Abstract
Objectives
To investigate whether baseline social participation modifies the effect of a long-term structured physical activity (PA) program on major mobility disability (MMD).
Methods
1,635 ...sedentary adults (70–89 years) with physical limitations were randomized to either a structured PA or health education (HE) intervention. Social participation was defined categorically at baseline. High social participation was defined as attending organized group functions at least once per week and visiting with noncohabitating friends and family ≥7 hr per week. Anything less was considered limited social participation. Participants performed a standardized walking test at baseline and every 6 months for up to 42 months. MMD was defined as the loss in the ability to walk 400 m.
Results
There was a significant intervention by social participation interaction (p = .003). Among individuals with high levels of social participation, those randomized to PA had significantly lower incidence of MMD (hazard ratio HR, 0.43 95% confidence interval (CI), 0.27–0.68; p < .01) than those randomized to HE. Individuals with limited social participation showed no mobility benefit of the PA intervention when compared with their HE counterparts (HR, 0.92 95% CI, 0.77–1.11; p = .40).
Discussion
Our findings suggest that baseline social participation is an important factor for the success of a PA intervention aimed at delaying mobility disability.
OBJECTIVES
Our aim was to examine the impacts of baseline fatigue on the effectiveness of a physical activity (PA) intervention to prevent major mobility disability (MMD) and persistent major ...mobility disability (PMMD) in participants from the Lifestyle Interventions and Independence for Elders (LIFE) study.
DESIGN
Prospective cohort of individuals aged 65 years or older undergoing structured PA intervention or health education (HE) for a mean of 2.6 years.
SETTING
LIFE was a multicenter eight‐site randomized trial that compared the efficacy of a structured PA intervention with an HE program in reducing the incidence of MMD.
PARTICIPANTS
Study participants (N = 1591) at baseline were 78.9 ± 5.2 years of age, with low PA and at risk for mobility impairment.
MEASUREMENTS
Self‐reported fatigue was assessed using the modified trait version of the Exercise‐Induced Feelings Inventory, a six‐question scale rating energy levels in the past week. Responses ranged from 0 (none of the time) to 5 (all of the time). Total score was calculated by averaging across questions; baseline fatigue was based on the median split: 2 or higher = more fatigue (N = 856) and lower than 2 = less fatigue (N = 735). Participants performed a usual‐paced 400‐m walk every 6 months. We defined incident MMD as the inability to walk 400‐m at follow‐up visits; PMMD was defined as two consecutive walk failures. Cox proportional hazard models quantified the risk of MMD and PMMD in PA vs HE stratified by baseline fatigue adjusted for covariates.
RESULTS
Among those with higher baseline fatigue, PA participants had a 29% and 40% lower risk of MMD and PMMD, respectively, over the trial compared with HE (hazard ratio HR for MMD = .71; 95% confidence interval CI = .57‐.90; P = .004) and PMMD (HR = .60; 95% CI = .44‐.82; P = .001). For those with lower baseline fatigue, no group differences in MMD (P = .36) or PMMD (P = .82) were found. Results of baseline fatigue by intervention interaction was MMD (P = .18) and PMMD (P = .05).
CONCLUSION
A long‐term moderate intensity PA intervention was particularly effective at preserving mobility in older adults with higher levels of baseline fatigue. J Am Geriatr Soc 68:619–624, 2020
To evaluate the extent of variability in functional responses in participants in the Lifestyle Interventions and Independence for Elders (LIFE) study and to identify the relative contributions of ...intervention adherence, physical activity, and demographic and health characteristics to this variability.
Secondary analysis.
Multicenter institutions.
A volunteer sample (N=1635) of sedentary men and women aged 70 to 89 years who were able to walk 400m but had physical limitations, defined as a Short Physical Performance Battery (SPPB) score of ≤9.
Moderate-intensity physical activity (n=818) consisting of aerobic, resistance, and flexibility exercises performed both center-based (2times/wk) and home-based (3-4times/wk) sessions or health education program (n=817) consisting of weekly to monthly workshops covering relevant health information.
Physical function (gait speed over 400m) and lower extremity function (SPPB score) assessed at baseline and 6, 12, and 24 months.
Greater baseline physical function (gait speed, SPPB score) was negatively associated with change in gait speed (regression coefficient β=-.185; P<.001) and change in SPPB score (β=-.365; P<.001), whereas higher number of steps per day measured by accelerometry was positively associated with change in gait speed (β=.035; P<.001) and change in SPPB score (β=.525; P<.001). Other baseline factors associated with positive change in gait speed and/or SPPB score include younger age (P<.001), lower body mass index (P<.001), and higher self-reported physical activity (P=.002).
Several demographic and physical activity-related factors were associated with the extent of change in functional outcomes in participants in the LIFE study. These factors should be considered when designing interventions for improving physical function in older adults with limited mobility.
The study reported had three purposes, namely, to analyze the effect of aging (cohort groups 20–29, 60–69, 70–79, and 80–89 years of age), step length, and self-efficacy on the time to reacquire ...stability after the execution of a step. The analysis of force-platform data showed that the time to reacquire a stable posture after taking a step increased with increments of age. Correlation analysis showed that older adults were less confident in their ability to complete daily activities without falling or losing balance and that participants with lower levels of balance-related efficacy required a longer time to reacquire stability. These findings provide evidence that aging imposes temporal limitations in the regaining of postural stability that are related to individuals’ perceptions of balance and falls efficacy.
Background: Poor treatment tolerance contributes to suboptimal outcomes for many older adults with acute myeloid leukemia (AML). Treatment-associated physical deconditioning during induction may ...limit therapeutic options and impair quality of life. Interventions to enhance physical function during therapy may improve treatment tolerance and benefit.
Objective: To test the feasibility of conducting a symptom-adapted inpatient physical activity (PA) intervention among older adults receiving intensive induction chemotherapy for AML.
Methods: A single institution randomized controlled pilot study (N=70) was conducted from October 2012-July 2015. Eligibility included age ≥60 years, newly diagnosed AML, and receipt of induction chemotherapy. Exclusion criteria included medical contraindication to PA at the time of enrollment, cognitive impairment, and/or receipt of low intensity therapy. Participants randomized to the intervention were offered a PA session five days per week tailored daily to symptoms and health status during the induction hospitalization. Session options included: 1) Standard (ward-based), walking + balance training + resistance exercises; 2) Intermediate (room-based), upper-body ergometer + balance training + resistance exercises; and 3) Low-intensity (bed-based), upper-body ergometer + resistance exercises. Counseling sessions to establish PA goals and trouble-shoot barriers were conducted weekly during hospitalization. Phone counseling to reinforce PA goals continued monthly post-hospitalization during follow-up (up to 6 months). The control arm received usual care. Assessment of physical function (self-report and objective), mood, symptoms, and quality of life was done at baseline, 3 months and 6 months with weekly physical function testing while hospitalized. The primary outcome was feasibility defined as recruitment (≥60%), adherence (>75%, average 3 sessions/week), and retention (85% follow-up for eligible participants).
Results: There were 97 eligible patients of which 70 enrolled (recruitment rate 72%). The study sample was 70% male, mean age was 72.1 years (Standard Deviation SD 6.3), mean Hematopoietic Cell Transplantation Comorbidity index score was 2.0 (SD 1.8), mean hemoglobin 9.3 (SD 1.6), mean white cell count 17 (SD 33.7), and 93% had adequate ECOG performance status (0-2). The majority had intermediate (61%) or poor (33%) risk cytogenetics. Most common induction regimens included anthracycline+cytarabine (80%) and clofarabine (15.7%). A total of 732 PA sessions were offered during the course of the study. Patients were deemed medically ineligible to participate in 13% of these sessions. Of eligible sessions, the participation rate was 80%. Of weeks with at least one eligible day, the average number of weekly sessions conducted per participant was 3.0 (SD 1.6). Overall mean number of sessions/participant was 14.5 (SD 9.4). Among the 35 participants randomized to the intervention 74% completed a program evaluation. Most reported that they liked the program (88%), found it helpful (88%) and planned to continue physical activity post discharge (69%). The activities rated to be most helpful were: combination of balance + resistance exercises + walking (31%), resistance exercises alone (23%) and balance exercises alone (15%). Retention was 96% among evaluable participants (survived at least to the 3 month follow-up assessment, N=53).
Conclusions: Delivery of a symptom-adapted inpatient PA intervention to older adults receiving intensive induction chemotherapy for AML is feasible and well received by participants. Next steps include estimation of the effect size of the intervention on physical function, symptoms, and quality of life.
Pardee:Celgene: Speakers Bureau; Novartis: Speakers Bureau.
Adherence is a complex phenomenon involving interactions among the individual, the environment and the community. In an adherence workshop, a small group of investigators discussed their experiences ...with challenges and innovations regarding adherence gleaned from clinical research. This article summarizes the information and outcomes of that meeting. Guided by theoretical frameworks for understanding and promoting adherence, challenges in the areas of measurement, community-based research, and interventions were explored and innovations for meeting these challenges suggested. The article concludes with recommendations for enhancing the adherence agenda: (1) adherence research must have a well-defined conceptual and theoretical basis; (2) individual perceptions and social context of behavior must be incorporated; (3) research must be undertaken as a collaborative process involving participants and the community. Looking ahead, it is clear that if we hope to develop a new and integrated model of adherence, we must continue to advance theory through theory testing, with particular attention given to mediators and diverse samples. Moreover, an interdisciplinary agenda is necessary to set the stage for bringing together researchers from various disciplines and backgrounds with both participants and community representatives.
Background
Data are sparse regarding the value of physical activity (PA) surveillance among older adults—particularly among those with mobility limitations. The objective of this study was to examine ...longitudinal associations between objectively measured daily PA and the incidence of cardiovascular events among older adults in the LIFE (Lifestyle Interventions and Independence for Elders) study.
Methods and Results
Cardiovascular events were adjudicated based on medical records review, and cardiovascular risk factors were controlled for in the analysis. Home‐based activity data were collected by hip‐worn accelerometers at baseline and at 6, 12, and 24 months postrandomization to either a physical activity or health education intervention. LIFE study participants (n=1590; age 78.9±5.2 SD years; 67.2% women) at baseline had an 11% lower incidence of experiencing a subsequent cardiovascular event per 500 steps taken per day based on activity data (hazard ratio, 0.89; 95% confidence interval, 0.84–0.96; P=0.001). At baseline, every 30 minutes spent performing activities ≥500 counts per minute (hazard ratio, 0.75; confidence interval, 0.65–0.89 P=0.001) were also associated with a lower incidence of cardiovascular events. Throughout follow‐up (6, 12, and 24 months), both the number of steps per day (per 500 steps; hazard ratio, 0.90, confidence interval, 0.85–0.96 P=0.001) and duration of activity ≥500 counts per minute (per 30 minutes; hazard ratio, 0.76; confidence interval, 0.63–0.90 P=0.002) were significantly associated with lower cardiovascular event rates.
Conclusions
Objective measurements of physical activity via accelerometry were associated with cardiovascular events among older adults with limited mobility (summary score >10 on the Short Physical Performance Battery) both using baseline and longitudinal data.
Clinical Trial Registration
URL: http://www.clinicaltrials.gov. Unique identifier: NCT01072500.
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