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Kathleen Benjamin, Nancy Edwards, Jenny Ploeg and Frances Legault

Despite the benefits of physical activity, residents living in long-term care (LTC) are relatively sedentary. Designing successful physical activity and restorative care programs requires a good understanding of implementation barriers. A database search (2002–2013) yielded seven studies (nine articles) that met our inclusion criteria. We also reviewed 31 randomized controlled trials (RCTs) to determine if the authors explicitly discussed the barriers encountered while implementing their interventions. Eleven RCTs (13 articles) included a discussion of the barriers. Hence, a total of 18 studies (22 articles) were included in this review. Barriers occurred at resident (e.g., health status), environmental (e.g., lack of space for physical activity), and organizational (e.g., staffing and funding constraints) levels. These barriers intersect to adversely affect the physical activity of older people living in LTC. Future studies targeting physical activity interventions for residents living in LTC are needed to address these multiple levels of influence.

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Dorothy Pekmezi, Shira Dunsiger, Ronnesia Gaskins, Brooke Barbera, Becky Marquez, Charles Neighbors and Bess Marcus

Background:

Due to high rates of inactivity and related chronic illnesses among Latinas,1 the current study examined the feasibility and acceptability of using pedometers as an intervention tool in this underserved population.

Methods:

Data were taken from a larger randomized, controlled trial2 and focused on the subsample of participants (N = 43) who were randomly assigned to receive a physical activity intervention with pedometers and instructions to log pedometer use daily and mail completed logs back to the research center each month for 6 months.

Results:

Retention (90.7% at 6 months) and adherence to the pedometer protocol (68.89% returned ≥ 5 of the 6 monthly pedometer logs) were high. Overall, participants reported increased physical activity at 6 months and credited pedometer use for helping them achieve these gains (75.7%). Participants who completed a high proportion (≥ 5/6) of pedometer logs reported significantly greater increases in physical activity and related process variables (stages of change, self-efficacy, behavioral processes of change, social support from friends) than those who were less adherent (completed < 5 pedometer logs).

Conclusions:

Pedometers constitute a low-cost, useful tool for encouraging self-monitoring of physical activity behavior in this at-risk group.

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Gary S. Goldfield

Objective:

To compare liking and other attitudes toward physical activity (PA) and television (TV) viewing versus PA behavior and time viewing TV at baseline as predictors of response to lifestyle intervention in 30, 8 to 12 year old overweight/obese children.

Method:

Secondary analyses from a randomized controlled trial designed to increase PA and reduce sedentary behavior. PA was measured by accelerometers worn by participants every day for 8 weeks. TV viewing at baseline and during intervention was assessed by self-report.

Results:

Multiple regression analyses showed that base rates of PA and TV viewing significantly predicted changes in PA (Beta = .39, P < .05) and TV viewing (Beta = .37, P < .05) during the intervention, even after statistically controlling for child age, gender, body mass index, as well as baseline attitudes and liking of PA and TV viewing. However, self-reported liking of TV viewing and PA, perceived adequacy, and predilection were not predictive of response to intervention.

Conclusions:

Baseline measure of PA and TV viewing behaviors may be better predictors of response to lifestyle intervention than measure of liking and other attitudinal variables of PA. The theoretical and clinical implications of these findings are discussed.

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Edward M. Phillips, Jeffrey Katula, Michael E. Miller, Michael P. Walkup, Jennifer S. Brach, Abby C. King, W. Jack Rejeski, Tim Church and Roger A. Fielding

Objectives:

To examine baseline characteristics and change in gait speed and Short Physical Performance Battery (SPPB) scores in participants medically suspended (MS) from a physical activity intervention (PA).

Design:

Randomized controlled trial.

Setting:

University and community centers.

Participants:

Sedentary older adults (N = 213) randomized to PA in the Lifestyle Interventions and Independence for Elders Pilot (LIFE-P).

Measurements:

MS was defined as missing 3 consecutive PA sessions in adoption and transition phases or 2 wk in maintenance phase because of a health event.

Results:

In all, 122 participants completed PA without MS (NMS subgroup), 48 participants underwent MS and resumed PA (SR subgroup), and 43 participants underwent MS and did not complete PA (SNR subgroup). At baseline, SNR walked slower (p = .03), took more prescribed medications (p = .02), and had lower SPPB scores than NMS and SR (p = .02). Changes from baseline to Month 12 SPPB scores were affected by suspension status, adjusted mean (SE) SPPB change: SNR 0.0957 (0.3184), SR 0.9413 (0.3063), NMS 1.0720 (0.1871); p = .03.

Conclusions:

MS participants unable to return to complete the PA in a trial of mobility-limited sedentary older adults had slower walking speeds, lower SPPB scores, and a higher number of prescribed medications at baseline. Change in SPPB scores at 12 months was related to suspension status.

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Colleen A. Cuthbert, Kathryn King-Shier, Dean Ruether, Dianne M. Tapp and S. Nicole Culos-Reed

Background:

Family caregivers are an important health care resource and represent a significant proportion of Canadian and US populations. Family caregivers suffer physical and psychological health problems because of being in the caregiver role. Interventions to support caregiver health, including physical activity (PA), are slow to be investigated and translated into practice.

Purpose:

To examine the evidence for PA interventions in caregivers and determine factors hampering the uptake of this evidence into practice.

Methods:

A systematic review and evaluation of internal and external validity using the RE-AIM (Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance) framework was conducted. Randomized controlled trials or pretest/posttest studies of PA interventions were included.

Results:

Fourteen studies were published between 1997 and 2015. Methodological quality of studies and risk of bias was variable. External validity criteria were often not reported. Mean reporting levels were 1) reach, 53%; 2) efficacy/effectiveness, 73%; 3) adoption, 18%; 4) implementation, 48%; and 5) maintenance, 2%.

Conclusions:

The lack of reporting of components of internal and external validity hinders the integration of caregiver PA interventions into clinical or community settings. Researchers should focus on standardized outcomes, accepted reporting criteria, and balancing factors of internal and external validity, to advance the state of the science.

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Wei Duan-Porter, Remy R. Coeytaux, Jennifer R. McDuffie, Adam P. Goode, Poonam Sharma, Hillary Mennella, Avishek Nagi and John W. Williams Jr.

Background:

This study describes evidence of yoga’s effectiveness for depressive disorders, general anxiety disorder (GAD), panic disorder (PD), and posttraumatic stress disorder (PTSD) in adults. We also address adverse events associated with yoga.

Methods:

We searched multiple electronic databases for systematic reviews (SRs) published between 2008 and July 2014, randomized controlled trials (RCTs) not identified in eligible SRs, and ongoing RCTs registered with ClincalTrials.gov.

Results:

We identified 1 SR on depression, 1 for adverse events, and 3 addressing multiple conditions. The high-quality depression SR included 12 RCTs (n = 619) that showed improved short-term depressive symptoms (standardized mean difference, –0.69, 95% confidence interval, –0.99 to –0.39), but there was substantial variability (I2 = 86%) and a high risk of bias for 9 studies. Three SRs addressing multiple conditions identified 4 nonrandomized studies (n = 174) for GAD/PD and 1 RCT (n = 8) and 2 nonrandomized studies (n = 22) for PTSD. We separately found 1 RCT (n = 13) for GAD and 2 RCTs (n = 102) for PTSD. Collectively, these studies were inconclusive for the effectiveness of yoga in treating GAD/PD and PTSD. The high-quality SR for adverse events included 37 primary reports (n = 76) in which inversion postures were most often implicated. We found 5 ongoing trials (3 for PTSD).

Conclusions:

Yoga may improve short-term depressive symptoms, but evidence for GAD, PD, and PTSD remain inconclusive.

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Erja Portegijs, Sanna Read, Inka Pakkala, Mauri Kallinen, Ari Heinonen, Taina Rantanen, Markku Alen, Ilkka Kiviranta, Sanna Sihvonen and Sarianna Sipilä

Our aim was to study the effects of sense of coherence (SOC) on training adherence and interindividual changes in muscle strength, mobility, and balance after resistance training in older people with hip fracture history. These are secondary analyses of a 12-week randomized controlled trial of progressive resistance training in 60- to 85-year-old community-dwelling people 0.5–7 years after hip fracture (n = 45; ISRCTN34271567). Pre- and posttrial assessments included SOC, knee extension strength, walking speed, timed up-and-go (TUG), and Berg Balance Scale (BBS). Group-by-SOC interaction effects (repeated-measures ANOVA) were statistically significant for TUG (p = .005) and BBS (p = .040), but not for knee extension strength or walking speed. Weaker SOC was associated with poorer training adherence (mixed model; p = .009). Thus, more complicated physical tasks did not improve in those with weaker SOC, independently of training adherence. Older people with weaker SOC may need additional psychosocial support in physical rehabilitation programs to optimize training response.

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Saija Karinkanta, Ritva Nupponen, Ari Heinonen, Matti Pasanen, Harri Sievänen, Kirsti Uusi-Rasi, Mikael Fogelholm and Pekka Kannus

This randomized, controlled trial evaluated the effects of exercise on health-related quality of life (HRQoL) and fear of falling (FoF) among 149 home-dwelling older women. The 12-mo exercise program was intended to reduce the risk of falls and fractures. HRQoL was assessed by the RAND-36 Survey, and FoF, with a visual analog scale, at baseline, 12 mo, and 24 mo. On all RAND-36 scales, the scores indicated better health and well-being. The exercise had hardly any effect on HRQoL; only the general health score improved slightly compared with controls at 12 mo (p = .019), but this gain was lost at 24 mo. FoF decreased in both groups during the intervention with no between-groups difference at 12 or 24 mo. In conclusion, despite beneficial physiological changes, the exercise intervention showed rather limited effects on HRQoL and FoF among relatively high-functioning older women. This modest result may be partly because of insufficient responsiveness of the assessment instruments used.

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Jakob Tarp, Lars B. Andersen and Lars Østergaard

Background:

Cycling to and from school is an important source of physical activity (PA) in youth but it is not captured by the dominant objective method to quantify PA. The aim of this study was to quantify the underestimation of objectively assessed PA caused by cycling when using accelerometry.

Methods:

Participants were 20 children aged 11 to 14 years from a randomized controlled trial performed in 2011. Physical activity was assessed by accelerometry with the addition of heart rate monitoring during cycling to school. Global positioning system (GPS) was used to identify periods of cycling to school.

Results:

Mean minutes of moderate-to-vigorous physical activity (MVPA) during round-trip commutes was 10.8 (95% CI: 7.1−16.6). Each kilometer of cycling meant an underestimation of 9314 (95% CI: 7719−11238) counts and 2.7 (95% CI: 2.1−3.5) minutes of MVPA. Adjusting for cycling to school increased estimates of MVPA/day by 6.0 (95% CI: 3.8−9.6) minutes.

Conclusions:

Cycling to and from school contribute substantially to levels of MVPA and to mean counts/min in children. This was not collected by accelerometers. Using distance to school in conjunction with self-reported cycling to school may be a simple tool to improve the methodology.

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Leon Mabire, Ramakrishnan Mani, Lizhou Liu, Hilda Mulligan and David Baxter

Background:

Brisk walking is the most popular activity for obesity management for adults. We aimed to identify whether participant age, sex and body mass index (BMI) influenced the effectiveness of brisk walking.

Methods:

A search of 9 databases was conducted for randomized controlled trials (RCTs). Two investigators selected RCTs reporting on change in body weight, BMI, waist circumference, fat mass, fat-free mass, and body fat percentage following a brisk walking intervention in obese adults.

Results:

Of the 5072 studies screened, 22 met the eligibility criteria. The pooled mean differences were: weight loss, –2.13 kg; BMI, –0.96 kg/m2; waist circumference, –2.83 cm; fat mass, –2.59 kg; fat-free mass, 0.29 kg; and body fat percentage, –1.38%. Meta-regression of baseline BMI showed no effect on changes.

Conclusions:

Brisk walking can create a clinically significant reduction in body weight, BMI, waist circumference, and fat mass for obese men and women aged under 50 years. Obese women aged over 50 years can achieve modest losses, but gains in fat-free mass reduce overall change in body weight. Further research is required for men aged over 50 years and on the influence of BMI for all ages and sexes.