Mary O. Whipple

What we learned through asking about evidence: A model for interdisciplinary student engagement

ABSTRACT Traditional university learning modalities of lectures and examinations do not prepare students fully for the evolving and complex world of gerontology and geriatrics. Students involved in more active, self-directed learning can develop a wider breadth of knowledge and perform better on practical examinations. This article describes the Evidence in Aging (EIA) study as a model of active learning with the aim of preparing students to be effective interdisciplinary researchers, educators, and leaders in aging. We focus particularly on the experiences and reflections of graduate students who collaborated with faculty mentors on study design, data collection, and analysis. Students acquired new methodological skills, gained exposure to diverse disciplines, built interdisciplinary understanding, and cultivated professional development. The EIA study is a model for innovative student engagement and collaboration, interactive learning, and critical scholarly development. Lessons learned can be applied to a range of collaborative research projects in gerontology and geriatrics education.

Variability in Individual Response to Aerobic Exercise Interventions Among Older Adults

Although a plethora of evidence supports the benefits of exercise among older adults, a majority of studies have emphasized group differences, while giving little, if any, attention to individual differences. Given the lack of data on variability in response, the present review examined how nonresponse to aerobic exercise has been defined in older adult populations and characteristics associated with nonresponse among older adults. The results of this review suggest that interindividual variability in response of maximal oxygen consumption to aerobic exercise interventions is prevalent among older adults (1.4-63.4%); age, sex, race, and body mass index may not be critical determinants of nonresponse; whereas health status, baseline fitness, and exercise dose appear important. Future intervention studies should evaluate and report the variability in individual response of older adults to exercise; investigators should develop programs that allow for modification of components to assist older adults in achieving optimal benefit from exercise programs.

Peripheral Artery Disease and Exercise in Patients with Diabetes

Peripheral artery disease (PAD) represents a serious health issue and is estimated to effect up to 30% of the ~23 million US adults who have diabetes. PAD occurs as the result of the development of plaque in the arteries of the lower limbs. The development of PAD can be attributed to a number of factors such as deleterious lifestyle behaviors (e.g., smoking, inactivity); however diabetes is one of the primary risk factors for developing the disease. Claudication is the most pronounced symptom of PAD and is described by patients as pain, aching, or cramping in the muscles of the legs during exertion that is relieved with rest. Claudication typically limits a patient’s ability to walk which ultimately leads to an exacerbation of poor metabolic control of the patient with diabetes. Patients with both PAD and diabetes who limit ambulatory activity have markedly lower functional ability and poor patient-reported outcomes and have an increased risk of adverse cardiovascular events and premature mortality. Exercise therapy is a cornerstone treatment option for patients who have both diseases, but it is considerably underused. This is attributed to a number of challenges for providing an ideal exercise prescription given the numerous physical limitations of patients. This chapter will provide a synthesis of the available literature using exercise therapy for PAD and diabetes and will propose future directions for treating patients who have both diseases.

Practical experience implementing supervised exercise therapy for peripheral artery disease in urban and rural Minnesota

Although numerous studies have demonstrated the effectiveness of treadmill-based supervised exercise therapy (SET) in improving pain-free and total walking distance and quality of life in individuals with peripheral artery disease (PAD), historically this treatment has not been widely available outside of research settings. Last year’s decision by Centers for Medicare and Medicaid Services (CMS) to cover up to 36 sessions of SET over a 12-week period for beneficiaries with symptomatic PAD (1) has enabled greater implementation of this effective treatment in clinical settings. An additional 36 sessions are available over an extended period with a new referral from a health care provider. At the University of Minnesota, we have been implementing SET in both urban and rural clinical settings since 2015. In this column, we provide examples of two patients who have participated in SET through these programs, highlighting their experiences and tips for those considering implementing SET for individuals with PAD at their own institutions.