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Association Between Physical Activity and Performance in Skill Learning Among Older Adults Based on Cognitive Function

Satoshi Kasahara, Ami Chiba, Linjing Jiang, Tomoya Ishida, Yuta Koshino, Mina Samukawa, Hiroshi Saito, and Harukazu Tohyama

Background/Objectives: Most older adults experience cognitive and physical functioning problems; however, they require the ability to learn skills in response to age-related or social environmental changes for independent living. This study aimed to clarify the associations between age-related physical activity and performance in skill learning tasks based on cognitive function. Methods: Fifty-eight adults participated in this study and were divided into two groups: the control group (aged under 65 years) and older adult group (aged over 65). All the participants performed two-skill learning exercises based on cognitive function. Habitual exercise was measured using an accelerometer and a self-reported questionnaire. Results: At baseline, the scores on skill tasks were lower in the older adult group than in the control group and were associated with habitual exercise and motor performance. Skill acquisition, observed in both groups, was associated with age and self-reported physical activity. Retention of the acquired skill was not associated with habitual exercise, and it declined significantly in the older group. Conclusions: Skill acquisition was maintained regardless of age; however, the ability to retain the acquired skills decreased among the older adults. Habitual physical activity was associated with skill acquisition but not the retention of the acquired skill. Significance/Implications: The study findings highlight the association between habitual exercise and motor skill learning in older adults, providing insight for practitioners in the rehabilitation and health care fields.

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The COVID Pandemic Worsened Physical Activity Disproportionately in Frailer Adults: A Canadian Longitudinal Study on Aging

Myles O’Brien, Andrea Mayo, and Olga Theou

Introduction: Frailty is associated with increased hospitalization and mortality and may be exacerbated with physical inactivity. The COVID-19 pandemic has heterogeneously impacted peoples’ physical activity level, but the impact on the frail population is unclear. Objective: The objective of this study is to test the hypothesis that higher frailty levels were associated with worse changes in physical activity, ability to move around the home, and do housework during the pandemic. Methods: We included 23,303 Canadians (age: 69.1 ± 9.5 years, 53% females) who participated in the Canadian Longitudinal Study on Aging COVID-19 Questionnaire study. Frailty prior to the pandemic (follow-up 1: 2015–2018) was measured via 52-item frailty index and grouped into 0.00–0.05, 0.05–0.10, 0.10–0.20, and >0.20 scores. Participants were asked whether they changed their levels of physical activity, ability to move at home, and ability to do housework during the pandemic. Results: The average frailty level was 0.09 ± 0.06. Compared with the lowest frailty group, participants with frailty levels >0.20 reported worse physical activity (17% vs. 45%), worse ability to move at home (3% vs. 26%), and perform housework (3% vs. 27%). Covariate-adjusted logistic regression models demonstrated that higher frailty level was associated with a greater odds of reporting worse physical activity (reference: 0.00–0.05; odds ratio for frailty index >0.20:4.03, 95% confidence interval [3.33, 4.87]), worse ability to move in home (odds ratio  = 11.16, 95% confidence interval [8.28, 15.03]), and worse ability doing housework (odds ratio  = 12.58, 95% confidence interval [9.24, 17.13]). Conclusions: The adverse changes in physical activity levels and ability to move at home among frail older adults during the pandemic document the need for strategies to help vulnerable populations move more.

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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.