Carola C. Ekelund

The Veterans Learning to Improve Fitness and Function in Elders Study: A Randomized Trial of Primary Care–Based Physical Activity Counseling For Older Men

OBJECTIVES: To determine the effects of primary care–based, multicomponent physical activity counseling (PAC) promoting physical activity (PA) guidelines on gait speed and related measures of PA and function in older veterans.

Effect of Physical Activity Guidelines on Physical Function in Older Adults

OBJECTIVES: To determine whether elderly people who meet national guidelines have higher physical function (PF) scores than those who do not and the effect on functional trajectory when physical activity (PA) levels change from above to below this threshold, or vice versa.

Long-term changes in physical activity following a one-year home-based physical activity counseling program in older adults with multiple morbidities.

This study assessed the sustained effect of a physical activity (PA) counseling intervention on PA one year after intervention, predictors of sustained PA participation, and three classes of post-intervention PA trajectories (improvers, maintainers, and decliners) in 238 older Veterans. Declines in minutes of PA from 12 to 24 months were observed for both the treatment and control arms of the study. PA at 12 months was the strongest predictor of post-intervention changes in PA. To our surprise, those who took up the intervention and increased PA levels the most, had significant declines in post-intervention PA. Analysis of the three post-intervention PA trajectories demonstrated that the maintenance group actually reflected a group of nonresponders to the intervention who had more comorbidities, lower self-efficacy, and worse physical function than the improvers or decliners. Results suggest that behavioral counseling/support must be ongoing to promote maintenance. Strategies to promote PA appropriately to subgroups of individuals are needed.

The impact of self-reported arthritis and diabetes on response to a home-based physical activity counselling intervention.

Objectives: Physical activity (PA) has the potential to improve outcomes in both arthritis and diabetes, but these conditions are rarely examined together. Our objective was to explore whether persons with arthritis alone or those with both arthritis and diabetes could improve amounts of PA with a home-based counselling intervention. Methods: As part of the Veterans LIFE (Learning to Improve Fitness and Function in Elders) Study, veterans aged 70–92 were randomized to usual care or a 12-month PA counselling programme. Arthritis and diabetes were assessed by self-report. Mixed models were used to compare trajectories for minutes of endurance and strength training PA for persons with no arthritis (n = 85), arthritis (n = 178), and arthritis plus diabetes (n = 84). Results: Recipients of PA counselling increased minutes of PA per week independent of disease status (treatment arm by time interaction p < 0.05 for both; endurance training time p = 0.0006 and strength training time p < 0.0001). Although PA was lower at each wave among persons with arthritis, and even more so among persons with arthritis plus diabetes, the presence of these conditions did not significantly influence response to the intervention (arthritis/diabetes group × time interactions p > 0.05 for both outcomes) as each group experienced a nearly twofold or greater increase in PA. Conclusions: A home-based PA intervention was effective in increasing minutes of weekly moderate intensity endurance and strength training PA in older veterans, even among those with arthritis or arthritis plus diabetes. This programme may serve as a useful model to improve outcomes in older persons with these pervasive diseases.

Is diabetes associated with poorer self-efficacy and motivation for physical activity in older adults with arthritis?

Objectives: The primary aim was to explore whether arthritis is associated with poorer self-efficacy and motivation for, and participation in, two specific types of physical activity (PA): endurance training (ET) and strength training (ST). A further objective was to determine whether the added burden of diabetes contributes to a further reduction in these PA determinants and types. Methods: Self-efficacy and motivation for exercise and minutes per week of ET and ST were measured in 347 older veterans enrolled in a home-based PA counselling intervention. Regression analyses were used to compare high versus low self-efficacy and motivation and PA minutes in persons without arthritis, with arthritis alone, and with arthritis plus diabetes. Results: Persons with arthritis alone reported lower self-efficacy for ET and ST than those without arthritis [odds ratio (OR)ET 0.71, 95% confidence interval (CI) 0.39–1.20; ORST 0.69, 95% CI 0.39–1.20]. A further reduction in self-efficacy for these two types of PA was observed for those with both arthritis and diabetes (ORET 0.65, 95% CI 0.44–0.92; ORST 0.64, 95% CI 0.44–0.93; trend p < 0.001). There was no trend towards a reduction in motivation for PA in those with arthritis alone or with arthritis and diabetes. Persons with arthritis exhibited higher motivation for ET than those without arthritis (ORET 1.85, 95% CI 1.12–3.33). There were no significant differences between the three groups in minutes of ET (p = 0.93), but persons with arthritis plus diabetes reported significantly less ST compared to individuals with arthritis only (p = 0.03). Conclusions: Despite reduced self-efficacy for ET and ST and less ST in older persons with arthritis, motivation for both PA types remains high, even in the presence of diabetes.

The Veterans LIFE Study: A Randomized Trial of Primary Care Based Physical Activity Counseling For Older Men

OBJECTIVES: To determine the effects of primary care–based, multicomponent physical activity counseling (PAC) promoting physical activity (PA) guidelines on gait speed and related measures of PA and function in older veterans.

The Veterans Learning to Improve Fitness and Function in Elders Study: A Randomized Trial of Primary CareâBased Physical Activity Counseling For Older Men: RCT OF PHYSICAL ACTIVITY COUNSELING

OBJECTIVES: To determine the effects of primary care–based, multicomponent physical activity counseling (PAC) promoting physical activity (PA) guidelines on gait speed and related measures of PA and function in older veterans.

Economic Analysis of Primary Care-Based Physical Activity Counseling in Older Men: The VA-LIFE Trial

To perform an economic evaluation of a primary care‐based physical activity counseling intervention that improved physical activity levels and rapid gait speed in older veterans.

The Effect of Nonselective and Selective Betablockade on Perceived Exertion During Treadmill Exercise in Mild Hypertensive Type A and B Males and the Interaction with Aerobic Training

Within many medical disciplines it is important to quantify subjective symptoms. Several scales have been developed to rate the perception of exertion during physical exercise (Carton, Rhodes, 1985). One of the most widely used scales is the category scale developed by Borg (1982). The Borg scale has been extensively studied both from a theoretical standpoint and in clinical practice (Borg, Linderholm, 1970; Pandolf, 1984; Carton, Rhodes, 1985). However, limited data are available about the effect of betablockade on the Borg rating, the effect of exercise training on rating and the influence of psychological factors (Morgan, 1973; Morgan, Borg, 1981; Morgan, 1981), including the behavior effects of Type A on rating of perceived exertion.

Differences between completely physically inactive and low active older men and their response to an exercise intervention: the Veterans LIFE study

Background: Physical activity interventions typically do not report behavioral changes in activity sub‐groups. The aim of this study was to compare baseline differences and changes in physical activity between truly physically inactive men and low active men enrolled in a twelve‐month, home‐based physical activity intervention. Methods: Veterans with a mean age of 77.6 years were randomized to either a physical activity intervention or usual care. Measures included self‐reported physical activity, physical function, and physical performance. Results: At baseline, the physically inactive group reported more symptoms and poorer functioning than the low active group. At 12 months, physically inactive men randomized to the intervention group increased their physical activity to an average of 73.3 minutes per week. Physically inactive individuals randomized to the control group were eight times more likely to remain inactive compared to the low active group. Conclusions: Completely physically inactive older men can markedly increase physical activity levels with a long‐term intervention. Without such intervention, the likelihood of this group remaining inactive is eightfold.