Impact of Type-2 Diabetes Time Since Diagnosis on Elderly Women Gait and Functional Status.

BACKGROUND AND PURPOSE: The gait, mobility and lower-limb strength alterations of diabetic elderly women without symptoms of diabetic neuropathy in different periods of the chronic disease can contribute to an early functional diagnosis, allowing prevention of adverse outcomes like falls and disability. This could also contribute to the development of interventions, cures and physiotherapy practice for this population. The aim of this study was to verify the impact of type-2 diabetes mellitus time since diagnosis on gait and functional status of elderly women. METHODS: Eighty-two diabetic elderly women without neuropathic symptoms participated and divided in two groups: 1) 49 elderly (71.4 ± 4.8 years) with less than 10 years of type-2 diabetes mellitus diagnosis, and 2) 33 elderly (70 ± 4.5 years) with 10 or more years of type-2 diabetes mellitus diagnosis. Outcomes were spatiotemporal gait parameters (speed, cadence, step length, base of support, stance time, swing time, and double support time) assessed through GAITRite® system, and functional status assessed using the Timed Up and Go test and five times sit-to-stand test. To compare spatiotemporal gait variables and performance on functional tests between groups, multivariate analysis of variance and Mann-Whitney test were performed, respectively. RESULTS: The group with 10 or more years of diagnosis showed lower gait speed and smaller step length (112.3 cm/s; 59.2 cm) compared with the group with less than 10 years of diagnosis (122.9 cm/s; 62.4 cm). In relation to Timed Up and Go test and five times sit-to-stand test, there were no statistically significant differences between the groups. CONCLUSION: Type-2 diabetes mellitus time since diagnosis has a negative impact on gait speed and step length, but not on functional status of the elderly women. Copyright © 2015 John Wiley & Sons, Ltd.

Adesão de idosas a um programa de exercícios domiciliares pós-treinamento ambulatorial / Adhesión de mujeres mayores a un programa de ejercicios domicilarios post-entrenamiento ambulatorio / Adhesion of older women to a home exercise program post ambulatory training

RESUMO A prática de exercícios terapêuticos por idosos visa melhorar o desempenho funcional. A prescrição de exercícios domiciliares é uma prática rotineira na fisioterapia, mas sua efetividade depende da adesão dos idosos, que frequentemente é muito baixa. O objetivo do estudo foi avaliar a adesão e retenção de idosas a um programa domiciliar e identificar os fatores associados a essa prática. Este estudo é observacional exploratório, composto por 96 idosas, (71,3±5,16 anos) submetidas a um programa de exercícios em casa. Foram avaliadas medidas clínicas, funcionais e um questionário de adesão para identificar os fatores motivadores e as barreiras. A taxa de retenção foi de 86% e a de adesão foi de 36%, com o mínimo de 85% de frequência. Os modelos de regressão aplicados não foram significativos, e nas análises estatísticas comparativas entre grupos foi verificada alta incidência de fatores negativos. A ausência de correlação entre pior desempenho funcional e físico com a baixa adesão evidencia que esse desfecho é complexo e multifatorial, e deve ser explorado também sob aspectos sociais, emocionais e culturais.

RESUMEN La práctica de ejercicios terapéuticos para mayores pretende mejorar el desempeño funcional. La prescripción de ejercicios domiciliarios es una práctica rutinera en la fisioterapia, pero su eficacia depende de la adhesión de los mayores, que a menudo es baja. El objetivo del estudio fue evaluar la adhesión y retención de mujeres mayores a un programa domiciliario e identificar los factores asociados a esta práctica. Este estudio es observacional exploratorio, formado por 96 mujeres mayores (71,3±5,16 años) sometidas a un programa de ejercicios en casa. Se evaluaron las medidas clínicas, funcionales y un cuestionario de adhesión para identificar los factores motivadores y las barreras. La tasa de retención fue del 86% y la de adhesión fue del del 36%, con un mínimo del 85% de frecuencia. Los modelos de regresión aplicados no fueron significativos y en los análisis estadísticos comparativos entre grupos se comprobó alta incidencia de factores negativos. La ausencia de correlación entre peor desempeño funcional y físico con la baja adhesión demuestra que este resultado es complejo y multifactorial, y que debe ser explorado también en los aspectos sociales, emocionales y culturales.

ABSTRACT Practice of therapeutic exercises for older adults aims at better functional performance. It is an everyday practice on physiotherapy, the prescription of home exercises; although its effectiveness depends on adhesion, which is usually very low. The aim of the study was to evaluate older women´s adhesion to and retention in a home program and to identify the factors associated with this practice. This study is exploratory and observational, n=96 older women, (71.3 years old ±5.16) subjected to a program of home exercises. Clinical and functional measures were applied with an adhesion questionnaire to identify motivational factors and barriers. Retention rate was 86% and adhesion was 36%, with a minimum frequency of 85%. Regression models applied were not significant and comparative static analysis between groups verified a high occurrence of negative factors. Correlation absence between worse functional and physical performance with low adhesion highlights such outcome is complex, has multi factors and should also be explored regarding social, emotional and cultural aspects.

Adherence to exercise programs for older people is influenced by program characteristics and personal factors: a systematic review.

QUESTION: How has adherence been measured in recent prospective studies focusing on adherence to exercise programs among older people? What is the range of adherence rates? Which factors are associated with better adherence? DESIGN: Systematic review of prospective studies that had a primary aim of assessing adherence to exercise programs. PARTICIPANTS: Older people undertaking exercise programs. INTERVENTION: Exercise programs. OUTCOME MEASURES: Measures of adherence, adherence rates and factors associated with adherence. RESULTS: Nine eligible papers were identified. The most common adherence measures were the proportion of participants completing exercise programs (ie, did not cease participation, four studies, range 65 to 86%), proportion of available sessions attended (five studies, range 58 to 77%) and average number of home exercise sessions completed per week (two studies, range 1.5 to 3 times per week). Adherence rates were generally higher in supervised programs. The person-level factors associated with better adherence included: demographic factors (higher socioeconomic status, living alone); health status (fewer health conditions, better self-rated health, taking fewer medications); physical factors (better physical abilities); and psychological factors (better cognitive ability, fewer depressive symptoms). CONCLUSION: Older people's adherence to exercise programs is most commonly measured with dropout and attendance rates and is associated with a range of program and personal factors.

Adherence of older women with strength training and aerobic exercise.

BACKGROUND: Participation of older people in a program of regular exercise is an effective strategy to minimize the physical decline associated with age. The purpose of this study was to assess adherence rates in older women enrolled in two different exercise programs (one aerobic exercise and one strength training) and identify any associated clinical or functional factors. METHODS: This was an exploratory observational study in a sample of 231 elderly women of mean age 70.5 years. We used a structured questionnaire with standardized tests to evaluate the relevant clinical and functional measures. A specific adherence questionnaire was developed by the researchers to determine motivators and barriers to exercise adherence. RESULTS: The adherence rate was 49.70% in the aerobic exercise group and 56.20% in the strength training group. Multiple logistic regression models for motivation were significant (P=0.003) for the muscle strengthening group (R(2)=0.310) and also significant (P=0.008) for the aerobic exercise group (R(2)=0.154). A third regression model for barriers to exercise was significant (P=0.003) only for the muscle strengthening group (R(2)=0.236). The present study shows no direct relationship between worsening health status and poor adherence. CONCLUSION: Factors related to adherence with exercise in the elderly are multifactorial.