Abby C. King

Physical Activity and Public Health in Older Adults Recommendation From the American College of Sports Medicine and the American Heart Association

OBJECTIVE To issue a recommendation on the types and amounts of physical activity needed to improve and maintain health in older adults. PARTICIPANTS A panel of scientists with expertise in public health, behavioral science, epidemiology, exercise science, medicine, and gerontology. EVIDENCE The expert panel reviewed existing consensus statements and relevant evidence from primary research articles and reviews of the literature. PROCESS After drafting a recommendation for the older adult population and reviewing drafts of the Updated Recommendation from the American College of Sports Medicine (ACSM) and the American Heart Association (AHA) for Adults, the panel issued a final recommendation on physical activity for older adults. SUMMARY The recommendation for older adults is similar to the updated ACSM/AHA recommendation for adults, but has several important differences including: the recommended intensity of aerobic activity takes into account the older adults aerobic fitness; activities that maintain or increase flexibility are recommended; and balance exercises are recommended for older adults at risk of falls. In addition, older adults should have an activity plan for achieving recommended physical activity that integrates preventive and therapeutic recommendations. The promotion of physical activity in older adults should emphasize moderate-intensity aerobic activity, muscle-strengthening activity, reducing sedentary behavior, and risk management.

CHAMPS Physical Activity Questionnaire for Older Adults: outcomes for interventions.

PURPOSE To evaluate effectively interventions to increase physical activity among older persons, reliable and valid measures of physical activity are required that can also detect the expected types of physical activity changes in this population. This paper describes a self-report physical activity questionnaire for older men and women, developed to evaluate the outcomes of the Community Healthy Activities Model Program for Seniors (CHAMPS), an intervention to increase physical activity. METHODS The questionnaire assesses weekly frequency and duration of various physical activities typically undertaken by older adults. We estimated caloric expenditure/wk expended in physical activity and created a summary frequency/wk measure. We calculated measures of each of these for: 1) activities of at least moderate intensity (MET value >/= 3.0); and 2) all specified physical activities, including those of light intensity. Six-month stability was estimated on participants not likely to change (assessment-only control group, physically active cohort). Several tests of construct validity were conducted, and sensitivity to change was analyzed based on response to the CHAMPS intervention. RESULTS The sample (N = 249) comprised underactive persons (N = 173 from the CHAMPS trial) and active persons (N = 76). The sample was aged 65-90 yr (mean = 74, SD = 6); 64% were women, and 9% were minorities. Six-month stability ranged from 0.58 to 0.67, using intraclass correlation coefficients. Nearly all construct validity hypotheses were confirmed, though correlations were modest. All measures were sensitive to change (P < or = 0.01), with small to moderate effect sizes (0.38-0.64). CONCLUSIONS The CHAMPS measure may be useful for evaluating the effectiveness of programs aimed at increasing levels of physical activity in older adults.

Personal and environmental factors associated with physical inactivity among different racial-ethnic groups of U.S. middle-aged and older-aged women.

Personal, program-based, and environmental barriers to physical activity were explored among a U.S. population-derived sample of 2,912 women 40 years of age and older. Factors significantly associated with inactivity included American Indian ethnicity, older age, less education, lack of energy, lack of hills in ones neighborhood, absence of enjoyable scenery, and infrequent observation of others exercising in ones neighborhood. For all ethnic subgroups, caregiving duties and lacking energy to exercise ranked among the top 4 most frequently reported barriers. Approximately 62% of respondents rated exercise on ones own with instruction as more appealing than undertaking exercise in an instructor-led group, regardless of ethnicity or current physical activity levels. The results underscore the importance of a multifaceted approach to understanding physical activity determinants in this understudied, high-risk population segment.

Long-term Effects of Varying Intensities and Formats of Physical Activity on Participation Rates, Fitness, and Lipoproteins in Men and Women Aged 50 to 65 Years

BACKGROUND Although exercise parameters such as intensity and format have been shown to influence exercise participation rates and physiological outcomes in the short term, few data are available evaluating their longer-term effects. The study objective was to determine the 2-year effects of differing intensities and formats of endurance exercise on exercise participation rates, fitness, and plasma HDL cholesterol levels among healthy older adults. METHODS AND RESULTS Higher-intensity, group-based exercise training; higher-intensity, home-based exercise; and lower-intensity, home-based exercise were compared in a 2-year randomized trial. Participants were 149 men and 120 postmenopausal women 50 to 65 years of age who were sedentary and free of cardiovascular disease. Recruitment was achieved through a random digit-dial community telephone survey and media promotion. All exercise occurred in community settings. For higher-intensity exercise training, three 40-minute endurance training sessions per week were prescribed at 73% to 88% of peak treadmill heart rate. For lower-intensity exercise, five 30-minute endurance training sessions per week were prescribed at 60% to 73% of peak treadmill heart rate. Treadmill exercise performance, lipoprotein levels and other heart disease risk factors, and exercise adherence were evaluated at baseline and across the 2-year period. Treadmill exercise test performance improved for all three training conditions during year 1 and was successfully maintained during year 2, particularly for subjects in the higher-intensity, home-based condition. Subjects in that condition also showed the greatest year 2 exercise adherence rates (P < .003). Although no significant increases in HDL cholesterol were observed during year 1, by the end of year 2 subjects in the two home-based training conditions showed small but significant HDL cholesterol increases over baseline (P < .01). The increases were particularly pronounced for subjects in the lower-intensity condition, whose exercise prescription required more frequent exercise sessions per week. For all exercise conditions, increases in HDL cholesterol were associated with decreases in waist-to-hip ratio in both men and women (P < .04). CONCLUSIONS While older adults can benefit from initiating a regular regimen of moderate-intensity exercise in terms of improved fitness levels and small improvements in HDL cholesterol levels, the time frame needed to achieve HDL cholesterol change (2 years) may be longer than that reported previously for younger populations. Frequency of participation may be particularly important for achieving such changes. Supervised home-based exercise regimens represent a safe, attractive alternative for achieving sustained participation.

Physical activity interventions targeting older adults. A critical review and recommendations

BACKGROUND Although many of the chronic conditions plaguing older populations are preventable through appropriate lifestyle interventions such as regular physical activity, persons in this age group represent the most sedentary segment of the adult population. The purpose of the current paper was to provide a critical selected review of the scientific literature focusing on interventions to promote physical activity among older adults. METHODS Comprehensive computerized searches of the recent English language literature aimed at physical activity intervention in adults aged 50 years and older, supplemented with visual scans of several journal on aging, were undertaken. Articles were considered to be relevant for the current review if they were community-based, employed a randomized design or a quasi-experimental design with an appropriate comparison group, and included information on intervention participation rates, pre- and post-intervention physical activity levels, and/or pre/post changes in relevant physical performance measures. RESULTS Twenty-nine studies were identified that fit the stated criteria. Among the strengths of the studies reviewed were reasonable physical activity participation rates and relatively long study durations. Among the weaknesses of the literature reviewed were the relative lack of specific behavioral or program-based strategies aimed at promoting physical activity participation, as well as the dearth of studies aimed at replication, generalizability of interventions to important subgroups, implementation, and cost-effectiveness evaluation. CONCLUSIONS Recommendations for future scientific endeavors targeting older adults are discussed.

Effect of Structured Physical Activity on Prevention of Major Mobility Disability in Older Adults: The LIFE Study Randomized Clinical Trial

IMPORTANCE In older adults reduced mobility is common and is an independent risk factor for morbidity, hospitalization, disability, and mortality. Limited evidence suggests that physical activity may help prevent mobility disability; however, there are no definitive clinical trials examining whether physical activity prevents or delays mobility disability. OBJECTIVE To test the hypothesis that a long-term structured physical activity program is more effective than a health education program (also referred to as a successful aging program) in reducing the risk of major mobility disability. DESIGN, SETTING, AND PARTICIPANTS The Lifestyle Interventions and Independence for Elders (LIFE) study was a multicenter, randomized trial that enrolled participants between February 2010 and December 2011, who participated for an average of 2.6 years. Follow-up ended in December 2013. Outcome assessors were blinded to the intervention assignment. Participants were recruited from urban, suburban, and rural communities at 8 centers throughout the United States. We randomized a volunteer sample of 1635 sedentary men and women aged 70 to 89 years who had physical limitations, defined as a score on the Short Physical Performance Battery of 9 or below, but were able to walk 400 m. INTERVENTIONS Participants were randomized to a structured, moderate-intensity physical activity program (n = 818) conducted in a center (twice/wk) and at home (3-4 times/wk) that included aerobic, resistance, and flexibility training activities or to a health education program (n = 817) consisting of workshops on topics relevant to older adults and upper extremity stretching exercises. MAIN OUTCOMES AND MEASURES The primary outcome was major mobility disability objectively defined by loss of ability to walk 400 m. RESULTS Incident major mobility disability occurred in 30.1% (246 participants) of the physical activity group and 35.5% (290 participants) of the health education group (hazard ratio [HR], 0.82 [95% CI, 0.69-0.98], P = .03).Persistent mobility disability was experienced by 120 participants (14.7%) in the physical activity group and 162 participants (19.8%) in the health education group (HR, 0.72 [95% CI, 0.57-0.91]; P = .006). Serious adverse events were reported by 404 participants (49.4%) in the physical activity group and 373 participants (45.7%) in the health education group (risk ratio, 1.08 [95% CI, 0.98-1.20]). CONCLUSIONS AND RELEVANCE A structured, moderate-intensity physical activity program compared with a health education program reduced major mobility disability over 2.6 years among older adults at risk for disability. These findings suggest mobility benefit from such a program in vulnerable older adults. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01072500.

An evaluation of three self-report physical activity instruments for older adults

PURPOSE To assess the known-groups and construct validity of measures from the CHAMPS Physical Activity Questionnaire, Physical Activity Survey for the Elderly (PASE), and the Yale Physical Activity Survey (YPAS). METHODS The three questionnaires were administered to a convenience sample of older adults (N = 87) recruited from community centers and retirement homes. Validation measures included the SF-36 measures of physical functioning, general health, mental health, and pain; body mass index; performance-based tests of lower body functioning and endurance; and Mini-Logger activity monitor data from ankle and waist sensors. Validity was estimated by testing hypotheses about associations between physical activity and validation measures. RESULTS As hypothesized, differences in activity levels on all measures were found between older adults in retirement homes (less active) and community centers (more active) (P-values < 0.0001). Correlations of physical activity measures with performance-based measures ranged from 0.44 to 0.68, conforming to hypotheses; hypotheses regarding associations with the SF-36 measures were also confirmed. Body mass index was not correlated with any of the physical activity measures, contrary to hypotheses. Correlations of physical activity measures with Mini-Logger counts ranged from 0.36 to 0.59 (ankle) and 0.42 to 0.61 (waist) as hypothesized. Correlations among the measures from the three instruments ranged from 0.58 to 0.68. CONCLUSIONS The PASE, YPAS, and CHAMPS each demonstrated acceptable validity, as all measures met nearly all hypotheses. Higher validity coefficients were found for subgroups (men, 65-74 yr, retirement home), suggesting that these instruments may perform better for certain segments of the older adult population.

Theoretical approaches to the promotion of physical activity: Forging a transdisciplinary paradigm

BACKGROUND Research in the physical activity promotion arena has focused on the application of theoretical perspectives aimed primarily at personal levels of understanding and analysis. The investigation of such theories has provided some insights related to potentially useful mediators of physical activity behavior. However, to continue to expand this field, new perspectives on personal-level theories, in addition to the exploration of more macro-level conceptual perspectives, are required. OBJECTIVE The purpose of this article is to: (1) briefly review the current strengths and limitations of the personal-level, physical activity-theory literature; and (2) introduce concepts and perspectives from other fields, including the social-ecology and urban-planning fields, of potential relevance to the physical activity arena. METHOD We provide an overview of potentially relevant theoretical perspectives aimed at different levels of understanding and analysis, from the personal level through the broader-scale meso- and macro-environmental perspectives. In addition, we suggest initial steps to take in developing a transdisciplinary paradigm encompassing all such levels of analysis and investigation. CONCLUSIONS Given the scope of the physical inactivity epidemic facing the U.S. population currently and in the future, methods and approaches that integrate theory and concepts across a broader group of disciplines will be increasingly necessary.

Depression and the Metabolic Syndrome in Young Adults: Findings From the Third National Health and Nutrition Examination Survey

Objective: Previous reports have suggested that depression may lead to the development of cardiovascular disease through its association with the metabolic syndrome; however, little is known about the relationship between depression and the metabolic syndrome. The aim of this study was to establish an association between depression and the metabolic syndrome in a nationally representative sample. Methods: The Third National Health and Nutrition Examination Survey is a population-based health survey of noninstitutionalized US citizens completed between 1988 and 1994. Three thousand one hundred eighty-six men and 3003 women, age 17 to 39, free of coronary heart disease and diabetes, completed the depression module from the Diagnostic Interview Schedule and a medical examination that provided clinical data needed to establish the presence of the metabolic syndrome, as defined by the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Cholesterol in Adults. Results: Women with a history of a major depressive episode were twice as likely to have the metabolic syndrome compared with those with no history of depression. The relationship between depression and metabolic syndrome remained after controlling for age, race, education, smoking, physical inactivity, carbohydrate consumption, and alcohol use. Men with a history of depression were not significantly more likely to have the metabolic syndrome. Conclusions: The prevalence of the metabolic syndrome is elevated among women with a history of depression. It is important to better understand the role depression may play in the effort to reduce the prevalence of the metabolic syndrome and its health consequences.

Real-Time Recognition of Physical Activities and Their Intensities Using Wireless Accelerometers and a Heart Rate Monitor

In this paper, we present a real-time algorithm for automatic recognition of not only physical activities, but also, in some cases, their intensities, using five triaxial wireless accelerometers and a wireless heart rate monitor. The algorithm has been evaluated using datasets consisting of 30 physical gymnasium activities collected from a total of 21 people at two different labs. On these activities, we have obtained a recognition accuracy performance of 94.6% using subject-dependent training and 56.3% using subject-independent training. The addition of heart rate data improves subject-dependent recognition accuracy only by 1.2% and subject-independent recognition only by 2.1%. When recognizing activity type without differentiating intensity levels, we obtain a subject-independent performance of 80.6%. We discuss why heart rate data has such little discriminatory power.