Shannon Halloway

Prehabilitation Interventions for Older Adults An Integrative Review

Prehabilitation aims to increase physical activity and improve physical fitness prior to elective surgery to improve postoperative outcomes. This integrative review examined the effect of prehabilitation randomized clinical trial (RCT) interventions on physical activity behavior and physical fitness in older adults. Seven studies met the search criteria. In two studies, effect sizes from baseline to the preoperative period exceeded d = .2, specifically in physical activity and in the physical-fitness dimensions of strength, cardiorespiratory fitness, and flexibility. For the effect sizes between baseline and the postoperative period, five studies had positive effects greater than d = .2 in strength, flexibility, balance, and speed. This review demonstrated that prehabilitation continues to be important to physical activity and physical-fitness research because it may improve physical-fitness measures and have implications for multiple dimensions of health in older adults.

Physical activity intervention studies and their relationship to body composition in healthy women.

Engaging in regular physical activity is a key component for maintaining a healthy weight and preventing overweight and obesity. Obesity continues to be a concern globally, especially for women, and women are less physically active than men. This systematic review examined current research on physical activity interventions designed for healthy community dwelling women and assessed the effects of those interventions on physical activity and body composition. Three author-developed data collection tools were used to extract and examine study variables. For studies with suitable data, effect sizes were obtained. The initial search identified 1,406 titles published between 2000 and 2012, of which 40 randomized clinical trials met inclusion criteria. Of these 40 studies, 16 had a physical activity intervention that did not have a diet component and 24 had a physical activity intervention along with a diet component. The overall weighted mean effect was

Effects of Endurance-Focused Physical Activity Interventions on Brain Health A Systematic Review

Physical activity intervention studies that focus on improving cognitive function in older adults have increasingly used magnetic resonance imaging (MRI) measures in addition to neurocognitive measures to assess effects on the brain. The purpose of this systematic review was to identify the effects of endurance-focused physical activity randomized controlled trial (RCT) interventions on the brain as measured by MRI in community-dwelling middle-aged or older adults without cognitive impairment. Five electronic databases were searched. The final sample included six studies. None of the studies reported racial or ethnic characteristics of the participants. All studies included neurocognitive measures in addition to MRI. Five of the six interventions included laboratory-based treadmill or supervised bike exercise sessions, while one included community-based physical activity. Physical activity measures were limited to assessment of cardiorespiratory fitness and, in one study, pedometer. Due to the lack of adequate data reported, effect sizes were calculated for only one study for MRI measures and two studies for neurocognitive measures. Effect sizes ranged from d = .2 to .3 for MRI measures and .2 to .32 for neurocognitive measures. Findings of the individual studies suggest that MRI measures may be more sensitive to the effects of physical activity than neurocognitive measures. Future studies are needed that include diverse, community-based participants, direct measures of physical activity, and complete reporting of MRI and neurocognitive findings.

Combined Effects of Sedentary Behavior and Moderate-to-Vigorous Physical Activity on Cardiovascular Health in Older, Community-Dwelling Latinos

This study examined the combined effects of sedentary behavior and moderate-to-vigorous physical activity (MVPA) on cardiovascular health in older Latinos. In a cross-sectional sample of 147 older, community-dwelling Latinos, time spent in sedentary behavior and MVPA were obtained using accelerometers. Analyses examined the effects of a measure of physical activity that combined levels of sedentary behavior (± 10 daily hours) and MVPA (< 30, 30-150, or > 150 weekly minutes) on cardiovascular health outcomes (blood pressure, BMI, waist circumference, cardiorespiratory fitness). Results suggest that cardiovascular health benefits of MVPA on BMI (p = .005), waist circumference (p = .002), and cardiorespiratory fitness (p = .012) may depend on a participants level of sedentary behavior. For all three, health benefits of 30-150 weekly minutes of MVPA were found only for those without excessive sedentary behavior (≥ 10 hr). Sedentary behavior may negatively impact cardiovascular health despite moderate participation in MVPA. Health guidelines should suggest reducing sedentary behavior while increasing MVPA.

Randomized Controlled Trial of Lifestyle Walking for African American Women: Blood Pressure Outcomes

The aim of this study was to test the effects of a lifestyle physical activity intervention (group meetings alone vs supplemented by personal or automated calls) on changes in systolic/diastolic blood pressures from baseline to 24 and 48 weeks among African American women. This was a randomized controlled trial with intervention conditions randomly assigned across 6 community health care sites. Participants were 288 sedentary African American women without major signs/symptoms of cardiovascular disease. Each intervention had 6 group meetings over 48 weeks, with 1 of 3 options between meetings: (1) no calls, (2) personal motivational calls, or (3) automated motivational calls. Blood pressures were taken at baseline, 24 weeks, and 48 weeks. Separate analyses were conducted using blood pressure classifications from the 2003 and 2017 high blood pressure guidelines. Average blood pressures decreased approximately 3 mm Hg for systolic and 2 mm Hg for diastolic from baseline to 48 weeks, with no differences between conditions. For both 2003 and 2017 blood pressure classifications, the risk ratio (odds of moving to a lower classification) was 1.44 for each assessment (P < .001). This lifestyle walking intervention appears beneficial in lowering blood pressure across blood pressure classifications in midlife African American women.

THE INTERACTIVE EFFECTS OF CHANGES IN PHYSICAL ACTIVITY AND COGNITIVE ACTIVITY ON GLOBAL COGNITION IN OLDER ADULTS WITHOUT MILD COGNITIVE IMPAIRMENT OR DEMENTIA

Occupational Information Network (O*NET) database, and tested whether it moderates effects of genetic risk and biomarkers of AD pathology on cognitive function in two independent studies of ageing and AD. Methods:We applied growth curve modelling to longitudinal data from a population based cohort (AgeCoDe, n1⁄42369) of non-demented individuals above age 75 at baseline to test whether higher OCR would attenuate APOE4 associated cognitive decline. In addition, we used data of n1⁄4317 participants of the DELCODE study (123 healthy controls, 96 with Subjective Cognitive Decline, 52 MCI, 25 AD dementia, 21 cognitively normal relatives of AD dementia patients; mean age 1⁄470.2 (SD1⁄45.9)). We tested with regression analyses whether higher OCR moderate the cross-sectional association between hippocampal volume and CSFAD biomarkers with performance in 5 cognitive domain scores derived from confirmatory factor analysis of an extensive neuropsychological test-battery. To operationalize OCR, we linked individual’s detailed lifetime occupation information to O*NET data according to the method of Poole et al. (2016). This method summarizes ratings of cognitive demands in 10 workrelated tasks (e.g. processing information, thinking creatively). Results: In AgeCoDe, detrimental effects of ApoE4 on cognitive decline in the MMSE were significantly attenuated for those with high OCR scores (Figure 1). Similarly, in DELCODE the expected cross-sectional associations of lower hippocampal volume and more pathological CSFAbeta42/Tau ratiowith a decrease in cognitive performance were significantly less pronounced in those with higher OCR scores (Figure 2). Results remained similar after adjustment for educational level. Conclusions: We observed moderating effects of OCR on the association of genetic risk and AD biomarkers with cognition. These results provide important, novel evidence that OCR contribute to cognitive reserve in late-life. In addition, they validate the recently developed, O*NET based operationalization of this protective factor with data from two independent cohorts.

The Relation Between Physical Activity and Cognitive Change in Older Latinos

Cognitive impairment in older Latinos is of concern due to the rapid growth of this population and their increased risk for dementia due to chronic disease. Evidence, primarily from studies of non-Latino Whites, suggests that physical activity (PA) may reduce cognitive decline. Few longitudinal studies have included older Latinos, objective measures of PA, or neurocognitive tests that assess domains of cognition. The purpose of this longitudinal study was to explore the relationship between changes in PA and cognitive decline in older Latinos over an average of 5 years. Inclusion criteria for the baseline sample were age ≥50 years, Latino ethnicity (English or Spanish speaking), no ambulation disability, no evidence of dementia, and Chicago address. Of the 174 baseline participants, 59 (33.9%) participated at follow-up. PA was measured by questionnaire and accelerometer worn for 7 days. A battery of neurocognitive tests assessed episodic memory, perceptual speed, and semantic memory. Change in cognitive function was dichotomized to maintenance versus decline. Binary logistic regression results indicated that those who had less decline from baseline to follow-up in self-reported light PA maintained episodic memory, odds ratio (OR) = 1.16 (95% confidence interval [CI] [1.03, 1.32]), while those who had less decline in accelerometer moderate–vigorous bouts maintained semantic memory, OR = 16.08 (95% CI [1.53, 168.89]), controlling for baseline age, chronic health problems, depressive symptoms, and acculturation. These findings suggest that maintenance of PA with aging may prevent cognitive decline. This work can inform future intervention development that aims to maintain PA in order to prevent cognitive decline.

African-American women's long-Term maintenance of physical activity following a randomized controlled trial

OBJECTIVES Our purpose was to determine long-term maintenance of physical activity (PA) following the 48-week Womens Lifestyle PA program, targeted/tailored for African-American women. METHODS The parent study consisted of a 3-arm randomized clinical trial with 3 assessment points: baseline (pre-intervention); 24 weeks post-baseline (end active intervention); and 48 weeks post-baseline (end maintenance intervention). Present analyses supplement the original results by adding a long-term maintenance assessment that occurred 2 to 4 years post-baseline. Participants were 288 African-American women aged 40 to 65 without major signs/symptoms of pulmonary/cardiovascular disease. The active intervention included 5 group meetings, with 9 personal motivational calls, 9 automated motivational calls, or no calls between meetings. The maintenance intervention included one group meeting and either 2 calls or no calls. PA was assessed with the Community Healthy Activities Model Program for Seniors. RESULTS Retention was 90%. Over long-term maintenance, there was a decline in PA, but levels remained significantly higher than baseline for moderate/vigorous PA (p < .001), leisure moderate/vigorous PA (p < .001) and walking (p = .006). Variations by condition/site were not statistically significant. CONCLUSIONS Our findings suggest that long-term maintenance of PA increases resulting from group meetings in an active intervention occur when followed by a maintenance intervention.