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Use of Accelerometry to Measure Physical Activity in Older Adults at Risk for Mobility Disability

Leslie A. Pruitt, Nancy W. Glynn, Abby C. King, Jack M. Guralnik, Erin K. Aiken, Gary Miller, and William L. Haskell

The authors explored using the ActiGraph accelerometer to differentiate activity levels between participants in a physical activity (PA, n = 54) or “successful aging” (SA) program (n = 52). The relationship between a PA questionnaire for older adults (CHAMPS) and accelerometry variables was also determined. Individualized accelerometry-count thresholds (ThreshIND) measured during a 400-m walk were used to identify “meaningful activity.” Participants then wore the ActiGraph for 7 days. Results indicated more activity bouts/day ≥10 min above ThreshIND in the PA group than in the SA group (1.1 ± 2.0 vs 0.5 ± 0.8, p = .05) and more activity counts/day above ThreshIND for the PA group (28,101 ± 27,521) than for the SA group (17,234 ± 15,620, p = .02). Correlations between activity counts/hr and CHAMPS ranged from .27 to .42, p < .01. The ActiGraph and ThreshIND might be useful for differentiating PA levels in older adults at risk for mobility disability.

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Effects of Tai Chi and Western Exercise on Physical and Cognitive Functioning in Healthy Community-Dwelling Older Adults

Ruth E. Taylor-Piliae, Kathryn A. Newell, Rise Cherin, Martin J. Lee, Abby C. King, and William L. Haskell

Objective:

To compare the effects of Tai Chi (TC, n = 37) and Western exercise (WE, n = 39) with an attention-control group (C, n = 56) on physical and cognitive functioning in healthy adults age 69 ± 5.8 yr, in a 2-phase randomized trial.

Methods:

TC and WE involved combined class and home-based protocols. Physical functioning included balance, strength, flexibility, and cardiorespiratory endurance. Cognitive functioning included semantic fluency and digit-span tests. Data were analyzed using intention-to-treat analysis.

Results:

At 6 mo, WE had greater improvements in upper body flexibility (F = 4.67, p = .01) than TC and C. TC had greater improvements in balance (F = 3.36, p = .04) and a cognitive-function measure (F = 7.75, p < .001) than WE and C. The differential cognitive-function improvements observed in TC were maintained through 12 mo.

Conclusion:

The TC and WE interventions resulted in differential improvements in physical functioning among generally healthy older adults. TC led to improvement in an indicator of cognitive functioning that was maintained through 12 mo.

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Evaluation of Enrollment Bias in a Physical-Activity-Promotion Program for Seniors

Kristin M. Mills, Anita L. Stewart, Barbara Y. McLellan, Carol J. Verboncoeur, Abby C. King, and Byron W. Brown

Health-promotion programs’ success depends on their ability to enroll representative samples of the target population, particularly those who are hard to reach and those who can benefit the most from such programs. This article evaluates enrollment bias in the recruitment process, examines the usefulness of a 2-phased recruitment strategy in enrolling representative proportions of eligible individuals in a physical-activity-promotion program for older adults, and explores predictors of enrollment. Of 1,381 randomly selected Medicare HMO members. 519 were eligible. Of these, 54% attended an informational meeting and 33% enrolled in the program. Relative to the target population, a representative proportion of women was enrolled, but those who enrolled were slightly younger. Of those who were eligible, a representative proportion of sedentary participants was recruited, those who were overweight were overrep-resented, and the oldest old, less educated, ethnic minorities, and precontem-plators of physical activity were underrepresented. Modifiable predictors of enrollment included interest in health, previous health-class attendance, and having had a physician recommend exercise.

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Neighborhood Environment and Physical Activity Among Older Adults: Do the Relationships Differ by Driving Status?

Ding Ding, James F. Sallis, Gregory J. Norman, Lawrence D. Frank, Brian E. Saelens, Jacqueline Kerr, Terry L. Conway, Kelli Cain, Melbourne F. Hovell, C. Richard Hofstetter, and Abby C. King

Some attributes of neighborhood environments are associated with physical activity among older adults. This study examined whether the associations were moderated by driving status. Older adults from neighborhoods differing in walkability and income completed written surveys and wore accelerometers (N = 880, mean age = 75 years, 56% women). Neighborhood environments were measured by geographic information systems and validated questionnaires. Driving status was defined on the basis of a driver’s license, car ownership, and feeling comfortable to drive. Outcome variables included accelerometer-based physical activity and self-reported transport and leisure walking. Multilevel generalized linear regression was used. There was no significant Neighborhood Attribute × Driving Status interaction with objective physical activity or reported transport walking. For leisure walking, almost all environmental attributes were positive and significant among driving older adults but not among nondriving older adults (five significant interactions at p < .05). The findings suggest that driving status is likely to moderate the association between neighborhood environments and older adults’ leisure walking.

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Exploring the Objective and Perceived Environmental Attributes of Older Adults’ Neighborhood Walking Routes: A Mixed Methods Analysis

Mika R. Moran, Perla Werner, Israel Doron, Neta HaGani, Yael Benvenisti, Abby C. King, Sandra J. Winter, Jylana L. Sheats, Randi Garber, Hadas Motro, and Shlomit Ergon

Walking is a central form of physical activity among older adults that is associated with the physical environment at various scales. This mixed-methods study employs a concurrent nested design to explore objective and perceived environmental characteristics of older adults’ local walking routes. This was achieved by integrating quantitative Geographic Information System (GIS) data with qualitative data obtained using the Stanford Discovery Tool (DT). Fifty-nine community-dwelling middle-aged and older adults (14 men and 45 women aged 50+) were recruited in a snowball approach through community centers in the city of Haifa (Israel). Four neighborhood environment themes were identified: pedestrian infrastructure, access to destinations, aesthetics, and environmental quality. Both geometrical traits (i.e., distance, slope) and urban features (i.e., land-uses, greenery) of the route may impact the experience of walking. The findings thus highlight the importance of micro-scale environmental elements in shaping environmental perceptions, which may consequently influence the choice of being active.

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Reliability and Validity of CHAMPS Self-Reported Sedentary-to-Vigorous Intensity Physical Activity in Older Adults

Eric B. Hekler, Matthew P. Buman, William L. Haskell, Terry L. Conway, Kelli L. Cain, James F. Sallis, Brian E. Saelens, Lawrence D. Frank, Jacqueline Kerr, and Abby C. King

Background:

Recent research highlights the potential value of differentiating between categories of physical activity intensities as predictors of health and well-being. This study sought to assess reliability and concurrent validity of sedentary (ie, 1 METs), low-light (ie, >1 and ≤2 METs; eg, playing cards), high-light (ie, >2 and <3 METs; eg, light walking), moderate-to-vigorous physical activity (MVPA, ≥3 METs), and “total activity” (≥2 METs) from the CHAMPS survey. Further, this study explored over-reporting and double-reporting.

Methods:

CHAMPS data were gathered from the Seniors Neighborhood Quality of Life Study, an observational study of adults aged 65+ years conducted in 2 US regions.

Results:

Participants (N = 870) were 75.3 ± 6.8 years old, with 56% women and 71% white. The CHAMPS sedentary, low-light, high-light, total activity, and MVPA variables had acceptable test-retest reliability (ICCs 0.56−0.70). The CHAMPS high-light (ρ = 0.27), total activity (ρ = 0.34), and MVPA (ρ = 0.37) duration scales were moderately associated with accelerometry minutes of corresponding intensity, and the sedentary scale (ρ = 0.12) had a lower, but significant correlation. Results suggested that several CHAMPS items may be susceptible to over-reporting (eg, walking, housework).

Conclusions:

CHAMPS items effectively measured high-light, total activity, and MVPA in seniors, but further refinement is needed for sedentary and low-light activity.

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Interruption of Physical Activity Because of Illness in the Lifestyle Interventions and Independence for Elders Pilot Trial

Edward M. Phillips, Jeffrey Katula, Michael E. Miller, Michael P. Walkup, Jennifer S. Brach, Abby C. King, W. Jack Rejeski, Tim Church, and Roger A. Fielding

Objectives:

To examine baseline characteristics and change in gait speed and Short Physical Performance Battery (SPPB) scores in participants medically suspended (MS) from a physical activity intervention (PA).

Design:

Randomized controlled trial.

Setting:

University and community centers.

Participants:

Sedentary older adults (N = 213) randomized to PA in the Lifestyle Interventions and Independence for Elders Pilot (LIFE-P).

Measurements:

MS was defined as missing 3 consecutive PA sessions in adoption and transition phases or 2 wk in maintenance phase because of a health event.

Results:

In all, 122 participants completed PA without MS (NMS subgroup), 48 participants underwent MS and resumed PA (SR subgroup), and 43 participants underwent MS and did not complete PA (SNR subgroup). At baseline, SNR walked slower (p = .03), took more prescribed medications (p = .02), and had lower SPPB scores than NMS and SR (p = .02). Changes from baseline to Month 12 SPPB scores were affected by suspension status, adjusted mean (SE) SPPB change: SNR 0.0957 (0.3184), SR 0.9413 (0.3063), NMS 1.0720 (0.1871); p = .03.

Conclusions:

MS participants unable to return to complete the PA in a trial of mobility-limited sedentary older adults had slower walking speeds, lower SPPB scores, and a higher number of prescribed medications at baseline. Change in SPPB scores at 12 months was related to suspension status.

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A Cost Analysis of a Physical Activity Intervention for Older Adults

Erik J. Groessl, Robert M. Kaplan, Steven N. Blair, W. Jack Rejeski, Jeffrey A. Katula, Abby C. King, Roger A. Fielding, Nancy W. Glynn, and Marco Pahor

We examined the costs of a physical activity (PA) and an educational comparison intervention. 424 older adults at risk for mobility disability were randomly assigned to either condition. The PA program consisted of center-based exercise sessions 3× weekly for 8 weeks, 2× weekly for weeks 9 to 24 and weekly behavioral counseling for 10 weeks. Optional sessions were offered during maintenance weeks (25−52). The comparison intervention consisted of weekly education meetings for 24 weeks, and then monthly for 6 months. Cost analyses were conducted from the “payer’s” perspective, with a 1-year time horizon. Intervention costs were estimated by tracking personnel activities and materials used for each intervention and multiplying by national unit cost averages. The average cost/participant was $1134 and $175 for the PA and the comparison interventions, respectively. A preliminary cost/effectiveness analysis gauged the cost/disability avoided to be $28,206. Costs for this PA program for older adults are comparable to those of other PA interventions. The results are preliminary and a longer study is required to fully assess the costs and health benefits of these interventions.

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The Scientific Foundation for the Physical Activity Guidelines for Americans, 2nd Edition

Kenneth E. Powell, Abby C. King, David M. Buchner, Wayne W. Campbell, Loretta DiPietro, Kirk I. Erickson, Charles H. Hillman, John M. Jakicic, Kathleen F. Janz, Peter T. Katzmarzyk, William E. Kraus, Richard F. Macko, David X. Marquez, Anne McTiernan, Russell R. Pate, Linda S. Pescatello, and Melicia C. Whitt-Glover

Background: The 2018 Physical Activity Guidelines Advisory Committee Scientific Report provides the evidence base for the Physical Activity Guidelines for Americans, 2nd Edition. Methods: The 2018 Physical Activity Guidelines Advisory Committee addressed 38 questions and 104 subquestions selected for their public health relevance, potential to inform public policies and programs, maturity of the relevant science, and applicability to the general US population. Rigorous systematic literature searches and literature reviews were performed using standardized methods. Results: Newly described benefits of physical activity include reduced risk of excessive weight gain in children and adults, incidence of 6 types of cancer, and fall-related injuries in older people. Physical activity is associated with enhanced cognitive function and mental health across the life span, plus improved mental health and physical function. There is no threshold that must be exceeded before benefits begin to accrue; the accrual is most rapid for the least active individuals. Sedentary time is directly associated with elevated risk of all-cause and cardiovascular mortality, incident cardiovascular disease and type 2 diabetes, and selected cancer sites. A wide range of intervention strategies have demonstrated success in increasing physical activity. Conclusion: The 2018 Physical Activity Guidelines Advisory Committee Scientific Report provides compelling new evidence to inform physical activity recommendations, practice, and policy.