James O. Judge

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.

Balance and Strength Training in Older Adults: Intervention Gains and Tai Chi Maintenance

OBJECTIVE: To determine the effect on balance and strength of 3 months of intensive balance and/or weight training followed by 6 months of low intensity Tai Chi training for maintenance of gains.

The relationship between physical performance measures and independence in instrumental activities of daily living

OBJECTIVES: Understanding the relationship between physical capacity and functional status is required to design exercise interventions to maintain independent living. This study assessed the importance of physical performance in maintaining independence in Instrumental Activities of Daily Living (IADL).

Effects of Resistive and Balance Exercises on Isokinetic Strength in Older Persons

OBJECTIVE: To determine the safety and efficacy of 3 months of resistive training of multiple lower extremity muscle groups compared with balance training in persons over 75 years.

Effects of Transdermal Testosterone on Bone and Muscle in Older Men with Low Bioavailable Testosterone Levels, Low Bone Mass, and Physical Frailty

OBJECTIVES: To investigate the effects of testosterone supplementation on bone, body composition, muscle, physical function, and safety in older men.

Initiation and Maintenance of Exercise Behavior in Older Women: Predictors from the Social Learning Model

The purpose of the present study was to determine the extent to which modifiable social learning constructs predicted long-term adherence to an exercise program in older individuals. Participants were 189 women aged 59 to 78 years and diagnosed with low bone density. Exercise behavior was assessed at 3-month intervals. Self-efficacy, readiness for change, orientation toward exercise, social support in general, and support specifically for exercise were measured at baseline and at 12-month follow-up. Analyses indicated that initial adoption of exercise behavior was best predicted by readiness to change. Maintenance was predicted by self-efficacy for exercise, and exercise behavior at 12 months was predicted by social support for exercise. The results were seen as supportive of the stages and processes of change model of health behavior change. Implications of the findings for interventions to enhance adoption and maintenance of exercise programs by older women are discussed.

Training Balance and Strength in the Elderly to Improve Function

Short‐term exposure to altered sensory input or destabilizing platform movement results in significant improvement in sway control and inhibition of inappropriate motor responses, resulting in improved balance during repetitive testing. In addition, there is recent evidence that strength and function can be increased in both active and frail elderly who participate in strength training programs. Therefore, the hypotheses to be tested are that (1) balance training alone, or (2) strength training alone will each be capable of significantly improving balance, gait, and functional mobility, and that (3) a combined program of balance and strength training will be more effective than either approach alone. These hypotheses will be tested relative to a control group, using a 2 times 2 design (30 subjects per group), in a community‐dwelling elderly at least 75 years of age. Intervention sessions of at least 45 minutes will occur three times per week for 3 months, with 6 months of follow‐up, home‐based Tai Chi training. The primary outcome variable is a basic measure of functional balance, ie, the occurrence of loss of balance during tilts of the support and/or movement of the visual surround.

Balance training to maintain mobility and prevent disability

Balance is important for the safe performance of many activities that allow older people to remain independent in their community. Housework, cooking, shopping, and travel generally require the ability to stand, reach, turn, and bend down and pick up objects from the floor. Multiple interacting factors are implicated in the deterioration of balance. Several strategies have been tested to improve balance and reduce falls. Home-based individualized training that attempted to improve identified deficits reduced falls and improved physical performance and stabilized or reduced disability. Home-based exercise programs that included low-intensity strength and balance training have improved balance and reduced fall rates by about 40% compared to controls. Class-based exercise programs in senior centers or exercise centers have improved balance and physical performance, and some have reduced falls. Programs such as tai chi and social dance look promising and should be further investigated.

Effect of Computerized Provider Order Entry with Clinical Decision Support on Adverse Drug Events in the Long-Term Care Setting

OBJECTIVES: To evaluate the efficacy of computerized provider order entry with clinical decision support for preventing adverse drug events in long‐term care.

Functional Impact of Relative Versus Absolute Sarcopenia in Healthy Older Women

OBJECTIVES: To determine whether adjustment of muscle mass for height2 or for body mass represents a more‐relevant predictor of physical performance.