Parental and familial factors related to participation in a home-based physical activity intervention in children with obesity or Prader-Willi syndrome.

Background: Increasing physical activity (PA) participation is vital to promote the development of health behaviors in childhood. This study examined which parental and familial factors predicted completion of and compliance with a home-based family PA program in a cohort of families with a child with Prader-Willi syndrome (PWS; a rare disorder with obesity and developmental disability) or with obesity but with neurotypical development. Methods: Participants (n = 105) were parents of children with PWS (n = 41) and parents of children with obesity but without PWS (n = 64). Parents completed a series of questionnaires documenting their demographic characteristics, self-efficacy, social support, and family environment (active-recreational orientation and cohesion). Relationships between these factors and intervention completion and compliance were evaluated using bivariate correlations and logistic regression (compliance) and multiple regression (completion) analyses with groups together and then separately if the child group was a significant predictor. Results: None of the variables of interest (marital status, employment, employed hours per week, self-efficacy, social support, and family environment) were significant predictors of intervention completion. Intervention compliance was negatively associated with parents working part-time and working full-time and positively associated with family cohesion (Model R2 = 0.107, F(3,100) = 4.011, p = .010). Child group was not a factor. Conclusions: Compliance with a 24-week family home-based PA intervention was related to fewer employment hours of the primary caregiver and family environment factors. Future interventions should consider how to reduce the intervention's burden in working parents along with strategies to foster family cohesion.

Process evaluation and challenges in collecting data from an after-school sports and literacy program in a diverse, low-income community.

BACKGROUND: To understand how programs succeed we must evaluate them. The purpose of this paper was to examine the intervention and evaluation processes and identify areas of success and challenges in delivering and evaluating the Reflective Educational Approach to Character and Health (REACH) after-school program in a low SES community. METHODS: Sixty-six fifth and sixth graders from two schools participated. Data were collected at the intervention and control schools at four time points over the year. Data collected at baseline (Aug/Sep 2016), and Time 4 (May, 2017) were used for the analysis. Reach and fidelity to the intervention were assessed along with information on the process of data collection for variables of interest (e.g., accelerometer-measured physical activity level, FITNESSGRAM tests, vertical jump, and literacy). Missing data were imputed and a 2(School) by 2(Time) mixed factorial ANOVA was performed to examine the efficacy of the intervention. RESULTS: There were no significant time by school interactions for any of the outcomes assessed. There were several challenges in evaluating the program such as low compliance to wearing the accelerometer, lack of effort during literacy tests, peers affecting effort on physical tests, and missing data. CONCLUSIONS: We posit that research implementation be re-examined in community-based research that is conducted with students at the elementary level in low-income communities. Future research should engage with youth in the data collection process to make it a meaningful experience for them and to possibly reduce attrition from the program.

Can Age Influence Functional Tests Differently to Predict Falls in Nursing Home and Community-Dwelling Older Adults?

Aim: The aim of this cross-sectional study was to determine which functional tests are able to predict falls in nursing home residents (NHR) and community-dwelling (CDW) older adults grouped by age. Methods: Two hundred and fifty-two older adults were assessed in the following tests, Mini-Mental State Examination, anthropometric characteristics, fall history and functional tests. The participants were assigned to one of the following groups: Young Older Adults (YOA; 60-69 years, n = 102; 27.5% NHR), Old Older Adults (OOA; 70-79 years; n = 100; 23.5% NHR) and Very Older Adults (VOA, ≥80 years; n = 50; 52% NHR). Results: The five times sit-to-stand showed 1.41 odds to experience a fall in the NHR of the VOA. In the CDW, the handgrip strength score decreased the odds to fall occurrence (0.92 odds) in the YOA, while the low score in timed up and go test of the OOA showed 1.21 odds to experience a fall. Conclusions: Therefore, the five times sit-to-stand test can predict falls in NHR of VOA groups, while handgrip strength and timed up and go tests can predict falls in CDW of YOA and OOA groups, respectively.

A Cross-Sectional Examination of Patterns of Sedentary Behavior and Cardiometabolic Risk in Community-Dwelling Adults Aged 55 Years and Older.

INTRODUCTION: Sedentary behavior (SB) is highly prevalent among older adults, with more than 25% engaging in 6 hours or more of SB daily. SB has been associated with several cardiometabolic biomarkers in younger adults; however, there is a paucity of research in older populations. This study examined associations between patterns of SB and cardiometabolic biomarkers in community-dwelling adults aged 55 years and older. METHODS: Data were drawn from a convenience sample of 54 community-dwelling individuals (12 males, 42 females; mean age = 72.6 ± 6.8 years, range = 56-89 years). Cardiometabolic biomarkers assessed included systolic (SBP) and diastolic blood pressure (DBP), body mass index, waist circumference, and fasting blood glucose and cholesterol parameters. SB was assessed via accelerometry over a 7-day period, and measures included daily time in SB, number and length of sedentary bouts, the number and length of breaks between sedentary bouts, moderate-to-vigorous physical activity (MVPA), and light physical activity (LPA). Associations between the SB measures and each cardiometabolic risk factor were examined using separate stepwise multiple regression models, controlling for sex, MVPA, and accelerometer wear time. Isotemporal substitution models were used to examine the change in cardiometabolic outcomes when SB is replaced by an equal duration of either LPA or MVPA. RESULTS: Adjusted regression analyses showed that daily sedentary time was positively associated with DBP (ß = 0.052, ∆R 2 = 0.112, p = 0.022) and inversely associated with HDL cholesterol (ß = -0.111, ∆R 2 = 0.121, p = 0.039). Sedentary bout length was also associated with DBP and HDL cholesterol (ß = 0.575, ∆R 2 = 0.152, p = 0.007; ß = -1.529, ∆R 2 = 0.196, p = 0.007, respectively). Replacement of 10 minutes of SB a day with LPA was associated with improved DBP and HDL cholesterol (p ≤ 0.05). No other significant associations (p ≤ 0.05) were found. CONCLUSION: Sitting for prolonged periods of time without interruption is unfavorably associated with DBP and HDL cholesterol. Prospective studies should identify causal relationships and observe specific changes in cardiometabolic profiles in older populations.

Quadriceps Impairment Is Associated with Gait Mechanics in Young Adults with Obesity.

PURPOSE: Obesity influences gait and muscle function, which may contribute to knee osteoarthritis. This study aimed 1) to compare gait biomechanics and quadriceps function between individuals with and without obesity and 2) to examine the association between quadriceps function and gait biomechanics. METHODS: Forty-eight individuals with and 48 without obesity participated and were matched on age and sex. Gait biomechanics at standardized and self-selected speeds were used to assess peak vertical ground reaction force (vGRF), vertical loading rate (vLR), internal knee extension moment (KEM), peak knee flexion angle (KFA), knee flexion excursion (KFE), and knee joint stiffness. Quadriceps function was assessed using peak isometric strength (peak torque), early (RTD100) and late (RTD200) rate of torque development (RTD), and vastus lateralis cross-sectional area (CSA) and echo intensity (EI). RESULTS: When normalized to fat-free mass, individuals with obesity had lower RTD100 (P = 0.04) and RTD200 (P = 0.02) but higher vastus lateralis CSA (P < 0.01) and EI (P < 0.01) compared with normal weight controls. The group-speed interaction was significant for normalized vGRF (P < 0.01), normalized vLR (P = 0.02), normalized KEM (P = 0.03), and normalized knee joint stiffness (P = 0.02). Post hoc analyses indicate a smaller normalized vGRF and normalized KEM, and lower knee joint stiffness in individuals with obesity compared with normal weight controls at self-selected speed. There were main effects of speed for all kinematic and kinetic variables, and body mass index group for all absolute kinetic variables as well as normalized vGRF (all P < 0.001). A lower vastus lateralis EI (P = 0.04) and greater RTD100 (P < 0.01) were associated with a larger KEM in individuals with obesity. CONCLUSION: Individuals with obesity have quadriceps dysfunction that is weakly associated with KEM during walking. Exercise interventions that improve quadriceps function may improve walking mechanics.

The relationship between metabolic syndrome, cytokines and physical activity in obese youth with and without Prader-Willi syndrome.

BACKGROUND: The objective of this study was to examine the associations between adiposity, metabolic syndrome (MetS), cytokines and moderate-to-vigorous physical activity (MVPA) in youth with Prader-Willi syndrome (PWS) and non-syndromic obesity (OB). METHODS: Twenty-one youth with PWS and 34 with OB aged 8-15 years participated. Measurements included body composition, blood pressure, fasting blood markers for glucose control, lipids and inflammation and MVPA. Group differences for adiposity, MetS, blood parameters and MVPA were determined using independent t-tests and chi-square (χ2) analyses. Bivariate correlations and analysis of variance (ANOVA) examined the associations between adiposity, MetS severity, cytokines and MVPA. RESULTS: PWS presented similar percentage of body fat (%), lower body mass index (BMI) z-scores, insulin resistance, triglycerides, MetS severity, C-reactive protein (CRP), tumor necrosis factor-α (TNF-α) and MVPA and higher high-density lipoprotein (HDL) and adiponectin (ADP) than OB. Fewer PWS presented MetS based on BMI z-score (61.9% vs. 91.2%) and glucose (14.3% vs. 44.1%) compared to OB. In all youth, MetS severity was significantly associated with body fat %, ADP, interleukin-6 (IL-6) and TNF-α and also with CRP in PWS, but associations became non-significant for CRP and IL-6 when controlling for body fat %. In PWS, those with low MVPA had significantly higher TNF-α than those with high MVPA (1.80±0.45 vs. 1.39±0.26 pg/mL). CONCLUSIONS: Although PWS presented better cardiometabolic profiles than OB and lower MetS risk, associations between body fat, MetS and cytokines were somewhat similar for both groups, with the exception of CRP. Results suggest a potential role for MVPA related to MetS and inflammation and extend associations shown in OB to PWS.

Comparing Class-Based and Home-Based Exercise for Older Adults With Chronic Health Conditions: 12-Month Follow-Up of a Randomized Clinical Trial.

OBJECTIVE: To assess the maintenance of physical activity (PA) and health gains among participants in a class-based (CB) or home-based (HB) PA intervention over a 12-month study period. METHODS: A total of 172 adults aged 50 years and older were randomly allocated to either a CB or an HB intervention, each involving an intensive 3-month phase with a 9-month follow-up period. Measures at baseline, 3, 6, and 12 months included self-reported PA and health, body mass index, waist circumference (WC), blood pressure, cardiovascular endurance (6-min walk test), physical function, and functional fitness (senior fitness test). Outcomes were analyzed using generalized estimating equations. RESULTS: Maximum improvement was typically observed at 3 or 6 months followed by a modest diminution, with no differences between groups. For body mass index, waist circumference, 6-min walk test, and senior fitness test, there was progressive improvement through the study period. Greater improvement was seen in the CB group compared with the HB group on three items on the senior fitness test (lower body strength and endurance [29% vs. 21%, p < .01], lower body flexibility [2.8 cm vs. 0.4 cm, p < .05], and dynamic agility [14% vs. 7%, p < .05]). CONCLUSION: The interventions were largely comparable; thus, availability, preferences, and cost may better guide program choice.

Predictors of Physical Activity Levels in Community-Dwelling Older Adults: A Multivariate Approach Based on a Socio-Ecological Framework.

The purpose of this study was to explore cross-sectional relationships between self-reported physical activity (PA) and personal, social, and environmental factors in community-dwelling adults aged 50 years and older. Accounting for clustering by neighborhood, generalized estimating equations were used to examine associations between selected correlates and the Physical Activity Scale for the Elderly (PASE) score while adjusting for confounders. Data for 601 participants were analyzed: 79% female, 37% married, mean age 76.8 (± 8.7) years, mean PASE score 112.6 (± 64.8). Age, living in seniors' housing, using nursing/home care services, receiving encouragement to be active, and having benches available in the neighborhood were inversely associated with PASE. Self-efficacy, SF-12 score, PA barriers, social support, and the presence of trails showed positive associations. Several personal, social, and environmental factors associated with PA were identified. The inverse association between PA and living in seniors' housing units should be considered when developing PA programs for older adults.

Is Self-Reported Physical Activity Participation Associated with Lower Health Services Utilization among Older Adults? Cross-Sectional Evidence from the Canadian Community Health Survey.

Purpose. To examine relationships between leisure time physical activity (LTPA) and health services utilization (H) in a nationally representative sample of community-dwelling older adults. Methods. Cross-sectional data from 56,652 Canadian Community Health Survey respondents aged ≥ 50 years (48% M; 52% F; mean age 63.5 ± 10.2 years) were stratified into three age groups and analysed using multivariate generalized linear modeling techniques. Participants were classified according to PA level based on self-reported daily energy expenditure. Nonleisure PA (NLPA) was categorized into four levels ranging from mostly sitting to mostly lifting objects. Results. Active 50-65-year-old individuals were 27% less likely to report any GP consultations (ORadj = 0.73; P < 0.001) and had 8% fewer GP consultations annually (IRRadj = 0.92; P < 0.01) than their inactive peers. Active persons aged 65-79 years were 18% less likely than inactive respondents to have been hospitalized overnight in the previous year (ORadj = 0.82, P < 0.05). Higher levels of NLPA were significantly associated with lower levels of HSU, across all age groups. Conclusion. Nonleisure PA appeared to be a stronger predictor of all types of HSU, particularly in the two oldest age groups. Considering strategies that focus on reducing time spent in sedentary activities may have a positive impact on reducing the demand for health services.

The relationship of chronic disease and demographic variables to physical activity in a sample of women aged 65 to 79 years.

This study explored the relationship between physical activity, marital status, income, education, and chronic disease in older women to determine which individuals are at risk of being inactive and to identify potential moderators of physical activity behavior. This was an analysis of cross-sectional data from a convenience sample of 271 community-dwelling women aged 65 to 79 years. Self-reported physical activity was measured using the Physical Activity Scale for the Elderly. Socio-demographic characteristics (including age, gender, marital status, education, employment, and income) and self-reported health were measured using previously validated instruments. To avoid seasonal variations in physical activity, data were collected during the summer months. Physical activity was negatively associated with age and the presence of cardio-respiratory disease and positively associated with income greater than $20,000 (p < 0.05). After controlling for other co-variates, no significant differences were observed in physical activity between married and unmarried individuals. Given the strong association between cardio-respiratory disease and income with physical activity, women 65 years of age and older in lower income brackets and suffering from these health conditions should be targeted for exercise counseling and support. Intervention research is needed to determine the most effective means to decrease inactivity among these women.

Saskatoon in motion: class- versus home-based exercise intervention for older adults with chronic health conditions.

BACKGROUND: The study aimed to compare the effectiveness of a class-based (CB) and home-based (HB) exercise program for older adults with chronic health conditions. METHODS: 172 sedentary older adults with overweight or obesity, type 2 diabetes, hypertension, dyslipidemia, or osteoarthritis were enrolled in a randomized controlled trial with a 3-month follow-up. RESULTS: A significant increase was seen in the CB group in the Physical Activity Scale for the Elderly (PASE) scores and SF-12 Physical and Mental Health scores. In both groups, significant increases were seen in 6-minute walk distance, Physical Performance Test (PPT), and Functional Fitness Test (FFT), and significant reductions were seen in systolic and diastolic blood pressure but not body mass index or waist circumference. Except for a greater increment in the FFT in the CB group, the degree of improvement was not significantly different between the 2 groups. CONCLUSION: After a 3-month intervention, both the CB and HB program produced comparable significant improvements in outcome measures.

Profile of physical activity levels in community-dwelling older adults.

PURPOSE: To examine relationships between selected sociodemographic, health-related and environmental factors and levels of physical activity in older adults across three age groups. METHODS: Seven hundred sixty-four older adults (mean age = 77.4 +/- 8.6 yr) from a midsize Canadian city completed a self-administered questionnaire under researcher supervision. Level of physical activity was determined using the Physical Activity Scale for the Elderly (PASE). Correlates of physical activity were examined using previously validated questionnaires. The findings pertaining to personal and environmental factors are presented. RESULTS: Overall, significantly higher mean PASE scores were seen in those individuals in the following categories: male (P < 0.001), married or common-law (P < 0.001), not living alone (P < 0.001), not living in senior's housing (P < 0.001), higher levels of education (P < 0.001) and higher incomes (P < 0.001). Better physical health showed significant positive associations (P < 0.001) with PASE score. Individuals reporting at least four or more chronic health conditions had significantly lower PASE scores than those reporting no chronic conditions (P < 0.001). Significantly lower PASE scores were also reported in those using domestic services (P < 0.001). Higher PASE scores were related to the presence of hills, biking and walking trails, street lights, various recreation facilities, seeing others active and unattended dogs (P < 0.001 to P < 0.05). CONCLUSION: An understanding of the factors that influence physical activity behavior in older adults is critical to developing effective intervention strategies that will address the problem of physical inactivity in this population, and in doing so, improve the health status and quality of life of the older adult, while having a significant impact on healthcare expenditures.