Call to Action on Making Physical Activity Assessment and Prescription a Medical Standard of Care.

The U.S. population is plagued by physical inactivity, lack of cardiorespiratory fitness, and sedentary lifestyles, all of which are strongly associated with the emerging epidemic of chronic disease. The time is right to incorporate physical activity assessment and promotion into health care in a manner that engages clinicians and patients. In April 2015, the American College of Sports Medicine and Kaiser Permanente convened a joint consensus meeting of subject matter experts from stakeholder organizations to discuss the development and implementation of a physical activity vital sign (PAVS) to be obtained and recorded at every medical visit for every patient. This statement represents a summary of the discussion, recommendations, and next steps developed during the consensus meeting. Foremost, it is a "call to action" for current and future clinicians and the health care community to implement a PAVS in daily practice with every patient.

The need to modify physical activity messages to better speak to older African American women: a pilot study.

BACKGROUND: Combating the physical inactivity crisis and improving health and quality of life is a challenge and a public health priority, especially in underserved populations. A key role of public health consists of informing, educating, and empowering individuals and communities about health issues. Researchers have found that mass communication messages often have limited effectiveness in reaching and impacting the health of underserved populations. The present pilot study was designed to explore perceptions of older African American women (AAW) in response to widely disseminated public information pertaining to physical activity (PA) and aging. METHODS: A total of 10 older AAW aged 60 years and over participated in this study. Participants were evenly assigned in one of the 2 focus groups (i.e. active, n = 5; and inactive, n = 5) based on their PA level. The focus group approach was employed to gather information about widely available public information materials related to PA that target the adult and older adult population. The three guides used were: (1) Exercise and Physical Activity: Your Everyday Guide; (2) The Physical Activity Guidelines for Older Adults; and (3) Be Active Your Way: A Guide for Adults. NVIVO 10 software was used to help in the qualitative data analysis. Descriptive thematic analysis was employed in identifying, analyzing and reporting patterns/themes within the data. RESULTS: Older AAW in the present study identified some shortcomings in current public health materials. Participants from both focus groups raised concerns regarding language and the types of activities used as examples in the materials. After analysis, two themes emerged: "We may have trouble in reading it" and "It does not reflect us". Participants' evaluation was found to be similar between the active and inactive focus groups. CONCLUSIONS: Older AAW's perceptions of the materials suggest that materials intended to educate and motivate the general public towards PA need to be modified to better speak to older African American women, especially to those who are sedentary and have difficulty in building PA into their daily lives.

Visual and participatory research methods for the development of health messages for underserved populations.

Mass communication health campaign messages play critical roles in public health, yet studies show mixed effectiveness in reaching and impacting underserved populations. The purpose of this study was to evaluate the benefits of using visual and participatory research techniques toward health message development targeting older Hispanic women. Demographic information and levels of physical activity were first obtained in a sample of older Mexican women (n = 23; ages 71.9 ± 7.6 years) living in the city of Chicago. Perceptions of physical activity were then assessed using a visual research method known as photo-elicitation. Health message concepts promoting physical activity were developed with a subsample of the target population using a participatory approach. Photo-elicitation helped develop a unique understanding into the many factors impacting physical activity among older Mexican women. Follow-up in-depth interviews provided detailed narratives that (a) built upon visual data and (b) identified characteristic differences between physically active and inactive women. Ultimately, these findings were beneficial in constructing new, culturally tailored message concepts. Findings suggest that this method may be a valuable tool in the development of mass communication health messages, extracting rich and meaningful data from target audiences while fostering a sense of partnership between researchers and community members. Tailoring and improving the message design process around the needs of underserved populations is essential in the effort to eliminate the burden of health disparities. This study uses innovative interdisciplinary research techniques to explore new approaches to public health communication in underserved populations.

Relationships of Low Cognitive Performance and Sleep Disorder With Functional Disabilities Among Older Adults.

ObjectivesThis study examined the relationships of low cognitive performance and sleep disorder with functional disabilities among older adults. Methods: NHANES 2011-2014 data on 3179 individuals [Mage=69.71] were analyzed. Functional domains included: activities of daily living (ADL), instrumental ADL (IADL) and leisure and social activities (LSA). Animal Fluency Test and the Digit Symbol Substitution Test assessed cognitive performance. Participants self-reported having physician-diagnosed sleep disorder. Results: Participants with both low cognitive performance and sleep disorder had 4- to 10-times greater odds for ADL, IADL, and LSA difficulties compared to the participants with no low cognitive performance/sleep disorder. Participants with only low cognitive performance and those with only sleep disorder were two to three times more likely to experience these difficulties. Discussion: Low cognitive performance and sleep disorder together or independently were associated with functional disabilities. Participants with both low cognitive performance and sleep disorder had higher odds of functional disabilities.

Is Acculturation Associated with the Cognitive Performance of Older Hispanics?

BACKGROUND: Hispanics in the United States are disproportionately affected by Alzheimer's disease and related dementias. Little is known about the impact of acculturation on cognitive performance. OBJECTIVE: This study examined the association between acculturation and cognitive performance among older Hispanics. METHODS: We analyzed cross-sectional data of 616 Hispanic participants in the National Health and Nutrition Examination Survey (NHANES) 2011-2014 [average age = 67.15 years, %Female = 51.46, %less than high-school graduate = 52.60]. Cognitive performance was measured by two neuropsychological tests: Animal Fluency Test (AFT) and Digit Symbol Substitution Test (DSST). We used two single-item proxy measures to quantify acculturation: nativity status (non-US-born residing < 15 years in the US (low acculturation), non-US-born residing ≥15 years in the US, and US-born (high acculturation)); and language acculturation (only/mostly Spanish (low acculturation), Spanish and English, only/mostly English (high acculturation)). We used adjusted linear regression to evaluate associations between acculturation and cognitive performance. RESULTS: Results indicated poorer cognitive performance among the low-acculturated groups for both nativity and linguistic measures. Participants who were non-US-born living ≥15 years (p = 0.02) and speaking only/mostly Spanish or Spanish and English (p = 0.01 and 0.006 respectively) had significantly lower AFT scores compared to US-born and only/mostly English-speaking groups. Participants who were non-US-born living < 15 years (p < 0.0001) or non-US-born living ≥15 years (p < 0.0001) and speaking only/mostly Spanish (p = 0.0008) scored lower on the DSST than the US-born and only/mostly English-speaking participants. CONCLUSION: In summary, low acculturation is associated with poorer cognitive performance among older Hispanics. Acculturation might be an important attribute to help understand cognitive decline and dementias among Hispanics.

Re-thinking Physical Activity Programs for Older Brazilians and the Role of Public Health Centers: A Randomized Controlled Trial Using the RE-AIM Model.

Background: Explored the role of public health centers in the delivery of physical activity programs to older Brazilians. Methods: Total of 114 older adults (81% women) from public health centers across the city of Florianopolis, Brazil, were randomized into three groups: behavior change group (n = 36), traditional exercise group (n = 52), and control group (n = 26). The behavioral change group included 12 weekly meetings (2 h each). The traditional exercise group offered a 12-week exercise class. Individuals in the control group participated only in measurements. Program evaluation included a mixed-methods approach following the RE-AIM framework (reach, effectiveness, adoption, implementation, and maintenance). Trained interviewers conducted 12 focus groups and 32 interviews with participants in the program, professionals delivering the programs, community health workers, and local and city administrators overseeing public health centers. Participants completed health, quality of life, and fitness assessments at four time points. Results: The study reached 11.5% of the eligible population in the community. Older adults' resistance to change and limited understanding of behavior change science by public health center staff hindered program reach. Physician encouraging patient participation and personal invitations by community health workers were perceived as favorable factors. Results of program effectiveness and maintenance suggest that behavior change strategies may be better suited than traditional exercise classes for decreasing sedentary time and increasing moderate-to-vigorous physical activity, as well as improving participants' quality of life. Only 14% of public health centers in the city adopted the programs. Heavy workload of health educators delivering the programs and limited physical space for program delivery were barriers for adoption. The fidelity of program delivery was high and indicates that the programs are culturally-appropriate for the Brazilian context and feasible for implementation by local health educators. Conclusions: Our findings support the potential for dissemination of behavior change and traditional exercise programs to older adults through public health centers in Brazil. REBEC: RBR-9pkxn2 (retrospectively registered) Register April 20, 2019.

Anthropometric cutoff points to identify lipodystrophy characteristics in people living with HIV/AIDS: an observational study.

INTRODUCTION: Introduction: currently, there is no consensus regarding accurate and low-cost methods for diagnosing lipodystrophy in people living with HIV/AIDS (PLWHA). The aim of this study was to propose anthropometric cutoff points for the diagnosis of lipodystrophy among PLWHA. Methods: we included 106 PLWHA (men = 65, women = 41) who are under antiretroviral therapy and have been clinically classified into either a "lipodystrophy" or "non-lipodystrophy" group. Anthropometric measurements included 19 regions of body perimeters and 6 skinfold thickness measures. The Youden index was used to establish anthropometric cutoff points for the diagnosis of lipodystrophy, using the mean values of the anthropometric data (referred to as "original") along with the "Z index" (ZI) values, which were adjusted by the "Phantom Strategy." The cutoff points were proposed when "original" anthropometric measurements and ZI values had a statistical significance of p < 0.01 and an area under the curve (AUC) higher than 70%. The size effect was assessed to verify the influence of lipodystrophy on each anthropometric measure. Results: our data analysis proposes sex-specific cutoff points for the diagnosis of lipodystrophy in PLWHA - 17 points using the "original" anthropometric measurements, and 20 using the ZI values (average effect size between 1.0 and 1.1, and AUC = 76.7% and 78%). Conclusions: our study proposes accurate cutoff points for the diagnosis of lipodystrophy using "original" anthropometric measurements and ZI values adjusted by the "Phantom Strategy." Our findings support the use of anthropometric measurements as a simplified method for diagnosing lipodystrophy and monitoring body composition alterations in people living with HIV/AIDS.

INTRODUCCIÓN: Introducción: no existe consenso con respecto a métodos precisos y de bajo coste para diagnosticar la lipodistrofia en personas que viven con VIH/SIDA (PVVS). El objetivo de este estudio es proponer puntos de corte antropométricos para el diagnóstico de lipodistrofia entre las PVVS. Métodos: se incluyeron 106 PVVS (hombres = 65, mujeres = 41) en tratamiento antirretroviral que se clasificaron clínicamente en dos grupos de "lipodistrofia" o "no lipodistrofia". Las mediciones antropométricas incluyeron 19 regiones de parámetros corporales y 6 medidas de pliegues cutáneos. El índice de Youden se utilizó para establecer puntos de corte antropométricos para el diagnóstico de lipodistrofia utilizando la media de los datos antropométricos (denominados "originales") junto con los valores del "índice Z" (IZ), que fueron ajustados por la "estrategia Phantom". Los puntos de corte se propusieron cuando las mediciones antropométricas "originales" y los valores de IZ fueron estadísticamente significativos con un valor p < 0,01 y un área bajo la curva (AUC) superior al 70%. Se evaluó el tamaño del efecto para verificar la influencia de la lipodistrofia en cada medida antropométrica. Resultados: se propusieron puntos de corte específicos según el sexo para el diagnóstico de lipodistrofia en PVVS: 17 puntos usando las medidas antropométricas "originales" y 20 usando los valores de IZ (tamaño del efecto promedio entre 1.0 y 1.1, y AUC = 76.7% y 78%). Conclusiones: se propusieron puntos de corte antropométricos para el diagnóstico de lipodistrofia. Las mediciones antropométricas son un método simplificado para diagnosticar y monitorear los cambios de composición corporal en las PVVS.

"We move kids"-the consensus report from the roundtable to examine strategies for promoting walking in the school environment.

In conjunction with the Walking for Health Conference, a Roundtable with 12 physical education teachers and 11 pedagogy researchers and public health professionals was organized to initiate a dialog between practicing school teachers and a group of researchers to identify practical and effective strategies for increasing physical activity, particularly walking, in the school setting. Discussions were organized on the following major themes: (1) promoting physical activity, (2) barriers for physical activity promotion in children, and (3) integrating physical activity with other health behaviors in the curriculum. There was a focus that came through on strategies to overcome barriers to allow opportunities for students to increase their physical activity levels. These strategies require the commitment not only of physical education teachers but also of their fellow teachers, school administrators, parents, local community members, and of course the students themselves. The issue of limited resources continually came up, thus realistically limiting strategies to those that could be implemented without additional cost. Any progress to be made with respect to the implementation of these strategies depends on the infrastructure of support that can be built on the excellent recommendations provided by the Roundtable focus groups.

Recommendations on Physical Activity and Exercise for Older Adults Living in Long-Term Care Facilities: A Taskforce Report.

A taskforce, under the auspices of The International Association of Gerontology and Geriatrics-Global Aging Research Network (IAGG-GARN) and the IAGG European Region Clinical Section, composed of experts from the fields of exercise science and geriatrics, met in Toulouse, in December 2015, with the aim of establishing recommendations of physical activity and exercise for older adults living in long-term care facilities (LTCFs). Due to the high heterogeneity in terms of functional ability and cognitive function that characterizes older adults living in LTCFs, taskforce members established 2 sets of recommendations: recommendations for reducing sedentary behaviors for all LTCF residents and recommendations for defining specific, evidence-based guidelines for exercise training for subgroups of LTCF residents. To promote a successful implementation of recommendations, taskforce experts highlighted the importance of promoting residents' motivation and pleasure, the key factors that can be increased when taking into account residents' desires, preferences, beliefs, and attitudes toward physical activity and exercise. The importance of organizational factors related to LTCFs and health care systems were recognized by the experts. In conclusion, this taskforce report proposes standards for the elaboration of strategies to increase physical activity as well as to prescribe exercise programs for older adults living in LTCFs. This report should be used as a guide for professionals working in LTCF settings.

An In-Depth Examination of Perceptions of Physical Activity in Regularly Active and Insufficiently Active Older African American Women: A Participatory Approach.

Despite considerable research and programmatic efforts to alleviate racial/ethnic disparities in physical activity (PA), disparities in PA among older minorities and major racial ethnic groups persist. This study explored perceptions of PA among regularly active (RA) and insufficiently active (IA) older African American women (AAW) and the factors that influence (positively and negatively) their physical participation in their socio-cultural environment. A total of 20 AAW aged 60 to 80 years participated in a cross-sectional mixed-methods study (i.e., qualitative and quantitative) employing participatory research approaches (i.e., photoelicitation) along with an objective assessment of PA. Nine women were considered RA and 11 IA according to current PA recommendations. RA and IA women held two major beliefs about the nature of PA (i.e., PA as a broadly defined construct that goes beyond traditional exercise routines; and PA and exercise are synonymous and can be used interchangeably) and had a good understanding of its benefits. Participants in both groups did not know about the importance of PA intensity for health benefits. Barriers and facilitator of PA were found to be similar among RA and IA participants. Special attention should be paid to providing access to no or low cost opportunities for PA participation in safe environments.

The National Blueprint Consensus Conference summary report: strategic priorities for increasing physical activity among adults aged >or=50.

This report summarizes the outcome of the National Blueprint Consensus Conference that was held in October 2002. At this conference, representatives of more than 50 national organizations convened in Washington DC with the goal of identifying high-priority and high-feasibility strategies that would advance the National Blueprint and that could be initiated within the next 12 to 24 months. The National Blueprint Consensus Conference has identified an ambitious agenda of 18 strategies that will need to be implemented in order to overcome societal barriers to physical activity among the middle-aged and older adult population. National organizations charged with the task of implementing the high-priority strategies will use professional networks, established delivery channels, and communication systems to translate the blueprint strategies into action.

Strategic priorities for increasing physical activity among adults age 50 and older: the national blueprint consensus conference summary report.

On May 1, 2001, a coalition of national organizations released a major planning document designed to develop a national strategy for the promotion of physically active lifestyles among the mid-life and older adult population. The National Blueprint: Increasing Physical Activity Among Adults Age 50 and Older was developed with input from 46 organizations with expertise in health, medicine, social and behavioral sciences, epidemiology, gerontology/geriatrics, clinical science, public policy, marketing, medical systems, community organization, and environmental issues. The Blueprint notes that, despite a wealth of evidence about the benefits of physical activity for mid-life and older persons, there has been little success in convincing age 50+ Americans to adopt physically active lifestyles. The Blueprint identifies barriers in the areas of research, home and community programs, medical systems, public policy and advocacy, and marketing and communications. In addition to identifying barriers, the Blueprint proposes a number of concrete strategies that could be employed in order to overcome the barriers to physical activity in society at large. This report summarizes the outcome of the National Blueprint Consensus Conference that was held in October 2002. In this conference, representatives of more than 50 national organizations convened in Washington, D.C. with the goal of identifying high priority and high feasibility strategies which would advance the National Blueprint and which could be initiated within the next 12 to 24 months. Participants in the consensus conference were assigned to one of five breakout groups: home and community, marketing, medical systems, public policy, and research. Each breakout group was charged with identifying the three highest priority strategies within their area for effectively increasing physical activity levels in the mid-life and older adult population. In addition to the 15 strategies identified by the breakout groups, three "cross-cutting" strategies were added which were considered to be broad-based in scope and which applied to more than one of the breakout themes. A national organization was identified to take the lead in planning and implementing each strategy. A summary of the 18 strategies and lead organizations is presented. The National Blueprint Consensus Conference has identified an ambitious agenda of strategies and tactics that will need to be implemented in order to overcome societal barriers to physical activity among the mid-life and older adult population. More than 50 national organizations have expressed a commitment to work towards the implementation of the Blueprint agenda. Eighteen priority strategies have been identified in the areas of home and community, marketing, medical systems, public policy, and research. The organizations charged with the task of implementing the high priority strategies will use professional networks and established delivery channels and communication systems to translate this plan into action.

Feasibility of integrating the "Healthy moves for aging well" program into home care aide services for frail older adults.

The purpose of the study was to assess the feasibility of implementing simple, safe, non-equipment evidence-based movements (Healthy Moves for Aging Well program) using an affordable and sustainable homecare-aide based delivery model that reaches the maximum possible number of frail older adults living at home in Illinois. Two local agencies were asked to identify two experienced home care aides and two inexperienced home care aides (n= 8). Each home care aides delivered the Healthy Moves to four clients (n= 16). Eight home care aides visited the client in the home and were asked to deliver the Healthy Moves program on a regular basis for a four-month time period. Outcome measures included a pre-and post- survey, a functional fitness test (older adults), and interviews. Evaluation procedures focused on older adult participants, homecare aids, and sites. The results showed that both interview and survey data revealed that most participants including older adults, home care aides, and site directors had a positive perception and high satisfaction with the program. Specially, 100% of older adult participants reported that they would recommend the program to others. Additionally, seniors and home care aides reported that they enjoyed working with each other on the program and both site directors reported that dissemination of the program in the State of Illinois employing home care aides was feasible and acceptable. Our study results indicate that Healthy Moves for Aging Well could be safely and successfully be disseminated to frail older adults in the State of Illinois.

Brazilian physical activity guidelines as a strategy for health promotion.

Public health actions endorsed by the federal government, for instance, health promotion initiatives, usually have greater impact at population level compared to other types of initiatives. This commentary aims to instigate debate on the importance and necessity of producing federally endorsed brazilian physical activity guidelines as a strategy for health promotion.

Employing a Participatory Research Approach to Explore Physical Activity among Older African American Women.

Introduction. Older African American women are particularly vulnerable to unhealthy lifestyle behaviors such as physical inactivity and the resultant chronic diseases and conditions. This study explored older African American women's perception of physical activity as well as facilitators of and barriers to being physically active in their local environment. Methods. Using a participatory research approach, a total of 7 women aged 65 years and over had their PA level assessed objectively through accelerometry. In addition, physical activity was discussed through the photo-elicitation procedure, which was supplemented by semistructured interviews. Qualitative thematic analysis was used to identify patterns and themes emerging from participants' interview. Results. Participants exhibited low levels of physical activity and viewed "physical activity" to be a broadly defined, nonspecific construct. Interviews revealed that many participants lack important knowledge about physical activity. A variety of personal, social, and environmental facilitators and barriers were reported by the participants. Conclusion. Efforts should be made towards clarifying information on physical activity in this population in order to help them incorporate physical activity into their routines, overcome barriers, and make use of opportunities to be active.

Reach of "VAMOS" program in basic healthcare - organizational barriers and facilitators / Alcance do programa "VAMOS" na atenção básica - barreiras e facilitadores organizacionais

Abstract Objective : To investigate the organizational barriers and facilitators to the reach of the "Active Life Health Improvement Program" (or VAMOS) implemented in two Basic Health Units (BHU) in Santa Catarina, Brazil. Method : An experimental study was carried out, based on the RE-AIM framework (http://www.re-aim.org/). Barriers and facilitators were identified through a focus group, semi-structured interview and content analysis. Results : In terms of reach, of the 297 Basic Health Care (BHC) users from the two BHU, 51 elderly people participated, a rate of 17.2%. One notable barrier identified was the lack of support from health teams, while the recommendation of the program by health professionals was found to be a facilitator. Conclusion : The VAMOS program has the potential to be incorporated as a public policy in the process of health care and promotion in BHC. It is an unprecedented strategy in Brazil, aimed at behavioral change, using a sustainable system, the BHU, which has a considerable population reach.

Resumo Objetivo : Investigar as barreiras e os facilitadores organizacionais para o alcance do programa Vida Ativa Melhorando a Saúde (VAMOS) implementado em duas Unidades Básicas de Saúde (UBS) em Santa Catarina, Brasil. Método : Trata-se de um estudo experimental, embasado na ferramenta RE-AIM (http://www.re-aim.org/). As barreiras e facilitadores foram identificados por meio de grupo focal, entrevista semiestruturada e análise de conteúdo. Resultados : Em relação ao alcance, dos 297 usuários da Atenção Básica à Saúde (ABS) considerados elegíveis nas duas UBS, participaram 51 idosos obtendo-se uma taxa de 17,2%. Como barreira destacou-se a falta de apoio das equipes de saúde e como facilitador a recomendação do programa pelos profissionais de saúde. Conclusão : O programa VAMOS apresenta potencial para ser incorporado como política pública no processo de cuidado e promoção da saúde na ABS. O programa consiste numa estratégia inédita no Brasil, voltada para a mudança de comportamento, utilizando um sistema sustentável, UBS, que apresentou considerável alcance populacional.

Searching for an operational definition of frailty: a Delphi method based consensus statement: the frailty operative definition-consensus conference project.

BACKGROUND: There is no consensus regarding the definition of frailty for clinical uses. METHODS: A modified Delphi process was used to attempt to achieve consensus definition. Experts were selected from different fields and organized into five Focus Groups. A questionnaire was developed and sent to experts in the area of frailty. Responses and comments were analyzed using a pre-established strategy. Statements with an agreement more than or equal to 80% were accepted. RESULTS: Overall, 44% of the statements regarding the concept of frailty and 18% of the statements regarding diagnostic criteria were accepted. There was consensus on the value of screening for frailty and about the identification of six domains of frailty for inclusion in a clinical definition, but no agreement was reached concerning a specific set of clinical/laboratory biomarkers useful for diagnosis. CONCLUSIONS: There is agreement on the usefulness of defining frailty in clinical settings as well as on its main dimensions. However, additional research is needed before an operative definition of frailty can be established.

[A critical analysis of physical activity recommendations in Spain]. / Un análisis crítico sobre las recomendaciones de actividad física en España.

OBJECTIVE: To identify official documents with recommendations on physical activity published by the autonomous regions of Spain with the goal of evaluating their compliance with the physical activity recommendations of the World Health Organization (WHO). METHODS: We conducted a content analysis of 55 documents of the ministries of health of several regional governments containing recommendations on physical activity. RESULTS: Eighty-four percent of the autonomous regions in Spain made recommendations on aerobic physical activity and 37% made recommendations on strength training. However, the number of documents consistent with the WHO criteria was as follows: aerobic activity (n=11, 58%), adults (n=10, 53%), the elderly (n=5, 26%), children/adolescents (n=1, 5%); strength training, adults (n=6, 32%), the elderly (n=3, 16%), children/adolescents (n=1, 5%); balance (n=5, 26%); at least 10minutes continuous physical activity (n=6, 32%); recommendation of up to 300minutes per week (n=10, 53%); intensity of physical activity (n=2, 11%). CONCLUSIONS: The recommendations of the autonomous regions tend to focus on aerobic physical activity and to under-represent strength training. Moreover, only one autonomous region conforms to the WHO recommendations for physical activity. The regions with higher rates of population aging and a higher percentage of children and adolescents fail to make recommendations on physical activity consistent with the WHO guidelines.