Physical Activity, Functional Ability, and Obesity in Older Adults: A Gender Difference.

Disability, institutionalization, and loss of independence may be directly caused or exacerbated by physical inactivity and obesity. The purpose of the current cross-sectional survey was to explore the impact of gender and obesity on functional ability tasks, physical activity, and psychosocial factors in older adults. Participants comprised 964 University retirees (55% female, mean age = 75.3 years, SD = 6.7 years) with a mean body mass index (BMI) of 26.1 kg/m2 (SD = 4.7 kg/m2). Results revealed significant gender and BMI interaction effects. Women were less active than men and obese women were most functionally impaired, particularly in activities that target lower extremity function, regardless of weight status. These findings suggest that physical activity interventions for older adults should focus on exercises that improve functional ability and are tailored to meet individual needs while considering weight and gender. Type, intensity, frequency, and duration of exercises should be individualized to limit injuries and improve functional ability and physical activity adherence. [Journal of Gerontological Nursing, 43(9), 38-46.].

Gardening/Yard Work and Depressive Symptoms in African Americans.

BACKGROUND: The purpose of this study was to examine the frequency of gardening/yard work in relation to depressive symptoms in African-Americans while controlling for biological and social factors. METHODS: A secondary analysis was performed on the National Survey of American Life (n=2,903) using logistic regression for complex samples. Gardening/Yard work was measured by self-reported frequency. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression scale. RESULTS: Biological and social factors, not gardening/yard work, were associated with depressive symptoms. CONCLUSIONS: Biological and social factors may need to be addressed before the association between gardening/yard work and depressive symptoms can be determined.

Depressive Symptoms and Walking in African-Americans.

OBJECTIVE: Although increased frequency of physical activity is associated with fewer depressive symptoms in African-Americans, most studies do not focus on a specific type of activity. Identifying the activity can provide helpful information for designing interventions that focus on depressive symptoms. The objective of this study was to examine the odds of depressive symptoms in relation to walking in African-Americans. DESIGN AND SAMPLE: A secondary analysis was performed on the National Survey of American Life. The sample was made up of community-dwelling African-American women (n = 1,903) and men (n = 1,075) who did not meet the DSM-IV-TR criteria for depression. MEASURES: Walking was measured by self-reported frequency (i.e., never, rarely, sometimes, often). Depressive symptoms were measured with the Center for Epidemiologic Studies Depression scale. Logistic regression for complex samples was used to examine the odds of depressive symptoms in relation to walking. RESULTS: Women who reported often walking had lower odds for depressive symptoms than women who reported never walking (OR = 0.56, 95% CI = 0.38-0.82). Walking frequency was not related to depressive symptoms in men. CONCLUSIONS: Walking frequency is a modifiable risk factor for elevated depressive symptoms in African-American women.

Leisure-time physical activity in relation to depressive symptoms in African-Americans: results from the National Survey of American Life.

OBJECTIVE: To examine the frequency of leisure-time physical activity (LTPA) in relation to depressive symptoms in a nationally representative sample of African American (AA) women and AA men with guidance by Stokols' Social Ecological Framework. METHOD: A secondary analysis of AA women (n=1811) and AA men (n=1038) was performed on the National Survey of American Life, where a four stage national area probability sampling was conducted. Interviews were conducted 2001-2003. Clinically depressed AA were excluded from the current study. LTPA was measured by self-report frequency (never, rarely, sometimes, often) of participation in sports/exercise. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression scale. Logistic regression for complex samples was used to examine the relationship between LTPA and depressive symptoms, adjusting for biopsychobehavioral and sociophysical environmental factors. RESULTS: Compared with AA women and AA men who reported never participating in LTPA, the multivariate OR for depressive symptoms in AA women and AA men who reported participating in LTPA often was 0.42 (95% CI=0.24-0.72) and 0.41 (95% CI=0.25-0.69) respectively. CONCLUSION: Increased frequency of LTPA was associated with fewer depressive symptoms in a nationally representative sample of non-clinically depressed AAs.

Physical Activity, Inflammation, and Physical Function in Older Adults: Results From the Health & Retirement Study.

Physical function declines with aging due to physical and biological changes. The biological process of aging has been associated with increases in systemic inflammation and a greater risk for chronic conditions. In older adults, physical activity aids in maintenance of function. However, the influence of inflammatory biomarkers and adiposity on physical activity and physical function needs to be further explored. METHODS: A cross-sectional secondary data analysis from Wave 13 of the Health & Retirement Study (HRS) core biennial data and Venous Blood Study (VBS) was conducted. Structural equation modeling was used to establish the model and test the relationships. RESULTS: Chronic low-level inflammation was moderately negatively correlated with physical activity (r = -0.326) and function (r = -0.367). Latent regressions showed that higher physical activity is associated with better physical function (unstandardized estimate = 0.600, p < .001) while inflammation negatively affects physical function (unstandardized estimate = -0.139, p < .001), and adiposity was not a predictor in the model (p = 0.055). CONCLUSION: For older adults, preserving physical function by participation in physical activity and decreasing chronic inflammation are key preventive health strategies for older adults to maintain independence, with a need to further explore pro and anti-inflammatory biomarkers.

Functional Exercise Improves Mobility Performance in Older Adults With Type 2 Diabetes: A Randomized Controlled Trial.

Background: Diabetes-related disability occurs in approximately two-thirds of older adults with diabetes and is associated with loss of independence, increased health care resource utilization, and sedentary lifestyle. The objective of this randomized controlled trial was to determine the effect of a center-based functional circuit exercise training intervention followed by a 10-week customized home-based program in improving mobility function in sedentary older adults with diabetes. Methods: Participants (n = 111; mean age 70.5 [7.1] y; mean body mass index 32.7 [5.9] kg/m2) were randomized to either a moderate-intensity functional circuit training (FCT) plus 10-week home program to optimize physical activity (FCT-PA) primary intervention or one of 2 comparison groups (FCT plus health education [FCT-HE] or flexibility and toning plus health education [FT-HE]). Results: Compared with FT-HE, FCT-PA improvements in comfortable gait speed of 0.1 m/s (P < .05) and 6-minute walk of 80 ft were consistent with estimates of clinically meaningful change. At 20 weeks, controlling for 10-week outcomes, improvements were found between groups for comfortable gait speed (FCT-PA vs FT-HE and FCT-HE vs FT-HE) and 6-minute walk (FCT-PA vs FCT-HE). Conclusions: Functional exercise training can improve mobility in overweight/obese older adults with diabetes and related comorbidities. Future studies should evaluate intervention sustainability and adaptations for those with more severe mobility impairments.

The bath environment, the bathing task, and the older adult: a review and future directions for bathing disability research.

PURPOSE: To review existing research studies to identify optimal intervention strategies for remediation and prevention of bathing disability and future directions for bathing disability research. METHOD: Bathing disability, defined as problems in the interaction between the person and the environment during bathing performance, is examined through a comprehensive, narrative literature review. RESULTS: Most studies focus on the relationship between the person and the environment (such as assistive device use and environmental hazards) while fewer studies focus on analysis of the bathing task or the interaction of the person, environment, and bathing task. Of intervention studies, most do not focus solely on remediation of bathing disability and outcomes vary widely. CONCLUSIONS: In order to help remediate and prevent bathing disability, it will be necessary to better understand and measure the person-environment-occupation interaction involved in bathing as it relates to specific groups of older adults.

Physical activity and function in older adults: theory of planned behavior.

OBJECTIVE: To assess the theory of planned behavior (TPB) and TPB with functional ability to explain intention and self-reported physical activity (PA) behavior of older adults. METHODS: A survey was mailed to 2056 retirees from a large Midwestern university. RESULTS: Structural equation modeling revealed that the TPB plus functional ability explained an additional 11% variance than the TPB alone in older adult PA and functional ability was the best predictor of PA (beta = .53, P<.05). CONCLUSIONS: Functional ability appears to be an important predictor of PA behavior and should be included when designing PA programs for older adults.

A Minimal Contact Diet and Physical Activity Intervention for White-Collar Workers.

Minimal contact lifestyle interventions with multiple components coupled with health screening have the potential to improve worker health. The purpose of this study was to test a minimal contact multiple component lifestyle diet and exercise intervention. The multiple components that were included in this project included a worksite health screening, brief counseling session, emailed newsletter, and a pedometer. In response to the intervention, participants reported an increase in green salad, fruit, and vegetable consumption as well as an increase in self-efficacy for consuming three servings of fruits and vegetables a day. Study participants also demonstrated a significant increase in physical activity as shown by their responses to the question, "During leisure time I walk." A minimal contact multiple component worksite health promotion program with relatively high feasibility and low cost can improve workers' health-related behaviors, and participants can become more aware of their health.

Correlates of cigarette smoking among low-income African American women.

OBJECTIVE: This study examines individual and contextual correlates of cigarette smoking in a randomly selected, community-based sample of low-income African American women. DESIGN: The study sample was selected by using a two-stage area probability sample design. SETTING: Participants were recruited from > 12,000 housing units selected from 39 census tracts in the city of Detroit. PARTICIPANTS: Participants for this study include a total of 921 women who completed the baseline assessment of a randomized clinical trial aimed at improving the oral health of African American families. MAIN OUTCOME MEASURES: Past month prevalence of cigarette use and number of cigarettes smoked during this period. RESULTS: Data were analyzed with fixed-effects and multilevel statistics. Social support was the only variable associated, inversely, with current smoking. Self-reported feelings of anger were positively associated, though marginally, with current smoking. Between-neighborhood variance was small, and no neighborhood level variables were associated with cigarette smoking. CONCLUSIONS: Previously established risk factors did not predict cigarette use in this randomly selected, community-based sample of low-income African American women. Further research is needed to identify risk and protective factors that might be unique to low-income African American populations in order to better inform preventive and cessation interventions.

Submaximal oxygen uptake kinetics, functional mobility, and physical activity in older adults with heart failure and reduced ejection fraction.

BACKGROUND: Submaximal oxygen uptake measures are more feasible and may better predict clinical cardiac outcomes than maximal tests in older adults with heart failure (HF). We examined relationships between maximal oxygen uptake, submaximal oxygen kinetics, functional mobility, and physical activity in older adults with HF and reduced ejection fraction. METHODS: Older adults with HF and reduced ejection fraction (n = 25, age 75 ± 7 years) were compared to 25 healthy age- and gender-matched controls. Assessments included a maximal treadmill test for peak oxygen uptake (VO2peak), oxygen uptake kinetics at onset of and on recovery from a submaximal treadmill test, functional mobility testing [Get Up and Go (GUG), Comfortable Gait Speed (CGS), Unipedal Stance (US)], and self-reported physical activity (PA). RESULTS: Compared to controls, HF had worse performance on GUG, CGS, and US, greater delays in submaximal oxygen uptake kinetics, and lower PA. In controls, VO2peak was more strongly associated with functional mobility and PA than submaximal oxygen uptake kinetics. In HF patients, submaximal oxygen uptake kinetics were similarly associated with GUG and CGS as VO2peak, but weakly associated with PA. CONCLUSIONS: Based on their mobility performance, older HF patients with reduced ejection fraction are at risk for adverse functional outcomes. In this population, submaximal oxygen uptake measures may be equivalent to VO2 peak in predicting functional mobility, and in addition to being more feasible, may provide better insight into how aerobic function relates to mobility in older adults with HF.

Cigarette smoking among low-income African Americans: a serious public health problem.

BACKGROUND: This study examines the current prevalence of cigarette smoking and the number of cigarettes smoked in a community-based sample of 1021 low-income African-American men and women. METHODS: Participants were selected using a two-stage, area probability sample design. Data were collected in 2002-2003 in face-to-face interviews and analyzed in 2005. All data and analyses were weighted to account for the complex sampling design. RESULTS: Fifty-nine percent of men and 41% of women were current smokers, with younger individuals apparently initiating smoking at an earlier age than older individuals. CONCLUSIONS: The high prevalence of cigarette use provides further evidence that the excess burden of tobacco-related disease among low-income African-American families may be on the rise. This is of great concern, and if confirmed by further research, indicates an urgent need for preventive intervention.

Promoting healthful diets and exercise: efficacy of a 12-week after-school program in urban African Americans.

This study examined the effectiveness of a unique extracurricular after-school initiative designed to promote healthy diets and exercise in urban African Americans. The Students and Parents Actively Involved in Being Fit after-school program was offered for 12 weeks to students and their parents/guardians at an urban middle school. Specific aims of the intervention were to increase participants' vegetable and fruit intake by using established 5 A Day for Better Health educational resource materials/activities and to affect their health-related fitness through dance, games, and fitness activities. Fifty-six children and 25 parents/guardians completed a standard battery of evaluations before and after the program. Pre-post pairwise t test revealed that both children and their parents/guardians showed an increase in fruit consumption and a reduction in diastolic blood pressure (P <.05). Moreover, children showed improvements in systolic blood pressure and fruit juice, salad, and nonfried potato consumption while parents/guardians showed a decrease in body fat, body mass index, and endurance walk/run time (P <.05). Overall, findings indicate that children tended to gain more diet-related benefits while parents/guardians tended to derive more fitness-related benefits. After-school programs like the Students and Parents Actively Involved in Being Fit initiative can potentially contribute to improved health levels in urban African Americans.

Beliefs of blue-collar workers: stage of readiness for exercise.

OBJECTIVE: To address a theoretical debate regarding contributions of self-efficacy and the theory of planned behavior (TPB) in explaining the amount of variance in stage of readiness to exercise among blue-collar workers. METHOD: A validated questionnaire was used for assessment. RESULTS: LISREL indicated that self-efficacy had the most influence on stage and TPB constructs were subjugated to self-efficacy. Univariate analyses indicated that self-efficacy and TPB variables are important for intervention. CONCLUSIONS: Self-efficacy plays a major role in explaining exercise stage among high-risk blue-collar workers, and self-efficacy and TPB constructs are important to consider in designing interventions.

Gender differences in neighborhood walking in older adults.

OBJECTIVE: This study examined mobility, self-efficacy, outcome expectations, neighborhood (density, destinations, and design), and neighborhood walking in older men (n = 106, 60-99 years, M = 76.78, SD = 8.12) and women (n = 216, 60-99 years, M = 75.81, SD = 8.46). METHOD/RESULTS: In hierarchical regression, the variables explained 32% of the variance in neighborhood walking in men (p < .001) and 27% of the variance in women (p < .01). Self-efficacy (ß = .49, p < .01), density (ß= .22, p < .05), and design (ß= .21, p = .05) were associated with walking in men. Significant design characteristics included sidewalks (ß= .25, p < .05) and crime (ß= .36, p < .01). In women, self-efficacy (ß= .48, p < .001) and destinations (ß= .15, p < .05) were associated with walking. Walking was associated with self-efficacy for walking despite individual barriers in women (ß= .38, p < .001) and neighborhood barriers in men (ß= .30, p < .05). CONCLUSION: Walking interventions targeting older women should incorporate local destinations. In older men, interventions should consider neighborhood sidewalk design and crime. Walking interventions for all older adults should include enhancement of self-efficacy, but gender differences may exist in the types of self-efficacy on which to focus.

Dog ownership, functional ability, and walking in community-dwelling older adults.

BACKGROUND: Regular walking improves overall health and functional ability of older adults, yet most are sedentary. Dog ownership/pet responsibility may increase walking in older adults. Goals of this study were to identify factors that influence older adult walking and compare physical activity, functional ability and psychosocial characteristics by dog ownership status. METHODS: In this cross-sectional study, older adults (65-95 years of age, n = 1091) completed and returned questionnaires via postal mail. Measures included: Physical Activity Scale for the Elderly, Physical Functioning Questionnaire and Theory of Planned Behavior Questionnaire. RESULTS: Dog owner/dog walkers (n = 77) reported significantly (P < .05) more total walking, walking frequency, leisure and total physical activity and higher total functional ability than dog owner/nondog walkers (n = 83) and nondog owners (n = 931). Dog owner/nondog walkers reported lower intention and perceived behavioral control and a less positive attitude than dog owner/dog walkers (P < .05). CONCLUSIONS: Dog owner/ dog walkers were significantly different than the nondog walker groups in nearly every study variable. Many dog owners (48.1%) reported walking their dogs regularly and the dog owner/dog walkers participated in nearly 50% more total walking than the 2 nondog walking groups, suggesting that pet obligation may provide a purposeful activity that motivates some older dog owners to walk.

Longitudinal change in physical activity and disability in adults.

OBJECTIVES: To prospectively examine whether physical activity or change in physical activity increases or decreases the risk of disability later in life. METHODS: Tobit regression models were used to examine the effect of physical activity at baseline and change from baseline on disability 10 and 20 years later in 6913 adults. RESULTS: Increasing recreational physical activity was associated with reduced risk of disability whereas reducing recreational physical activity increased the risk of disability after 10 years. CONCLUSIONS: The analyses reveal a protective effect of sustained physical activity on disability among adults.

Influences on neighborhood walking in older adults.

The purpose of this cross-sectional survey study was to examine the influence of self-efficacy, outcome expectations, and environment on neighborhood walking in older adults with (n = 163, mean age = 78.7, SD = 7.96 years) and without (n = 163, mean age = 73.6, SD = 7.93 years) mobility limitations, controlling for demographic characteristics. Multiple regression revealed that in mobility-limited older adults, demographic characteristics, self-efficacy, and outcome expectations explained 17.4% of variance in neighborhood walking, while environment (neighborhood destinations and design) explained 9.4%. Destinations, self-efficacy, sex, and outcome expectations influenced walking. In those without mobility limitations, demographic characteristics, self-efficacy, and outcome expectations explained 15.6% of the variance, while environment explained 5.6%. Self-efficacy, sex, and design influenced walking. Neighborhood walking interventions for older adults should include self-efficacy strategies tailored to mobility status and neighborhood characteristics.

Physical Activity Effects on Depressive Symptoms in Black Adults.

OBJECTIVES: Randomized trials found physical activity (PA) effective in decreasing depressive symptoms. Few studies included Black participants. The purpose of this systematic literature review was to determine the effects of PA on depressive symptoms in Black adults. METHODS: Articles were abstracted by conducting a computer and hand search of eligible studies. RESULTS: Eight of 13 studies found a significant inverse relationship between PA and depressive symptoms in Black adults. Sources for the heterogeneity were explored. CONCLUSION: Future studies should include representative samples of Black adults, incorporate a theory which considers multiple levels of influence, account for genetic factors in the etiology of depressive symptoms, include individuals diagnosed with depression and with health conditions which may increase the risk of depressive symptoms, account for intra-group ethnic heterogeneity, measure and differentiate between social support and social network, consider aspects of the physical environment and use standardized measurements of PA.

Neighborhood factors relevant for walking in older, urban, African American adults.

Focus-group and photo-voice methodology were used to identify the salient factors of the neighborhood environment that encourage or discourage walking in older, urban African Americans. Twenty-one male (n = 2) and female (n = 19) African Americans age 60 years and older (M = 70 +/- 8.7, range = 61-85) were recruited from a large urban senior center. Photographs taken by the participants were used to facilitate focus-group discussions. The most salient factors that emerged included the presence of other people, neighborhood surroundings, and safety from crime, followed by sidewalk and traffic conditions, animals, public walking tracks and trails, and weather. Future walking interventions for older African Americans should include factors that encourage walking, such as the presence of other friendly or active people, attractive or peaceful surroundings, and a sense of safety from crime.