Older Adults' Physical Activity and Healthcare Costs, 2003-2014.

INTRODUCTION: Research has documented the health benefits of physical activity among older adults, but the relationship between physical activity and healthcare costs remains unexplored at the population level. Using data from 50 U.S. states and the District of Columbia, this study investigates the extent to which physical activity prevalence is associated with healthcare costs among older adults. METHODS: Twelve-year state-level data (2003-2014) were obtained from 5 secondary sources (n=611). Healthcare costs were captured by Medicare Parts A and B spending. Fixed-effect models were estimated in 2019 to assess the relationship between the state-level physical activity prevalence and Medicare costs. The potential lagged associations were captured by lagged variables of physical activity prevalence (i.e., t-1, t-2, and t-3). RESULTS: Physical activity prevalence was not associated with Medicare costs occurring in the concurrent and subsequent year (p>0.05); however, the 2-year lagged variable (p=0.03) and the 3-year lagged variable (p=0.01) for physical activity prevalence were negatively associated with Medicare costs, indicating a time-lagged relationship. It was estimated that a 10 percentage point increase in physical activity prevalence in each state is associated with reduced Medicare Parts A and B costs of 0.4% after 2 years and 1.0% after 3 years. CONCLUSIONS: Results revealed a time lag effect highlighted by a delayed inverse relationship between state-level physical activity prevalence and healthcare costs among older adults. This evidence offers governments and communities new insights to guide policymaking on long-term public investment in physical activity intervention programs.

Enhancing Older Adults' Sense of Belonging and Subjective Well-Being Through Sport Game Attendance, Team Identification, and Emotional Support.

Objective: We investigate how (a) attendance at sport games and (b) identification with a sport team as fans (i.e., team identification) influence older adults' perceptions of emotional support, belonging, and subjective well-being (SWB). Method: An experimental pilot study was conducted with 50 older adults, followed by a main survey study administered to 534 older adults from various communities across the United States. Results: Pilot study results indicated that game attendance and team identification had a positive and significant influence on older adults' perceptions of emotional support from fellow team fans. These results were replicated in the main study, which also showed that older adults' perceived emotional support from fellow fans was positively associated with their sense of belonging which predicted their SWB. Discussion: The findings provide insights into how older adults may be engaged in meaningful forms of social life to help them maintain and enhance mental health.

Effect of resistance training and aerobic conditioning on muscular strength and submaximal fitness for individuals with chronic heart failure: influence of age and gender.

The hallmark characteristic of chronic heart failure (CHF) is exercise intolerance. This study evaluated a combined exercise program that would be consistent with current cardiac rehabilitation guidelines. The program consisted of progressive resistance training (intensity progressing from 50 to 80% maximum) and aerobic conditioning (70% of heart rate reserve). Outcomes included muscular strength measured as 8-repetition maximum and submaximal aerobic fitness indicators (measured at 50% of predicted maximal oxygen consumption) including heart rate, blood pressure, and rate pressure product. Subjects were taken retrospectively from a database of CHF patients who underwent cardiac rehabilitation between 1998 and 2004 with the Cardiac Rehabilitation Center of River Cities Cardiology in Jeffersonville, IN. The same data set was used to evaluate 2 research questions: to compare training outcomes between gender (men and women) and to compare outcomes between young (65 years) subjects. Forty-two subjects (15 women and 27 men; 19 were 65 years of age) met inclusion and exclusion criteria and underwent 36 sessions of cardiac rehabilitation over a 14-week time period. Repeated-measures analysis of variance was used to test whether strength and submaximal responses differed across gender or age. Analysis indicated that regardless of gender or age, subjects significantly increased their strength on each of 6 strength tests. Heart rate, systolic blood pressure, and rate pressure product were lower after training indicating increased aerobic efficiency. Progressive resistance training and aerobic conditioning prescribed in a manner consistent with cardiac rehabilitation guidelines resulted in similar improvements regardless of gender or age for individuals with CHF suggesting that no training program adjustments are necessary to accommodate age or gender.

Evaluation of anticipation bias for RPE during progressive exercise testing.

This study evaluated a possible anticipation bias when ratings of perceived exertion (RPE) were obtained during submaximal progressive exercise testing. Perceptual estimates were obtained using the CR-10 category-ratio scale. 13 subjects, 7 men and 6 women (M age = 26.8 +/- 6.4 yr., height = 2.7 +/- .17 m, weight = 73.0 +/- 18.2 kg, VO2 peak = 46.7 +/- 5.6 ml x kg(-1) x min(-1) for men and 47.8 +/- 7.3 ml x kg(-1) x min(-1) for women) recruited from the university student population participated. Each subject underwent two submaximal progressive exercise tests separated by at least 48 hr. using the cycle as test mode and the YMCA protocol. Power outputs established during the first test were presented in random order during the second test. Differentiated RPE for the Peripheral, Respiratory-Metabolic, and the undifferentiated signals, and heart rate, were measured during the last 15 sec. of each of the four stages of exercise. In comparing responses between the two tests, significant differences were observed for both heart rate and the Respiratory-Metabolic signal during power output 4, using repeated-measures analysis of variance. However, a 95% limit of agreement test was significant only for heart rate as the 95% confidence interval for the Respiratory-Metabolic signal overlapped zero and thus was not significantly different. No significant differences were found for the undifferentiated or peripheral signals between the two tests. Results indicate that both undifferentiated and differentiated RPE are given without significant anticipation bias during submaximal progressive cycle exercise.

Echocardiographic evaluation of stress test for determining safety of participation in strength training.

Suitability for safe participation in aerobic exercise is typically determined by a cardiopulmonary exercise test, using a treadmill or cycle. With increased participation in strength training by healthy clients as well as rehabilitation patients, there is a need to develop a test for determining suitability for safe participation in strength training. This investigation describes a strength stress test that may be used for determining safety of participation in strength training. Ten healthy subjects (28.3 +/- 5.9 years and 75.3 +/- 14.4 kg) with strength training experience participated. Following a resting echocardiogram, subjects performed 3 sets of leg presses at an 8 repetition maximum. Resting and exercise end-diastolic and end-systolic volumes were obtained during the last repetition of each set and were indexed for body surface area (ESV(I), EDV(I)). Ejection fraction, cardiac output, and stroke volume were calculated. Cardiac output increased significantly (p < 0.05) for each set in comparison to rest and also during the third set in comparison to sets 1 and 2. Ejection fraction increased, whereas ESV(I) and EDV(I) decreased significantly for each set compared to rest, and also during sets 2 and 3 when compared to set 1. Responses to sets 2 and 3 indicate increased cardiac stress with increasing sets to exhaustion analogous to changes observed during tests designed to assess anaerobic and aerobic power. Thus, this protocol may be used as a test for evaluating the ability to participate in modest strength training consistent with exercise prescriptions developed for participants of health clubs and rehabilitation facilities. Strength testing protocol described may be adapted and modified for evaluating other lifts such as arm work and job-related tasks.

Impact of prior exercise on hamstring flexibility: a comparison of proprioceptive neuromuscular facilitation and static stretching.

Position stands from the American College of Sports Medicine and the Surgeon General site a need for strategies capable of enhancing the effectiveness of stretching on flexibility and joint range of motion. One strategy for enhancing flexibility that has received anecdotal support but lacks substantial experimental evidence is the impact of prior exercise. This study compared 5 minutes of static stretching and proprioceptive neuromuscular facilitation (PNF) on hamstring flexibility performed with and without exercise. Forty undergraduate student-athletes participated in a repeated measure, counterbalanced experimental design. Within-group comparisons indicated that PNF resulted in a significant (p < 0.05) increase in flexibility after 60 minutes of exercise when compared with baseline (9.6%) and without exercise (7.8%). No differences were observed with static stretching across time. In addition, no differences were observed between the groups at any time point. Results demonstrated that PNF performed after exercise enhanced acute hamstring flexibility, and implementing a PNF stretching routine following exercise may augment current stretching practices among athletes.

Adding weights to stretching exercise increases passive range of motion for healthy elderly.

Stretching exercise is effective for increasing joint range of motion (ROM). However, the Surgeon General's Report and the American College of Sports Medicine cite a lack of studies identifying strategies capable of increasing the effectiveness of stretching exercise. This investigation evaluated adding modest weight (0.45-1.35 kg) to a stretching exercise routine (Body Recall [BR]) on joint ROM. Forty-three subjects ages 55-83 years participated in 1 of 2 training groups, BR, BR with weights (BR+W), or a control group (C). ROM was evaluated at the neck, shoulder, hip, knee, and ankle before and after 10 weeks of exercise. Using ANCOVA, significant differences (p < 0.01) were observed for right and left cervical rotation, hip extension, ankle dorsiflexion, ankle plantar flexion, and shoulder flexion. Post hoc analysis revealed that cervical rotation (left and right), hip extension, and ankle dorsiflexion for BR+W subjects differed significantly from BR and C (p < 0.01). Significant differences with shoulder flexion and ankle plantar flexion were found for both BR and BR+W in comparison to C (p < 0.01). Results indicate that addition of weights enhanced the effectiveness of stretching exercise for increasing joint ROM with 4 of the 6 selected measurements. Thus, a modest intensity exercise program that is within the reach of most elderly may significantly affect joint ROM and flexibility.