Julie J. Keysor

Does late-life physical activity or exercise prevent or minimize disablement?: A critical review of the scientific evidence

Physical activity and exercise are widely purported to enhance health and minimize or prevent functional loss and disability. Yet, do the benefits of late-life physical activity or exercise extend beyond disease and impairment-level factors? Does late-life physical activity minimize or prevent functional limitations and disability? To address these questions, a best-evidence framework was used to examine the effects of late-life physical activity on disablement outcomes. This review shows that exercise-particularly walking-increases muscle strength and aerobic capacity and reduces functional limitations. It is less clear, however, whether physical activity or exercise prevents or minimizes physical disability. Furthermore, this review shows a discrepancy between prospective and experimental studies: several well-conducted prospective studies show a beneficial effect of physical activity on minimizing disability, whereas the majority of experimental studies that have examined disability as an outcome do not show improvements in disability. Three research priorities are identified that would advance the science in this field: (1). development of a clear conceptual and theoretical framework of late-life physical activity and assessment; (2). use of a disablement outcomes framework to examine the outcomes of late-life physical activity; and (3). development of a mechanism of action explaining the relationship between physical activity and exercise and disablement outcomes.

Foot musculoskeletal disorders, pain, and foot-related functional limitation in older persons

Objectives: To examine whether common musculoskeletal disorders of feet are associated with pain and foot‐related functional limitation.

Community Environmental Factors Are Associated With Disability in Older Adults With Functional Limitations: The MOST Study

BACKGROUND There is limited evidence supporting the hypothesized environment-disability link. The objectives of this study were to (a) identify the prevalence of community mobility barriers and transportation facilitators and (b) examine whether barriers and facilitators were associated with disability among older adults with functional limitations. METHODS Four hundred and thirty-five participants aged 65+ years old with functional limitations were recruited from the Multicenter Osteoarthritis Study, a prospective study of community-dwelling adults with or at risk of developing symptomatic knee osteoarthritis. Presence of community barriers and facilitators was ascertained by the Home and Community Environment survey. Two domains of disability, (a) daily activity limitation (DAL) and (b) daily activity frequency (DAF), were assessed with the Late-Life Disability Instrument. Covariates included age, gender, education, race, comorbidity, body mass index, knee pain, and functional limitation. Multivariable logistic regression was used to examine adjusted associations of community factors with presence of DAL and DAF. RESULTS Approximately one third of the participants lived in a community with high mobility barriers and low transportation facilitators. High mobility barriers was associated with greater odds of DAL (odds ratio [OR] = 2.0, 95% confidence interval [CI] 1.2-3.1) after adjusting for covariates, and high transportation facilitators was associated with lower odds of DAL (OR = 0.5, 95% CI 0.3-0.8) but not with DAF in adjusted models. CONCLUSION People with functional limitations who live in communities that were more restrictive felt more limited in doing daily activities but did not perform these daily activities any less frequently.

Development of the home and community environment (HACE) instrument.

OBJECTIVE To develop and pilot test the Home and Community Environment instrument (HACE), a self-report measure designed to characterize factors in a persons home and community environment that may influence level of participation. DESIGN A cross-sectional survey. SUBJECTS Sixty-two adults recruited from community organizations and an outpatient rehabilitation center. METHODS Six environmental domains were assessed: (i) home mobility; (ii) community mobility; (iii) basic mobility devices; (iv) communication devices; (v) transportation factors; and (vi) attitudes. Descriptive statistics, Kappa statistics and Kruskal-Wallis tests were used to ascertain whether persons were capable of assessing characteristics of their environment, could do so reliably and whether the distribution of environmental factors differed by type of living situation. RESULTS Participants were capable of characterizing their home environment and most aspects of their community with acceptable reliability. The median percent agreement of the 6 environmental domains ranged from 75% to 100% (median Kappa values ranged from 0.47 to 1.0). Percent agreement for individual HACE items ranged from 58% to 100%. The lowest reliability values were observed in the community mobility domain. As hypothesized, individuals who lived in private homes characterized home and community mobility factors differently from those who lived in multi-unit complexes; evidence of HACEs validity. CONCLUSION HACE is a promising self-report instrument for assessing characteristics of an individuals home and community environments. Additional research is needed to assess its utility for rehabilitation research.

Are Foot Disorders Associated With Functional Limitation and Disability Among Community-Dwelling Older Adults?

The objectives of this study are to examine whether specific foot disorders and ankle weakness and foot pain are related to functional limitations or disabilities in elders. Community-dwelling adults 65 and older were enrolled in a population-based, cross-sectional study of foot disorders and health outcomes. Demographics, health status, comorbidities, self-reported foot and knee pain, function and disability, and observed structural foot disorders, body mass index, and ankle muscle strength were assessed on 717 participants. The associations of foot disorders, foot pain, and ankle muscle weakness with function and disability were examined with regression analyses. Foot disorders were not associated with functional outcomes or disability. Ankle weakness was associated with performance-based function (p = .005), self-report function (p < .001), and disability (p = .009). Foot pain was associated with self-report function (p = .01) and disability (p = .007). Foot pain and ankle weakness seem to be related to important health outcomes among older adults.

Are features of the neighborhood environment associated with disability in older adults

Purpose. To explore the association of features of a persons neighborhood environment with disability in daily activities. Method. We recruited 436 people aged 65 years and over (mean 70.4 years (SD = 3.9)) with functional limitations from the Multicenter Osteoarthritis Study (MOST). Features of the neighborhood environment were assessed using the Home and Community Environment (HACE) survey. The Late-Life Disability Instrument (LLDI) was used to assess disability in daily activities. We used logistic regression to examine the association of individual environmental features with disability. Results. Older adults whose neighborhoods did not have parks and walking areas less frequently engaged in a regular fitness program (OR = 0.4, 95% CI (0.2, 0.7)), and in social activities (OR = 0.5, 95% CI (0.3, 1.0)). Those whose neighborhoods had adequate handicap parking had 1.5–1.8 higher odds of engagement in several social and work role activities. The presence of public transportation was associated with 1.5–2.9 higher odds of not feeling limited in social, leisure, and work role activities, and instrumental activities of daily living. Conclusion. Our exploratory study suggests that parks and walking areas, adequate handicap parking, and public transportation are associated with disability in older adults.

Measures of adult general functional status: SF‐36 Physical Functioning Subscale (PF‐10), Health Assessment Questionnaire (HAQ), Modified Health Assessment Questionnaire (MHAQ), Katz Index of Independence in Activities of Daily Living, Functional Independence Measure (FIM), and Osteoarthritis‐Function‐Computer Adaptive Test (OA‐Function‐CAT)

Self-reported measures to assess and quantify functional status are important tools for clinicians and investigators. These measures qualify limitation with different types of functional activities and quantify the extent of limitation. We are particularly interested in measures of general functional status. Although these “generic” measures of function were originally developed in other patient populations, they are relevant to the field of rheumatology. In particular, these instruments have been found to be valid and reliable measures of function, sensitive to changes in function, and have distinct thresholds for important change in people with rheumatologic disease. Some notable studies have been added to the literature for general functional status measures in the last decade. Most of these additions are in the area of identifying thresholds for minimum clinically important difference, i.e., the smallest amount of change associated with a minimally important decline or improvement in function. To reflect changes in clinical practice over the last decade, we chose to review the Functional Independence Measure, which is a commonly used measure in practice to assess function. Also, Computer Adaptive Testing has developed over the past decade, which represents an innovative and exciting change to how self-reported tests of function are administered. Therefore, the purpose of this report is to provide an update to measures of general functional status commonly employed for people with rheumatologic diseases and provide a review of a Computer Adaptive Testing measure of functioning for people with osteoarthritis.

Do worsening knee radiographs mean greater chances of severe functional limitation

Development of functional limitation is thought to be unrelated to changes in severity of radiographic osteoarthritis (OA) of the knee. We evaluated the relationship of change in radiographic OA to the incidence of severe functional limitation.

Clinically Important Improvement in Function Is Common in People with or at High Risk of Knee OA: The MOST Study

Objective. To calculate the frequency of clinically important improvement in function over 30 months and identify risk factors in people who have or are at risk of knee osteoarthritis (OA). Methods. Subjects were from the Multicenter Osteoarthritis (MOST), a longitudinal study of persons with or at high risk of knee OA. We defined minimal clinically important improvement (MCII) with the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) physical function using 3 different methods. Baseline risk factors tested for improvement included age, sex, educational attainment, presence of radiographic knee OA (ROA), the number of comorbidities, body mass index (BMI), knee pain, walking speed, isokinetic knee extensor strength, depressive symptoms, physical activity, and medication usage. We used logistic regression to evaluate the association of baseline risk factors with MCII. Results. Of the 1801 subjects (mean age 63 yrs, BMI = 31, 63% women), most had mild limitations in baseline function (WOMAC = 19 ± 11). Regardless of how defined, a substantial percentage of subjects (24%–39%) reached MCII at 30 months. Compared to their counterparts, people with MCII were less likely to have ROA and to use medications, and were more likely to have a lower BMI, less knee pain, a faster walking speed, more knee strength, and fewer depressive symptoms. After adjustment, MCII was 40% to 50% less likely in those with ROA, and 1.9 to 2.0 times more likely in those walking 1.0 meters/second faster than counterparts. Conclusion. Clinically important improvement is frequent in people with or at high risk of knee OA. The absence of ROA and a faster walking speed appear to be associated with clinically important improvements.

When it hurts, a positive attitude may help: association of positive affect with daily walking in knee osteoarthritis. Results from a multicenter longitudinal cohort study

While depressive symptoms and knee pain are independently known to impede daily walking in older adults, it is unknown whether positive affect promotes daily walking. This study investigated this association among adults with knee osteoarthritis (OA) and examined whether knee pain modified this association.