Association of Daily Physical Activity With Motivation in Prefrail and Frail Older Adults Living in Retirement Communities.

Older adults living in retirement communities are an understudied population, and the association between their motivation and daily physical activity is unknown. We recruited participants (n = 173) living in a retirement community who completed the Behavioral Regulation in Exercise Questionnaire-2 and wore an activPAL accelerometer to evaluate this relationship. Participants had a median age of 81 years and demonstrated low levels of daily activity with an average step count of 3,637 (±1,965) steps per day and 52 (±25) min of daily stepping time. External motivation was negatively associated with the square root of daily step count (ß = -4.57; p < .001) and square root of daily stepping time (ß = -0.49; p < .001). Older adults living in retirement communities demonstrated low levels of daily activity, with a negative association between external motivation and daily activity. Strategies are needed to make an active lifestyle supportive and enticing for older adults in these communities.

Factors That Influence Walking Intervention Adherence for Older Adults Living in Retirement Communities.

Walking interventions improve health outcomes among older adults. However, few clinical trials evaluate long-term behavior change adherence. The authors explored factors that influence walking adherence in older adults following their participation in a clinical trial. They conducted n = 7 focus groups with n = 23 participants enrolled in the parent study (ClinicalTrials.gov number: NCT03654807). The authors used content analysis to code data according to the social-ecological model. They found that supportive services (exercise classes) in retirement communities have multilevel impacts on adherence to walking activity. Residents from communities offering services continued walking because of increased confidence gained in the parent trial, while residents in communities without services were motivated by their functional improvements. Residents voiced frustration with retirement community physical activity programs that did not address the full spectrum of physical functioning. Findings support the need for retirement communities to account for various motivational factors in tailoring programs to promote increased physical activity for older adults.

Qualitative Development of a Discrete Choice Experiment for Physical Activity Interventions to Improve Knee Osteoarthritis.

OBJECTIVE: To describe the qualitative process used to develop attributes and attribute levels for inclusion in a discrete choice experiments (DCE) for older adult physical activity interventions. DESIGN: Five focus groups (n=41) were conducted, grounded in the Health Action Process Approach framework. Discussion emphasized identification and prioritization attributes for a DCE on physical activity. Semi-structured interviews (n=6) investigated attribute levels and lay-language for the DCE. A focus group with physical activity researchers and health care providers was the final stakeholder group used to establish a comprehensive approach for the generation of attributes and levels. A DCE pilot test (n=8) was then conducted with individuals of the target patient population. All transcripts were analyzed using a constant comparative approach. SETTING: General community and university-based research setting. PARTICIPANTS: Volunteers (N=55) aged >45 years with knee pain, aches, or stiffness for at least 1 month over the previous 12 months. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Interview guides, attributes, attribute levels, and discrete choice experiment. RESULTS: The most influential identified attributes for physical activity were time, effort, cost, convenience, enjoyment, and health benefits. Each attribute had 3 levels that were understandable in the pilot test of the DCE. CONCLUSIONS: The identification of 6 physical activity attributes that are most salient to adults with knee osteoarthritis resulted from a systematic qualitative process, including attribute-ranking exercises. A DCE will provide insight into the relative importance of these attributes for participating in physical activity, which can guide intervention development.

Design and development of a mobile exercise application for home care aides and older adult medicaid home and community-based clients.

We describe a community-engaged approach with Medicaid home and community-based services (HCBS), home care aide (HCA), client, and physical therapist stakeholders to develop a mobile application (app) exercise intervention through focus groups and interviews. Participants desired a short exercise program with modification capabilities, goal setting, and mechanisms to track progress. Concerns regarding participation were training needs and feasibility within usual care services. Technological preferences were for simple, easy-to-use, and engaging content. The app was piloted with HCA-client dyads (n = 5) to refine the intervention and evaluate content. Engaging stakeholders in intervention development provides valuable user-feedback on both desired exercise program contents and mobile technology preferences for HCBS recipients.

Feasibility and Impact of High-Intensity Walking Training in Frail Older Adults.

To investigate the impact of high-intensity walking training (HIWT) on prefrail and frail older adults, five assisted living residents underwent a supervised 12-session intervention. The intervention consisted of 30 min of HIWT at 70-80% of heart rate reserve or ratings of 15 to 17 (hard to very hard) on the Borg Rating of Perceived Exertion scale. Training included walking at fast speeds, multi-directions, stairs, and outdoor surfaces with and without an assistive device. Training significantly reduced frailty using the SHARE-FI (p = .008), increased fast gait speed (p = .01), improved 6-min walk test distance (p = .03), and enhanced Berg Balance Scale scores (p = .03). There were no adverse events and all participants reached target training intensity in all 12 sessions. Participants viewed the walking intervention as highly satisfactory (9.6/10 on a Likert scale) and 100% recommended that the assisted living facility should offer HIWT as part of routine programming.

Methods and baseline characteristics for a social engagement technology-based randomized controlled trial for older adults.

Background: Growing evidence suggests that increasing opportunities for social engagement has the potential to support successful aging. However, many older adults may have limited access to in-person social engagement opportunities due to barriers such as transportation. We outline the development, design, methodology, and baseline characteristics of a randomized controlled trial that assessed the benefits of a social engagement intervention delivered through the OneClick video conferencing platform to older adults with varying levels of cognitive functioning. Methods: Community-dwelling older adults with and without cognitive challenges were randomly assigned to a social engagement intervention group or a waitlist control group. Participants were asked to attend twice-weekly social engagement events for 8 weeks via OneClick. Outcomes included social engagement and technology acceptance for both groups at baseline, week-4, and week-8 assessments. As an extension, the waitlist control group had an opportunity to participate in the intervention, with outcomes assessed at weeks 12 and 16. Results: We randomly assigned 99 participants (mean age = 74.1 ± 6.7, range: 60-99), with 50 in the immediate intervention group and 49 in the waitlist control group. About half of the participants reported living alone (53.5%), with a third (31%) falling into the cognitively impaired range on global cognitive screening. The groups did not differ at baseline on any of the outcome measures. Conclusions: Outcomes from this study will provide important information regarding the feasibility and efficacy of providing technology-based social engagement interventions to older adults with a range of cognitive abilities.

Accuracy of Self-Reported Physical Capacities as a Clinical Screening Test for Older Adults With Mobility Disability.

Background: Screening for poor physical performance has the potential to identify older adults at risk for loss of future independence, yet clinically feasible measures have yet to be identified. Methods: Using data from the National Health and Aging Trends Study, we evaluated the diagnostic utility of self-reported physical capacities of older adults (walking three blocks or six blocks, climbing 10 stairs or 20 stairs) compared to the objectively measured Short Physical Performance Battery (SPPB). Sensitivity, specificity, and likelihood ratio (LR) were calculated across three SPPB cut-points (≤8, ≤9, ≤10). Results: Sensitivity of single item-measures for detecting a low SBBP averaged 0.39 (range: 0.26-0.52), specific averaged 0.97 (range: 0.94-0.99) and likelihood ratio averaged 20.0 (range: 9.0-35.5). Among age and gender subgroups, all measures maintained clinically applicable LRs (minimum = 4.59). Conclusion: Single-item self-reported physical capacities are accurate for screening older adults with physical limitations, making them potentially useful in healthcare settings.

Systematic review of the effectiveness of caregiver training with functional mobility tasks for informal caregivers assisting patients with neurological diagnoses.

PURPOSE: To complete a systematic review to identify evidence of the effectiveness of informal caregiver training with functional mobility tasks for patients with neurological diagnoses routinely completed by physical therapists (PTs). METHODS: Databases searched: PubMed, PEDro, CINAHL, Web of Science, Proquest Health and Medical, and Scopus. Authors included studies with adult patients requiring assistance with functional mobility due to a neurological diagnosis, with the care provided by informal caregivers. Authors excluded studies with paid caregivers, or patient diagnoses of human immunodeficiency virus, dementia, or cancer. Data extracted included type of study, methodological quality review (using Downs and Black scale), number of subjects, outcome measures, interventions, and main results. RESULTS: Of 2372 total articles screened, 36 full-text articles were analyzed, with seven articles identified for inclusion in the review. All studies showed variability in number of subjects, methods, interventions, outcome measures, and results. Four of the studies showed positive results from the training of informal caregivers. CONCLUSIONS: While there is initial evidence that training informal caregivers in physical mobility tasks may help to lessen caregiver burden, further investigation is warranted. The topics typically addressed by PTs with informal caregiver training, such as transfers and ambulation, have not been extensively studied in the literature.Implications for rehabilitationPhysical therapists routinely complete training for caregivers on functional mobility tasks, with some initial evidence of the effectiveness of this training.Training for informal caregivers assisting individuals with neurological conditions has the potential to reduce injuries and decrease caregiver burden.Rehabilitation professionals should implement effective training methods for caregivers, resulting in a safer home environment for individuals with neurological diagnoses.

Feasibility and impact of a 1-minute daily functional exercise regimen prescribed to older adults by their primary care physician.

Despite the inverse relationship between physical activity (PA) and physical function, few older adults achieve PA recommendations. In response to observations that "lack of time" underlies reduced PA among older adults, recent work suggests even short bouts of PA can improve health and fitness. In addition, because they are frequently visited by older adults, an important conduit for PA promotion could be the primary care physician (PCP). However, most PCPs receive little training related to PA, rendering it difficult for them to offer meaningful counseling. Therefore, we explored the feasibility and impact of a PCP-prescribed one-minute daily functional exercise program, consisting of 30 s each of bodyweight push-ups and squats, among 24 patients 60 years of age or older. 42% of patients who were contacted started the exercise prescription and, over 24-weeks, completed approximately 114 sessions, while 75% completed at least half of the possible daily exercise sessions. As a group, the patients demonstrated increases in both maximal push-up and squat performance, though these increases plateaued following week-12. These preliminary results suggest that a PCP prescription of one-minute of daily functional exercise among older adult patients was feasible, acceptable, and effective for improving functional physical fitness. Given these findings, formal controlled research with recruitment from multiple clinics, random assignment to treatment conditions, and blinded assessments of objective functional physical performance should be pursued.