Ing-Mari Dohrn

Taking balance training for older adults one step further: the rationale for and a description of a proven balance training programme:

Objective: To give the rationale and evidence for and a detailed description of a rehabilitation programme of proven effectiveness in improving balance in older adults. Background theory and evidence: Based on the knowledge that balance loss usually occurs in situations when attention is divided, especially when being older, and that balance control relies on the interaction of several physiological systems, we have developed a specific and progressive balance training programme with dual- and multi-task exercises for older adults. Practical application: Balance demanding exercises, specific to the various components of balance control and to situations in daily life, were performed in sitting, standing and walking at three different levels of progression (basic, moderate and advanced) of increasing difficulty and complexity. The training was performed in 45-minutes group sessions, with 6–10 participants in each group, three times per week during 12 weeks, with two or three physiotherapists present. Conclusions: This balance training programme strengthens self-efficacy in balance control leading to improved fall-related self-efficacy, reduced fear of falling, increased walking speed, and improved physical function. Participants found the programme motivating, valuable, fun, and enjoyable, which was reflected in a high attendance rate.

Gait Speed, Quality of Life, and Sedentary Time are Associated with Steps per Day in Community-Dwelling Older Adults with Osteoporosis

AIM To describe objectively-measured physical activity levels and patterns among community-dwelling older adults with osteoporosis, impaired balance, and fear of falling, and to explore the associations with gait, balance performance, falls self-efficacy, and health-related quality of life (HRQoL). METHODS Ninety-four individuals (75.6 ± 5.4 years) were included. Physical activity was assessed with pedometers and accelerometers. Mean steps/day, dichotomized into < 5,000 or ≥ 5,000 steps/day, and time spent in different physical activity intensities were analyzed. Gait was assessed with a GAITRite walkway, balance performance was assessed with the modified figure-eight test and one-leg stance, falls self-efficacy was assessed with the Falls Efficacy Scale International, and HRQoL was assessed with Short Form-36. RESULTS Mean steps/day were 6,201 (991-17,156) and 40% reported < 5,000 steps/day. Participants with < 5,000 steps/day spent more time sedentary, had slower gait speed, poorer balance performance, and lower HRQoL than participants with ≥ 5,000 steps/day. No participants with < 5,000 met the recommended level of physical activity.

Replacing sedentary time with physical activity: a 15-year follow-up of mortality in a national cohort

Background Sedentary behavior is associated with health risks in adults. The potential benefits of reducing sedentary time may be dependent not only on decrease per se, but also on the type of activity it replaces. Few longitudinal studies have investigated the effects on mortality when replacing objectively assessed sedentary time with another physical activity (PA) behavior. Objective To investigate the effects of replacing objectively assessed sedentary time with time in light-intensity PA or moderate-vigorous PA (MVPA) on all-cause mortality, cardiovascular disease (CVD) mortality or cancer mortality in a cohort with 15 years follow-up time. Methods In total, 851 women and men from the population-based Sweden Attitude Behaviour and Change study were included. Time spent sedentary, in light-intensity PA and in MVPA were assessed using an Actigraph 7164 accelerometer. Mortality data were obtained from Swedish registers. Cox proportional hazards models estimated hazard ratios (HR) of mortality with 95% confidence intervals (CI) and isotemporal substitution models were used to estimate the effect of replacing sedentary behavior with PA for the same amount of time. Results Over a follow-up of 14.2 years (SD 1.9) with 12,117 person-years at risk, 79 deaths occurred, 24 deaths from CVD, 27 from cancer, and 28 from other causes. Replacing 30 minutes/day of sedentary time with light-intensity PA was associated with significant reduction in all-cause mortality risk (HR: 0.89, 95% CI: 0.81–0.98) and CVD mortality risk (HR: 0.76, 95% CI: 0.63–0.92). Replacing 10 minutes of sedentary time with MVPA was associated with reduction in CVD mortality risk (HR: 0.62, 95% CI: 0.42–0.91). No statistically significant reductions were found for cancer mortality. Conclusion This statistical modelling study suggests that replacing sedentary time with light-intensity PA could have beneficial effect on both all-cause mortality and CVD mortality. Replacing sedentary time with MVPA could reduce CVD mortality.

Comparison of Pedometer and Accelerometer Derived Steps in Older Individuals With Parkinson’s Disease or Osteoporosis Under Free-Living Conditions

AIM To compare self-reported pedometer steps with accelerometer steps under free-living conditions in individuals with Parkinsons disease (PD) or osteoporosis (OP). METHODS Seventy-three individuals with PD and 71 individuals with OP wore a pedometer (Yamax LS2000) and an accelerometer (ActiGraph GT1M/GT3X+) simultaneously for one week. RESULTS Fifty-one individuals with PD (72.6 ± 5.3 years) and 61 with OP (75.6 ± 5.3 years) provided simultaneously recorded data for 3-7 consecutive days. Pedometer steps were significantly lower than accelerometer steps in the PD group (p = .002) but not in the OP group (p = .956). Bland-Altman plots demonstrated wide limits of agreement between the instruments in both PD (range = 6,911 steps) and OP (range = 6,794 steps). CONCLUSION These results suggest that the ActiGraph GT1M/GT3X+ should be preferred over the Yamax LS2000 for the assessment of steps in both research and clinical evaluations, particularly in individuals with PD or altered gait.

“You Have to Keep Moving, Be Active”: Perceptions and Experiences of Habitual Physical Activity in Older Women With Osteoporosis

Background Physical activity (PA) is essential for older adults with osteoporosis, and health care professionals play important roles in promoting PA and encouraging patients to make healthy choices. However, many factors influence habitual PA, and there is only limited knowledge about the perceptions and experiences of PA among older women with osteoporosis. Objectives The purpose of this study was to describe perceptions and experiences of PA and the factors that influence habitual PA among older adults with osteoporosis, impaired balance, and fear of falling. Design This was a qualitative interview study applying interpretive content analysis with an inductive approach. Methods Informants were a purposeful sample of 18 women, aged 66 to 86 years, with osteoporosis, impaired balance, and fear of falling. Individual, semistructured, face-to-face interviews were recorded, transcribed, condensed, and coded to find subthemes and themes. Results The overall theme found was “Physical activity—a tool for staying healthy with osteoporosis.” This overall theme comprised 2 main themes interpreting the challenges and possibilities of being physically active with osteoporosis. These themes were not separate but rather linked to each other like 2 sides of the same coin, with factors that could act as both barriers to and facilitators of PA. Personal preferences and osteoporosis-related concerns influenced habitual PA, and individualization was perceived as important. Limitations Some results may be context specific and limit the transferability to people with other cultural or socioeconomic backgrounds. Conclusions The women perceived that PA was an important tool to maintain health with osteoporosis and believed that they had a responsibility to use this tool. They had adapted to disease-specific limitations and developed strategies to overcome challenges and barriers to PA. Lack of PA promotion and conflicting advice about PA from physicians created uncertainty. Encouragement and guidance from physical therapists, individually or in groups, were very important.

Short- and Long-Term Effects of Balance Training on Physical Activity in Older Adults With Osteoporosis: A Randomized Controlled Trial.

Background and Purpose: We have developed a 12-week balance training program for older adults shown to improve fall-related concerns, gait speed, balance performance, and physical function. We hypothesized that this balance training would also contribute to higher habitual physical activity (PA) levels and improved health-related quality of life (HRQoL). The primary aim was to evaluate short- and long-term effects of the balance training program on objectively measured habitual PA in older adults with osteoporosis. Secondary aims were to assess the effects of the balance training on HRQoL, and to study whether any effects on PA were associated with changes in HRQoL, gait speed, balance performance, fall-related concerns, and physical function. Methods: A randomized controlled trial with follow-up at 3, 9, and 15 months, including 91 participants with osteoporosis (75.6 ± 5.4 years), compared a balance training group (n = 61) with a control group (n = 30). The primary outcome was effect on habitual PA measured as steps/day, dichotomized into less than 5000 or 5000 or more steps/day. Physical activity was assessed with pedometers (Yamax) and accelerometers (Actigraph), HRQoL with the Short Form-36 (SF-36), gait with a GAITRite walkway, balance performance with Modified-Figure-Eight test and one-leg stance, fall-related concerns with Falls Efficacy Scale International, and physical function with the advanced lower extremity subscale of the questionnaire Late Life Function and Disability Instrument. Statistical methods used were multivariate logistic regression and logistic generalized estimating equation. Results: Sixty-eight participants completed the short-term follow-up at 3 months, and 53 participants completed the long-term follow-up at 15 months. Per-protocol analysis (n = 68) showed that the odds ratio for having a daily step count of 5000 or more at 3 months was 6.17 (95% confidence interval, 1.23-30.91), P = .027, for the intervention group compared with the control group. The longitudinal analysis (n = 91) showed that the odds ratio for having a daily step count of 5000 or more at 15 months was 2.02 (95% confidence interval, 0.88-4.64), P = .096, for the intervention group compared with the control group. The mental component sum of the SF-36 improved significantly from baseline to 3 months in the intervention group, and the physical component sum improved in both groups, but no statistically significant differences were found between groups. No associations were found between PA and changes in covariates. Discussion and Conclusions: The short-term evaluation showed that balance training increased habitual PA in community-dwelling older adults with osteoporosis. A significantly higher proportion of participants in the intervention group reached a level of 5000 or more steps/day, which is important for overall health. This effect was not associated with improvements in HRQoL, gait speed, balance performance, or fall-related concerns, and did not persist through the long-term follow-up. To accomplish a sustained PA change, a prolonged intervention or more support regarding habitual PA may be required, such as reinforcement with personalized behavior change counseling or PA on prescription.

Accelerometer-measured sedentary time and physical activity—A 15 year follow-up of mortality in a Swedish population-based cohort

OBJECTIVES To investigate the associations of objectively assessed sedentary time, light intensity physical activity (PA), moderate to vigorous intensity PA (MVPA), and total PA with all-cause mortality and mortality from cardiovascular disease (CVD) or cancer in a Swedish population-based cohort with 15 years follow-up time. DESIGN Longitudinal prospective cohort study. METHODS Data from 851 persons (56% women) ≥35 years at baseline were included. Primary exposure variables were time (min/day) spent sedentary, in light intensity PA and in MVPA, and total counts from an Actigraph 7164 accelerometer. Data on all-cause mortality and mortality from CVD or cancer were obtained from Swedish registers. Cox proportional hazards models estimated hazard ratios (HR) of mortality with 95% confidence intervals (CI). RESULTS Compared with the least sedentary participants, those in the most sedentary tertile had an increased risk of all-cause mortality, HR: 2.7 (1.4, 5.3), CVD mortality, HR: 5.5 (1.4, 21.2) and cancer mortality, HR: 4.3 (1.2, 16.0). For all-cause mortality, those in the highest light intensity PA tertile had a HR 0.34 (0.17, 0.67) compared with the lowest tertile. A similar pattern was found for CVD and cancer mortality. More time spent in MVPA was associated with the largest risk reduction for CVD mortality, with an almost 90% lower risk in the tertile with the most time in MVPA. CONCLUSIONS This study confirms a strong inverse relationship between MVPA and mortality, and adds new insight for the understanding of the associations between sedentary time and light intensity PA and mortality.