Colleen Keller

A Review of Clinical Trials of Tai Chi and Qigong in Older Adults

Initiation and maintenance of physical activity (PA) in older adults is of increasing concern as the benefits of PA have been shown to improve physical functioning, mood, weight, and cardiovascular risk factors. Meditative movement forms of PA, such as tai chi and qigong (TC&QG), are holistic in nature and have increased in popularity over the past few decades. Several randomized controlled trials have evaluated TC&QG interventions from multiple perspectives, specifically targeting older adults. The purpose of this report is to synthesize intervention studies targeting TC&QG and identify the physical and psychological health outcomes shown to be associated with TC&QG in community dwelling adults older than 55. Based on specific inclusion criteria, 36 research reports with a total of 3,799 participants were included in this review. Five categories of study outcomes were identified, including falls and balance, physical function, cardiovascular disease, and psychological and additional disease-specific responses. Significant improvement in clusters of similar outcomes indicated interventions utilizing TC&QG may help older adults improve physical function and reduce blood pressure, fall risk, and depression and anxiety. Missing from the reviewed reports is a discussion of how spiritual exploration with meditative forms of PA, an important component of these movement activities, may contribute to successful aging.

Risk factors for mobility limitation in community-dwelling older adults: a social ecological perspective.

Although a variety of risk factors for mobility limitation in older adults have been examined, a collective review of relevant literature has not been reported. The purposes of this review are to report the intrapersonal, interpersonal, environmental, and organizational risk factors related to mobility limitation using a social ecological perspective and to discuss the direction of future clinical practice consistent with current literature on mobility limitation of community-dwelling older adults. Intrapersonal risk factors related to mobility limitation include advanced age, female gender, low socioeconomic status, comorbidity, lack of motivation (i.e., dependent personality, decreased self-efficacy), lifestyle factors (i.e., sedentary lifestyle, smoking, obesity), and physiological factors (i.e., vitamin D deficiency, inflammation, poor nutritional status). Interpersonal risk factors related to mobility limitation include weak social networks and limited social activities. Geriatric clients may also experience a decline in mobility when they encounter environmental challenges such as an inconvenient home environment and lack of availability of services in their community, as well as lack of organizational resources stemming from social policy. Potential intervention strategies focused on modifiable risk factors may include lifestyle modifications, social networking programs, and enhancing awareness of environmental and organizational resources in the community for older adults at risk for mobility limitation.

Interventions for promoting mobility in community-dwelling older adults

Purpose: The purposes of this review were to provide an updated report of intervention studies designed to enhance mobility in older adults and discuss the strengths and limitations of existing intervention studies and their implications for practice. Data sources: Medline, CINAHL, and PsychInfo were searched to identify original research articles reporting interventions for promoting mobility in community‐dwelling older adults. Conclusion: Effective interventions for enhancing mobility in older adults include walking, aerobic exercise, and resistance training focusing on strength, balance, and flexibility. Group‐based interventions show significant beneficial effects in increasing mobility. To obtain significant effects of physical activity interventions, the patient should participate in the exercise programs for at least 12 weeks. Strengths of existing clinical trials for promoting mobility in older adults include testing of various types of physical activity and training interventions and the use of an experimental design with a control group. The major challenges of creating mobility enhancement recommendations for older adults include detailing a mobility enhancement program will delay disability, creating a specific program dose for different populations by gender and ethnicity, and developing culturally appropriate mobility enhancement programs to improve adherence over time. Implications for practice: Prescribing regular physical activity including aerobic exercise and resistance training in a primary care setting can be a beneficial approach to minimize progression of impaired mobility in older adults. The typical dose of the physical activity prescription is 20‐60 min of aerobic activity three times weekly. Adherence to mobility enhancement recommendations by older patients can be followed up by in‐person interview or use of mobility monitoring tools such as exercise diary or log.

Using Visual Methods to Uncover Context

The accurate assessment of physical activity and dietary intake is essential for assessing the relationships between physical activity, dietary intake, and health outcomes. However, the measurement of physical activity and dietary intake among women, particularly minority women, poses unique challenges related to gender, ethnicity, and social context. Measures that are not culturally relevant or sensitive to the experiences, traditions, or beliefs of ethnically diverse women might result in data that are unreliable, or which cannot be interpreted. Visual methods show promise for elucidating concepts that are important to refine established measures for assessing dietary intake and physical activity in diverse ethnic groups. Hispanic women, a largely understudied subgroup that experiences long-term health risks associated with dietary and physical activity behaviors, serves as the focal group for this discussion of the potential for visual methods to develop culturally and contextually relevant and valid approaches to outcome assessment.

Exploring Resources for Physical Activity in Hispanic Women, Using Photo Elicitation

Addressing cultural, social, and contextual resources to promote physical activity behavior among Hispanic women is necessary to establish effective intervention approaches. With this research we intended to (a) explore cultural, social, and contextual resources for physical activity among Hispanic women; and (b) evaluate the acceptability of visual methods as an innovative, formative method to enhance intervention relevance. A qualitative descriptive methodological design incorporating photo elicitation was used with 7 Hispanic women, aged 23 to 60 (X = 44.2). Results were varied, and themes captured cultural, social, and contextual resources. Culture provided an overarching perspective, guiding identification and choice of physical activity resources, support, and setting. Themes included being active as a way of life, acknowledging tradition, moving with me, creating place, and building resources. Photo elicitation was evaluated as an acceptable method. Data provide an initial step toward generating a more complete understanding of perceived resources for physical activity in Hispanic women, and support the acceptability of photo elicitation.

The Role of Lay Health Advisors in Cardiovascular Risk Reduction: A Review

Interventions are needed to reduce the negative impact of cardiovascular disease. The combination of health risks for disease, disability, and mortality, particularly among underserved populations, might be best addressed with programs designed to enhance awareness and development of resources within a context of community support. The objectives of this review were to: (1) provide a comprehensive review and evaluation of the roles, evaluation, and effectiveness of LHA in community-based programs with an emphasis on cardiovascular risk reduction; and (2) provide recommendations for future research involving LHA in such programs. Computer and manual searches were conducted of articles in the English-language literature from 1980 to 2007. Twenty articles were evaluated, which emphasized the role of the LHA in cardiovascular risk reduction. A review of research literature provides a starting point for determining salient approaches for intervention and evaluation, issues related to program implementation and sustainability, and strengths and limitations of existing approaches.

Interventions for Weight Management in Postpartum Women

OBJECTIVE To report the results of a comprehensive review of published intervention studies to identify the best evidence available for guiding weight management interventions in postpartum women. DATA SOURCES Electronic searches were conducted of three electronic databases: Cumulative Index to Nursing and Allied Health Literature; Medline; and the Science Citation Index, Expanded, in the Web of Science from 1994 to May 2007. Keyword searches were conducted using the terms obesity, obese, overweight, postpartum, pregnancy weight, and weight management in postpartum women. STUDY SELECTION Six studies were selected that met the inclusion criteria of testing interventions and one that reported preintervention planning and targeted a weight management intervention for postpartum women. DATA EXTRACTION All six interventions showed significant impact with diet and exercise or some combination on body composition in the targeted sample of women. DATA SYNTHESIS The strengths of previous studies include an emphasis on precision in outcome measures and experimental conditions; limitations were that the theoretical basis for the interventions was frequently omitted and limited attention given to the cultural, social, and contextual factors established in descriptive research. CONCLUSIONS Interventions need to target women early in their childbearing years to have the most significant long-term impact.

Barriers to Physical Activity Among African American Women: An Integrative Review of the Literature

A key aspect for researchers to consider when developing culturally appropriate physical activity (PA) interventions for African American (AA) women are the specific barriers AA women face that limit their participation in PA. Identification and critical examination of these barriers is the first step in developing comprehensive culturally relevant approaches to promote PA and help resolve PA-related health disparities in this underserved population. We conducted a systematic integrative literature review to identify barriers to PA among AA women. Five electronic databases were searched, and forty-two studies (twenty-seven qualitative, fourteen quantitative, one mixed method) published since 1990 (range 1998–2013) in English language journals met inclusion criteria for review. Barriers were classified as intrapersonal, interpersonal, or environment/community according to their respective level of influence within our social ecological framework. Intrapersonal barriers included lack of time, knowledge, and motivation; physical appearance concerns; health concerns; monetary cost of exercise facilities; and tiredness/fatigue. Interpersonal barriers included family/caregiving responsibilities; lack of social support; and lack of a PA partner. Environmental barriers included safety concerns; lack of facilities; weather concerns; lack of sidewalks; and lack of physically active AA role models. Results provide key leverage points for researchers to consider when developing culturally relevant PA interventions for AA women.

Factors related to physical activity in Hispanic women.

Hispanic women are more likely to be sedentary than the general population. Increasing physical activity in this at-risk group is an important challenge in the prevention and management of coronary heart disease. This article reviews research conducted with Hispanic women in whom physical activity was the primary focus of study or the primary outcome of interest. Computer and manual searches were performed to identify articles published from 1990 to 2005. Factors that influence physical activity in Hispanic women include self-efficacy, having a concern for own and family health, social support and norms for physical activity, serving as a role model to others, and perceived neighborhood resources. Despite significant efforts to understand and promote physical activity among Hispanic women, much work remains to be done in this area. Future research should include attention to cultural, social, and contextual resources in understanding and promoting physical activity.

A Review of the Efficacy of the Self-Management Model on Health Outcomes in Community-Residing Older Adults with Arthritis

BACKGROUND Chronic disease and disability have a significant impact on individuals, families, and society, resulting in limitations in personal care, premature loss of wages, higher mortality rates, and overall poor quality of life. Arthritis is a painful disease that limits physical activity, social functioning, and mental health and is hallmarked by an increasing prevalence in community-dwelling older adults. Self-management strategies reduce pain and disability while improving self-efficacy and quality of life. AIMS The purpose of this review is to evaluate the efficacy of the self-management program in adults with arthritis on the outcome of functional disability. METHODS Literature review. Search strategy included MEDLINE, CINAHL, and the Cochrane Library from 1985 to 2008 for studies using self-management interventions. RESULTS Across studies of chronic disease, effect sizes were moderate for most variables. Subgroup ana- lyses for arthritis only demonstrated a greater magnitude of effect in variables related to functional health. CONCLUSIONS While this review suggests small efficacy in the self-management program, with improvement in certain cognitive-behavioral markers for self-management, the functional gains that can be achieved in a growing older adult population translate into a larger effect overall.