The Fall Prevention Center of Excellence designed three progressive-intensity fall prevention program models, Increasing Stability Through Evaluation and Practice (InSTEP), to reduce risk in community-dwelling older adults. Each model included physical activity, medical risk, and home safety components and was implemented as a 12-week program for small class sizes (12–15 people) in community and senior centers. Change in fall rates and fall risk factors was assessed using a battery of performance tests, self-reports of function, and fall diaries in a 3-group within-subjects (N = 200) design measured at baseline, immediately postintervention, and at 3 and 9 months postintervention. Overall, participants experienced a reduction in falls, improved self-perception of gait and balance, and improved dynamic gait function. The medium-intensity InSTEP model signifcantly (p = .003) reduced self-reported falls in comparison with the other models. InSTEP is a feasible model for addressing fall risk reduction in community-dwelling older adults.
B. Josea Kramer, Beth Creekmur, Michael N. Mitchell, Debra J. Rose, Jon Pynoos and Laurence Z. Rubenstein
Jaap Swanenburg, Anne Gabrielle Mittaz Hager, Arian Nevzati and Andreas Klipstein
The purpose of this prospective cohort study was to determine whether the maximal width of the base of support (BSW) measure is able to predict the risk of multiple falls in community-dwelling women. Thirty-eight community-dwelling women (mean age of 72 ± 8 years old) participated. Falls were prospectively recorded during the following year. Overall, 29 falls were recorded; six (16%) women were multiple fallers and 32 (84%) were nonfallers. There was a significant difference in the BSW between the fallers and nonfallers (F[1, 37] = 5.134 [p = .030]). A logistic regression analysis indicated a significant contribution of the BSW test to the model (odds ratio = 0.637; 95% CI [0.407, 0.993]; p = .046 per 1 cm).The cut-off score was determined to be 27.8 cm (67% sensitivity and 84% specifcity). These results indicate that women with a smaller BSW at baseline had a significantly higher risk of sustaining a fall.
Li-Tang Tsai, Merja Rantakokko, Anne Viljanen, Milla Saajanaho, Johanna Eronen, Taina Rantanen and Erja Portegijs
This cross-sectional study investigated associations between reasons to go outdoors and objectively-measured walking activity in various life-space areas among older people. During the study, 174 community-dwelling older people aged 75–90 from central Finland wore an accelerometer over seven days and recorded their reasons to go outdoors in an activity diary. The most common reasons for going outdoors were shopping, walking for exercise, social visits, and running errands. Activities done in multiple life-space areas contributed more to daily step counts than those done in the neighborhood or town and beyond. Those who went shopping or walked for exercise accumulated higher daily step counts than those who did not go outdoors for these reasons. These results show that shopping and walking for exercise are common reasons to go outdoors for community-dwelling older people and may facilitate walking activity in older age. Future studies on how individual trips contribute to the accumulation of steps are warranted.
Stephen M. Haley, Larry H. Ludlow and Jill T. Kooyoomjian
As a preliminary step in developing the physical-functioning measure of the Late-Life Function and Disability Instrument (LLFDI), the authors compared its items with the physical-functioning items (PF-10) on the SF-36 Health Survey. They compared the item coverage, hierarchy, and scale-separation properties of the PF-10 items with those of the physical-functioning items of the LLFDI. Both questionnaires were administered to 50 community-dwelling older adults. A partial-credit, 1-parameter, item-response-theory model was used to scale the items. The LLFDI improved the range of ability of daily activities that was encompassed by the PF-10 items by 46%. By sequentially deleting new items with poor fit to the overall scale and items with redundant content, the authors developed a scale more capable of accurately assessing low-functioning activities. The LLFDI function component incorporates a broader content range and better person and item separation than the PF-10 items. It appears to have potential as a comprehensive functional-activity assessment for community-dwelling older adults.
Robert M. Kaplan, Alison K. Herrmann, James T. Morrison, Laura F. DeFina and James R. Morrow Jr.
Despite benefits of physical activity (PA), exercise is also associated with risks. Musculoskeletal injury (MSI) risk increases with exercise frequency/intensity. MSI is associated with costs including medical care and time lost from work.
To evaluate the economic costs associated with PA-related MSIs in community-dwelling women.
Participants included 909 women in the Women’s Injury Study reporting PA behaviors and MSI incidence weekly via the Internet for up to 3 years (mean follow-up 1.89 years). Participants provided consent to obtain health records. Costs were estimated by medical records and self-reports of medical care. Components included physician visits, medical facility contacts, medication costs, and missed work.
Of 909 participants, 243 reported 323 episodes of expenditure or contact with the health care system associated with PA. Total costs of episodes ranged from $0–$18,934. Modal cost was $0 (mean = $433 ± $1670). Costs were positively skewed with nearly all participants reporting no or very low costs.
About 1 in 4 community-dwelling women who are physically active experienced a PA-related MSI. The majority of injuries were minor, and large expenses associated with MSI were rare. The long-term health benefits and costs savings resulting from PA likely outweigh the minor costs associated with MSI from a physically-active lifestyle.
Jakob L. Vingren, James R. Morrow Jr., Elaine Trudelle-Jackson and Merly T. Mathew
Aerobic and muscle-strengthening activities are related to morbidities and mortality. Resistance exercise/strength training items are included in national surveys, but the manner in which muscle-strengthening activity is queried varies among these surveys.
The purpose of this study was to use different self-report measures to examine the prevalence of meeting the 2008 Physical Activity Guidelines for Americans regarding muscle-strengthening activities among women.
We surveyed 606 community-dwelling women at 4 points in time across a 1.5- to 3-year time period to determine whether the respondents met the national physical activity guidelines for performing muscle-strengthening activities ≥ 2 days per week.
Results were consistent across time but depended on the manner in which the question was asked. If asked to reflect over the past month or a general question about the typical number of days engaged, approximately 40% of women reported engaging in ≥ 2 days per week of resistance exercise/strength training. However, when reports were obtained weekly for 13 weeks, only approximately 18% of respondents met the guidelines.
Results indicate that the timing and nature of questioning can substantially influence the self-reported prevalence of muscle-strengthening physical activities for community-dwelling women.
Catrine Tudor-Locke, Tiago V. Barreira, Robert M. Brouillette, Heather C. Foil and Jeffrey N. Keller
The relationship between clinically assessed and free-living walking is unclear. Cadence (steps/min) can be measured accurately under both conditions using modern technologies, thus providing a common measurement metric. Therefore, the purpose of this study was to compare clinical and free-living cadence in older adults.
15 community-dwelling older adults (7 men, 8 women; 61–81 years) completed GAITRite-determined normal and dual-task walks and wore objective monitors for 1 week. Descriptive data included gait speed (cm/sec), steps/day, as well as cadence. Nonparametric tests evaluated differences between normal and dual-task walks and between accelerometer- and pedometer-determined steps/day. Free-living time detected above clinically determined cadence was calculated.
Participants crossed the GAITRite at 125.56 ± 15.51 cm/sec (men) and 107.93 ± 9.41 steps/min (women) during their normal walk and at 112.59 ± 17.90 cm/sec and 103.10 ± 1.30 steps/min during their dual-task walk (differences between walks P < .05). Overall, they averaged 7159 ± 2480 (accelerometer) and 7813 ± 2919 steps/day (pedometer; difference NS). On average, < 10 min/day was spent above clinically determined cadences.
High-functioning, community-dwelling older adults are capable of walking at relatively high cadences (ie, > 100 steps/min). However, the same behavior appears to be uncommon in daily life, even for a minute.
Kim T.J. Bongers, Yvonne Schoon, Maartje J. Graauwmans, Marlies E. Hoogsteen-Ossewaarde and Marcel G.M. Olde Rikkert
Self-management of mobility and fall risk might be possible if older adults could use a simple and safe self-test to measure their own mobility, balance, and fall risk at home. The aim of this study was to determine the safety, feasibility, and intraindividual reliability of the maximal step length (MSL), gait speed (GS), and chair test (CT) as potential self-tests for assessing mobility and fall risk. Fifty-six community-dwelling older adults performed MSL, GS, and CT at home once a week during a four-week period, wherein the feasibility, test-retest reliability, coefficients of variation, and linear mixed models with random effects of these three self-tests were determined. Forty-nine subjects (mean age 76.1 years [SD: 4.0], 19 females [42%]) completed the study without adverse effects. Compared with the other self-tests, MSL gave the most often (77.6%) valid measurement results and had the best intraclass correlation coefficients (0.95 [95% confidence interval: 0.91−0.97]). MSL and GS gave no significant training effect, whereas CT did show a significant training effect (p < .01). Community-dwelling older adults can perform MSL safely, correctly, and reliably, and GS safely and reliably. Further research is needed to study the responsiveness and beneficial effects of these self-tests on self-management of mobility and fall risk.
Tamar Semerjian and Dawn Stephens
This study examined the relationships between older women’s comparison styles, physical self-perceptions, and functional fitness. Participants were community-dwelling women (N = 102, age 65-99) living in the mid-Atlantic region of the United States. Individuals were categorized as relying primarily on social comparisons, temporal comparisons, or a combination of both styles. Also of interest was whether individuals evaluated themselves positively or negatively when making comparisons. Participants who evaluated themselves positively as compared with others were found to have higher levels of physical self-perception. Analyses revealed that women who relied primarily on temporal comparisons had higher self-perceptions of their functional ability than those who relied on a combination of comparison styles. An avoidance of both temporal and social comparisons was also related to higher levels of physical self-perception.
David Alexander Leaf and Holden MacRae
The purpose of this study was to examine the criterion-related validity of two indirect measures of energy expenditure (EE): American College of Sports Medicine (ACSM) predictive equations, and estimated EE based on the Caltrac accelerometer. These measures were compared in 20 community-dwelling older men and women (mean age 71 years). The strength of the relationships among major determinants of EE during self-selected speeds of treadmill and outdoor walking was also examined. EE measured by respiratory gas analysis during an exercise stress test was highly correlated with ACSM predictive equations and poorly correlated with Caltrac. Multivariate regression equations were established to evaluate the ability of independent variables—body weight and height, age, and preferred treadmill walking speed—to predict EE (dependent variable). It was concluded that the ACSM predictive equations are suitable for use in elderly individuals, and that the apparent differences in the relationships between treadmill and outdoor walking speeds on EE deserve further investigation.