Factors influencing older adult community fall prevention exercise implementation: a scoping review.

BACKGROUND: Exercise that challenges balance is the most effective fall prevention intervention in community-dwelling older adults. Identifying factors influencing implementation of community fall prevention exercise programs is a critical step in developing strategies to support program delivery. OBJECTIVE: To identify implementation facilitators, barriers, and details reported in peer-reviewed publications on community fall prevention exercise for older adults. DESIGN: Scoping review. METHODS: We searched multiple databases up to July 2023 for English-language publications that reported facilitators and/or barriers to implementing an evidence-based fall prevention exercise program in adults aged 50+ years living independently. At least two reviewers independently identified publications and extracted article, implementation, and exercise program characteristics and coded barriers and facilitators using the Consolidated Framework for Implementation Research (CFIR). RESULTS: We included 22 publications between 2001 and July 2023 that reported factors influencing implementation of 10 exercise programs. 293 factors were reported: 183 facilitators, 91 barriers, 6 described as both a facilitator and barrier, and 13 unspecified factors. Factors represented 33 CFIR constructs across all five CFIR domains: implementation inner setting (n = 95 factors); innovation (exercise program) characteristics (n = 84); individuals involved (n = 54); implementation process (n = 40) and outer setting (n = 20). Eight publications reported implementation strategies used; 6 reported using a conceptual framework; and 13 reported implementation outcomes. CONCLUSION: The high number of factors reflects the complexity of fall prevention exercise implementation. The low reporting of implementation strategies, frameworks and outcomes highlight the ongoing need for work to implement and sustain community fall prevention exercise programs.

Comparing Online and In-Person Delivery of a Fall Prevention Exercise Program for Older Adults.

Exercise is the single most effective strategy to reduce the risk of falls. Online classes have grown in popularity, but the benefits of online classes remain unknown. Zoomers on the Go is a peer-led 12-week exercise program offered twice weekly to adults 50+ years old. The main outcome was lower body strength measured by the 30-s chair stand test. Other outcomes included dropout, attendance, balance, cardiorespiratory fitness, and perceived health. A total of 74 participants (age 66.3 ± 7.1 years) in the online group and 84 participants in the in-person group (age 67.3 ± 7.2 years) completed the program, with attendance for the online group. Both groups significantly improved their 30-s chair stand, cardiorespiratory fitness, and balance (p < .001) with no difference in functional benefits between groups. The in-person group improved their perceived health and significantly reduced levels of stress and depression, while no such changes were observed in the online group.

Synchronous Group-Based Online Exercise Programs for Older Adults Living in the Community: A Scoping Review.

Older adults are the least physically active group with specific barriers to regular exercise, and online exercise programs could overcome some of those barriers. This scoping review aimed to describe the characteristics of supervised group-based synchronous online exercise programs for older adults living in the community, their feasibility, acceptability, and potential benefits. MEDLINE (Ovid), Embase, SPORTDiscus, and the Cumulative Index to Nursing and Allied Health Literature were searched until November 2022. The included studies met the following criteria: participants aged 50 years and above, a minimum of a 6-week group-based supervised and synchronous intervention, and original articles available in English. Eighteen articles were included, with 1,178 participants (67% female, average age of 71 [57-93] years), most (83%) published in the past 3 years. From the limited reported studies, delivering supervised, synchronous online exercise programs (one to three times/week, between 8 and 32 weeks) for older adults living in the community seems feasible, accepted, and can improve physical function.

Long-term care residents' acceptance of a standing intervention: A qualitative intrinsic case study.

Older adults in long-term care are sedentary. Standing is recommended to reduce sedentary time, but there is limited research on long-term care residents' acceptability of standing interventions. The acceptability of the Stand If You Can (SIYC) randomized clinical trial among long-term care residents was explored using a single intrinsic qualitative case study design. The five month intervention consisted of supervised 100 min standing sessions per week. Participants completed post-intervention interviews, which were analyzed using the Thematic Framework Analysis through the lens of an acceptability framework. The 10 participants (7 female), age 73 to 102 years, stood a median of 53% of the intervention offered time (range 20%-94%). The participants reported acceptability in many aspects of the Theoretical Framework of Acceptability. Standing is a simple intervention to decrease sedentary time and seems to be accepted among long-term care residents when burden is not perceived as too high.

Variability in physical function for patients living with breast cancer during a 12-week exercise program.

PURPOSE: To describe the variability during weekly performance on physical function tests during a 12-week individualized exercise program for patients with breast cancer and to test if the expected improvements in physical function surpass the minimally clinically important difference (MCID), after accounting for week-to-week variance. METHODS: Twenty-five participants, 19 years and older living with breast cancer within 2 years of their initial diagnosis, were recruited. Some participants were undergoing active treatment, while others completed their treatment. The intervention was an individualized exercise session twice a week, for 1 h each session, for a total of 12 weeks. Main outcomes tested included the 6-min walk test and chair stand test. RESULTS: A significant average improvement was observed in the 6MWT (p < .01) and the chair stand test (p < .001) following the intervention. Individual confidence intervals were wide across all testing measures with only 28% and 8% of participants meeting or surpassing the MCID for the 6MWT and chair stand test, respectively. CONCLUSION: Despite a significant improvement in physical function during the program, the majority of patients did not reach the MCID, which could be due to large variability resulting from treatment-related side effects or measurement error.

Potential value of home square-stepping exercises for inactive older adults: an exploratory case study.

BACKGROUND: Most older adults do not engage in regular physical activity. However, more research on options to partake in regular exercise in this population by reducing barriers and enhancing enablers while still reaching benefits is needed. METHODS: Using embedded mixed methods, 10 inactive older adults over the age of 65 completed a 3-week square-stepping exercise intervention to help overcome the initial barriers and activate initial enablers to perform regular exercise. Physical activity level was tracked at home with a pedometer using median steps/day over seven days for pre-post measure. Aerobic intensity while doing square-stepping exercises was quantified via a heart rate monitor in a supervised session. Each participant had an interview asking about barriers and enablers to regular exercise and if the intervention could modify any. Based on initial physical activity a framework matrix was used to pull potential barriers to compare, contrast, and search for patterns between participants with lower and higher initial physical activity levels. RESULTS: The 3-week square-stepping exercise intervention helped participants overcome barriers such as being uncomfortable in a fitness facility and body image and activate enablers such as the use of home equipment and convenience. The median total steps/day increased by 12% (p = 0.02), and a moderate-intensity level was reached by 80% of the sample participants when performing the square stepping exercise during a supervised session. Common barriers such as having a suitable program, hard to keep the intensity were reported by participants regardless of the initial physical activity level. CONCLUSION: Regardless of initial physical activity level, inactive older adults can increase physical activity level at the recommended intensity and overcome common barriers to exercise when performing square-stepping exercises, especially for those intimidated by a fitness facility setting and those concerned with their body image. A longer intervention including more participants using the square-stepping exercises is required to understand if square-stepping exercises can increase the proportion of older adults exercising regularly.

Directions for Exercise Treatment Response Heterogeneity and Individual Response Research.

Treatment response heterogeneity and individual responses following exercise training are topics of interest for personalized medicine. Proposed methods to determine the contribution of exercise to the magnitude of treatment response heterogeneity and categorizing participants have expanded and evolved. Setting clear research objectives and having a comprehensive understanding of the strengths and weaknesses of the available methods are vital to ensure the correct study design and analytical approach are used. Doing so will ensure contributions to the field are conducted as rigorously as possible. Nonetheless, concerns have emerged regarding the ability to truly isolate the impact of exercise training, and the nature of individual responses in relation to mean group changes. The purpose of this review is threefold. First, the strengths and limitations associated with current methods for quantifying the contribution of exercise to observed treatment response heterogeneity will be discussed. Second, current methods used to categorize participants based on their response to exercise will be outlined, as well as proposed mechanisms for factors that contribute to response variation. Finally, this review will provide an overview of some current issues at the forefront of individual response research.

Difference in total workload during sprint interval training for adults living with or without obesity.

PURPOSE: The primary objective of the study was to compare the implications of body composition on work volume, power outputs (peak, mean, and minimum), and relative drop load throughout 4 weeks of sprint interval training (SIT) in individuals living with and without obesity. METHODS: Thirty-four participants living with (n = 16) and without (n = 18) obesity took part in 12 sessions of SIT over 4 weeks. SIT consisted of repeated 30-s Wingate with a drop load of 7.5% of the participant's body mass separated by 4 min of active recovery. Fat-free mass was estimated using a BOD POD. Work volume, drop load, and power output (peak, mean, and minimum) relative to body mass and fat-free mass were calculated using a Monark 874E Weight cycle ergometer. RESULTS: Individuals living with obesity had a significantly larger drop load relative to fat-free mass (p < 0.001) and absolute drop load (p < 0.001) as well as a lower cycling cadence (p < 0.001) compared to individuals without obesity. No significant difference was observed in work volume (p = 0.167) as well as mean (p = 0.903), peak (p = 0.294), and minimum (p = 0.103) power relative to fat-free mass between groups. CONCLUSION: The findings suggest that individuals living with obesity work at a higher relative drop load when utilizing a percentage of body mass; however, a reduced cycling cadence results in similar total work volume throughout SIT.

Potential functional benefits of a comprehensive evaluation of physical activity for aging adults: a CLSA cross-sectional analysis.

BACKGROUND: Physical activity recommendations for aging adults do not account for possible benefits of light-intensity physical activity on physical function. The purpose of this study was to assess if a sum of all physical activities (regardless of intensity) related to physical function for aging adults, independent of physical activity guidelines. METHODS: This cross-sectional study was conducted with baseline data of the Canadian Longitudinal Study on Aging (CLSA n = 25,072) including ages from 45 to 85. Physical activity was collected via the Physical Activity Scale for Elderly questionnaire. The sum of all activities, based on the Metabolic Equivalent of a Task (MET), was called Total Index. Physical function was derived from objective measures. Logistic regression was used for statistical analysis based on the specific age and sex median values of physical function. RESULTS: The Total Index was associated with being in the lowest median of physical function when adjusted for the physical activity guidelines and other potential confounders (OR = 1.02, 95% CI = 1.01-1.03, p < 0.05). CONCLUSION: This study suggests that components of physical activity not currently included in current guidelines may be associated with better physical function outcomes for aging adults.

Does lean body mass equal health despite body mass index?

OBJECTIVE: To determine the association between having simultaneously high body mass index (BMI) and high relative lean body mass (LBM) and cardio-metabolic risk factors, metabolic syndrome (MetS), and diabetes in adults. MATERIALS AND METHODS: A cross-sectional analysis was performed on 4982 adults aged 19-85 years that participated in the National Health and Nutrition Examination Survey (cycles 1999-2000-2005-2006). The primary exposure variable was categorization into four groups: (a) Low-BMI/Low-LBM, (b) Low-BMI/High-LBM, (c) High-BMI/Low-LBM, and (d) High-BMI/High-LBM. LBM was assessed using dual-energy X-ray absorptiometry. The primary outcome measures were cardio-metabolic risk factors, MetS based on the ATP III definition; participants were required to have at least three of the following five criteria: high waist circumference, low HDL cholesterol, elevated triglyceride levels, high resting blood pressure, and self-reported diabetes. RESULTS: Compared to the High-BMI/High-LBM, most cardio-metabolic risk factors were significantly different among groups (P < .05) while no such differences were observed for the High-BMI/Low-LBM (P > .05). Exception of waist circumference (OR [95%]: 21.8 [8.84-53.82]), there was no increased odds of having cardio-metabolic risk factors in the High-BMI/Low-LBM compared with the High-BMI/High-LBM (P > .05). The odds of having MetS and diabetes for the High-BMI/Low-LBM compared with the High-BMI/High-LBM were OR (95% CI): 1.68 (0.84-3.36) and 0.59 (0.26-1.34), respectively. CONCLUSIONS: Our results suggest that having a high-BMI as well as high relative LBM levels is not associated with cardio-metabolic risk factors, MetS, and diabetes. Therefore, maintaining a BMI below 30 kg/m2 appears to be clinically relevant, regardless of LBM levels.

The ability of exercise to meaningfully improve glucose tolerance in people living with prediabetes: A meta-analysis.

BACKGROUND: Individuals with prediabetes are likely to progress to Type 2 diabetes. Although exercise training is an established method to improve glycemic control, the degree to which this translates into meaningful improvements, particularly in individuals with prediabetes, is unclear. The purpose of this meta-analysis was to investigate the ability of exercise training to improve 2-hour glucose tolerance beyond the smallest worthwhile difference in individuals with prediabetes. It was hypothesized that the majority of implemented exercise programs designed for individuals with prediabetes would not result in meaningful improvements in glucose tolerance. METHODS: Searches were performed in MEDLINE, The Cumulative Index to Nursing and Allied Health Literature, SPORTDiscus, and the Cochrane Library. Included studies reported glucose tolerance using a 2-hour oral glucose tolerance test at baseline and post-intervention; implemented an exercise program lasting at least 12 weeks; and included adults living with prediabetes. Mean effect summaries were determined using random-effects models. Magnitude-based inference statistic was used to estimate the likelihood that observed changes in glucose tolerance were meaningful to patients. RESULTS: Nine articles were included in the meta-analysis, producing 12 independent exercise interventions. The interventions led to an average improvement in glucose tolerance of 5.9% (95% confidence interval: 3.7%-8.0%). Seven (58%) exercise interventions were deemed likely to benefit patients, whereas five (42%) had trivial or unclear findings. CONCLUSION: While exercise intervention led to statistically significant improvements in 2-hour glucose tolerance, the benefit for individuals living with prediabetes remains unclear. Further research is needed to delineate optimal prescription parameters for generating meaningful benefits in glucose tolerance.

Does Age Impact the Clinical Presentation of Adult Women Seeking Specialty Eating Disorder Treatment?

Recent evidence suggests that eating disorders (EDs) are becoming increasingly common in older women. Previous research examining differences between younger and older women with EDs has been mixed, making it unclear whether older women with EDs represent a distinct group. We sought to determine whether there are age differences in the clinical presentation of women seeking specialty treatment for an ED. We examined the linear relationship between age and clinical constructs among adult women (N = 436) diagnosed with a Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, ED. Across analyses, there was no impact of age on most measures of ED symptoms, comorbid psychopathology, self-esteem, quality of life, and motivation to change. However, older age was associated with fewer interoceptive awareness difficulties, maturity fears, anxiety symptoms, and body image concerns. These findings suggest that the clinical presentation of older ED cases is largely similar, although somewhat less severe than in younger women. The implications of this research for future research and treatment are discussed.

Association between physical function and various patterns of physical activity in older adults: a cross-sectional analysis.

BACKGROUND: To improve physical function, physical activity (PA) guidelines for older adults recommend completing PA in bouts of 10 min or more. Spontaneous PA (< 10 min) can also benefit older adults. However, a paucity of research exists examining if shorter bouts of PA are associated with greater physical function. AIM: To determine the association between various patterns of PA and the likelihood of greater physical function in older adults. METHODS: Older adults from the 2003-2004 and 2005-2006 cycles of the National Health and Nutrition Examination Survey were included for analysis. PA lasting 1, 5, 10, 30, and 60 min was quantified using accelerometers. Physical function was assessed using a Likert scale reflecting the self-reported capability to complete 11 tasks. A single function score was then computed using factor analysis. Logistic regression analyses calculated the association between PA bout length and the likelihood of above average function. RESULTS: PA performed in 1-min (odds ratio [OR] 1.02; 95% confidence interval [CI] 1.01-1.03), 5-min (OR 1.02; CI 1.01-1.03), or 10-min bouts (OR 1.02; CI 1.01-1.03) was associated with greater physical function following adjustment for confounders. When scaled to represent an accumulation of 10 min of MVPA, likelihoods increased for both 1-min ([OR] 1.25; 95% [CI] 1.11-1.39) and 5-min (OR 1.22; 95% CI 1.08-1.37) bouts. DISCUSSION/CONCLUSIONS: Our findings suggest bouts of PA lasting 10 min or shorter in duration are associated with greater physical function in older adults.

Can older adults improve the identification of moderate intensity using walking cadence?

BACKGROUND: The majority of older adults do not reach the physical activity guidelines. One possible explanation for this may be that older adults overestimate their physical activity levels, because they are unable to identify exercise intensity. METHODS: Forty-four older adults were recruited and randomly assigned into two walking groups lasting 6 weeks. The intervention group was asked to walk a minimum of 150 min per week at moderate intensity using walking cadence indicated with a pedometer. The control group did not get any feedback on walking intensity. RESULTS: The ability to identify moderate intensity while walking did not significantly improve in neither groups (p = 0.530). However, participants in the intervention group increased significantly the time spent at moderate intensity, in 10 min bouts (p < 0.01). DISCUSSION: A pedometer providing walking cadence to reach moderate intensity is a good tool for increasing time walked at the recommended intensity, but not because participants know more what is considered moderate intensity.

Impact of Walking Cadence Prescription to Reach the Global Physical Activity Recommendations in Older Adults.

Walking cadence is a new monitoring strategy used to increase bouts of time at moderate intensity. Inactive older adults were instructed to walk 150 min per week at no specified intensity during phase one. In phase two, the intervention group (N = 23) received instructions on how to reach moderate intensity, using a pedometer and an individualized walking cadence, while the control group (N = 22) did not. The main outcomes were time at moderate intensity and moderate intensity in 10-min bouts. During phase two only the intervention group increased time at moderate intensity and moderate intensity in 10-min bouts compared with phase one and compared with the control group (p ≤ .01). Older adults can increase time walked at moderate intensity in 10-min bouts weekly by using individually prescribed walking cadence, a pedometer to track intensity, and practicing walking at this cadence.

Identification and Prediction of the Walking Cadence Required to Reach Moderate Intensity Using Individually-Determined Relative Moderate Intensity in Older Adults.

Many international agencies recommend using 40% of VO2reserve to individually prescribe moderate aerobic intensity to achieve health benefits. Few studies have evaluated the walking cadence needed to reach that intensity for older adults. A total of 121 apparently healthy adults with an average age of 69 and an average VO2peak of 24.1 ± 6.7 ml/kg/min (women) and 28.9 ± 9.1 ml/kg/min (men) were studied. Walking cadence at moderate intensity was established when participants reached 40% of VO2reserve on an indoor flat surface using a portable metabolic cart. Other clinical variables potentially associated with walking cadence were collected to create a clinical algorithm. Mean walking cadence to reach moderate intensity was 115 ± 10 steps per minute. The best algorithm to predict the walking cadence needed to reach moderate intensity in this sample was 113.6-0.23 (body weight in kg) + 0.21 (self-selected walking cadence in steps per minute).

Impact of Outdoor Play Structures on Moderate to Vigorous Physical Activity in Children during Recess: A Comparative Study.

BACKGROUND/OBJECTIVES: It is believed that outdoor play structures lead to more physical activity for kids during school recess. However, the intensity of this activity remains unknown. This study explored whether access to outdoor play structures during recess interferes with children's physical activity levels. METHODS: Forty-one children (8-10 years old) accessed play structures during the afternoon recess but not in the morning for one entire week. To control for temperature differences, the same number of participants from another school who did not access playground structures were invited to participate. Moderate to Vigorous Physical Activity (MVPA) was determined using heart rate reserve. Heart rate was recorded using the Fitbit Inspire 2 (San Francisco, CA, USA) for at least three full school days. Wilcoxon signed-rank and Mann-Whitney U tests analyzed within- and between-group differences. RESULTS: The findings show no difference in MVPA when accessing or not accessing outdoor play structures, both within groups [(n = 37) median (25th-75th) 16 min (7-30) vs. 14 min (5-22)] and between groups [(n = 22) 16 min (7-26)]. The weekly MVPA for all participants (n = 59) [172 min (117-282)] was the strongest variable associated with MVPA during recess [t(df) = 5.40 (38), 95% CI 0.04-0.09, p < 0.001]. CONCLUSION: accessibility to outdoor play structures does not increase MVPA during recess in children aged 8 to 10. Therefore, schools may need various options for children to play during recess, allowing them to accumulate MVPA.

Resistance Training on an Outdoor Exercise Structure Improves Lower-Body Relative Strength in Older Adults.

Improving relative strength is important for maintaining functionality with age, and outdoor exercise structures could be useful to facilitate this. A total of 29 adults aged 65+ participated in a non-randomized crossover study with a 6-week control followed by a 6-week resistance training intervention on an outdoor exercise structure (3x/week). Relative strength (predicted maximal leg press/lower body lean mass [Dual-energy X-ray Absorptiometry]) and physical function variables were measured at baseline, post-control, and post-intervention. Represented as median (25th-75th), lower body relative strength improved from 7.91 (7.01-9.35) post-control to 8.50 (7.99-9.72) post-intervention (p = .002) in study completers (n = 17). Maximum leg press (p = .002), 30-second chair stand (p < .001), one-leg stance (p = .011), and maximum chest press (p = .009) also improved significantly during the intervention. There were no significant changes in aerobic activity, grip strength, lean mass, or muscle power. This study demonstrates that there could be potential relative strength benefits associated with the use of outdoor exercise structures in older adults.

Increasing aerobic exercise intensity fails to consistently improve the glycemic response in people living with prediabetes or type 2 diabetes mellitus: the INTENSITY trial.

Some individuals with prediabetes or type 2 diabetes mellitus (T2DM) who engage in exercise will not experience the anticipated improvements in glycemic control, referred to as non-responders. Increasing exercise intensity may improve the proportion of individuals who become responders. The objectives were to (i) identify responders and non-responders based on changes in glycated hemoglobin (HbA1c) in individuals with prediabetes or T2DM following 16 weeks of aerobic exercise; (ii) investigate if increasing exercise intensity enhances the responders' status for individuals not previously responding favourably to the intervention. Participants (n = 40; age = 58.0 years (52.0-66.0); HbA1c = 7.0% (6.0-7.2)) engaged in a two-phase, randomized study design. During phase one, participants performed 16 weeks of treadmill-based, supervised, aerobic exercise at 4.5 metabolic equivalents (METs) for 150 min per week. Thereafter, participants were categorized as responders, non-responders, or unclear based on the 90% confidence interval above, below, or crossing a 0.3% reduction in HbA1c. For phase two, participants were randomized to a maintained intensity (4.5 METs) or increased intensity (6.0 METs) group for 12 weeks. Following phase one, two (4.1%) participants were categorized as responders, four (8.2%) as non-responders, and 43 (87.7%) as unclear. Following phase two, two from the increased intensity group and one from the maintained intensity group experienced an improvement in response categorization. There were no significant between or within group (maintained vs. increased) differences in HbA1c. For most people with prediabetes or T2DM, increasing exercise intensity by 1.5 METs does not improve response categorization.

Does type 2 diabetes duration influence the effectiveness of an aerobic exercise intervention: Results from the INTENSITY study.

BACKGROUND: Studies suggest that longer durations of T2DM increase the risk of T2DM complications and premature mortality. However, whether T2DM duration impacts the efficacy of an aerobic exercise intervention is unclear. OBJECTIVE: The purpose of this study was: 1) to compare changes in body composition, cardiorespiratory fitness, and glycemia between individuals with short- and long-duration T2DM after aerobic exercise and 2) to determine whether these changes were associated with changes in glycemia by T2DM duration. METHODS: A secondary analysis of the INTENSITY study (NCT03787836), including thirty-four adults (≥19 years) with T2DM who participated in 28 weeks of aerobic exercise training for 150 minutes per week at a moderate-to-vigorous intensity (4.5 to 6.0 metabolic equivalents (METs)). Using pre-established cut-points, participants were categorized into two groups 1) short-duration T2DM (<5 years) or 2) long-duration T2DM (≥5 years). Glycemia was measured by glycated hemoglobin (HbA1c), body composition by BodPod, and cardiorespiratory fitness by a measure of peak oxygen consumption (VO2peak). All measurements were performed at baseline, 16 weeks, and 28 weeks. RESULTS: Participants in the short-duration T2DM group experienced decreases in fat mass (kg) (p = 0.03), HbA1c (p = 0.05), and an increased relative VO2peak (p = 0.01). Those with long-duration T2DM experienced decreases in fat mass (kg) (p = 0.02) and HbA1c (p <0.001) and increased fat-free mass (p = 0.02). No significant differences were observed between groups in any outcomes. Changes in fat mass (r = 0.54, p = 0.02), and body fat percentage (r = 0.50, p = 0.02) were significantly associated with the change in HbA1c in those with a long-duration T2DM only. CONCLUSION: Our results suggest T2DM duration did not differently impact the efficacy of a 28-week aerobic exercise intervention. However, changes in body composition were associated with better glycemia in individuals with longer T2DM duration only.