Physical Activity, Injurious Falls, and Physical Function in Aging: An Umbrella Review.

PURPOSE: To review and update the evidence of the relationship between physical activity, risk of fall-related injury, and physical function in community-dwelling older people that was presented in the 2018 Physical Activity Guidelines Advisory Committee Scientific Report (PAGAC Report). METHODS: Duplicate independent screenings of 1415 systematic reviews and meta-analyses published between 2006 and 2016 identified from PubMed®, Cochrane Library, and CINAHL databases yielded 111 articles used for the PAGAC Report. The PAGAC Aging Subcommittee members graded scientific evidence strength based upon a five-criteria rubric and assigned one of four grades: strong, moderate, limited, or not assignable. An updated search of 368 articles published between January 2017 and March 2018 yielded 35 additional pertinent articles. RESULTS: Strong evidence demonstrated that physical activity reduced the risk of fall-related injuries by 32% to 40%, including severe falls requiring medical care or hospitalization. Strong evidence also supported that physical activity improved physical function and reduced the risk of age-related loss of physical function in an inverse graded manner among the general aging population, and improved physical function in older people with frailty and with Parkinson's disease. Aerobic, muscle-strengthening, and/or multicomponent physical activity programs elicited the largest improvements in physical function in these same populations. Moderate evidence indicated that for older adults who sustained a hip fracture or stroke, extended exercise programs and mobility-oriented physical activity improved physical function. CONCLUSIONS: Regular physical activity effectively helps older adults improve or delay the loss of physical function and mobility while reducing the risk of fall-related injuries. These important public health benefits underscore the importance of physical activity among older adults, especially those living with declining physical function and chronic health conditions.

CDC's Active People, Healthy NationSM: Creating an Active America, Together.

Physical activity can reduce the risk of at least 20 chronic diseases and conditions and provide effective treatment for many of these conditions. Yet, physical activity levels of Americans remain low, with only small improvements over 20 years. The Centers for Disease Control and Prevention (CDC) considered what would accelerate progress and, as a result, developed Active People, Healthy NationSM, an aspirational initiative to improve physical activity in 2.5 million high school youth and 25 million adults, doubling the 10-year improvement targets of Healthy People 2020. Active People, Healthy NationSM will implement evidence-based guidance to improve physical activity through 5 action steps centered on core public health functions: (1) program delivery, (2) partnership mobilization, (3) effective communication, (4) cross-sectoral training, and (5) continuous monitoring and evaluation. To achieve wide-scale impact, Active People, Healthy NationSM will need broad engagement from a variety of sectors working together to coordinate activities and initiatives.

Development of a National Physical Activity Plan for the United States.

BACKGROUND: Efforts to increase population levels of physical activity are increasingly taking the form of strategic plans at national, state/regional, and local levels. The processes employed for developing such plans have not been described previously. The purpose of this article is to chronicle the processes employed in and lessons learned from developing the US National Physical Activity Plan (NPAP). METHODS: The Coordinating Committee oversaw development of the NPAP. Key steps in the process included creating a private-public coalition based in the private sector, organizing the NPAP around 8 societal sectors, reviewing the evidence base for promotion of physical activity in each sector, conducting a national conference to initiate development of the NPAP's core content, ensuring broad participation in developing and refining the NPAP, and launching the NPAP through a press event that attracted national attention. RESULTS AND CONCLUSION: The 3-year effort to develop the NPAP was guided by a private-public collaborative partnership involving private sector organizations and government agencies. Launched in May 2010, the NPAP included more than 250 evidence-based recommendations for changes to policy and practice at the national, state, and local levels across 8 societal sectors.

Activity-related energy expenditure in older adults: a call for more research.

The purposes of this article were to 1) provide an overview of the science of physical activity-related energy expenditure in older adults (≥65 yr), 2) offer suggestions for future research and guidelines for how scientists should be reporting their results in this area, and 3) present strategies for making these data more accessible to the layperson. This article was meant to serve as a preliminary blueprint for future empirical work in the area of energy expenditure in older adults and translational efforts to make these data useful and accurate for older adults. This document was based upon deliberations of experts involved in the Strategic Health Initiative on Aging Committee of the American College of Sports Medicine. The article was designed to reach a broad audience who might not be familiar with the complexities of assessing energy expenditure, especially in older adults.

Ethnic disparities in objectively measured physical activity may be due to occupational activity.

OBJECTIVES: We examined whether Mexican American adults report occupations that involve higher levels of objectively assessed physical activity compared with Non-Hispanic White and Black adults, and if the differences were independent of income. METHODS: Data from the 2003-2004 National Health and Nutrition Examination Survey (NHANES; N=2707) were analyzed in 2012-2013. An existing classification scheme was used to classify self-reported occupation as sedentary, low-active, or moderately active. From NHANES accelerometer data, proportion of wear time was stratified by intensity. RESULTS: A dose-response relationship was found such that workers in more active occupations spent more time in light-intensity activity and less time engaged in sedentary activities. The findings did not suggest a compensation effect for moderate-to-vigorous intensity physical activity. Mexican American adults engaged in more activity than Non-Hispanic Black or White adults for incomes between $10,000 and $64,999. CONCLUSIONS: Mexican American adults may have higher total physical activity levels in NHANES because of occupational activity, particularly among lower income households. To the extent that light-intensity activity may provide health benefits, occupational activity may partly explain the Hispanic paradox.

Estimating older adults' preferences for walking programs via conjoint analysis.

BACKGROUND: Physical inactivity is a major driver of costly health problems, especially in older adults. Structured walking programs are one approach for increasing physical activity, although there is little information about how the characteristics of these programs influence their effectiveness. It was hypothesized that cash incentives would increase acceptability and effectiveness while a group participation requirement would place a net burden on participants. METHODS: To measure preferences for specific characteristics of walking programs (i.e., minutes per day, days per week, organized or individual/informal group, cash incentive) and the likelihood of participation, a conjoint-analysis survey of 501 inactive adults aged >or=50 years was conducted in October 2006. Data were analyzed in 2007-2008. RESULTS: The most-preferred program was three 20-minute walks per week. Respondents had a strong preference for programs conducted outside of a formal group setting. Offering an incentive of $9 in cash per week ($468 per year) increased predicted participation by 31%. CONCLUSIONS: The results suggest that the characteristics of walking programs, such as whether they involve participation in a formal group, substantially influence their perceived acceptability and the likelihood of participation. The results also suggest that, independent of other program attributes, modest financial incentives increase the likelihood of program participation by sedentary older adults, and thus are a potential means to increase the effectiveness of walking programs.

Cost effectiveness of community-based physical activity interventions.

BACKGROUND: Physical inactivity is associated with the increased risk of many chronic diseases. Such risks decrease with increases in physical activity. This study assessed the cost-effectiveness of population-wide strategies to promote physical activity in adults and followed disease incidence over a lifetime. METHODS: A lifetime cost-effectiveness analysis from a societal perspective was conducted to estimate the costs, health gains, and cost-effectiveness (dollars per quality-adjusted life year [QALY] gained, relative to no intervention) of seven public health interventions to promote physical activity in a simulated cohort of healthy U.S. adults stratified by age, gender, and physical activity level. Interventions exemplifying each of four strategies strongly recommended by the Task Force on Community Preventive Services were evaluated: community-wide campaigns, individually adapted health behavior change, community social-support interventions, and the creation of or enhanced access to physical activity information and opportunities. Each intervention was compared to a no-intervention alternative. A systematic review of disease burden by physical activity status was used to assess the relative risk of five diseases (coronary heart disease, ischemic stroke, type 2 diabetes, breast cancer, and colorectal cancer) across a spectrum of physical activity levels. Other data were obtained from clinical trials, population-based surveys, and other published literature. RESULTS: Cost-effectiveness ratios ranged between $14,000 and $69,000 per QALY gained, relative to no intervention. Results were sensitive to intervention-related costs and effect size. CONCLUSIONS: All of the evaluated physical activity interventions appeared to reduce disease incidence, to be cost-effective, and--compared with other well-accepted preventive strategies--to offer good value for money. The results support using any of the seven evaluated interventions as part of public health efforts to promote physical activity.

A randomized study of financial incentives to increase physical activity among sedentary older adults.

OBJECTIVE: Less than half of all U.S. adults meet public health recommendations for physical activity, and even fewer older adults (aged 50 years and over) are sufficiently active. Because inactivity increases the risk of costly medical complications, successful efforts to increase physical activity among older adults may potentially be cost-effective. We sought to test if financial incentives for walking could increase physical activity among sedentary older adults. METHODS: We conducted a 4-week randomized controlled study using pedometers. A total of 51 adults age 50+ from the Raleigh-Durham area of North Carolina participated in the study in April-May 2007. Individuals were randomized into one of two arms. The control group received a fixed payment of $75; the intervention group received a fixed payment of $50 plus up to $25 more per week depending on the number of weekly aerobic minutes, defined as 10+ minutes of continuous walking or jogging. RESULTS: The control group logged 2.3 h per week, on average. The intervention group logged 4.1 h per week and received an additional weekly payment of $17.50, on average. CONCLUSION: Modest financial incentives tied to aerobic minutes are an effective, and potentially cost-effective, approach for increasing physical activity among sedentary older adults.

Results of the first year of active for life: translation of 2 evidence-based physical activity programs for older adults into community settings.

OBJECTIVES: Translating efficacious interventions into practice within community settings is a major public health challenge. We evaluated the effects of 2 evidence-based physical activity interventions on self-reported physical activity and related outcomes in midlife and older adults. METHODS: Four community-based organizations implemented Active Choices, a 6-month, telephone-based program, and 5 implemented Active Living Every Day, a 20-week, group-based program. Both programs emphasize behavioral skills necessary to become more physically active. Participants completed pretest and posttest surveys. RESULTS: Participants (n=838) were aged an average of 68.4 +/-9.4 years, 80.6% were women, and 64.1% were non-Hispanic White. Seventy-two percent returned posttest surveys. Intent-to-treat analyses found statistically significant increases in moderate-to-vigorous physical activity and total physical activity, decreases in depressive symptoms and stress, increases in satisfaction with body appearance and function, and decreases in body mass index. CONCLUSIONS: The first year of Active for Life demonstrated that Active Choices and Active Living Every Day, 2 evidence-based physical activity programs, can be successfully translated into community settings with diverse populations. Further, the magnitudes of change in outcomes were similar to those reported in the efficacy trials.

Best practices for physical activity programs and behavior counseling in older adult populations.

Physical activity offers one of the greatest opportunities for people to extend years of active independent life and reduce functional limitations. The article identifies key practices for promoting physical activity in older adults, with a focus on those with chronic disease or low fitness and those with low levels of physical activity. Key practices identified: (a) A multidimensional activity program that includes endurance, strength, balance, and flexibility training is optimal for health and functional benefits; (b) principles of behavior change including social support, self-efficacy, active choices, health contracts, assurances of safety, and positive reinforcement enhance adherence; (c) manage risk by beginning at low intensity but gradually increasing to moderate physical activity, which has a better risk:benefit ratio and should be the goal for older adults; (d) an emergency procedure plan is prudent for community-based programs; and (e) monitoring aerobic intensity is important for progression and motivation. Selected content review of physical activity programming from major organizations and institutions is provided.

Footwear style and risk of falls in older adults.

OBJECTIVES: To determine how the risk of a fall in an older adult varies in relation to style of footwear worn. DESIGN: Nested case-control study. SETTING: Group Health Cooperative, a large health maintenance organization in Washington state. PARTICIPANTS: A total of 1,371 adults aged 65 and older were monitored for falls over a 2-year period; 327 qualifying fall cases were compared with 327 controls matched on age and sex. MEASUREMENTS: Standardized in-person examinations before fall occurrence, interviews about fall risk factors after the fall occurred, and direct examination of footwear were conducted. Questions for controls referred to the last time they engaged in an activity broadly similar to what the case was doing at the time of the fall. RESULTS: Athletic and canvas shoes (sneakers) were the styles of footwear associated with lowest risk of a fall. Going barefoot or in stocking feet was associated with sharply increased risk, even after controlling for measures of health status (adjusted odds ratio=11.2, 95% confidence interval (CI)=2.4-51.8). Relative to athletic/canvas shoes, other footwear was associated with a 1.3-fold increase in the risk of a fall (95% CI=0.9-1.9), varying somewhat by style. CONCLUSION: Contrary to findings from gait-laboratory studies, athletic shoes were associated with relatively low risk of a fall in older adults during everyday activities. Fall risk was markedly increased when participants were not wearing shoes.

The effects of multidimensional home-based exercise on functional performance in elderly people.

BACKGROUND: This study tested the hypothesis that a home-based exercise program would improve functional performance in elderly people. METHODS: We conducted a 6-month, single-blinded, randomized controlled trial. 72 community dwelling men and women (aged >/=70 years) with self-reported and laboratory-based functional impairment were recruited for the study. Participants were randomly assigned to either a home-based progressive strength, balance, and general physical activity intervention or an attention-control group that received home-based nutrition education. Functional performance was measured in the laboratory using the Physical Performance Test (PPT) and the Established Populations for Epidemiologic Studies of the Elderly (EPESE) short physical performance battery. Physiologic capacity was measured by strength (one repetition maximum), dynamic balance (tandem walk), gait speed (2-meter walk), and cardiovascular endurance (6-minute walk). RESULTS: 70 participants (97%) completed the 6-month trial. Compliance with study interventions within each group ranged from 75% in controls to 82% in exercisers. PPT increased by 6.1 +/- 13.4% in exercisers and decreased by 2.8 +/- 13.6% in controls (p =.02). EPESE improved by 26.2 +/- 37.5% in exercisers and decreased by 1.2 +/- 22.1% in controls (p =.001). Dynamic balance improved by 33.8 +/- 14.4% in exercisers versus 11.5 +/- 23.7% in controls (p =.0002). There were no differences between groups in the change in strength, gait speed, or cardiovascular endurance. CONCLUSIONS: Minimally supervised exercise is safe and can improve functional performance in elderly individuals. The improvements in functional performance occurred along with improvements in balance but without a significant change in muscle strength or endurance.

Recruitment of older participants in frailty/injury prevention studies.

Despite the lifelong health benefits of physical activity, frailer older adults have typically been excluded from studies promoting more active lifestyles. This study documents the recruitment process and costs from a multisite study to identify effective strategies for recruiting older adults in frailty/injury prevention research. Randomized controlled clinical trials were conducted at 7 sites; an 8th site was a compliance study. Interventions reflected center- and home-based health promotion programs. Site objectives, eligibility criteria, and contact and screening methods were obtained from manuals of operation. Recruitment results (number screened, eligibility rates, randomized to screened ratios) were ascertained from recruitment data. Sites furnished estimated recruitment costs (nonlabor expenses, investigator and staff time, fringe benefits) up to signing the consent form. The sites targeted diverse populations and sample sizes. The majority revised recruitment methods to meet their recruitment goals. Most sites estimated costs of recruitment at over $300 per participant randomized. Recruitment costs were affected by staff time spent alleviating concerns about participants' health, essential interactions with family members, and arranging for transportation. Neither frailty nor intervention intensity was found to be a major predictor of recruitment outcomes. Recruitment expense was associated with selection criteria and frailty status of the target population. Older people can be successfully recruited into beneficial health promotion programs, but it is often challenging. In planning health promotion studies, investigators need to be aware of the numbers of older people they may need to screen and different strategies for increasing recruitment success.