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.
Lesley Day, Margaret J. Trotter, Alex Donaldson, Keith D. Hill and Caroline F. Finch
Marissa E. Mendelsohn, Denise M. Connelly, Tom J. Overend and Robert J. Petrella
Although popular in clinical settings, little is known about the utility of all-extremity semirecumbent exercise machines for research. Twenty-one community-dwelling older adults performed two exercise trials (three 4-min stages at increasing workloads) to evaluate the reliability and validity of exercise responses to submaximal all-extremity semirecumbent exercise (BioStep). Exercise responses were measured directly (Cosmed K4b2) and indirectly through software on the BioStep. Test–retest reliability (ICC2,1) was moderate to high across all three stages for directly measured METs (.92, .87, and .88) and HR (.91, .83, and .86). Concurrent criterion validity between the K4b2 and BioStep MET values was moderate to very good across the three stages on both Day 1 (r = .86, .71, and .83) and Day 2 (r = .73, .87, and .72). All-extremity semirecumbent submaximal exercise elicited reliable and valid responses in our sample of older adults and thus can be considered a viable exercise mode.
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.
Jill A. Bennett, Kerri Winters-Stone, Lillian M. Nail and Jennifer Scherer
This review describes the definitions of sedentary used to screen community-dwelling adults in physical-activity-intervention trials published from 2000 to 2005. Results of 42 trials showed that definitions of sedentary varied from <20 to <150 min/week of physical activity, and few reported the type (work, household, or leisure) or intensity of activity that was used to screen participants. The range of “sedentary” samples makes it difficult to compare trial results or generalize findings. Published reports of exercise trials would be more useful to practitioners and researchers if they included an explicit description of the cut point used to define sedentary adults in the sample, in terms of maximum minutes or days per week of activity and the wording of the screening measure in terms of type and intensity of activity.
Kristin Musselman and Brenda Brouwer
This study examined gender differences in balance, gait, and muscle performance in seniors and identified gender-specific factors contributing to physical performance. Forty (20 men, 20 women) healthy, community-dwelling seniors (74.5 ± 5.3 years) participated. Limits of stability, gait speed, lower limb flexor and extensor isokinetic concentric peak torques, self-reported activity level, and balance confidence were measured. No gender differences were detected in gait speed, limits of stability when normalized to height, activity level, or balance confidence (p ≥ .188). Women were weaker than men (p ≤ .007), even after controlling for weight and body-mass index, suggesting that other gender-related factors contribute to strength. Gender accounted for 18–46% of the variance in strength and served as a modifier of the relationship between activity level and strength in some muscle groups. The primary factors relating to gender-specific strength was activity level in men and body weight in women.
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.
Barbara Resnick, Kathleen Michael, Marianne Shaughnessy, Eun Shim Nahm, Susan Kopunek, John Sorkin, Denise Orwig, Andrew Goldberg and Richard F. Macko
Self-report measures of physical activity have well-known drawbacks, and physiologic measures alone do not account for behavioral variables important in the perception and performance of physical activity. Therefore, we considered multiple measures to quantify physical activity in community-dwelling men and women with chronic stroke.
This analysis included data from a volunteer sample of 87 individuals at least 6 months poststroke. Physical activity was measured using self-report questionnaires, step activity monitors, self-efficacy expectations related to exercise, and VO2peak from treadmill testing, and a model of physical activity was tested.
Most of the variance in objective physical activity was explained by VO2peak, and most of the variance in subjective physical activity was explained by self-efficacy expectations. There were significant discrepancies between subjective and objective findings.
This study helps to understand the perspective of stroke survivors with regard to physical activity.
Kristiann C. Heesch, Jannique van Uffelen and Wendy J. Brown
The aim of this study was to examine older adults’ understanding and interpretation of a validated questionnaire for physical activity surveillance, the Active Australia Survey (AAS). To address this aim, cognitive interviewing techniques were used during face-to-face semistructured interviews with 44 adults age 65–89 years. Qualitative data analysis revealed that participants were confused with questionnaire phrasing, misunderstood the scope of activities to include in answers, and misunderstood the time frame of activities to report. They also struggled to accurately estimate the frequency and duration of their activities. Our findings suggest that AAS questions may be interpreted differently by older adults than intended by survey developers. Findings also suggest that older adults use a range of methods for calculating PA frequency and duration. The issues revealed in this study may be useful for adapting AAS for use in older community-dwelling adults.
Joe R. Nocera, Keith M. McGregor, Chris J. Hass and Bruce Crosson
Studies suggest improvements of neurocognitive function among older adults who undergo aerobic exercise training. This study sought to examine the impact of an aerobic exercise intervention on verbal fluency in sedentary older adults. Twenty community-dwelling older adults were recruited and enrolled in either a spin exercise group or a control condition. Participants were evaluated with an estimated V02max test and on measures of letter, category, and switching verbal fluency both before and after a 12-week intervention period. Spin exercise resulted in a significant improvement in category (semantic) verbal fluency when compared with the control group (15% vs. 2% increase, respectively; P = .001). Spin exercise also resulted in a significant improvement in estimated V02max (P = .005). Also important, the spin exercise group demonstrated a high level of adherence (mean adherence = 82.5%). Spin exercise can be an effective mode of aerobic exercise to improve semantic fluency in previously sedentary older adults.
Koen A.P.M. Lemmink, Han C.G. Kemper, Mathieu H.G. de Greef, Piet Rispens and Martin Stevens
This article focuses on the validity of the circumduction test for measuring shoulder flexibility in older adults. Participants included 137 community-dwelling older adults. Equipment consisted of a cord with a fixed handle on one end and a sliding handle on the other. The sliding handle was adjusted so that the cord length between the 2 handles equaled the participant’s shoulder width. Holding the 2 handles, the participant must pass the cord from the front of the body over the head and as far back as possible with extended arms. The score is the fanning-out angle. Forward flexion, abduction, horizontal retroflexion, and outward rotation were also measured. The test and criterion measurements were administered within 1 wk. The criterion-related validity of the circumduction test as a measure of forward flexion and horizontal retroflexion received support from moderate correlations. Its use as a measure of abduction and outward rotation, however, received no support from the data.