Thomas R. Prohaska

Physical activity programs and behavior counseling in older adult populations

Physical activity offers one of the greatest opportunities for people to extend years of active independent life and reduce functional limitations. The purpose of this paper is to identify key practices for promoting physical activity in older adults, with a focus on older adults with chronic disease or low fitness and those with low levels of physical activity. Key practices identified in promotion activity in older adults include: 1) A multidimensional activity program that includes endurance, strength, balance, and flexibility training is optimal for health and functional benefits; 2) Principles of behavior change, including: social support, self-efficacy, active choices, health contracts, assurances of safety, and positive reinforcement enhance adherence; 3) Management of risk by beginning at low intensity but gradually increasing to moderate physical activity, which has a better risk-to-benefit ratio and should be the goal for older adults; 4) An emergency procedure plan is prudent for community based programs; and 5) Monitoring aerobic intensity is important for progression and for motivation. Selected content review of physical activity programming from major organizations and institutions are provided. Regular participation in physical activity is one of the most effective ways for older adults, including those with disabilities, to help prevent chronic disease, promote independence, and increase quality of life in old age.

Effect of Exercise on Cognitive Performance in Community‐Dwelling Older Adults: Review of Intervention Trials and Recommendations for Public Health Practice and Research

There is evidence from observational studies that increasing physical activity may reduce the risk of cognitive decline in older adults. Exercise intervention trials have found conflicting results. A systematic review of physical activity and exercise intervention trials on cognition in older adults was conducted. Six scientific databases and reference lists of previous reviews were searched. Thirty studies were eligible for inclusion. Articles were grouped into intervention–outcome pairings. Interventions were grouped as cardiorespiratory, strength, and multicomponent exercises. Cognitive outcomes were general cognition, executive function, memory, reaction time, attention, cognitive processing, visuospatial, and language. An eight‐member multidisciplinary panel rated the quality and effectiveness of each pairing. Although there were some positive studies, the panel did not find sufficient evidence that physical activity or exercise improved cognition in older adults. Future research should report exercise adherence, use longer study durations, and determine the clinical relevance of measures used.

The relationship between expectations for aging and physical activity among older adults.

AbstractBACKGROUND: New strategies to increase physical activity among sedentary older adults are urgently needed. OBJECTIVE: To examine whether low expectations regarding aging (age-expectations) are associated with low physical activity levels among older adults. DESIGN: Cross-sectional survey. PARTICIPANTS: Six hundred and thirty-six English- and Spanish-speaking adults aged 65 years and above attending 14 community-based senior centers in the Los Angeles region. Over 44% were non-Latino whites, 15% were African American, and 36% were Latino. The mean age was 77 years (range 65 to 100). MEASUREMENTS: Self-administered written surveys including previously tested measures of age-expectations and physical activity level in the previous week. RESULTS: Over 38% of participants reported <30 minutes of moderate-vigorous physical activity in the previous week. Older adults with lower age-expectations were more likely to report this very low level of physical activity than those with high age-expectations, even after controlling for the independent effect of age, sex, ethnicity, level of education, physical and mental health-related quality of life, comorbidity, activities of daily living impairment, depressive symptoms, self-efficacy, survey language, and clustering at the senior center. Compared with the quintile of participants having the highest age-expectations, participants with the lowest quintile of age-expectations had an adjusted odds ratio of 2.6 (95% confidence intervals: 1.5, 4.5) of reporting <30 minutes of moderate-vigorous physical activity in the previous week. CONCLUSIONS: In this diverse sample of older adults recruited from senior centers, low age-expectations are independently associated with very low levels of physical activity. Harboring low age-expectations may act as a barrier to physical activity among sedentary older adults.

Mobility and Aging: New Directions for Public Health Action

Optimal mobility, defined as relative ease and freedom of movement in all of its forms, is central to healthy aging. Mobility is a significant consideration for research, practice, and policy in aging and public health. We examined the public health burdens of mobility disability, with a particular focus on leading public health interventions to enhance walking and driving, and the challenges and opportunities for public health action. We propose an integrated mobility agenda, which draws on the lived experience of older adults. New strategies for research, practice, and policy are needed to move beyond categorical promotion programs in walking and driving to establish a comprehensive program to enhance safe mobility in all its forms.

Impact of symptoms and aging attribution on emotions and coping.

Two experimental studies and a large field study were designed to examine how symptom severity, symptom duration, symptom ambiguity, and the association of symptoms with aging affected emotional responses and coping with illness threats. In Study 1, 280 respondents from the surrounding community reported the emotional and coping responses they would manifest to scenarios that varied the severity, duration, and ambiguity (i.e., labeled vs. unlabeled) of a common set of symptoms. Severity had more of an impact on coping strategies than did duration or illness label; severe symptoms elicited stronger emotional upset and a higher incidence of both self-care behaviors and seeking of medical care. Symptoms of longer duration also resulted in increased seeking of medical care. Responses of the 334 adults participating in Study 2 replicated and extended these findings: A closed-ended item asking participants whether the symptoms could be attributed to aging showed that attribution of symptoms to aging increased with age, was more frequent for mild symptoms, and was associated with reduced emotional response to symptoms and a tendency to delay seeking treatment. Participants in the field study (168 patients seeking medical care for a variety of symptoms) completed interviews tracing symptom processing and emotional and coping reactions. The results provided evidence for the external validity of the scenario studies, as the attribution of symptoms to aging was greater for older than younger patients and resulted in a significant tendency to delay seeking medical care. Results of these studies suggest that symptom experience and symptom interpretation must be considered in the study of coping responses to illness threats.

A survey of exercise beliefs and exercise habits among people with arthritis

OBJECTIVE To explore a possible explanation for the problem of why few people exercise despite the positive health advantages, by examining the relationship between exercise beliefs and participation in exercise activities. METHODS Eighty-one respondents aged 27-80 were recruited from 3 Chicago-area health care facilities to complete the study survey; 68 (84%) did so. Participants were asked about their participation in 6 types of exercise activities; they also reported their beliefs concerning their ability to exercise (self-efficacy for exercise), barriers to exercise, benefits of exercise, and the impact of exercise on their arthritis. RESULTS Study results indicate that belief in the benefits of exercise and self-efficacy for exercise are associated with participation in exercise activities. Also, severity of disease differentiated exercisers from non-exercisers. CONCLUSIONS Results suggest the importance of finding ways to strengthen belief in the benefits of exercise and self-efficacy for exercise in people with arthritis, particularly people with moderate to severe disease-related limitations.

Help or Hindrance? How Family and Friends Influence Chronic Illness Self-Management among Older Adults

We contribute to knowledge about older adults with chronic illnesses by identifying positive and negative influences of family and friends on self-management. Thirteen focus groups were conducted in upstate New York with 84 African American and White men and women, 65 years old or older, with arthritis, diabetes, and/or heart disease. Specific positive and negative social network influences are discussed in the areas of disease management (medication management, dietary activities, physical activity, and health care appointments); decision-making about the illness; and psychosocial coping. Overall, we found many more positive than negative social network influences, and more negative influences from family members than from friends. We discuss differences between influences of family members versus friends, and point out a few suggestive differences by gender and race. We conclude with limitations of the study as well as implications for the design of self-management interventions involving family members and friends.

Pilot Test of an Attribution Retraining Intervention to Raise Walking Levels in Sedentary Older Adults

OBJECTIVES: To pilot test a new behavioral intervention to increase walking in sedentary older adults.

Older adults and assistive devices: Use, multiple-device use, and need

Responses of older adults (> 65 years) from the 1990 National Health Interview Survey and Assistive Device Supplement are analyzed to determine if selected demographic and health variables are associated with the use of assistive devices, multiple-device use, and the expressed need for such devices. Bivariate and multi-variate analyses show that, in general, poorer health is consistently associated with the use of assistive devices, multiple-device use, and expressed need. Demographic characteristics, however, vary in their relationships to assistive device use and need. Findings support the importance of considering multiple-device use and expressed need in studying assistive devices and older adults.

Lower-Body Function, Neighborhoods, and Walking in an Older Population

BACKGROUND Poor lower-body capacity is associated with reduced mobility in older populations. PURPOSE This study sought to determine whether neighborhood environments (e.g., land-use patterns and safety) moderate that association. METHODS The study is based on a cross-sectional sample of 884 people aged > or =65 years identified through service organizations in Alameda County CA, Cook County IL, Allegheny County PA, and Wake and Durham counties NC. In-person interviews focused on neighborhood characteristics, physical and cognitive function, and physical activity and walking. Functional capacity was tested using measures of lower-body strength, balance, and walking speed. The main outcome was time spent walking in a typical week (<150 vs > or =150 minutes per week). Objective environmental measures were also included. Estimates of main and interaction effects were derived from regression models. RESULTS Living in a residential area, compared to a mixed-use or commercial area, was associated with less time spent walking (<150 minutes per week; OR=1.57, 95% CI=1.04, 2.38). Living in a less-compact area (greater median block length) is also significantly associated with less walking for seniors, but only among those with excellent lower-body strength. CONCLUSIONS Neighborhood type is associated with walking among older people, as it is among the general adult population. In individuals with poor lower-body function, no association was found between residence in a less-compact area and walking. For those people, the relationship between neighborhood characteristics and walking requires further study.