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Jiska Cohen-Mansfield, Dov Shmotkin and Shira Goldberg

The study aimed to investigate factors influencing older adults’ physical activity engagement over time. The authors analyzed 3 waves of data from a sample of Israelis age 75–94 (Wave 1 n = 1,369, Wave 2 n = 687, Wave 3 n = 154). Findings indicated that physical activity engagement declined longitudinally. Logistic regressions showed that female gender, older age, and taking more medications were significant risk factors for stopping exercise at Wave 2 in those physically active at Wave 1. In addition, higher functional and cognitive status predicted initiating exercise at Wave 2 in those who did not exercise at Wave 1. By clarifying the influence of personal characteristics on physical activity engagement in the Israeli old-old, this study sets the stage for future investigation and intervention, stressing the importance of targeting at-risk populations, accommodating risk factors, and addressing both the initiation and the maintenance of exercise in the face of barriers.

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Mirja Hannele Hirvensalo, Jiska Cohen-Mansfield, Shlomit Rind and Jack Guralnik

Prescribing the correct exercise program is a challenge for older adults with multiple physiological impairments. The authors evaluated an assessment instrument that incorporates results of multiple categories of impairment, including strength, balance, gait, vision, and cognitive function. The physical therapist made judgments on the relative impact of 9 different impairments on specific exercises and on the total impact of all impairments on particular exercises. In a cohort age 75–85 y, functional limitations, impaired balance, pain, and low physical endurance were estimated to have the largest impact on the ability to carry out exercise activities, primarily walking, stair climbing, balance exercises, and stationary bicycling. The assessments revealed that the ability to exercise was related to objective measures of function, indicating that the therapist incorporated such objective measures into the impairment-impact rating. The impairment-impact assessment facilitates creating individualized exercise prescriptions for individuals with impairments.

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Milan Chang, Suzanne Leveille, Jiska Cohen-Mansfield and Jack M. Guralnik

The Hebrew Home Study of Impairment and Exercise is a cross-sectional community-based study of nondisabled adults age 75–85 years that assessed attitude toward exercise by asking level of agreement with four statements evaluating participants’ perceptions of the health benefits and personal rewards of exercise. A physical-performance battery evaluated lower extremity function on a scale of 0 to 12. Attitude toward exercise was compared across 4 groups: non-vigorous exercisers with scores of 4–6 (n = 21), 7–9 (n = 90), or 10–12 (n = 113) and vigorous exercisers (n = 71). Vigorous exercisers had a significantly better attitude toward exercise than the reference group did, with odds ratios of 1.8-5.5 in all attitude statements. The lowest and moderate-performance groups had less positive attitudes toward exercise than the reference group did, with odds ratios of 0.27–0.62 for all statements. There was a highly significant gradient with better attitude toward exercise and higher functional-status level. Future work in improving older adults’ compliance with exercise should take into account the less positive attitude of those with functional limitations toward the benefits of exercise.

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Jiska Cohen-Mansfield, Marcia S. Marx and Jack M. Guralnik

This study aimed to ascertain perceived barriers and motivators to exercise in people age 74–85 and to clarify the meaning of these barriers and motivators by examining participant characteristics that relate to them. 324 community-dwelling participants age 74–85 completed a health questionnaire that included items on barriers and motivators to exercise, as well as questions on demographic variables, health, and exercise. Selected participants then completed a physical-performance battery to measure functional performance. Barriers and motivators were related internally, as well as to many other factors including pain and depressed affect on the Geriatric Depression Scale. The findings suggest a need for individualized and comprehensive approaches to the presentation of exercise programs. Health interventions are needed that will address both physical pain and depressed affect and explain the importance of exercise even in the presence of health problems. An understanding of the context of reported barriers and motivators is necessary for correct interpretation and program development.

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Marcia S. Marx, Jiska Cohen-Mansfield and Jack M. Guralnik

The article describes the process of identifying 100 community-dwelling elderly adults at risk for physical disability, yet not functionally disabled, for participation in a research project to develop appropriate exercise programs for at-risk elderly. Over a period of 14 months, initial contact was made with 941 older adults, 11% of whom (101 people) were eligible for and willing to complete all stages of the study protocol. The most successful recruitment strategies were a mass mailing followed by a telephone call and advertising in a newspaper with a large circulation (rather than a local paper). Aspects of the recruitment and retention of study participants are discussed.

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Suzanne G. Leveille, Jiska Cohen-Mansfield and Jack M. Guralnik

The authors examined the relationship between musculoskeletal pain, self-efficacy, attitudes and beliefs about exercise, and physical activity in 75- to 85-year-old adults. Participants rated their pain during the preceding month in their back, hips, knees, and feet on a scale of 0 to 10. Pain was categorized by number of sites of moderate to severe pain. Among the 325 participants, 42.8% reported at least moderate pain in at least 1 site. Having more pain sites was associated with younger age, lower income, depressed mood, and poorer self-rated health. Participants with more pain sites scored lower on exercise attitudes, beliefs, and self-efficacy, but the self-efficacy scale was most strongly associated with physical activity. Participants with 2–4 pain sites and low self-efficacy were >4 times as likely to be sedentary as those with no pain and high self-efficacy. These findings suggest that improving self-efficacy for exercise might be an important component of programs to increase physical activity in adults with chronic musculoskeletal pain.

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Jack M. Guralnik, Suzanne Leveille, Stefano Volpato, Marcia S. Marx and Jiska Cohen-Mansfield

Epidemiological studies have demonstrated that, using objective performance measures of physical functioning, disability risk can be predicted in nondisabled older adults. This makes it possible to recruit a nondisabled but at-risk population for clinical trials of disability prevention. Successful disability prevention in this population, for example through an exercise program, would have a major public health impact. To enhance the development of exercise interventions in this group it would be valuable to have additional information not available from existing epidemiologic studies. This report examines the evidence that functional limitations preceding disability can be identified in a community-dwelling population and that it is feasible to recruit these people into studies. It introduces a series of articles examining the characteristics of this population: motivators and barriers to exercise, exercise habits and preferences, the impact of positive and negative affect, and the impact of pain and functional limitations on attitudes toward exercise.

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Glenn V. Ostir, Jiska Cohen-Mansfield, Suzanne Leveille, Stefano Volpato and Jack M. Guralnik

This study investigated whether positive or negative affect has an independent association with exercise self-efficacy. Participants (N = 324) age 75-85 were classified as high or at-risk performers, and three exercise-self-efficacy items (scored 1-10) were assessed. For at-risk performers, positive affect was significantly associated with confidence in the ability to perform strength and flexibility (b = 0.83, SE = 0.23, p = .001) and aerobic exercise (b = 0.59, SE = 0.28, p = .04) and with the perception that exercise would not worsen preexisting symptoms (b = 0.73, SE = 0.24, p = .001). Among high performers, nonsignificant associations were found for positive and negative affect and exercise-self-efficacy. For at-risk performers, higher positive affect was associated with an increased odds ratio of 2.72 for scoring 10 on the muscle strength and flexibility item, 4.08 on the aerobic item, and 2.94 on the item assessing preexisting symptoms. The results suggest that improving at-risk older adults’ positive affect might increase their participation in exercise.