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David E. Vance, Virginia G. Wadley, Karlene K. Ball, Daniel L. Roenker and Matthew Rizzo

Physical activity has been shown to be positively associated with cognitive health, but the mechanisms underlying the benefits of physical activity on cognitive health are unclear. The present study simultaneously examined two hypotheses using structural equation modeling (SEM). The depression-reduction hypothesis states that depression suppresses cognitive ability and that physical activity alleviates dysphoric mood and thereby improves cognitive ability. The social-stimulation hypothesis posits that social contact, which is often facilitated by socially laden physical activities, improves cognitive functioning by stimulating the nervous system. Sedentary behavior in the absence of physical activity is expected to exert an inverse relationship on cognitive health through each of these hypotheses. Community-dwelling elders (N = 158) were administered a variety of measures of cognition, depression, social support, and physical activity. SEM techniques provided partial support for the social-stimulation hypothesis and depression-reduction hypothesis. Implications for treating depression and improving cognitive functioning are discussed.

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Corjena Cheung, Jean Wyman, Cynthia Gross, Jennifer Peters, Mary Findorff and Holly Stock

The transtheoretical model (TTM) was developed as a guide for understanding behavior change. Little attention has been given, however, to the appropriateness of the TTM for explaining the adoption of exercise behavior in older adults. The purposes of this study were to determine the reliability of the TTM instruments and validate TTM predictions in 86 community-dwelling older adults (mean age 75.1 ± 7.0 years, 87% women) who were participants in a 16-week walking program. TTM construct scales—self-efficacy, decisional balance (pros and cons), and processes of change (behavioral and cognitive)—were generally reliable (all α > .78). Behavioral processes of change increased from baseline to follow-up, but pros, cons, and cognitive processes did not change among participants who became regular exercisers. Stage of change did not predict exercise adoption, but baseline self-efficacy predicted walking behavior. These results lend partial support to the TTM in predicting exercise behavior.

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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.

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Minna Rasinaho, Mirja Hirvensalo, Raija Leinonen, Taru Lintunen and Taina Rantanen

The purpose of this study was to investigate what older adults with severe, moderate, or no mobility limitation consider motives for and barriers to engaging in physical exercise. Community-dwelling adults (N = 645) age 75–81 years completed a questionnaire about their motives for and barriers to physical exercise and answered interview questions on mobility limitation. Those with severely limited mobility more often reported poor health, fear and negative experiences, lack of company, and an unsuitable environment as barriers to exercise than did those with no mobility limitation. They also accentuated disease management as a motive for exercise, whereas those with no or moderate mobility limitation emphasized health promotion and positive experiences related to exercise. Information about differences in motives for and barriers to exercise among people with and without mobility limitation helps tailor support systems that support engagement in physical activity among older adults.

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Elissa Burton, Gill Lewin and Duncan Boldy

The proportion of older people living in our communities is rising and, to live independently, some require assistance from home care services. Physical activity can improve and maintain function, strength, and balance, which are important for those receiving home care. This study reviewed the evidence on physical activity/exercise interventions trialed with older people receiving a home care service. A systematic review of studies published from January 1982 to September 2012, from five databases, was undertaken. Inclusion criteria were: aged 65+ years; community dwelling; no dementia diagnosis; receiving home care services; and a physical activity/exercise program. Eight articles were included and results show there were few consistencies between intervention types, groups, outcome measures, and follow-up. Study quality was mixed. Future studies should include pragmatic randomized controlled trials involving home care practitioners and their clients to gain “real-world” knowledge of what interventions are effective and can be delivered within this setting.

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Priscilla Gilliam MacRae, Michael E. Feltner and Sibylle Reinsch

This study examined the effects of a 1-year low intensity exercise program in community dwelling older women on falls, injuries, and risk factors for falls such as poor balance, muscular weakness, and gait abnormalities. Eighty older women were assigned to an exercise (Ex, n = 42) or attention control (Co, n = 38) group. During the 1-year study, 36% of the Ex group experienced a fall compared to 45% of the Co group (χ2 = 0.22, p ≥ 0.05). None of the 10 fallers in the Ex group suffered an injury that required medical attention, compared with 3 of the 14 fallers (21%) in the Co group. Further analyses indicated that the Co group declined significantly in isometric strength of the knee extensors and ankle dorsiflexors while the Ex group did not change significantly across the 1-year study. On measures of hip abductor strength, balance, and gait, the groups were not significantly different from each other pre- to post intervention.

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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.

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Gareth R. Jones, Jennifer M. Jakobi, Albert W. Taylor, Rob J. Petrella and Anthony A. Vandervoort

Community-based rehabilitative exercise programs might be an effective means to improve functional outcomes for hip-fracture patients. The purpose of this study was to evaluate the effectiveness of a community exercise program (CEP) for older adults recovering from hip fracture. Twenty-five older adults (mean age 80.0 ± 6.0 years; 24 women; 71 ± 23 days post–hip fracture) participated in this pilot study (17 exercise, 8 control). The CEP involved functional stepping and lower extremity–strengthening exercises. Control participants received only standard outpatient therapy. Measures of functional mobility, balance confidence, falls efficacy, lower extremity strength, and daily physical activity were evaluated at baseline and at 16 weeks. Improvements for self-reported physical activity, mobility, balance, and knee-extensor strength were observed for the CEP group. This study demonstrated that a CEP is beneficial for community-dwelling older adults post–hip fracture.

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Lesley Day, Margaret J. Trotter, Alex Donaldson, Keith D. Hill and Caroline F. Finch

The study aim was to evaluate the implementation of group- and home-based exercise falls prevention programs delivered through community health agencies to community-dwelling older people. Interviews with program staff were guided by the Diffusion of Innovations theory. Highly consistent themes emerged for the two types of programs. Both had high overall compatibility, high relative advantage, good observability and high inherent trialability—all factors known to strengthen implementation. The level of complexity and low financial compatibility emerged as the strongest potential inhibitors to program implementation in the context examined. The two main factors contributing to complexity were the need to challenge balance safely across a broad range of capability, and practical considerations associated with program delivery.A range of strategies to provide more technical support for exercise program leaders to tailor balance challenge for exercise program leaders may enhance implementation of falls prevention exercise programs.