Physical activity promotion in the health care system.

Physical activity (PA) and exercise training (ET) have great potential in the prevention, management, and rehabilitation of a variety of diseases, but this potential has not been fully realized in clinical practice. The health care system (HCS) could do much more to support patients in increasing their PA and ET. However, counseling on ET is not used widely by the HCS owing partly to attitudes but mainly to practical obstacles. Extensive searches of MEDLINE, the Cochrane Library, the Database of Abstracts of Reviews of Effects, and ScienceDirect for literature published between January 1, 2000, and January 31, 2013, provided data to assess the critical characteristics of ET counseling. The evidence reveals that especially brief ET counseling is an efficient, effective, and cost-effective means to increase PA and ET and to bring considerable clinical benefits to various patient groups. Furthermore, it can be practiced as part of the routine work of the HCS. However, there is a need and feasible means to increase the use and improve the quality of ET counseling. To include PA and ET promotion as important means of comprehensive health care and disease management, a fundamental change is needed. Because exercise is medicine, it should be seen and dealt with in the same ways as pharmaceuticals and other medical interventions regarding the basic and continuing education and training of health care personnel and processes to assess its needs and to prescribe and deliver it, to reimburse the services related to it, and to fund research on its efficacy, effectiveness, feasibility, and interactions and comparability with other preventive, therapeutic, and rehabilitative modalities. This change requires credible, strong, and skillful advocacy inside the medical community and the HCS.

Effect of brisk walking in 1 or 2 daily bouts and moderate resistance training on lower-extremity muscle strength, balance, and walking performance in women who recently went through menopause: a randomized, controlled trial.

BACKGROUND AND PURPOSE: Menopause may induce a phase of rapid decreases in bone mineral density, aerobic fitness, muscle strength, and balance, especially in sedentary women. The purpose of this study was to examine the effects and feasibility of an exercise program of 1 or 2 bouts of walking and resistance training on lower-extremity muscle strength (the force-generating capacity of muscle), balance, and walking performance in women who recently went through menopause. SUBJECTS AND METHODS: The subjects were 134 women who recently went through menopause. The study was a 15-week, randomized, controlled trial with continuous and fractionated exercise groups. The outcomes assessed were lower-extremity muscle strength, balance, and walking time over 2 km. Feasibility was assessed by questionnaires, interviews, and training logs. RESULTS: One hundred twenty-eight women completed the study. Adherence to the study protocol was 92%. Both continuous and fractionated exercise groups improved equally in lower-extremity muscle strength and walking time but not in balance. Almost 70% of the subjects considered the program to be feasible. Two daily walking sessions caused fewer lower-extremity problems than did continuous walking. DISCUSSION AND CONCLUSION: Brisk walking combined with moderate resistance training is feasible and effective. Fractionating the walking into 2 daily sessions is more feasible than continuous walking.

Associations of leisure-time physical activity with mobility difficulties among middle-aged and older adults.

The authors investigated the associations of the amount, frequency and intensity, and type of leisure-time physical activity (LTPA) with the risk of self-reported difficulty in walking (WD) and stair climbing (SCD) over 16 years in a population-based cohort age 40-64 years at the onset of the study. Their results indicated that the risk for SCD was highest among men and women with a low amount of weekly LTPA. The risk was high also among women with weekly light LTPA compared with women with weekly vigorous LTPA. The risk for WD was highest among men who engaged in fitness activity once a week compared with men who engaged in fitness activity at least three times a week. A low amount of weekly LTPA, light LTPA twice or more a week, and LTPA for keeping fit and healthy less than three times a week are associated with future risk of mobility difficulties among middle-aged and older adults.

A health-related fitness and functional performance test battery for middle-aged and older adults: feasibility and health-related content validity.

OBJECTIVE: To evaluate the feasibility and health-related content validity of 6 health-related fitness (HRF) and 3 functional performance (FP) tests among middle-aged and older persons. DESIGN: Cross-sectional methodologic study. SETTING: Field laboratories in 3 communities of northeast Finland. PARTICIPANTS: A regionally representative, community-based cohort of 55- to 79-year-old men (n=501) and women (n=632). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Health-related test exclusion rates (%) by age groups and odds ratios (ORs) of subjective health outcomes by fitness categories (least 20%, next 40%, most fit 40%). RESULTS: The health-related test exclusion rates increased with age, mainly because of musculoskeletal health limitations among the women and cardiovascular and musculoskeletal health limitations among the men. With the exception of dynamic back extension, 1-leg squat, 1-leg standing balance, and the 1-km walk among the women 75 years and older, 85% or more of the subjects qualified for the HRF tests and 95% or more for the FP tests. Strong and graded associations were found for cardiorespiratory and musculoskeletal fitness and the FP test levels with perceived health and functional ability status among both the men and the women (OR range, 2-31). The motor fitness test level was primarily associated with functional ability status. CONCLUSIONS: All the HRF and FP tests showed health-related content validity, and 4 of 6 of the HRF tests and all of the FP tests proved to be safe, with minor health-related test exclusions for middle-aged and older adults. The findings may help to target physical activity intervention toward persons at high risk for declining health and functional ability.