This review examined effects of structured exercise (aerobic walking, with or without complementary modes of exercise) on cardiorespiratory measures, mobility, functional status, healthcare utilization, and quality of life in older adults (≥60 years) hospitalized for acute medical illness. Inclusion required exercise protocol, at least one patient-level or utilization outcome, and at least one physical assessment point during hospitalization or within 1 month of intervention. MEDLINE, Embase, and CINAHL databases were searched for studies published from 2000 to March 2015. Qualitative synthesis of 12 articles, reporting on 11 randomized controlled trials (RCTs) and quasi-experimental trials described a heterogeneous set of exercise programs and reported mixed results across outcome categories. Methodological quality was independently assessed by two reviewers using the Cochrane Collaboration Risk of Bias tool. Larger, well-designed RCTs are needed, incorporating measurement of premorbid function, randomization with intention-to-treat analysis, examination of a targeted intervention with predefined intensity, and reported adherence and attrition.
Frances A. Kanach, Amy M. Pastva, Katherine S. Hall, Juliessa M. Pavon and Miriam C. Morey
Katherine S. Hall, Gail M. Crowley, Hayden B. Bosworth, Teresa A. Howard and Miriam C. Morey
The purpose of this study was to examine what happens to goals over the course of a physical activity counseling trial in older veterans. At baseline, participants (N = 313) identified 1 health-related goal and 1 walking goal for their participation in the study and rated where they perceived themselves to be relative to that goal at the current time. They rated their current status on these same goals again at 6 and 12 mo. Growth-curve analyses were used to examine longitudinal change in perceived goal status. Although both the intervention and control groups demonstrated improvement in their perceived proximity to their health-related and walking goals (L = 1.19, p < .001), the rates of change were significantly greater in the intervention group (β = –.30, p < .05). Our results demonstrate that this physical activity counseling intervention had a positive impact on self-selected goals over the course of the intervention.
Holiday A. Durham, Miriam C. Morey, Cheryl A. Lovelady, Rebecca J. Namenek Brouwer, Katrina M. Krause and Truls Østbye
Low physical activity (PA) during the postpartum period is associated with weight retention. While patterns of PA have been examined in normal weight women during this period, little is known about PA among overweight and obese women. The aim of this cross-sectional study was to investigate PA and determine the proportion of women meeting recommendations for PA.
Women (n = 491), with a body mass index (BMI) ≥ 25 kg/m2 were enrolled in a behavioral intervention. PA was assessed at six weeks postpartum using the Seven-Day PA Recall.
Women averaged 923 ± 100 minutes/day of sedentary/ light and 33 ± 56 minutes/day of combined moderate, hard, and very hard daily activity. Women with a BMI ≥ 40 kg/m2 reported more time in sedentary/light activities and less hours of sleep than those with a lower BMI. Only 34% met national PA guidelines; this proportion was significantly lower among blacks (OR 0.5, CI 0.3−0.9).
These overweight and obese postpartum women reported a large percentage of time spent in sedentary/light activity, and a high proportion failed to meet minimal guidelines for PA. Promotion of PA in the postpartum period should focus on reducing sedentary behaviors and increasing moderate PA.
Miriam C. Morey, Carola Ekelund, Megan Pearson, Gail Crowley, Matthew Peterson, Richard Sloane, Carl Pieper, Eleanor McConnell and Hayden Bosworth
The authors describe a medical center-based randomized trial aimed at determining the feasibility and effectiveness of partnering patients and primary-care providers with an exercise health counselor. Study participants included 165 veterans age 70 years and older. The primary end point was change in physical activity at 3 and 6 months comparing patients receiving high-intensity physical activity counseling, attention control counseling, and usual care after receiving standardized clinic-based counseling. We noted a significant Group × Time interaction (p = .041) for physical activity frequency and a similar effect for caloric expenditure (p = .054). Participants receiving high-intensity counseling and usual care increased physical activity over the short term, but those with usual care returned to baseline by the end of the study. The intervention was well received by practitioners and patients. We conclude that partnering primary-care providers with specialized exercise counselors for age- and health-appropriate physical activity counseling is effective.
Miriam C. Morey, Patricia M. Dubbert, Martha E. Doyle, Helga MacAller, Gail M. Crowley, Maggie Kuchibhatla, Margaret Schenkman and Ronnie D. Horner
Getting older adults to initiate and maintain long-term exercise is an important public health mandate. This study is an analysis of a clinical trial of 112 sedentary adults, age 65–90 years, randomly assigned to 1 of 2 exercise interventions. We examined predictors and patterns of adherence of the 6-month home-based component of the trial. Telephone follow-up and diaries were used to assess adherence. Adherence to weekend exercise during the supervised phase of the program was the strongest predictor of subsequent home-based adherence. Adherence appeared stable throughout the intervention, indicating that adherence or nonadherence was established from the outset. The authors conclude that nonadherence can be identified early in the behavioral-change process. Future studies should focus on developing strategies for adults with chronic illnesses, depressive symptoms, and functional limitations who are nonadherent early on as they initiate and attempt to maintain exercise.
Odessa Addison, Monica C. Serra, Leslie Katzel, Jamie Giffuni, Cathy C. Lee, Steven Castle, Willy M. Valencia, Teresa Kopp, Heather Cammarata, Michelle McDonald, Kris A. Oursler, Chani Jain, Janet Prvu Bettger, Megan Pearson, Kenneth M. Manning, Orna Intrator, Peter Veazie, Richard Sloane, Jiejin Li and Miriam C. Morey
Veterans represent a unique population of older adults, as they are more likely to self-report a disability and be overweight or obese compared with the general population. We sought to compare changes in mobility function across the obesity spectrum in older veterans participating in 6 months of Gerofit, a clinical exercise program. A total of 270 veterans (mean age: 74 years) completed baseline, 3-, and 6-month mobility assessments and were divided post hoc into groups: normal weight, overweight, and obese. The mobility assessments included 10-m walk time, 6-min walk distance, 30-s chair stands, and 8-foot up-and-go time. No significant weight × time interactions were found for any measure. However, clinically significant improvements of 7–20% were found for all mobility measures from baseline to 3 months and maintained at 6 months (all ps < .05). Six months of participation in Gerofit, if enacted nationwide, appears to be one way to improve mobility in older veterans at high risk for disability, regardless of weight status.