Physician counseling of older adults about physical activity: the importance of context.

PURPOSE: Physicians are encouraged to discuss physical activity with their older adult patients. Studies of physician-initiated counseling have yielded inconsistent results, perhaps because older adults' perceptions and concerns about such counseling have not been addressed. The objective of the present work was therefore to explore such perceptions and their implications. DESIGN: Qualitative study, using a grounded theory approach. Data were collected using both focus groups and semistructured interviews. SETTING: Data were collected in several settings, including a fitness center and physicians' offices. SUBJECTS: In a first sample, 56 adults aged 65 and older participated in one of six focus group sessions examining physical activity and exercise. Subsequently, 16 older adults participated in one of two focus groups comprising a second, validation sample. Individual semistructured interviews were conducted with a sample of five physicians. METHODS: Data collection and analysis took place concurrently. Transcripts were analyzed using the constant comparative method. Recruitment, data collection, and analysis were informed by grounded theory. RESULTS: Inactive older adults experiencing a health problem were more receptive than their healthy counterparts to receiving physical activity counseling from their physicians. Those who were receptive appeared to find such an intervention useful in leading to behavior change. CONCLUSION: This study suggests that physicians' efforts in physical activity counseling may have the best impact when provided in the context of a health problem.

Response of postpoliomyelitis patients to bisphosphonate treatment.

OBJECTIVE: To evaluate (1) the rate of change of bone mineral density (BMD) at the hip in postpolio patients treated with bisphosphonates compared with the rate of change in BMD in (a) postpolio patients not treated with bisphosphonates and (b) non-postpolio patients treated with bisphosphonates; and (2) to compare the fracture rate in postpolio patients before and after treatment. DESIGN: Retrospective chart review. SETTING: University-affiliated hospital postpolio clinic and bone metabolism clinic. PARTICIPANTS: Patients with at least 2 BMD assessments. We included 144 postpolio patients and 112 non-postpolio patients. For the fracture analysis, 32 postpolio patients with a history of fractures and treatment with bisphosphonates were included. METHODS: The effect of treatment on BMD in postpolio patients was analyzed with use of a multiple linear regression model and a mixed effects model, with the rate of change in hip BMD and the change in BMD from baseline, respectively, as the dependent variables. The effect of treatment on occurrence of fractures in postpolio patients was analyzed with use of conditional logistic regression and Poisson regression. MAIN OUTCOME MEASURES: BMD measurements at the femoral neck (g/cm²) and occurrence of fractures before and after initiation of treatment. RESULTS: In an adjusted model, postpolio patients treated with bisphosphonates (54/144) had a greater rate of change in BMD (0.031 g/cm²/year; 95% confidence interval 0.010-0.052) compared with nontreated postpolio patients. The effect of treatment in postpolio patients was similar to that in non-postpolio patients. Evidence indicated that treated postpolio patients have a lower risk of fracture after treatment (odds ratio 0.3, P = .046; rate ratio 0.4, P = .183). CONCLUSIONS: In this retrospective study, it was found that treatment with oral bisphosphonates significantly increases BMD at the hip in postpolio patients. The effect of bisphosphonate treatment appears to be similar in postpolio patients compared with a control group without polio. Treatment with bisphosphonates may have a protective effect on fracture risk in this population.

Gender and transportation access among community-dwelling seniors.

PURPOSE: This study estimates the prevalence of problems with transportation in a sample of community-dwelling seniors residing in an urban setting and investigates the role that gender plays in the ability of seniors to remain mobile in their communities. DESIGN AND METHODS: Data collected as part of a study assessing the prevalence and consequences of unmet needs for community-based services in a random sample of 839 elderly aged 75 years and older were employed in bivariate and multivariable analyses. RESULTS: The prevalence of problems with transportation was 23 per cent, with 33 per cent of females and 10 per cent of males categorized as having problems with transportation. Of those subjects categorized as having problems with transportation, 88 per cent were women. In addition to being predominantly women, those who reported problems with transportation were older, in poorer health, and had lower income and income satisfaction. IMPLICATIONS: Problems with transportation are an important issue facing seniors; women, in particular. These results highlight the differences in aging as experienced by women and men with respect to social effects, needs, and the significance attached to the experience.

Five-year predictors of physical activity decline among adults in low-income communities: a prospective study.

BACKGROUND: Obesity in North America is now endemic, and increased understanding of the determinants of physical inactivity is critical. This analysis identified predictors of declines in physical activity over 5 years among adults in low-income, inner-city neighbourhoods. METHODS: Data on leisure time physical activity were collected in telephone interviews in 1992 and 1997 from 765 adults (47% of baseline respondents), as part of the evaluation of a community-based cardiovascular disease risk reduction program. RESULTS: One-third of 527 participants who were physically active at baseline, were inactive in 1997. Predictors of becoming inactive included female sex (OR = 1.63 95% CI (1.09, 2.43)), older age (1.02 (1.01, 1.04)), higher BMI (1.57 (1.03, 2.40)), poor self-rated health (1.39 (1.05, 1.84)), lower self-efficacy for physical activity (1.46 (1.00, 2.14)), and not using a neighborhood facility for physical activity (1.61 (1.02, 2.14)). CONCLUSION: These results highlight the fact that a variety of variables play a role in determining activity level, from demographic variables such as age and sex, to psychosocial and environmental variables. In addition, these results highlight the important role that other health-related variables may play in predicting physical activity level, in particular the observed association between baseline BMI and the increased risk of becoming inactive over time. Lastly, these results demonstrate the need for multi-component interventions in low-income communities, which target a range of issues, from psychosocial factors, to features of the physical environment.