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“Are Your Clients Having Fun?” The Implications of Respondents’ Preferences for the Delivery of Group Exercise Programs for Falls Prevention

Lucy McPhate, Emily M. Simek, Terry P. Haines, Keith D. Hill, Caroline F. Finch, and Lesley Day

Background:

Group exercise has been shown to be effective in preventing falls; however, adherence to these interventions is often poor. Older adults’ preferences for how these programs can be delivered are unknown.

Objective:

To identify older people’s preferences for how group exercise programs for falls prevention can be delivered.

Design:

A two-wave, cross-sectional, state-wide telephone survey was undertaken. Respondents were community-dwelling men and women aged 70+ in Victoria, Australia.

Methods:

Open-ended questions were asked to elicit information regarding respondent preferences of the program, which were analyzed using a framework approach.

Results:

Ninetyseven respondents completed the follow-up survey. The results indicate that older adults most frequently report the short-term advantages and disadvantages when describing their preferences for group exercise, such as enjoyment, social interaction, and leader qualities. Longer-term advantages such as falls prevention were described less frequently.

Conclusions:

This study indicates the importance of interpersonal skills, and that the opportunity for social interaction should not be overlooked as a positive feature of a group exercise program.

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Enhancing Adoption of a Home-Based Exercise Program for Mild Balance Dysfunction: A Qualitative Study

Claudia Meyer, Susan Williams, Frances Batchelor, and Keith Hill

Introduction:

The aim was to identify barriers and opportunities facing community health physiotherapists in delivering a home-based balance exercise program to address mild balance dysfunction and, secondly, to understand the perspectives of older people in adopting this program.

Method:

Focus groups, written surveys, and data recording sheets were used with nine older people and five physiotherapists. Focus groups were audio taped, transcribed, and coded independently by two researchers.

Results:

Thematic content analysis was undertaken. Emerging themes were: engaging in preventive health (various benefits, enhancing independence); adoption of strategies (acceptable design and implementation feasibility); exercising in context (convenience, practicality, and safety); and broader implementation issues (program design, proactive health messages, and a solid evidence base).

Conclusion:

The views of older people and physiotherapists were sought to understand the adoption of a previously successful home-based program for mild balance dysfunction. Understanding the unique context and circumstances for individuals and organizations will enhance adoption.

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Evaluation of Tai Chi Program Effectiveness for People with Arthritis in the Community: A Randomized Controlled Trial

Leigh F. Callahan, Rebecca J. Cleveland, Mary Altpeter, and Betsy Hackney

Objective:

Evaluate effectiveness of the Arthritis Foundation Tai Chi Program for community participants with arthritis.

Methods:

343 individuals were randomized to either the intervention or wait-list control group. Performance and self-reported outcome (SRO) measures were assessed at baseline and eight weeks. At one year, SROs only were assessed. Adjusted means were determined using regression models adjusting for covariates, and effect sizes (ES) were calculated.

Results:

Average participant age was 66 years, 87% were female, and 87% were Caucasian. Among 284 (83%) participants who returned at eight weeks, balance by reach (ES = 0.30) and helplessness, sleep, and role participation satisfaction (ES = 0.24–0.54) improved significantly; pain, fatigue, and stiffness improvement (ES = 0.15–0.23) approached significance. No change was noted in mobility, lower extremity strength, or single-leg stance balance. At one year, improvements in pain, fatigue, stiffness, helplessness, and role participation satisfaction at eight weeks were maintained; 30% continued tai chi practice.

Conclusion:

Moderate effectiveness of the Arthritis Foundation Tai Chi Program was confirmed.

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Key Factors Influencing Implementation of Falls Prevention Exercise Programs in the Community

Lesley Day, Margaret J. Trotter, Alex Donaldson, Keith D. Hill, and Caroline F. Finch

The study aim was to evaluate the implementation of group- and home-based exercise falls prevention programs delivered through community health agencies to community-dwelling older people. Interviews with program staff were guided by the Diffusion of Innovations theory. Highly consistent themes emerged for the two types of programs. Both had high overall compatibility, high relative advantage, good observability and high inherent trialability—all factors known to strengthen implementation. The level of complexity and low financial compatibility emerged as the strongest potential inhibitors to program implementation in the context examined. The two main factors contributing to complexity were the need to challenge balance safely across a broad range of capability, and practical considerations associated with program delivery.A range of strategies to provide more technical support for exercise program leaders to tailor balance challenge for exercise program leaders may enhance implementation of falls prevention exercise programs.

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Older Adults’ Uptake and Adherence to Exercise Classes: Instructors’ Perspectives

Helen Hawley-Hague, Maria Horne, Dawn A. Skelton, and Chris Todd

Exercise classes provide a range of benefits for older adults, but adherence levels are poor. We know little of instructors’ experiences of delivering exercise classes to older adults. Semistructured interviews, informed by the Theory of Planned Behavior (TPB), were conducted with instructors (n = 19) delivering multicomponent exercise classes to establish their perspectives on older adults’ uptake and adherence to exercise classes. Analysis revealed ‘barriers’ to uptake related to identity, choice/control, cost, and venue, and ‘solutions’ included providing choice/control, relating exercise to identity, a personal touch, and social support. Barriers to adherence included unrealistic expectations and social influences, and solutions identified were encouraging commitment, creating social cohesion, and an emphasis on achieving outcomes. Older adults’ attitudes were an underlying theme, which related to all barriers and solutions. The instructor plays an important, but not isolated, role in older adults’ uptake and adherence to classes. Instructors’ perspectives help us to further understand how we can design successful exercise classes.

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The Effect of a Six-Month Dancing Program on Motor-Cognitive Dual-Task Performance in Older Adults

Dennis Hamacher, Daniel Hamacher, Kathrin Rehfeld, Anita Hökelmann, and Lutz Schega

Dancing is a complex sensorimotor activity involving physical and mental elements which have positive effects on cognitive functions and motor control. The present randomized controlled trial aims to analyze the effects of a dancing program on the performance on a motorcognitive dual task. Data of 35 older adults, who were assigned to a dancing group or a health-related exercise group, are presented in the study. In pretest and posttest, we assessed cognitive performance and variability of minimum foot clearance, stride time, and stride length while walking. Regarding the cognitive performance and the stride-to-stride variability of minimum foot clearance, interaction effects have been found, indicating that dancing lowers gait variability to a higher extent than conventional health-related exercise. The data show that dancing improves minimum foot clearance variability and cognitive performance in a dual-task situation. Multi-task exercises (like dancing) might be a powerful tool to improve motor-cognitive dual-task performance.

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Similarities and Differences in the Determinants of Trips Outdoors Performed by UK Urban- and Rural-Living Older Adults

Jolanthe L. de Koning, Afroditi Stathi, and Kenneth R. Fox

The frequency of trips outdoors is a strong indicator of older adults’ physical activity levels. This qualitative study compared and contrasted determinants of trips outdoors between rural- (n = 13) and urban-living (n = 15) people aged 65 and older living in England. Interview transcripts were analyzed through directed and summative content analysis employing the Ecological Model framework. Some personal-level determinants (age-related barriers) and environment-level factors (car dependence, bus services) were shared across samples. The main differences were seen in how a community-based social network instigated trips outdoors for rural participants while family ties mostly led to trips outdoors for urban-living participants. Urban participants used and valued recreational facilities, but rural participants did not report them as important in determining trips outdoors. Strategies to improve public transport and minimize age-related barriers may translate from urban to rural contexts. However, social and/or physical environment interventions could be more effective if they were rural-grounded, not urban-translated.

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Investigation of Older Adults’ Participation in Exercises Following Completion of a State-wide Survey Targeting Evidence-based Falls Prevention Strategies

Den-Ching A. Lee, Lesley Day, Caroline F. Finch, Keith Hill, Lindy Clemson, Fiona McDermott, and Terry P. Haines

This paper examines whether involvement in an observational study may prompt participants to change their exercise behaviors. Data were collected from 394 older community dwellers in Victoria, Australia using a baseline survey, and 245 of these participated in a follow-up survey one year later. Survey domains were drawn from constructs of relevant health behavior models. Results showed that the proportion of respondents who were currently participating in exercises to prevent falls at follow-up was 12% higher than at baseline (Wilcoxon p value < .001). Twenty-nine percent reported they had changed their perceptions about falls and their risk of falls, with comments focused on threat appraisal. Forty-four percent reported having taken strategies to reduce their risk of falling, with comments based on implementation of different preventive strategies. Respondents who held favorable views toward exercises for the prevention of falls appear to change their behaviors that might address falls when participating in observational studies.

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Social Patterning in Grip Strength, Chair Rise, and Walk Speed in an Aging Population: The Czech HAPIEE Study

Jitka Jancova-Vseteckova, Martin Bobak, Ruzena Kubinova, Nada Capkova, Anne Peasey, Michael G. Marmot, and Hynek Pikhart

Background:

The aim was to examine the association of objective measures of physical functioning (PF) with education and material circumstances and the decline in PF with age by socioeconomic position (SEP).

Methods:

In 3,205 subjects (60–75 years) from the Czech Republic, we assessed relationship between PF, SEP, and age. Linear regression was used to assess PF measures and SEP measures.

Results:

Cross-sectional decline in PF by age was similar in all individuals. Differences between SEP groups were similar across age groups, except for the difference in walk speed by material circumstances in men—bigger at older ages (p = .004). Men and women with the highest education were about 2 s faster at the chair rise test than those with the lowest education.

Discussion:

Findings suggest strong educational gradient in PF, an inconsistent role of self-assessed material circumstances, and virtually no interaction of SEP with the cross-sectional decline in PF by age.

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Age and Task Differences in Functional Fitness in Older Women: Comparisons With Senior Fitness Test Normative and Criterion-Referenced Data

Diane E. Adamo, Susan Ann Talley, and Allon Goldberg

Age-related changes in physical abilities, such as strength and flexibility, contribute to functional losses. However, older individuals may be unaware of what specific physical abilities compromise independent functioning. Three groups of women, aged 60 to 69, 70 to 79, and 80 to 92 years, were administered the Senior Fitness Test (SFT) to determine age differences in physical abilities and risk for functional losses. The oldest group showed significant differences in lower body strength, aerobic endurance, and agility and dynamic balance when compared with the other groups who performed similarly. Across all groups, a faster rate of decline was found for lower body strength (50.6%) and dynamic balance and agility (45.7%) than upper body strength (21.3%) and aerobic endurance (33.6%). Criterion-referenced (CR) fitness standards suggested that 45% of the individuals were at risk for loss of independent functioning. This study highlights age-related differences in physical abilities and the risk for the loss of independence in later life.