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Jane Chung, George Demiris and Hilaire J. Thompson

Mobility is critical in maintaining independence in older adults. This study aims to systematically review the scientific literature to identify measures of mobility limitation for community-dwelling older adults. A systematic search of PubMed, CINAHL, and psycINFO, using the search terms “mobility limitation”, “mobility disability”, and “mobility difficulty” yielded 1,847 articles from 1990 to 2012; a final selection of 103 articles was used for the present manuscript. Tools to measure mobility were found to be either self-report or performance-based instruments. Commonly measured constructs of mobility included walking, climbing stairs, and lower extremity function. There was heterogeneity in ways of defining and measuring mobility limitation in older adults living in the community. Given the lack of consistency in assessment tools for mobility, a clear understanding and standardization of instruments are required for comparison across studies and for better understanding indicators and outcomes of mobility limitation in community-dwelling older adults.

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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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David M. Wert, Jessie M. VanSwearingen, Subashan Perera and Jennifer S. Brach

The purpose of this study was to assess the relative and absolute reliability of metabolic measures of energy expenditure and gait speed during overground walking in older adults with mobility limitations. Thirty-three (mean age [SD] = 76.4 [6.6] years; 66% female) older adults with slow gait participated. Measures of energy expenditure and gait speed were recorded during two 6-min bouts of overground walking (1 week apart) at a self-selected “usual” walking pace. The relative reliability for all variables was excellent: ICC = .81−.91. Mean differences for five of the six outcome variables was less than or equal to the respected SEM, while all six mean differences fell below the calculated MDC95. Clinicians and researchers can be confident that metabolic measures of energy expenditure and gait speed in older adults with slow walking speeds can be reliably assessed during overground walking, providing an alternative to traditional treadmill assessments.

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Michael P. Corcoran, Miriam E. Nelson, Jennifer M. Sacheck, Kieran F. Reid, Dylan Kirn, Roger A. Fielding, Kenneth K.H. Chui and Sara C. Folta

, E.M. , Naydeck , B.L. , Boudreau , R.M. , Kritchevsky , S.B. , Nevitt , M.C. , … Harris , T.B. ( 2006 ). Association of long-distance corridor walk performance with mortality, cardiovascular disease, mobility limitation, and disability . The Journal of the American Medical Association

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Deborah Hebling Spinoso, Nise Ribeiro Marques, Dain Patrick LaRoche, Camilla Zamfollini Hallal, Aline Harumi Karuka, Fernanda Cristina Milanezi and Mauro Gonçalves

younger women between the ages of 18 and 25 years was recruited from the university. The study specifically recruited women because they are more likely to possess low muscle mass and strength, placing them at risk for mobility limitation ( Lindle et al., 1997 ). During an initial interview, participants

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Astrid C.J. Balemans, Han Houdijk, Gilbert R. Koelewijn, Marjolein Piek, Frank Tubbing, Anne Visser-Meily and Olaf Verschuren

was expressed as a percentage of muscle activity during walking and not as a percentage of maximal voluntary contraction as this is not feasible in persons with impaired muscle activation. Muscle activity during walking might be higher in people with severe mobility limitation; therefore, the absolute

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Jennifer Ryan, Michael Walsh and John Gormley

This study investigated the ability of published cut points for the RT3 accelerometer to differentiate between levels of physical activity intensity in children with cerebral palsy (CP). Oxygen consumption (metabolic equivalents; METs) and RT3 data (counts/min) were measured during rest and 5 walking trials. METs and corresponding counts/min were classified as sedentary, light physical activity (LPA), and moderate to vigorous physical activity (MVPA) according to MET thresholds. Counts were also classified according to published cut points. A published cut point exhibited an excellent ability to classify sedentary activity (sensitivity = 89.5%, specificity = 100.0%). Classification accuracy decreased when published cut points were used to classify LPA (sensitivity = 88.9%, specificity = 79.6%) and MVPA (sensitivity = 70%, specificity = 95–97%). Derivation of a new cut point improved classification of both LPA and MVPA. Applying published cut points to RT3 accelerometer data collected in children with CP may result in misclassification of LPA and MVPA.

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Ching-Yi Wang, Ching-Fan Sheu and Elizabeth Protas

The purpose of this study was to test the construct validity of the hierarchical levels of self-reported physical disability using health-related variables and physical-performance tests as criteria. The study participants were a community-based sample of 368 adults age 60 years or older. These older adults were grouped into 4 levels according to their physical-disability status (able, mildly disabled, moderately disabled, and severely disabled groups) based on their self-reported measures on the mobility, instrumented activity of daily living (IADL), and activities of daily living (ADL) domains. Health-related variables (body-mass index, number of comorbidities, depression status, mental status, and self-perceived health status) and eight performance-based tests demonstrated significant group differences. Self-reported measures of physical disability can be used to categorize older adults into different stages of physical functional decline.

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Jieling Chen, Emily Joy Nicklett, Yaping He and Vivian W.Q. Lou

, and/or other chronic conditions), BMI, and mobility limitation (Table  1 ). The disease stage was classified into Stage 3a, Stage 3b, and Stage 4, according to KDIGO 2012 clinical practice guidelines ( Eknoyan et al., 2013 ). Four chronic conditions were separately examined: diabetes, hypertension

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Kevin R. Short, April M. Teague, Jake C. Klein, Elizabeth Malm-Buatsi and Dominic Frimberger

Purpose:

Whole body or leg exercise before a meal can increase insulin sensitivity, but it is unclear whether the same can occur with upper body exercise since a smaller muscle mass is activated. We measured the impact of a single session of handcycle exercise on glucose tolerance and insulin sensitivity.

Methods:

Nonambulatory (Non-Amb) adolescents with spina bifida or cerebral palsy (4F/3M), or ambulatory peers (Control, 4F/7M) completed 2 glucose tolerance tests on separate days, preceded by either rest or a 35-min bout of moderate-to-vigorous intermittent handcycle exercise.

Results:

The Non-Amb group had higher body fat (mean ± SD: 38 ± 12%, Control: 24 ± 9, p = .041) but similar VO2peak (17.7 ± 6.1 ml/kg/min, Control: 21.1 ± 7.9). Fasting glucose and insulin were normal for all participants. Compared with the rest trial, exercise resulted in a reduction in glucose area under the curve (11%, p = .008) without a significant group x trial interaction and no difference in the magnitude of change between groups. Insulin sensitivity was increased 16% (p = .028) by exercise in the Control group but was not significantly changed in the Non-Amb group.

Conclusion:

A single bout of handcycle exercise improves glucose tolerance in adolescents with and without mobility limitations and could therefore help maintain or improve metabolic health.