Physical activity outcomes of CHAMPS II: a physical activity promotion program for older adults.

BACKGROUND: Despite well-known benefits of physical activity for older adults, about two thirds are underactive. Community-based programs are needed to facilitate increased physical activity. We examine the effectiveness of CHAMPS II, an inclusive, choice-based physical activity promotion program to increase lifetime physical activity levels of seniors. CHAMPS guided participants to choose activities that took into account their health, preferences, and abilities. It offered information on ways for them to exercise safely, motivate themselves, overcome barriers, and develop a balanced exercise regimen. METHODS: A 1-year randomized controlled trial was conducted with physically underactive seniors in a multispecialty group practice. Changes in self-reported physical activity by group were evaluated using ANCOVA, controlling for age and sex. RESULTS: Of 173 randomized subjects, 164 (95%) completed the trial. Subjects were aged 65 to 90 years (M = 74, SD = 6); 66% were female. The intervention group increased estimated caloric expenditure by 487 calories/week in moderate (or greater) intensity activities (MET >/= 3.0; p <.001) and by 687 calories/week in physical activities of any intensity (p <.001). Control group changes were negligible. Between-group analyses found that the changes were significantly different in both measures (p values <.05). Overweight persons especially benefited from this program. The program was as effective for women, older adults (75+), and those who did not set aside time to exercise at baseline. CONCLUSIONS: The program led to meaningful physical activity increases. Individually tailored programs to encourage lifestyle changes in seniors may be effective and applicable to health care and community settings.

Sexual function in 1,202 aging males: differentiating aspects.

BACKGROUND: Late-life sexuality is an important quality-of-life issue that has been minimally explored. This survey seeks to extend our knowledge of the relationship of sexual attitudes and preferences to sexual functioning of a large group of older, community-dwelling men. METHODS: Older men aged 58-94 (N = 1,202) were surveyed with an anonymous self-administered questionnaire including 63 items regarding present and past, actual and desired sexual practices and attitudes. RESULTS: Although age correlated consistently with increased erectile dysfunction and decreased sexual activity, a substantial number of older men continued active sexual behaviors supported by positive attitudes toward sexual function. It was found that both health status and perceived partner's responsiveness are prominent moderators of the age effect. CONCLUSION: In the absence of social isolation and health issues, many older men show persistently active sexual lifestyles as evidenced in their interest and participation in sexual activities. These findings negate a portion of the starkly negative imagery of sexual expression in aging males.

Physical fitness, aging, and sexuality.

Sexuality is a major quality-of-life issue, even into advanced age. Although relatively few studies have addressed sexuality, most studies have emphasized the decline in both sexual performance and satisfaction with aging. In an effort to assess possible positive modifiers of the decline, we included questions concerning sexuality in a multipurpose 90-item questionnaire submitted to members of the Fifty Plus Fitness Association based in Stanford, California. This group is unique in its commitment to a very active lifestyle and has served as a cohort for many prior studies related to fitness and medical outcomes. Sixty-seven percent of the membership returned the mail questionnaire, and 59% of these respondents replied to the sexually relevant items. The results indicated a high level of sexual activity and satisfaction in both older men and women of the Fifty Plus Fitness Association members. Further, sexual satisfaction seemed to correlate with the degree of fitness. We conclude that physical fitness and high levels of sexual activity are mutually supportive elements of successful aging.

How fast do we age? Exercise performance over time as a biomarker.

BACKGROUND: The rate of true chronologic functional change in humans has been previously obscured by inadvertent inclusion of data derived from sick or ill-conditioned individuals. The Masters athlete fulfills the need for a study cohort. METHODS: Performance data by age were collected from recognized certifying organizations for running, rowing, and swimming events and plotted as percent decline from age 35, and a rate of decline of performance by age was plotted. RESULTS: Close coincidence of the decay slopes of the events surveyed was observed. This rate is 0.5% per year. We argue that inasmuch as these strenuous events are subtended by most of the major body systems and are thereby rate-limited by them all, that no supporting system can decline faster than this rate. CONCLUSION: The virtual identity of the performance slopes of the different athletic events with one another and to that of other functions including that of a central physiologic measure, VO2 max, indicates that 0.5% per year may be a basic biomarker of the aging process.

Sexuality and aging--usual and successful.

BACKGROUND: As aging research increasingly reflects an effort to dissociate true time-driven changes from those that can be improved, sexuality in later life remains largely unexplored. Several problems are evident. There is a lack of normative data, a lack of a conceptual framework relating to the biology, psychology, and sociology of sex, and an attitudinal resistance that obscures the entire topic. METHODS: We conducted a three-part instructional series on major topics involved with sexuality and aging. We surveyed our group of attendees (n 158, average age 68 for males, 65 for females) before and after the series. RESULTS: A remarkably robust sex life was evidenced by both the men and the women, even until advanced old age. Yet, a substantially decreased involvement was reported from 10 years earlier. Despite current activities, people of both sexes wished they were participating even more than they currently were. Impotency was identified as the major negative feature for the men; relationship problems were for the women. A questionnaire 6 months after the series reported improved sexual attitudes, but no change in sexual activities from the earlier survey. CONCLUSION: Sexuality is a major quality-of-life issue which persists into old age. Our study showed that the usual sexual practices reported by our group were not considered by them to be ideal. The intervention of this instructional series provided improved sexual attitudes but not performance. Additional studies are encouraged.

Factors associated with enrollment of older adults into a physical activity promotion program.

This article investigates the extent to which a proactive two-phased recruitment approach resulted in recruitment of a representative sample of older adults from two lower income congregate housing facilities into a physical activity promotion program. Enrollees were similar to nonenrollees with respect to education, gender, marital status, race/ethnicity, self-rated health, physical functioning, psychological distress, exercise frequency, level of social contact, having a confidant, use of alcohol, and smoking status. However, enrollees were younger, more likely to speak English as a primary language, less likely to be completely sedentary, and more likely to be overweight. Overall, 21% of the target population were recruited into the program. Recruitment strategies such as those used in this study appeared to enable enrollment of a reasonably representative sample of a small well-defined population.

Effects of cessation of caffeinated-coffee consumption on ambulatory and resting blood pressure in men.

Coffee consumption has been weakly linked to high blood pressure (BP). The hypothesis that cessation of caffeinated-coffee consumption lowers ambulatory BP was tested in men in a randomized trial. One hundred eighty-six middle-aged, normotensive, male, habitual caffeinated-coffee consumers were recruited. Of these subjects, 150 had sufficiently complete, ambulatory BP measurements for analysis. After 2 months of standard caffeinated-coffee consumption, subjects were randomized to consume an equal amount of the same standard caffeinated coffee or a standard decaffeinated coffee, or to discontinue coffee consumption for 2 months. Diet composition, body weight and exercise did not change. Resting BP and heart rate were not different between the groups before and after intervention. In comparison with the continued caffeinated-coffee group (control), the decaffeinated-coffee group revealed significant reductions in mean ambulatory systolic BP during the morning (-4.0 +/- 11 mm Hg; p = 0.014), afternoon (-5.3 +/- 10 mm Hg; p = 0.001) and evening (-3.2 +/- 10 mm Hg; p = 0.003) hours, reductions in mean ambulatory diastolic BP during the afternoon (-1.8 +/- 10 mm Hg; p = 0.063) and evening (-1.8 +/- 10 mm Hg; p = 0.059) hours and no change in ambulatory heart rate.(ABSTRACT TRUNCATED AT 250 WORDS)

The physics of frailty.

The contribution of frailty to human morbidity and mortality is immense. Yet it lacks a conceptual framework. By borrowing from the hypotheses provided by the thermophysicists, frailty can be understood in a way that both interrelates the relationship between form and function and provides medical science with an operational insight that yields clinical benefit. Frailty results where the organism is uncoupled from its environment yielding a break in the forward feedback cycle of stimulus to reaction to growth to increased functional competence to improved response to stimulus. Recognition of the centrality of this interrelatedness to health becomes a key theme for illness prevention and therapy.

Coronary artery size and dilating capacity in ultradistance runners.

BACKGROUND: Increases in coronary artery size and dilating capacity have been observed in some animals after endurance training, and at autopsy, active men appear to have enlarged epicardial coronary arteries. This cross-sectional study was designed to test the hypothesis that highly trained endurance runners have larger epicardial coronary arteries and greater dilating capacity than inactive men. METHODS AND RESULTS: The subjects, ages 39-66 years, included 11 male volunteers who had participated in ultradistance running during the past 2 years and 11 physically inactive men who had been referred for arteriography but had no visible coronary artery disease. The internal diameter of the proximal segments of each major epicardial coronary artery was measured before and after nitroglycerin administration using a computer-based quantitative arteriographic analysis system. Measurements also included maximal oxygen uptake, plasma lipoprotein concentrations, body composition, and cardiac mass by echocardiography. Before nitroglycerin, the sum of the cross-sectional areas for the proximal right, left anterior descending, and circumflex arteries was not different for the runners and the inactive men: 22.7 +/- 4.79 versus 21.0 +/- 7.97 mm2 (p = 0.57), respectively. However, the increase in the sum of the cross-sectional area for the proximal right, left anterior descending, and circumflex arteries in response to nitroglycerin was greater for the runners (13.20 +/- 4.76 versus 6.00 +/- 3.02 mm2; p = 0.002). Left ventricular mass index (152 +/- 21 versus 116 +/- 41 g/m2; p < 0.05) but not left ventricular mass (284 +/- 40 versus 246 +/- 91 g; p = 0.22) was significantly greater for the runners. Among the runners, dilating capacity was positively correlated with aerobic capacity and negatively related to adiposity, resting heart rate, and plasma lipoprotein concentrations. CONCLUSIONS: Highly trained, middle-aged endurance runners demonstrated a significantly greater dilating capacity of their epicardial coronary arteries in response to nitroglycerin compared with inactive men. The causes of this greater dilating capacity and its clinical significance need to be determined.

Health behavior and experiences of physicians. Results of a survey of Palo Alto Medical Clinic physicians.

The results of a health practice questionnaire submitted to the 152 physician members of the Palo Alto Medical Clinic, 126 of whom responded, indicate a generally favorable profile of preventive medicine strategies. Physicians generally smoke less, drink about the same, exercise more, and use their seat belts more than the population at large. They also can expect to live longer. These results are compared with those of other physician surveys and surveys of the general public.

The trajectory of dying. Functional status in the last year of life.

The case records of the 97 patients in the largely geriatric clinical practice at the Palo Alto Medical Clinic who died in 1987 were reviewed. Functional states 12 months, six months, and one week before death were determined retrospectively in an attempt to establish the degree of functionality in the period before death, and particularly to assess the impact of age on this functionality. The data of the series suggest that age per se is not closely correlated with dysfunction. Further, use of the hospital for terminal care was largely confined to more functional patients.

Intensive care for the elderly: outcome of elective and nonelective admissions.

Survival, quality of life, and need for continuing medical care were evaluated for 134 elderly patients admitted to the intensive care units (ICU) at Stanford University Hospital and for a control group. Of the patient group, 57.5% were admitted to the ICU following elective surgery; 42.5% were emergency surgical and medical patients. Hospital mortality was 3.9% for elective and 22.8% for nonelective patients; 18-month mortality was 13.0% and 47.4%, respectively. Fifty-nine patients (60.8% of survivors) completed follow-up questionnaires. Subjective and objective quality of life was good. Quality of life was slightly worse for ICU survivors than for controls; elective and nonelective patients did not differ significantly. Although the cost of ICU hospitalization was high, additional medical care was not excessive. Nonelective patients required more continuing care than elective patients, and both groups required more than controls.

Aging as entropy.

Like the weather, many people talk about aging, but no one seems able to do anything about it. This implacability derives, at least in part, from our inability to provide a conceptual base from which analytic insight might derive. The emerging field of nonlinear thermodynamics presents a new view of the universe. It relates matter and energy in the framework of time. Entropy, "time's arrow," gives direction. Energy, rendered coherent through the metabolism of biology, acts to retard dissipation as entropy. For physicians, particularly those interested in geriatrics, this provides the challenge to understand how these forces are inscribed onto the human condition. The homeostatic controls which order our existence are energy dependent. As energies diminish, homeostasis as order deteriorates, aging proceeds and life is threatened. It seems to follow that if we are to diminish the entropic declines of aging our clinical strategies should emphasize actions which might retard the disruption of ordering processes. Homeostasis is at risk to the ravages of disease. This has been the standard business of medicine. But homeostasis is manifestly determined by the ordering effects of an energy flow. Either too little energy flow as disuse, or too much, as stress, lends further major burden to homeostatic controls. Every body system, at every level of organization, is beholden to this mandate. As our wisdom stretches to encompass the notion that aging and illness have other dimensions than just disease our view of ourselves will become more whole and in enlarging consonance with universal law.