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.
Kelly Doran and Barbara Resnick
We aimed to assess work-related factors and their association with long-term care workers’ self-efficacy for encouraging and engaging residents in physical activity. Baseline data from a worksite wellness study with 98 workers were used. We used a linear regression model, to assess if job satisfaction, work ability, and social support for staff health behaviors from coworkers and supervisors were associated with staffs’ self-efficacy for Function-Focused Care (FFC) and Staffs’ Outcome Expectations for FFC. Staffs’ social support for healthy behaviors from coworkers was the only factor that was significantly associated with Staffs’ Outcome Expectations for FFC and staffs’ self-efficacy-FFC, respectively explaining 19% and 14% of the variance. Our findings show that staffs’ social support from coworkers is associated with higher self-efficacy for encouraging and engaging residents in physical activity suggests future worksite wellness studies with long-term care workers may wish to consider assessing program impacts on residents’ physical activity levels.
Barbara Resnick, Marie Boltz, Elizabeth Galik, Steven Fix, and Shijun Zhu
This study tested the feasibility, reliability, and validity of the MotionWatch 8 among assisted living residents with and without cognitive impairment. Data from the Dissemination and Implementation of Function Focused Care in Assisted Living Using the Evidence Integration Triangle study were used. The sample included 781 individuals from 85 facilities with a mean age of 89.48 (SD = 7.43) years. The majority were female (71%), White (97%), and overall (44%) had cognitive impairment. A total of 70% were willing to wear the MotionWatch 8. Reliability was supported as there was no difference in time spent in activity across three consecutive wear days. Validity was based on hypothesis testing, and function was associated with counts of activity at baseline (p = .001) and 4 months (p = .001). Those with cognitive impairment engaged in less physical activity (p = .04). The MotionWatch 8 is a useful option for measuring physical activity in older adults with and without cognitive impairment.
Barbara Resnick, Marie Boltz, Elizabeth Galik, and Shijun Zhu
The purpose of this study was to test the impact of function-focused care on adverse outcomes in assisted living. This was a randomized trial including 85 settings. The age of the 794 recruited participants was 89.48 (SD = 7.43) years, the majority was female (n = 561, 71%) and White (n = 771, 97%). The percentage of residents in the treatment group experiencing a fall decreased at 12 months from 26% to 20% and the control group increased from 24% to 25%, p = .02. A greater percentage of residents in the treatment group transferred to nursing facilities at 4 months (4–1% in control vs. 4–5% in treatment, p = .02) and 12 months (4–2% in control and 4–7% in treatment, p = .01). There was no treatment effect on emergency room or hospital transfers. The findings support the safety of function-focused care related to falls and need for hospital transfers.
Ashley Kuzmik, Barbara Resnick, Pamela Cacchione, Rachel Arendacs, and Marie Boltz
Persons with dementia are at high risk for hospital-acquired disability, associated with low physical activity during hospitalizations. To determine the effectiveness of efforts to increase physical activity, a valid and reliable measurement approach is required. Data from an ongoing cluster randomized clinical trial examined the feasibility and validity of the MotionWatch 8 (MW8) triaxial actigraphy device. The sample included 321 participants of which 259 (81%) were willing to wear the MW8 for 24 hr. Regression analysis revealed that time in low activity, β = 0.17, t(255) = 2.9, p = .004, and time in moderate activity, β = 0.14, t(255) = 2.4, p = .017, measured by the MW8, were associated with participants’ physical function. Engagement in moderate physical activity was associated with return to baseline function at discharge (Wald χ2 = 4.10, df = 1, p = .043). The study provides preliminary support for the feasibility and validity of the MW8 in hospitalized persons with dementia.
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).
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.