Comparing Class-Based and Home-Based Exercise for Older Adults With Chronic Health Conditions: 12-Month Follow-Up of a Randomized Clinical Trial.

OBJECTIVE: To assess the maintenance of physical activity (PA) and health gains among participants in a class-based (CB) or home-based (HB) PA intervention over a 12-month study period. METHODS: A total of 172 adults aged 50 years and older were randomly allocated to either a CB or an HB intervention, each involving an intensive 3-month phase with a 9-month follow-up period. Measures at baseline, 3, 6, and 12 months included self-reported PA and health, body mass index, waist circumference (WC), blood pressure, cardiovascular endurance (6-min walk test), physical function, and functional fitness (senior fitness test). Outcomes were analyzed using generalized estimating equations. RESULTS: Maximum improvement was typically observed at 3 or 6 months followed by a modest diminution, with no differences between groups. For body mass index, waist circumference, 6-min walk test, and senior fitness test, there was progressive improvement through the study period. Greater improvement was seen in the CB group compared with the HB group on three items on the senior fitness test (lower body strength and endurance [29% vs. 21%, p < .01], lower body flexibility [2.8 cm vs. 0.4 cm, p < .05], and dynamic agility [14% vs. 7%, p < .05]). CONCLUSION: The interventions were largely comparable; thus, availability, preferences, and cost may better guide program choice.

Predictors of Physical Activity Levels in Community-Dwelling Older Adults: A Multivariate Approach Based on a Socio-Ecological Framework.

The purpose of this study was to explore cross-sectional relationships between self-reported physical activity (PA) and personal, social, and environmental factors in community-dwelling adults aged 50 years and older. Accounting for clustering by neighborhood, generalized estimating equations were used to examine associations between selected correlates and the Physical Activity Scale for the Elderly (PASE) score while adjusting for confounders. Data for 601 participants were analyzed: 79% female, 37% married, mean age 76.8 (± 8.7) years, mean PASE score 112.6 (± 64.8). Age, living in seniors' housing, using nursing/home care services, receiving encouragement to be active, and having benches available in the neighborhood were inversely associated with PASE. Self-efficacy, SF-12 score, PA barriers, social support, and the presence of trails showed positive associations. Several personal, social, and environmental factors associated with PA were identified. The inverse association between PA and living in seniors' housing units should be considered when developing PA programs for older adults.

Postgraduate internal medicine residents' roles at patient discharge - do their perceived roles and perceptions by other health care providers correlate?

Knowing one's own role is a key collaboration competency for postgraduate trainees in the Canadian competency framework (CanMEDS®). To explore methods to teach collaborative competency to internal medicine postgraduate trainees, baseline role knowledge of the trainees was explored. The perceptions of roles (self and others) at patient discharge from an acute care internal medicine teaching unit amongst 69 participants, 34 physicians (25 internal medicine postgraduate trainees and 9 faculty physicians) and 35 health care professionals from different professions were assessed using an adapted previously validated survey (Jenkins et al., 2001). Internal medicine postgraduate trainees agreed on 8/13 (62%) discharge roles, but for 5/13 (38%), there was a substantial disagreement. Other professions had similar lack of clarity about the postgraduate internal medicine residents' roles at discharge. The lack of interprofessional and intraprofessional clarity about roles needs to be explored to develop methods to enhance collaborative competence in internal medicine postgraduate trainees.

Psychometric Properties of Activity, Self-Efficacy, and Quality-of-Life Measures in Individuals with Parkinson Disease.

PURPOSE: To examine the psychometric properties of six outcome measures in people with Parkinson disease (PD). METHOD: Twenty-four participants completed the following twice within 2 weeks: the timed up-and-go test (TUG), Northwestern University Disability Scale (NUDS), Schwab & England ADL Scale (S&E), Activities-specific Balance Confidence (ABC) Scale, PD Questionnaire-Short Form (PDQ 8), and Stanford Self-Efficacy for Managing Chronic Disease 6-Item Scale (SSE). Internal consistency, test-retest reliability (ICC[3,1]), and minimal detectable change (MDC) scores were calculated. Convergent and discriminant validity of the ABC were examined. RESULTS: Cronbach's alpha scores for the NUDS, ABC, PDQ-8, and SSE were 0.47, 0.92, 0.72, and 0.91 respectively. The intra-class correlation coefficient (ICC[3,1]) for the TUG was 0.69 and could be improved by averaging two trials. ICCs for the NUDS, S&E, ABC, PDQ-8, and SSE were 0.56, 0.70, 0.79, 0.82, and 0.72 respectively. The ABC correlated with the TUG (r=-0.44, p=0.03) and with PDQ-8 (r(s)=0.51, p=0.01) and NUDS (r(s)=0.48, p=0.02) walking items. The ABC was able to discriminate between stages 1 and 3 of disease progression but not between stages 1 and 2, which suggests that the ABC can distinguish large differences in disease progression but cannot detect more subtle differences. CONCLUSIONS: Homogeneity of the ABC, PDQ-8, and SSE is good to excellent. Test-retest reliability scores of all measures except the NUDS are moderate to good. The ABC is a valid measure for use in PD. The MDC statistic may be useful for interpreting group score changes.

Scoring of the physical therapist clinical performance instrument (PT-CPI): analysis of 7 years of use.

PURPOSE: The aims of this study were to (1) describe the completion rates of the 24 performance criteria (PCs) from the Physical Therapist Clinical Performance Instrument (PT-CPI) by clinical instructors; (2) evaluate change in PC visual analogue scores (VAS) with students' clinical experience; and (3) evaluate scoring patterns over time. METHODS: Final VAS scores for 208 physiotherapy (PT) students (seven cohorts) from 1,039 clinical placements between 2001 and 2008 were analyzed. Completion rates were calculated for each PC. Kruskal-Wallis tests evaluated differences in VAS scores between cohorts. Friedman's tests were used to compare VAS scores for each PC over time. RESULTS: Completion rates were above 90% for 18 PCs. Data from the seven cohorts were combined. All PC scores showed significant change from 10 to 15 weeks and from 15 to 20 weeks of clinical experience (p≤0.001). Although differences in scores decreased over time, 19 PCs showed significant differences between 20 and 25 weeks, and 11 PCs showed significant differences between 25 and 31 weeks of clinical experience (p<0.01). CONCLUSIONS: Certain PCs had lower completion rates. The PT-CPI was used consistently by clinical instructors to evaluate student performance over time. A continual progression in acquisition of clinical competencies was illustrated by PT-CPI scoring patterns as students advanced through their PT education programme.

Saskatoon in motion: class- versus home-based exercise intervention for older adults with chronic health conditions.

BACKGROUND: The study aimed to compare the effectiveness of a class-based (CB) and home-based (HB) exercise program for older adults with chronic health conditions. METHODS: 172 sedentary older adults with overweight or obesity, type 2 diabetes, hypertension, dyslipidemia, or osteoarthritis were enrolled in a randomized controlled trial with a 3-month follow-up. RESULTS: A significant increase was seen in the CB group in the Physical Activity Scale for the Elderly (PASE) scores and SF-12 Physical and Mental Health scores. In both groups, significant increases were seen in 6-minute walk distance, Physical Performance Test (PPT), and Functional Fitness Test (FFT), and significant reductions were seen in systolic and diastolic blood pressure but not body mass index or waist circumference. Except for a greater increment in the FFT in the CB group, the degree of improvement was not significantly different between the 2 groups. CONCLUSION: After a 3-month intervention, both the CB and HB program produced comparable significant improvements in outcome measures.

Reductions in functional balance, coordination, and mobility measures among patients with stable chronic obstructive pulmonary disease.

PURPOSE: To compare measures of balance, coordination, and mobility between patients with chronic obstructive pulmonary disease (COPD) and healthy control subjects, and to determine whether differences in these measures are associated with measures of disease severity. METHODS: The subjects were divided into three groups: 15 patients with COPD who required the use of supplemental oxygen (WO), 15 patients with COPD who did not require the use of supplemental oxygen (NO), and 21 healthy control subjects (CO). The subjects performed spirometry and several measures of balance, coordination, and mobility including the Community Balance and Mobility Scale, the timed up and go test, the fast-gait speed test, posturography, and both a finger-to-nose test and a toe-tapping coordination test. Significance was set at an alpha less than 0.05. RESULTS: When control was used for age, significant differences were found between the WO group and the CO group for the finger-to-nose test, and for both the sway index and peak sway index for the eyes open, moving-platform test. Differences were found among all three groups for the Community Balance and Mobility Scale overall score. The scores for the WO group were significantly worse than for the NO group on the timed up and go and the fast-gait speed tests. Moderate correlation was found among all of the measures, demonstrating significant differences in forced-expiratory volume in 1 second (FEV1), peak expiratory flow, and forced-expiratory volume. When controls were used for both age and FEV1, between-group differences disappeared. CONCLUSIONS: Patients with COPD exhibit deficiencies in functional balance, coordination, and mobility tasks associated with disease severity or differences in activity levels, but not in the requirement for supplemental oxygen.

Effects of short versus long bouts of aerobic exercise in sedentary women with fibromyalgia: a randomized controlled trial.

BACKGROUND AND PURPOSE: The purposes of this study were: (1) to assess the effectiveness of a 16-week progressive program of home-based, videotape-based, low-impact aerobic exercise on physical function and signs and symptoms of fibromyalgia in previously sedentary women aged 20 to 55 years and (2) to compare the effects of 1 long exercise bout versus 2 short exercise bouts per training day (fractionation) on physical function, signs and symptoms of fibromyalgia, and exercise adherence. SUBJECTS: One hundred forty-three sedentary women were randomly assigned to 1 of 3 groups: a group who trained using a long bout of exercise (LBE group, n=51), a group who trained using short bouts of exercise (SBE group, n=56), and a group who performed no exercise (NE group, n=36). METHODS: The SBE group exercised twice daily, and the LBE group worked out once daily. Both groups progressed in total daily training duration from 10 to 30 minutes, 3 to 5 times a week, for 16 weeks. Physical and psychological well-being, symptoms, and self-efficacy were evaluated using a multivariate analysis of variance. RESULTS: Dropout rates for the NE, SBE, and LBE groups were 14%, 38%, and 29%, respectively. The NE group differed from the LBE group in disease severity, self-efficacy, and psychological well-being (midtest, efficacy analysis) and from the SBE group in disease severity and self-efficacy (posttest, efficacy analysis). Exercise adherence was greater for the LBE group than for the SBE group between weeks 5 and 8 of the training program. No other differences between exercise groups were found. DISCUSSION AND CONCLUSION: Progressive, home-based, low-impact aerobics improved physical function and fibromyalgia symptoms minimally in participants who completed at least two thirds of the recommended exercise. Fractionation of exercise training provided no advantage in terms of exercise adherence, improvements in fibromyalgia symptoms or physical function. High attrition rates and problems with exercise adherence were experienced in both exercise groups.

Are longer hospital stays beneficial for the elderly?

Utilization review is a way to manage healthcare costs and is widespread in Canada, as managers attempt to use available acute-care beds in a best practice manner. As we reduce beds and decrease length of stay, we often wonder if the outcomes for patients are affected, particularly if the patients are elderly.