The purpose of this study was to test a model of overall activity in older adults. It was hypothesized that (a) mental and physical health directly influence sell-efficacy expectations; (b) mental and physical health, age, and self-efficacy expectations influence outcome expectations; and (c) all of these variables directly or indirectly influence overall activity. The sample included 175 older adults living in a continuing care retirement community, and a one-time interview was conducted. The mean age of the participants was 86 ± 5.7 years, and the majority were Caucasian (n = 173, 99%), women (n = 136, 78%), and unmarried (widowed or single; n = 137, 78%). Seven of the 10 hypothesized paths were significant. The variables physical health, self-efficacy expectations. and outcome expectations directly influenced activity, and age and mental health indirectly influenced activity through self-efficacy and outcome expectations. The data fit the model, and combined, these variables accounted for 29% of the variance in activity.
Development of a reliable and valid measure of outcome expectations for exercise for older adults will help establish the relationship between outcome expectations and exercise and facilitate the development of interventions to increase physical activity in older adults. The purpose of this study was to test the reliability and validity of the Outcome Expectations for Exercise-2 Scale (OEE-2), a 13-item measure with two subscales: positive OEE (POEE) and negative OEE (NOEE). The OEE-2 scale was given to 161 residents in a continuing-care retirement community. There was some evidence of validity based on confirmatory factor analysis, Rasch-analysis INFIT and OUTFIT statistics, and convergent validity and test criterion relationships. There was some evidence for reliability of the OEE-2 based on alpha coefficients, person- and item-separation reliability indexes, and R 2 values. Based on analyses, suggested revisions are provided for future use of the OEE-2. Although ongoing reliability and validity testing are needed, the OEE-2 scale can be used to identify older adults with low outcome expectations for exercise, and interventions can then be implemented to strengthen these expectations and improve exercise behavior.
Barbara Resnick and Elizabeth Galik
The purpose of this study was to develop and test a measure of physical activity for residents in long-term-care facilities, the Physical Activity Survey in Long-Term Care (PAS-LTC). Sixty-six activities are included in the PAS-LTC: routine physical activity, personal-care activities, structured exercise, recreational activities, caretaking activities, and repetitive activities. The study included 13 residents in a long-term-care facility, most of whom were women (62%), with an average age of 84 years (± 6.0) and an average Mini Mental State Examination score of 6 (± 6.9). There was evidence of interrater reliability of the PAS-LTC with intraclass correlations of .83-.94. There was some evidence of validity of the measure with statistically significant correlations between PAS-LTC recorded during the evening and night shifts and the number of counts of activity per the ActiGraph (r = .60 and r = .57, respectively, p < .05) and the calories estimated (r = .58 and r = .60, respectively, p < .05). The PAS-LTC completed during the day shift and total activity based on the PAS-LTC showed nonsignificant correlations of .40 or greater with the ActiGraph activity counts and calories.
Barbara Resnick, Elizabeth Galik, Marie Boltz, William Hawkes, Michelle Shardell, Denise Orwig and Jay Magaziner
The purpose of this study was to characterize physical activity (PA) based on survey and ActiGraphy data from older adults at 2 mo post–hip fracture and consider the factors that influence PA among these individuals. The sample included participants from a current Baltimore hip study, the BHS-7. Measurement of PA was based on the Yale PA Survey (YPAS) and 48 hr of ActiGraphy. The sample included the first 200 individuals enrolled in the study, with analyses including 117 individuals (59%) who completed the YPAS and wore the ActiGraph for 48 hr. Half the participants were male, with an overall mean age of 81.3 yr (SD = 7.9). Findings indicate that at 2 mo post–hip fracture participants were engaged in very limited levels of PA. Age and comorbidities were the only variables to be significantly associated with PA outcomes.
Barbara Resnick, Elizabeth Galik, Marie Boltz, Erin Vigne, Sarah Holmes, Steven Fix and Shijun Zhu
The purpose of this study was to describe physical activity and function of older adults in assisted living communities and test the association between moderate and vigorous activity and falls. This study used baseline data from 393 participants from the first two cohorts in the Function-Focused Care in Assisted Living Using the Evidence Integration Triangle study. The majority of participants were female (N = 276, 70%) and White (N = 383, 97%) with a mean age of 87 years (SD = 7). Controlling for age, cognition, gender, setting, and function, the time spent in moderate or vigorous levels of physical activity was associated with having a fall in the prior 4 months. Those who engaged in more moderate physical activity were 0.6% less likely to have a fall (OR = 0.994, Wald statistic = 5.54, p = .02), and those who engaged in more vigorous activity were 2% less likely to have a fall (OR = 0.980, Wald statistic = 3.88, p = .05).
Shijun Zhu, Eun-Shim Nahm, Barbara Resnick, Erika Friedmann, Clayton Brown, Jumin Park, Jooyoung Cheon and DoHwan Park
This secondary data analyses of a longitudinal study assessed whether self-efficacy for exercise (SEE) mediated online intervention effects on exercise among older adults and whether age (50−64 vs. ≥65 years) moderated the mediation. Data were from an online bone health intervention study. Eight hundred sixty-six older adults (≥50 years) were randomized to three arms: Bone Power (n = 301), Bone Power Plus (n = 302), or Control (n = 263). Parallel process latent growth curve modeling (LGCM) was used to jointly model growths in SEE and in exercise and to assess the mediating effect of SEE on the effect of intervention on exercise. SEE was a significant mediator in 50- to 64-year-old adults (0.061, 95 BCI: 0.011, 0.163) but not in the ≥65 age group (−0.004, 95% BCI: −0.047, 0.025). Promotion of SEE is critical to improve exercise among 50- to 64-year-olds.
Barbara Resnick, Kathleen Michael, Marianne Shaughnessy, Eun Shim Nahm, Susan Kopunek, John Sorkin, Denise Orwig, Andrew Goldberg and Richard F. Macko
Self-report measures of physical activity have well-known drawbacks, and physiologic measures alone do not account for behavioral variables important in the perception and performance of physical activity. Therefore, we considered multiple measures to quantify physical activity in community-dwelling men and women with chronic stroke.
This analysis included data from a volunteer sample of 87 individuals at least 6 months poststroke. Physical activity was measured using self-report questionnaires, step activity monitors, self-efficacy expectations related to exercise, and VO2peak from treadmill testing, and a model of physical activity was tested.
Most of the variance in objective physical activity was explained by VO2peak, and most of the variance in subjective physical activity was explained by self-efficacy expectations. There were significant discrepancies between subjective and objective findings.
This study helps to understand the perspective of stroke survivors with regard to physical activity.
Barbara Resnick, Christopher D’Adamo, Michelle Shardell, Denise Orwig, William Hawkes, J. Richard Hebel, Justine Golden, Jay Magaziner, Sheryl Zimmerman and Janet Yu-Yahiro
The purpose of this study was to evaluate adherence to home-based exercise interventions among older women post hip fracture that were randomized to one of three exercise intervention groups or a routine care group. A total of 157 female hip fracture patients provided data for the intervention analysis. Factors evaluated baseline, 2, 6, and 12 months post hip fracture included demographic variables, adherence to treatment visits, self-efficacy, outcome expectations, stage of change for exercise, social support for exercise, mood, health status, pain, and fear of falling. The hypothesized model tested the direct and indirect impact of all study variables on adherence to exercise intervention sessions. Different factors appeared to influence adherence to visits across the recovery trajectory.
Barbara Resnick, Marcia G. Ory, Kerrie Hora, Michael E. Rogers, Phillip Page, Jane N. Bolin, Roseann M. Lyle, Cody Sipe, Wojtek Chodzko-Zajko and Terry L. Bazzarre
The Exercise Assessment and Screening for You (EASY) is a tool developed to help older individuals, their health care providers, and exercise professionals identify different types of exercise and physical activity regimens that can be tailored to meet the existing health conditions, illnesses, or disabilities of older adults. The EASY tool includes 6 screening questions that were developed based on an expert roundtable and follow-up panel activities. The philosophy behind the EASY is that screening should be a dynamic process in which participants learn to appreciate the importance of engaging in regular exercise, attending to health changes, recognizing a full range of signs and symptoms that might indicate potentially harmful events, and becoming familiar with simple safety tips for initiating and progressively increasing physical activity patterns. Representing a paradigm shift from traditional screening approaches that focus on potential risks of exercising, this tool emphasizes the benefits of exercise and physical activity for all individuals.