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Association Between Accelerometer-Measured Physical Activity and Mobility Limitations in Twins

Pia Pullinen, Jari Parkkari, Jaakko Kaprio, Henri Vähä-Ypyä, Harri Sievänen, Urho Kujala, and Katja Waller

Background: The associations between mobility limitations and device-measured physical activity are sparsely studied. In this study, these associations are studied among community-dwelling older twins. Methods: This cross-sectional study utilized data gathered in 2014–2016 for the MOBILETWIN study. Participants were twins born in Finland between 1940 and 1944 (774 participants, mean age 73 years). Physical activity was measured with a hip-worn accelerometer. Mobility limitations were assessed with a questionnaire. Results: Individual-level analyses revealed that physical activity was associated with mobility limitations. Participants with severe mobility limitations took 2,637 (SD = 1,747) steps per day, those with some mobility limitations 4,437 (SD = 2,637) steps, and those without mobility limitations 7,074 (SD = 2,931) steps (p < .05). The within-twin pair analyses revealed the same pattern for the 144 dizygotic twin pairs, but no associations were seen for the 117 monozygotic twin pairs. Conclusions: Accelerometer-measured physical activity and mobility limitations were associated in community-dwelling older adults. Genetic factors may explain some of the variations in physical activity. Significance: A personalized exercise program to promote increased physical activity should be provided for older adults who report mobility difficulties. Future research is needed to examine causality between physical activity and mobility limitations.

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Muscle Matters: Bridging the Gap Between Terminology of Age-Related Muscle Loss and Exercise Interventions

Claudio Gil S. Araújo and Nien Xiang Tou

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A Qualitative Study Investigating Health Care Professionals’ Views on Barriers to Integrating Physical Activity Into Mild Cognitive Impairment/Dementia Care

Yan Lou, Sixue Hong, and Wei Li

This study aimed to investigate health care professionals’ (HCPs) views on barriers to integrating physical activity (PA) into mild cognitive impairment/dementia care. Semistructured online interviews form 16 HCPs were completed between November 2022 and December 2022. Data were subjected to thematic analysis and were later mapped deductively to the Theoretical Domains Framework. Four themes were identified: (1) “Dementia-inclusive infrastructure or PA recommendations have not yet been systematically developed and implemented;” (2) “Roles and challenges of the multidisciplinary team;” (3) “HCPs believe that patients’ PA participation is influenced by their disease or individual factors;” and (4) “HCPs’ thoughts on current practice and opinions.” Deductive mapping of these themes revealed that 13 of the 14 Theoretical Domains Framework domains influenced it. Integrating PA into mild cognitive impairment/dementia care is subject to several modifiable determinants. Policymakers should focus on improving the environmental context and resources to encourage PA in mild cognitive impairment/dementia.

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Relationships of Physical Activity and Type 2 Diabetes With Cognition in Mexican Americans and Non-Hispanic Whites

Fang Yu, Keenan Pituch, Molly Maxfield, Rodney P. Joseph, Jeremy J. Pruzin, Dev Ashish, David W. Coon, Gabriel Shaibi, and HABS-HD Study Team

Problem, Research Strategy, and Findings: Low physical activity (PA) and Type 2 diabetes are associated with cognitive aging and Alzheimer’s disease, but the evidence is inconsistent and particularly limited by ethnicity. The purpose of this study was to examine the relationships of PA and Type 2 diabetes with cognition in Mexican Americans and non-Hispanic Whites. The study was a cross-sectional analysis of the Health and Aging Brain Study-Health Disparities (n = 1,982–2,000 after removing outliers). Predictors included Rapid Assessment of Physical Activity and hemoglobin A1c (HbA1c). Episodic memory was assessed by Weschler Memory Scale–Third Edition Logical Memory and Spanish-English Verbal Learning Test, executive function by Weschler Memory Scale–Third Edition Digit Span and Digit Symbol Substitution Test, verbal fluency by FAS and animal naming, and global cognition by the Mini-Mental State Examination. Results show that aerobic PA and HbA1c were not associated with domain-specific, or global cognition, but strength/flexibility PA was associated with FAS (b = 0.404, 95% CI [0.023, 0.761]). Higher aerobic PA was associated with greater verbal fluency for Mexican Americans (b = 0.294, 95% CI [0.96, 0.497]) only. HbA1c was negatively associated with Mini-Mental State Examination (b = 0.838, 95% CI [0.008, 1.656]). For low HbA1c, the association between aerobic PA and Digit Symbol Substitution Test was significant for non-Hispanic Whites (b = 0.838, 95% CI [0.008, 1.656]) in comparison to Mexican Americans. Takeaway for Practice: The relationships between PA, Type 2 diabetes, and cognition vary by cognitive domains and ethnicity. Increasing aerobic activities may be particularly important for Mexican Americans who have elevated HbA1c to potentially improve fluency or executive function.

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Wii Fit Exercise’s Effects on Muscle Strength and Fear of Falling in Older Adults With Alzheimer Disease: A Randomized Controlled Trial

Fatma Uğur and Meral Sertel

Purpose: This study aimed to investigate how Wii Fit exercises affect muscle strength and fear of falling in older adults with Alzheimer’s disease. Method: The study included a total of 32 volunteers with Alzheimer’s disease, aged 65–80 years. These participants were divided into two groups: the exercise group and the control group. The exercise group received a 30-min (one session) twice-weekly exercise program for 6 weeks with games selected from different categories, such as balance and aerobic exercises, with the Nintendo Wii virtual reality device. During this period, the control group did not receive any treatment, and routine medical treatments continued. At baseline and 6 weeks later, Mini-Mental State Examination, knee extension muscle strength, Timed Up and Go Test, and Tinetti Fall Efficacy Scale results were recorded in the exercise and control groups. Results: In intragroup comparison, a statistically significant difference was found in all tests (muscle strength, Timed Up and Go Test, and Tinetti Fall Efficacy Scale) in the exercise group after the exercise program (p < .05), while no significant difference was found in the control group (p > .05). According to the interaction of group and time in the intergroup comparison, there was no difference between the groups (exercise and control group) in muscle strength and Timed Up and Go Test (p > .05), but there was a difference in Tinetti Fall Efficacy Scale (p < .05). Conclusions: This randomized controlled trial supports the claim that Wii Fit exercises can reduce the fear of falling in older adults with Alzheimer’s disease.

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Volume 32 (2024): Issue 5 (Oct 2024)

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The ESCAPE Trial for Older People With Chronic Low Back Pain: A Feasibility Study of a Clinical Trial of Group-Based Exercise in Primary Health Care

Hytalo de Jesus Silva, Júlio Pascoal de Miranda, Camila Silva de Melo, Leticia Soares Fonseca, Rodrigo de Oliveira Mascarenhas, Nathalia Soares Veloso, Whesley Tanor Silva, Alessandra de Carvalho Bastone, and Vinícius Cunha Oliveira

Low back pain is a highly disabling health condition that generates high costs for patients and healthcare systems. For this reason, it is considered a serious public health problem worldwide. This pilot study aimed to assess the feasibility of a future randomized controlled trial (RCT) by evaluating adherence to treatment, contamination between groups, satisfaction with treatment, and understanding of the exercise instructions provided by the physiotherapist. Additionally, we sought to identify and implement necessary modifications to the exercise protocol for better suitability in older people. We conducted a prospective, registered pilot RCT comparing an 8-week group-based exercise program with a waiting list in older people (≥60 years old) with chronic low back pain. Sixty participants were recruited through social media, pamphlets, and invitations at community referral centers. The study demonstrated the feasibility of a full RCT. Participants reported high satisfaction with the treatment (i.e., 100% indicated willingness to return for future services) and a high understanding of the exercise instructions (i.e., 81.8% reported “very easy” comprehension). Adherence to the exercise program exceeded the average reported for group exercise interventions in older adults (i.e., 82.58%). Dropout was associated solely with preexisting physical activity levels. The exercise protocol was successfully adapted to better suit the needs of the older adult population. This pilot RCT demonstrates the feasibility of a full-scale RCT to evaluate the effectiveness of group exercise in improving pain intensity and disability in older adults with chronic low back pain. The implemented adjustments to the exercise protocol and overall study approach strengthen the methodological foundation and expected accuracy of the future RCT.

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Effects of Tai Chi Chuan on Older Adults’ Balance: A Systematic Review With Meta-Analysis

Rafael Bertolini, Rafael Vercelino, Luis Fernando Ferreira, and Luis Henrique Telles da Rosa

Background: Tai Chi Chuan (TCC) is considered a mind and body practice of Chinese origin, considered as an intangible cultural heritage of humanity by UNESCO, and recommended by the World Health Organization as a therapeutic approach to prevent falls. Objective: To assess the effects of TCC on older adult’s balance. Methods: A systematic review of randomized clinical trials was conducted by two independent reviewers using the ROB2 tool to assess the risk of bias under the following databases: PubMed, SCOPUS, Web of Science, PEDro, Embase, Cochrane, CINAHL, and LILACS. A meta-analysis of the selected articles for the dynamic and static balance criteria was conducted in a population of older adults (over 65 years) with publications from 2010 to 2024. Results: Eighteen randomized clinical trials fulfilled the criteria. TCC improves dynamic balance in the timed up and go and gait speeds tests, and static balance in the single-leg test and functional reach test when compared with the control group in the meta-analysis. Adverse events were found in only one study, and the training parameters were heterogeneous. Conclusion: TCC improves older adults with both dynamic and static balance. The results of the parameters indicate a direction in which TCC is prescribed for clinical practice with minimal or no risk of adverse effects.

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The Current Status of Leisure Constraints, Leisure Sports Behaviors, and Active Aging Among Chinese Older Adults

Yajun Qiu, Yi Shang, Haibo Tian, and Dongjun Yang

Background: Against the backdrop of China’s active response to population aging, an increasing number of older adults are participating in leisure sports activities to enrich later life and experience active aging. However, when participating in these activities, older adults encounter constraints that affect their leisure sports behaviors. Methods: To understand the current state of leisure constraints, leisure sports behaviors, and active aging among Chinese seniors, we collected 1,581 surveys from older adults in Zhejiang Province, China. A stepwise regression model was used to explore the relationships between leisure constraints and leisure sports behavior as well as between leisure sports behavior and active aging. Results: The respondents’ leisure sports were characterized by light-intensity, moderate duration, high-frequency, and long-term participation with various leisure constraints, such as a lack of organized leisure sports activities. However, the respondents reported that their aging status was positive. Leisure constraints were negatively associated with leisure sports behavior, and self-constraint had a significant impact on leisure sports behavior. Leisure sports behavior positively affected the active aging of older participants and was positively associated with the four subdimensions of active aging: health, participation, security, and lifelong learning. Conclusion: High-frequency and long-term participation in leisure sports is an effective strategy for Chinese seniors to promote active aging. However, there are still many constraints that limit the leisure sports behaviors of older adults. Implications: The findings may inspire Chinese older adults to achieve active aging through leisure sports and provide support for the literature.

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Whey Protein Supplementation in Older Adults With Type 2 Diabetes Undergoing a Resistance Training Program: A Double-Blind Randomized Controlled Trial

Celine de Carvalho Furtado, Giovana Jamar, Alan Carlos Brisola Barbosa, Victor Zuniga Dourado, José Reinaldo do Nascimento, Glaucia Cristina Antunes Ferraz de Oliveira, Edgar Matias Bach Hi, Thiago de Arruda Souza, Maria José Gonzalez Parada, Felipe Granado de Souza, Claudia Ridel Juzwiak, and Império Lombardi Júnior

Background/Objective: This study aims to analyze the effect of whey protein (WP) supplementation on glycemic control, muscle strength, quality of life, and body composition in older adults with non-insulin-dependent diabetes undergoing a resistance training program. Methods: A double-blind, placebo-controlled, randomized study was carried out with older adults with Type 2 diabetes. Body composition, food intake, muscle strength, glycemic profile, markers of renal function, cardiopulmonary capacity, and quality of life were evaluated. Older adults were randomized into a supplementation group with 33 g of WP consumed twice a week on days of resistance training for 12 weeks supplemented group and a placebo group. Results: In total, 39 older adults were randomized into two groups, 19 in the supplement group and 20 in the placebo group. Both groups showed improvement in muscle strength, with the WP group failing to exceed that of the control group. WP supplementation slightly increased blood urea compared with the placebo group (p = .05), but values remained within normal limits. The group that used WP showed a small improvement in mental health, according to the 12-Item Short-Form Health Survey questionnaire, but without clinically important improvements. Conclusion: Both groups showed improvements in muscle strength and mass, regardless of supplementation, showing that resistance exercises performed twice a week can contribute to the nonprogression of sarcopenia in older adults with Type 2 diabetes. More studies are needed to determine the safe and effective amount of supplementation to improve muscle strength without renal impairment in older adults with diabetes.