean differences on EBBS benefits and barriers scores existed among disability types, between sexes, among age groups, and between physical activity levels. Sum scores were computed to determine the strongest benefit and barrier responses.ResultsNo significant mean differences in EBBS scores were found between disability types, sexes, age groups, or physical activity levels (p > 0.05). Strongest benefit responses varied by group. Strongest barrier responses were the same for all demographic groups: “Exercise tires me,” “Exercise is hard work for me,” and “I am fatigued by exercise.”ConclusionsEBBS scores were similar across disability/health condition, sex, age, and physical activity level. Primary benefits reported were in the areas of improved physical performance and psychological outlook whereas the primary barriers were in the area of physical exertion.     

“My hair or my health:” Overcoming barriers to physical activity in African American women with a focus on hairstyle-related factors

ABSTRACT

Physical activity disparities among African American (AA) women may be related to sociocultural barriers, including difficulties with restyling hair after exercise. We sought to identify physical activity barriers and facilitators in AA women with a focus on sociocultural factors related to hairstyle maintenance. Participants (n = 51) were AA women aged 19–73 years who completed valid surveys and participated in structured focus groups, stratified by age and physical activity levels, from November 2012 to February 2013. The Constant Comparison method was used to develop qualitative themes for barriers and facilitators. The most frequently reported general physical activity barrier among exercisers was “lack of money” (27%) and among non-exercisers was “lack of self-discipline” (57%). A hairstyle-related barrier of “sweating out my hairstyle” was reported by 7% of exercisers and 29% of non-exercisers. This hairstyle-related barrier included the need for extra time and money to restyle hair due to perspiration. Hairstyle-related facilitators included: prioritizing health over hairstyle and high self-efficacy to restyle hair after perspiration. Participants were interested in resources to simplify hairstyle maintenance. AA women whose hairstyle is affected by perspiration may avoid physical activity due to time and financial burdens. Increasing self-efficacy to restyle hair after perspiration may help to overcome this barrier.     

Positive Effects of “Textured Lunches” Gatherings and Oral Exercises Combined with Physical Exercises on Oral and Physical Function in Older Individuals: A Cluster Randomized Controlled Trial

Objectives

Proper nutrition and physical exercises are essential to prevent frailty in older adults. Proper masticatory performance and oral function may influence on physical activities as well since the mouth is the entrance of nutrition and digestion. Thus, the present study aimed to test the combined program of specially devised lunch gatherings containing textured foods with oral and physical exercises on the improvement of oral and physical function in community-dwelling older adults.

Design

A Cluster randomized controlled trial

Setting and Participants

Eighty-six community-dwelling older adults in Daito city, Japan, were randomly assigned into control (n = 43) or intervention (n = 43) groups.

Intervention

The control group performed the physical exercise regimen only. The intervention group participated in a 12-week physical and oral exercise program and ate a so-called “munchy lunch” that introduced textured foods with proper nutrients together after performing the physical exercise twice a week following brief dietary instruction at the intervention onset. Physical training and lunch gatherings were held at local public centers.

Measurements

The differences in measured variables for physical and oral function between baseline and 12 weeks of intervention were statistically tested. Results: Oral function as measured by tongue pressure increased significantly in the intervention group (p=0.031), but not in the control group. Physical properties and activities, including body fat percentage and results of the timed up and go test, decreased more significantly in the intervention group than in controls (p<0.05).

Conclusions

Our findings suggest that a combined program of textured lunch gatherings with oral and physical exercises may improve physical and oral function as a preventative approach for frailty in community-dwelling older adults.

     

Characteristics of dropouts and completers from hypnobehavioral treatment for bulimia nervosa

This study compares demographic and psychological characteristics of a group of dropouts and completers from a hypnobehavioral treatment program for bulimia nervosa. Prior to treatment, 30 dropouts and 30 completers were assessed on the following questionnaires and scales: the Eating Disorders Inventory, the Zung Depression Scale, the General Health Questionnaire, the Eysenck Personality Inventory, the Stanford Hypnotic Clinical Scale, and five Visual Analogue Scales and Expectancy Scales. Results of ANOVA and chi-square analyses showed no significant differences between dropouts and completers on any of the demographic variables or psychological measures or scales. The results suggest that neither demographic nor psychological characteristics play a role in identifying dropouts from bulimia nervosa treatment.     

Changes in cognitive function after a 12-week exercise intervention in adults with Down syndrome

Background

Between 250,000 and 400,000 individuals in the United States are diagnosed with Down syndrome (DS). Nearly all adults with DS will develop Alzheimer's disease pathology starting in their thirties. Recent studies suggest that increased physical activity (PA) may be important for maintaining components of cognition, including memory.

Attrition in a behavioral weight-control program: A comparison of dropouts and completers

A major problem in weight-reduction programs is that a significant number of individuals terminate treatment prematurely. To help alleviate some of the problems associated with high attrition, it is important to understand the ways in which treatment dropouts are different from those individuals who complete a weight-reduction program. In the present study 271 obese persons who participated in a Health Maintenance Organization's low-cost behavioral program were evaluated. At the end of the 12-session program, dropouts (N = 161) and completers (N = 110) were identified. Treatment dropouts were compared to treatment completers on the following variables: initial weight, percent overweight, age, sex, occupation, education, number of previous attempts to lose weight, plus scores on the eating questionnaires. The major finding was that dropouts did not differ much from completers. The largest difference between these two groups occurred with respect to reported occupations. The completer group contained significantly more women working in the home than the dropout group. Reasons for this finding were hypothesized. To prevent high attrition rates, further research is recommended, particularly on the role of cognitive factors in weight control.     

Efficacy of progressive resistance training interventions in older adults in nursing homes: a systematic review

ObjectiveTo provide a synthesis of the evidence from clinical trials to determine whether progressive resistance training, as a single exercise intervention, improves strength and functional performance in older institutionalized adults.MethodsA comprehensive systematic database search for randomized controlled trials was performed, including AMED, CINAHL, COCHRANE, and all EMB reviews: Cochrane DSR, ACP Journal Club, DARE, MEDLINE, PREMEDLINE, and PsycINFO, completed in July 2011. Studies were then assessed for potential inclusion. Study quality indicators, cohort characteristics, training intervention, muscle strength, and functional performance outcomes were extracted.ResultsThirteen studies were reviewed; the mean cohort age range was 80 to 89 years. In general, the quality of the reviewed studies was moderately robust; an average of 9 of 11 quality criteria were accounted for in the reviewed literature. Significant improvements were found in muscle strength outcomes and functional performance outcomes, including chair to stand time, stair climbing, gait speed, balance, and functional capacity following progressive resistance training interventions.ConclusionsSignificant improvements in muscle strength and functional performance occur in response to progressive resistance training exercise, despite advanced age, presence of chronic diseases, extremely sedentary habits, and functional disabilities in older institutionalized individuals. Therefore, the incorporation of a progressive resistance training exercise program is an effective means to preserve independence levels by maintaining or improving the ability to perform activities of daily living and the implementation of this type of exercise program should be promoted and incorporated into the recreational schedules of long term care institutions.     

Impact of Tailored Multicomponent Exercise for Preventing Weakness and Falls on Nursing Home Residents’ Functional Capacity

ObjectivesWe aimed to determine whether the benefits of long (24 weeks) and short (4 weeks) training programs persisted after short (6 weeks) and long (14 weeks) periods of inactivity in older adult nursing home residents with sarcopenia.DesignMulticenter randomized trial.InterventionThe Vivifrail tailored, multicomponent exercise program (http://vivifrail.com) was conducted to individually prescribe exercise for frail older adults, depending on their functional capacity. The training included 4 levels combining strength and power, balance, flexibility, and cardiovascular endurance exercises.Setting and ParticipantsTwenty-four institutionalized older adults (87.1 ± 7.1 years, 58.3% women) diagnosed with sarcopenia were allocated into 2 groups: the Long Training-Short Detraining (LT-SD) group completed 24 weeks of supervised Vivifrail training followed by 6 weeks of detraining; the Short Training-Long Detraining (ST-LD) group completed 4 weeks of training and 14 weeks of detraining.MeasuresChanges in functional capacity and strength were evaluated at baseline, and after short and long training and detraining periods.ResultsBenefits after short and long exercise interventions persisted when compared with baseline. Vivifrail training was highly effective in the short term (4 weeks) in increasing functional and strength performance (effect size = 0.32-1.44, P < .044) with the exception of handgrip strength. Continued training during 24 weeks produced 10% to 20% additional improvements (P < .036). Frailty status was reversed in 36% of participants, with 59% achieving high self-autonomy. Detraining resulted in a 10% to 25% loss of strength and functional capacity even after 24 weeks of training (effects size = 0.24-0.92, P < .039).Conclusions and ImplicationsIntermittent strategies such as 4 weeks of supervised exercise 3 times yearly with no more than 14 weeks of inactivity between exercise periods appears as an efficient solution to the global challenge of maintaining functional capacity and can even reverse frailty in vulnerable institutionalized older adults.     

Evaluation of a theory-based nutrition intervention for older adults with diabetes mellitus

OBJECTIVE: To evaluate an intervention to improve food label knowledge and skills in diabetes management among older adults with diabetes mellitus. DESIGN: A randomized pretest-posttest control group design was used. SUBJECTS/SETTING: Participants (48 experimental, 50 control) were aged 65 years and older with type 2 diabetes for 1 year or longer; 93 participants (95%) completed the study, conducted in an outpatient setting. INTERVENTION: The intervention included 10 weekly group sessions led by a dietitian. Information processing, learning theory, and Social Cognitive Theory principles were used in program development and evaluation. MAIN OUTCOME MEASURES: Participants' knowledge, outcome expectations (expected results of behavior), self-efficacy, and decision-making skills were assessed. Instrument validity and reliability were established before program evaluation. STATISTICAL ANALYSES PERFORMED: Factor analysis identified underlying factor structures. Analysis of covariance with pretest score as covariate was used to compare groups at posttest. Paired t tests compared results within groups. RESULTS: Two factors were identified for outcome expectations (positive and negative) and for self-efficacy (promoters of and barriers to diabetes management). The experimental group had greater improvement in total knowledge scores (mean +/- standard error of the mean: 7.8+/-0.7) than the control group (0.2+/-0.7) (P < .0001), positive outcome expectations (0.59+/-0.15 vs 0.06+/-0.15, P = .01), promoters of diabetes management (0.83+/-0.12 vs -0.09+/-0.18, P < or = .001) and decision-making skills (5.1+/-0.5 vs 0.3+/-0.5, P < .0001) and greater reduction in barriers to diabetes management (1.1+/-0.16 vs 0.34+/-0.16, P < .01). No significant difference in negative outcome expectations occurred between groups at posttest. APPLICATIONS/CONCLUSIONS: Older adults with diabetes can benefit from nutrition education designed to improve knowledge and skills necessary for diabetes management.     

A translational research evaluation of the Stay Active and Independent for Life (SAIL) community-based fall prevention exercise and education program

Falls in older adults are the leading cause of injury hospitalizations and fatalities in the United States; primary risk factors are muscle weakness, impaired mobility, and balance deficits. This article describes the 12-month translational research evaluation of the Stay Active and Independent for Life (SAIL) community-based public health, public domain fall prevention exercise and education program. Recruitment reached the target goal by 154%; 331 adults (mean age = 74.6) attended more than one class (mean classes attended = 24.8, SD = 26.6, range = 1-120) at nine community sites in one county in the 12-month period; 173 completed health and demographic forms, 132 completed program surveys, and 91 completed baseline and follow-up physical function tests. Physical function test results showed significant improvements in strength, balance, and mobility in those who were below normal limits at baseline, and in those who attended classes twice a week or more for more than 2 months. Survey results found that 93% of respondents reported improved performance of daily activities; 92% reported improved strength, balance, fitness, or flexibility; and 80% found the SAIL information guide education component helpful.