Translating exercise interventions to an in-home setting for seniors: preliminary impact on physical activity and function.

AIMS: The purpose of this study is to investigate whether an in-home, individually tailored intervention is efficacious in promoting increases in physical activity (PA) and improvements in physical functioning (PF) in low-active older adults. METHODS: Participants were randomized to two groups for the 8-week intervention. The enhanced physical activity (EPA) group received individualized exercise programming, including personalized step goals and a resistance band training program, and the standard of care (SoC) group received a general activity goal. Pre- and post-intervention PF measures included choice step reaction time, knee extension/flexion strength, hand grip strength, and 8 ft up and go test completion time. RESULTS: Thirty-nine subjects completed this study (74.6 ± 6.4 years). Significant increases in steps/day were observed for both the EPA and SoC groups, although the improvements in the EPA group were significantly higher when including only those who adhered to weekly step goals. Both groups experienced significant PF improvements, albeit greater in the EPA group for the 8 ft up and go test and knee extension strength. CONCLUSION: A low cost, in-home intervention elicited improvements in both PA and PF. Future research is warranted to expand upon the size and scope of this study, exploring dose thresholds (and time frames) for PA to improve PF and strategies to further bolster adherence rates to maximize intervention benefits.

Dose-response walking activity and physical function in older adults.

The aim of this study was to examine the dose-response relationship between walking activity and physical function (PF) in community-dwelling older adults. Physical activity (PA, pedometry) and PF (self-report [SF-36] and 6-minute walk test [6MWT]) were assessed in 836 individuals. Accumulated PA was categorized into four groups (1 = ≤ 2,500; 2 = 2,501-5,000; 3 = 5,001-7,500; and 4 = ≥ 7,501 steps/day). Across individual groups 1-4, SF-36 scores increased from 66.9 ± 25.0% to 73.5 ± 23.2% to 78.8 ± 19.7% to 81.3 ± 20.6%, and 6MWT increased from 941.7 ± 265.4 ft to 1,154.1 ± 248.2 ft to 1,260.1 ± 226.3 ft to 1,294.0 ± 257.9 ft. Both SF-36 and 6MWT scores were statistically different across all groups, apart from groups 3 and 4. PA and ranks of groups were highly significant predictors (p < .0001) for both SF-36 and 6MWT. There was a positive dose-response relationship evident for both SF-36 and 6MWT with increasing levels of PA. Low levels of PA appear to be an important indicator of poor functionality in older adults.

Geospatial Relationships between Awareness and Utilization of Community Exercise Resources and Physical Activity Levels in Older Adults.

Introduction. It is unclear if community-based fitness resources (CBFR) translate to heightened activity levels within neighboring areas. The purpose of this study was to determine whether awareness and utilization of fitness resources and physical activity differed depending on residential distance from CBFR. Methods. Four hundred and seventeen older adults (72.9 ± 7.7 years) were randomly recruited from three spatial tiers (≤1.6, >1.6 to ≤3.2, and >3.2 to 8.0 km) surrounding seven senior centers, which housed CBFR. Participants completed questionnaires on health history, CBFR, and physical activity, gathering data on CBFR awareness, utilization, and barriers, overall levels, and predictors to engagement in moderate to vigorous physical activity (MVPA). Results. Across spatial tiers, there were no differences in positive awareness rates of CBFR or CBFR utilization. Engagement in MVPA differed across spatial tiers (P < 0.001), with the >3.2 to 8.0 km radius having the highest mean energy expenditure. Across all sites, age and income level (P < 0.05) were significant predictors of low and high amounts of MVPA, respectively, and current health status and lack of interest represented barriers to CBFR utilization (P < 0.05). Conclusion. Closer proximity to CBFR did not impact awareness or utilization rates and had an inverse relationship with physical activity.

Accuracy of uploadable pedometers in laboratory, overground, and free-living conditions in young and older adults.

PURPOSE: The purpose of this study was to examine the accuracy of uploadable pedometers to accurately count steps during treadmill (TM) and overground (OG) walking, and during a 24 hour monitoring period (24 hr) under free living conditions in young and older adults. METHODS: One hundred and two participants (n=53 aged 20-49 yrs; n=49 aged 50-80 yrs) completed a TM protocol (53.6, 67.0, 80.4, 93.8, and 107.2 m/min, five minutes for each speed) and an OG walking protocol (self-determined "< normal", "normal", and "> normal" walking speeds) while wearing two waist-mounted uploadable pedometers (Omron HJ-720ITC [OM] and Kenz Lifecorder EX [LC]). Actual steps were manually tallied by a researcher. During the 24 hr period, participants wore a New Lifestyles-1000 (NL) pedometer (standard of care) attached to a belt at waist level over the midline of the left thigh, in addition to the LC on the belt over the midline of the right thigh. The following day, the same procedure was conducted, replacing the LC with the OM. One-sample t-tests were performed to compare measured and manually tallied steps during the TM and OG protocols, and between steps quantified by the NL with that of the OM and LC during the 24 hr period. Mean error step scores (MES, criterion - device) and 95% Limits of Agreement (LoA) were calculated. RESULTS: There were no significant differences between the OM and tallied steps for any of the TM speeds for either the young or older adult groups. The LC significantly underestimated steps for the young adult group during the 53.6 m/min TM speed (MES 31.4 [14.5, 48.3]) and during the OG < normal walking speed (MES 12.0 [0.9, 23.1] (p<0.01 for both age groups). The LC also significantly underestimated steps for the older adult group during the TM speeds of 53.6 m/min (MES 64.5 [45.6, 83.4]), 67.0 m/min (MES 15.1 [6.1, 24.0]), and 80.4 m/min (MES 3.2 [0.6, 5.9]) (p<0.01 for all speeds), in addition to the OG < normal walking speed (MES 14.7 [-13.3, 42.6] (p<0.01). The OM reported significantly lower steps during the 24 hr period for the young adult group by 949.1 steps (t=6.111, p<0.025) and for the older adult group by 612.9 steps (t=2.397, p<0.025). CONCLUSION: Both the OM and LC pedometers were more accurate as TM and OG walking speed increased. The OM significantly underestimated steps during the 24 hr compared with a standard of care evaluation. Overall, both uploadable pedometers appear acceptable to use in young or old age groups to measure walking behavior.

Measured and perceived environmental characteristics are related to accelerometer defined physical activity in older adults.

BACKGROUND: Few studies have investigated both the self-perceived and measured environment with objectively determined physical activity in older adults. Accordingly, the aim of this study was to examine measured and perceived environmental associations with physical activity of older adults residing across different neighborhood types. METHODS: One-hundred and forty-eight older individuals, mean age 64.3 ± 8.4, were randomly recruited from one of four neighborhoods that were pre-determined as either having high- or low walkable characteristics. Individual residences were geocoded and 200 m network buffers established. Both objective environment audit, and self-perceived environmental measures were collected, in conjunction with accelerometer derived physical activity behavior. Using both perceived and objective environment data, analysis consisted of a macro-level comparison of physical activity levels across neighborhood, and a micro-level analysis of individual environmental predictors of physical activity levels. RESULTS: Individuals residing in high-walkable neighborhoods on average engaged in 11 min of moderate to vigorous physical activity per day more than individuals residing in low-walkable neighborhoods. Both measured access to non-residential destinations (b = .11, p < .001) and self-perceived access to non-residential uses (b = 2.89, p = .031) were significant predictors of time spent in moderate to vigorous physical activity. Other environmental variables significantly predicting components of physical activity behavior included presence of measured neighborhood crime signage (b = .4785, p = .031), measured street safety (b = 26.8, p = .006), and perceived neighborhood satisfaction (b = .5.8, p = .003). CONCLUSIONS: Older adult residents who live in high-walkable neighborhoods, who have easy and close access to nonresidential destinations, have lower social dysfunction pertinent to crime, and generally perceive the neighborhood to a higher overall satisfaction are likely to engage in higher levels of physical activity behavior. Efforts aimed at promoting more walkable neighborhoods could influence activity levels in older adults.