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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.

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Association of Daily Physical Activity With Motivation in Prefrail and Frail Older Adults Living in Retirement Communities

Daniel S. Rubin, David E. Conroy, and Margaret K. Danilovich

Older adults living in retirement communities are an understudied population, and the association between their motivation and daily physical activity is unknown. We recruited participants (n = 173) living in a retirement community who completed the Behavioral Regulation in Exercise Questionnaire-2 and wore an activPAL accelerometer to evaluate this relationship. Participants had a median age of 81 years and demonstrated low levels of daily activity with an average step count of 3,637 (±1,965) steps per day and 52 (±25) min of daily stepping time. External motivation was negatively associated with the square root of daily step count (β = −4.57; p < .001) and square root of daily stepping time (β = −0.49; p < .001). Older adults living in retirement communities demonstrated low levels of daily activity, with a negative association between external motivation and daily activity. Strategies are needed to make an active lifestyle supportive and enticing for older adults in these communities.

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Associations of Physical Activity and Sedentary Behavior With Self-Rated Health Status in Brazilian Older Adults

Pedro Olivares-Tirado and Rosendo Zanga

In a longevity society, as we live longer, adopting healthy lifestyles is essential to develop and maintain functional ability, which enables well-being in older adults. We aim to examine the associations of physical activity (PA) and sedentary behaviors (SBs) with self-rated health (SRH) status in older Brazilian adults. We analyzed 21,701 persons aged 60 or older from the Brazilian National Health Survey. A partial proportional odds model for SRH adjusted by sociodemographic confounders was estimated. The marginal effects of PA and SB on SRH status were expressed in terms of the average-adjusted probabilities. In addition, average-adjusted probabilities for the better and worse SRH status among representative cases of Brazilian socioeconomic inequalities were calculated. The main findings of the study indicate: (a) a significant positive association exists between PA and SRH status and, conversely, a negative association exists between SB and SRH; (b) the PA effect across daily sitting time watching TV attenuated and improved the probability of declaring a worse and better SRH status, respectively; and (c) the SRH status differences associated with PA and SB represent the socioeconomic inequalities in the older Brazilian population. Beyond some methodological limitations, we conclude that increasing PA and SB in older persons is significantly associated with better and worse SRH status, respectively. In addition, the results suggest that SRH status is a consistent health inequality measurement. In societies moving on longevity transition, substantial efforts are required in individuals’ behavior across the life courses and public policies to promote healthy aging.

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Participant Experiences With a Community-Based, “Older Adult” Walking Football Initiative in Australia: A Qualitative Exploration

Lauren Fitzsimons, Sera Dogramaci, Andrew Bennie, Tony Rossi, Nicole Taylor, Ashleigh McInerny, Carmen Young, and Rhiannon Lee White

Despite the growing popularity of walking sports, little is known about who is attracted to them, and what skills, motivations, and experiences encourage ongoing participation. The aim of this study was to gain an in-depth understanding of the phenomenon of walking football in Australia. The authors first conducted semistructured interviews with 53 older adults (M = 62.37 years, 30.19% female) participating in walking football in Australia. Next, they conducted thematic analysis to develop themes that represented participant perspectives. Results indicated that walking football led to several physical benefits, but the social and mental benefits seemed to be more closely associated with continued participation. The slower pace of walking football created a valuable option to engage in physical activity among those with injuries or severe health issues, as well as older adults concerned about injuries. The slower pace also shifted the focus of walking football away from fitness and ability, and toward technique and skill development, and this focus, along with the mix in abilities, led to informal coaching and mentoring roles which were highly valued among older participants. Participant views about competition in walking football were diverse, with some expressing a mild concern. Understanding such diverse experiences of walking football helps to better understand how different aspects of the sport influence the perceived benefits and likelihood of continuing for different people. Using these findings to further develop walking sports in Australia could have large impacts on the health and well-being of older people.

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Effects of Walking-Only Intervention on Physical Function, Fall-Related Outcomes, and Health-Related Quality of Life in Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis

Tomoya Ishigaki, Shogo Misu, Toshinori Miyashita, Daisuke Matsumoto, Midori Kamiya, Akio Okamae, Tatsuya Ogawa, Hikaru Ihira, Yoshiaki Taniguchi, Takeshi Ohnuma, Tomohisa Chibana, Natsu Morikawa, Tome Ikezoe, and Hyuma Makizako

This study aimed to determine the effects of walking-only intervention (walking was the only exercise in which people participated) on physical function, fall-related outcomes, and health-related quality of life in community-dwelling older adults. We conducted a systematic search across five electronic databases, assessing risk of bias using Minds Manual for Guideline Development. Meta-analyses were performed, and pooled standardized mean differences were calculated. Nine studies (a total of 1,309 participants) were included, showing that walking-only interventions improved walking endurance (standardized mean difference: 1.11, 95% confidence interval: [0.08, 2.15]) and health-related quality of life (standardized mean difference: 0.71, 95% confidence interval: [0.18, 1.25]). However, there were no significant improvements in other outcomes. The certainty of the evidence based on the Grading of Recommendations, Assessment, Development, and Evaluation approach for all outcomes was graded as very low, primarily due to significant inconsistency and imprecision. Our results suggest that walking-only intervention can be effective for enhancing walking endurance and health-related quality of life for community-dwelling older adults. Further studies are required to investigate the effects of walking-only intervention. This need stems from the limited number of randomized controlled trials, heterogeneous intervention settings and results, and the very low certainty of the evidence.

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Does Attraction Toward Physical Activity Predict Physical Activity Behavior in Older Adults?

Brynn L. Hudgins, Yeongjun Seo, Kelsey M. Bittel, Kemiah Williams, Derek J. Hevel, Jeffrey D. Labban, and Jackie P. Maher

Background/Objectives: Few studies have investigated associations between the motivational outcome based on physical activity (PA) affective experiences (i.e., attraction vs. antipathy toward PA) and behavior. This study investigated cross-sectional and longitudinal associations between attraction (vs. antipathy) toward PA and device-based PA in older adults. Methods: Older adults (n = 139; 71% female, M age = 70.5) completed assessments of attraction (vs. antipathy) toward PA and 14 days of device-based accelerometry at Times 1 and 2. Results: Greater attraction toward PA at Time 1 was associated with greater steps (β = 5.31, p < .01) and moderate to vigorous intensity PA (β = 3.08, p < .05) at Time 1. Greater attraction toward PA at Time 1 was not significantly associated with steps or moderate to vigorous intensity PA at Time 2. Conclusion: Greater emphasis on resultant motivation from PA affective experiences may be useful in promoting PA in older adults. Significance/Implications: In spite of mixed findings in the present study, there is strong evidence that positive affective responses during a single bout of PA play an important role in predicting future engagement. Yet, affective experiences during PA can be individualistic and often influenced by contextual factors. Interventions designed to increase PA should focus on factors that may create positive affective experiences for participants.