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Robert M. Kaplan, Alison K. Herrmann, James T. Morrison, Laura F. DeFina and James R. Morrow Jr.

Background:

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.

Purpose:

To evaluate the economic costs associated with PA-related MSIs in community-dwelling women.

Method:

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.

Results:

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.

Conclusions:

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.

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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.

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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.

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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.

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L. Jerome Brandon, Lisa W. Boyette, Adreinne Lloyd and Deborah A. Gaasch

The purpose of this study was to evaluate the effects of a 24-month moderate-intensity resistive-training intervention on strength and function in older adults. A repeated-measures experimental research design was employed as a sample of 55 apparently healthy, older, community-dwelling volunteers (30 exercisers—25 women and 5 men; 25 comparisons—16 women and 9 men) were evaluated for strength of 5 muscle groups that influence lower extremity movement and physical function. Strength and function were evaluated at 6-month intervals. The findings from this study indicate that a moderate-intensity resistive-training program increases strength in older adults and that the strength benefits are retained for the duration of the intervention. Furthermore, a long-term strength-training program can increase independent-function skills in older adults and might therefore aid in prolonging functional independence.

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Susan Williams, Claudia Meyer, Frances Batchelor and Keith Hill

The objective of this study was to determine whether improved balance outcomes achieved in a randomized controlled trial (RCT) using balance screening to identify mild balance dysfunction and home exercises could be translated into community settings. Community-dwelling people aged over 65 who expressed concerns about their balance, had less than two falls in the preceding 12 months, and who had mild balance impairment on screening were given an individualized home-based balance and strengthening exercise program with intermittent home-visit support by a physiotherapist. Of 71 participants assessed (mean age 77.3 years, 76% female), 58 (82%) completed the six-month intervention. Twenty six percent of participants regained balance performance within normal limits—similar to those achieved in the previous RCT. Successful results from a previous RCT were able to be translated into community settings, with a similar magnitude of effect on balance and mobility.

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Christine B. Phillips, Jerri D. Edwards, Ross Andel and Marcus Kilpatrick

Physical activity (PA) is believed to preserve cognitive function in older adulthood, though little is known about these relationships within the context of daily life. The present microlongitudinal pilot study explored within- and between-person relationships between daily PA and cognitive function and also examined within-person effect sizes in a sample of community-dwelling older adults. Fifty-one healthy participants (mean age = 70.1 years) wore an accelerometer and completed a cognitive assessment battery for five days. There were no significant associations between cognitive task performance and participants’ daily or average PA over the study period. Effect size estimates indicated that PA explained 0–24% of within-person variability in cognitive function, depending on cognitive task and PA dose. Results indicate that PA may have near-term cognitive effects and should be explored as a possible strategy to enhance older adults’ ability to perform cognitively complex activities within the context of daily living.

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Bang Hyun Kim, Roberta A. Newton, Michael L. Sachs, Peter R. Giacobbi Jr. and Joseph J. Glutting

The purpose of this study was to examine the effects of a 6-wk intervention that used guided relaxation and exercise imagery (GREI) to increase self-reported leisure-time exercise behavior among older adults. A total of 93 community-dwelling healthy older adults (age 70.38 ± 8.15 yr, 66 female) were randomly placed in either a placebo control group or an intervention group. The intervention group received instructions to listen to an audio compact disk (CD) containing a GREI program, and the placebo control group received an audio CD that contained 2 relaxation tracks and instructions to listen to music of their choice for 6 wk. Results revealed that listening to a GREI CD for 6 wk significantly increased self-reported leisure-time exercise behaviors (p = .03). Further exploration of GREI and its effects on other psychological variables related to perceived exercise behaviors may substantiate its effectiveness.

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Kristin Taraldsen, Beatrix Vereijken, Pernille Thingstad, Olav Sletvold and Jorunn L. Helbostad

The aim of the study was to investigate the precision of estimated upright time during one week in community-dwelling older adults after hip fracture when monitoring activity for different numbers of consecutive days. Information about upright time was collected by thigh-worn accelerometers during 7 consecutive days in 31 older adults (mean age 81.8 years ± 5.3) 3 months after hip-fracture surgery. Mean time in upright position, including both standing and walking, was 260.9 (±151.2) min/day. A cutoff value of half an hour was used to provide recommendations about number of recording days. Large variability between participants between days, as well as a nonconstant within-participant variability between days indicates that at least 4 consecutive days of recording should be used to obtain a reliable estimate of upright time for individual persons. However, at a group level, one day of recording is sufficient.

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Ronald D. Adelman, Michele G. Greene, Erika Friedmann, Marcia G. Ory and Caitlin E. Snow

This cross-sectional observational study examined the frequency of older patient–physician discussions about exercise, who initiates discussions, and the quality of questioning, informing, and support about exercise. The study used a convenience sample of 396 follow-up visits at 3 community-based practice sites, with 376 community-dwelling older patients and 43 primary-care physicians. Audiotapes were analyzed using the Multi-Dimensional Interaction Analysis coding system. Results demonstrate that exercise was discussed in 13% of visits and the subject was raised equally by patients and physicians. Exercise was significantly more likely to be discussed in dyadic visits (14.7%) than in triadic visits (4.1%). Patient level of education, patient overall physical health, and the physician’s being female were significant predictors of the occurrence of exercise discussion. Given the importance of exercise for maintaining health and independence in older adults, more clinical and research attention is needed to address barriers to effective discussions in this area.