Perceptions of physical activity among elderly residents and professionals in assisted living facilities

Background

Physical activity is often described as being important for people of all ages, but what different people mean when they talk about physical activity is unclear.

Method

A phenomenographic method was used to analyze how 13 older people and 17 professionals answer the question, “If I say physical activity, what does the concept mean to you?” as part of semi-structured interviews conducted in four assisted living facilities in two different municipalities.

Results

We identified a number of different perceptions of physical activity, with the older people and professionals having different responses. Elderly and professionals alike, define physical activity as a requirement for life and as an opportunity to maintain the body although they define the concepts in different ways. Elderly define the concept as a way to create meaning and the professionals have the attitude that the concept means everyday activities.

Conclusion

The concept of physical activity may be defined in many different ways. This study has shown that elderly and professionals do not define physical activity in the same way. Therefore, professionals need to be aware of these differences when talking with elderly about individual needs in everyday life.

     

Assessment of recovery in older patients hospitalized with different diagnoses and functional levels,evaluated with and without geriatric assessment

Background

The objective of the present study was to investigate 1) the role of different admission diagnoses and 2) the degree of functional loss, on the rate of recovery of older patients after acute hospitalization. Furthermore, to compare the predictive value of simple assessments that can be carried out in a hospital lacking geriatric service, with assessments including geriatric screening tests.

Methods

Prospective, observational cohort study, including 961community dwelling patients aged?≥?70 years, transferred from medical, cardiac, pulmonary and orthopedic acute hospital departments to intermediate care in nursing home. Functional assessment with Barthel index (BI) was performed at admission to the nursing home and further geriatric assessment tests was performed during the first week. Logistic regression models with and without geriatric assessment were compared concerning the patients having 1) slow recovery (nursing home stay up to 2 months before return home) or, 2) poor recovery (dead or still in nursing home at 2 months).

Results

Slow recovery was independently associated with a diagnosis of non-vertebral fracture, BI subgroups 50–79 and <50, and, in the model including geriatric assessment, also with cognitive impairment. Poor recovery was more complex, and independently associated both with BI?<?50, receiving home care before admission, higher age, admission with a non-vertebral fracture, and in the geriatric assessment model, cognitive impairment.

Conclusions

Geriatric assessment is optimal for determining the recovery potential of older patients after acute hospitalization. As some hospitals lack geriatric services and ability to perform geriatric screening tests, a simpler assessment based on admission diagnoses and ADL function (BI), gives good information regarding the possible rehabilitation time and possibility to return home.

     

Barriers and facilitators to adherence to group exercise in institutionalized older people living with dementia: a systematic review

Objectives

Research suggests targeted exercise is important for people living with dementia, especially those living in residential care. The aim of this review was to collect and synthesize evidence on the known barriers and facilitators to adherence to group exercise of institutionalized older people living with dementia.

Methods

We searched all available electronic databases. Additionally, we searched trial registries (clinicaltrial.gov, and WHO ICTRP) for ongoing studies. We searched for and included papers from January 1990 until September 2017 in any language. We included randomized, non-randomized trials. Studies were not eligible if participants were either healthy older people or people suffering from dementia but not living in an institution. Studies were also excluded if they were not focused on barriers and facilitators to adherence to group exercise.

Results

Using narrative analysis, we identified the following themes for barriers: bio-medical reasons and mental wellbeing and physical ability, relationships dynamics, and socioeconomic reasons. The facilitators were grouped under the following thematic frames: bio-medical benefits and benefits related to physical ability, feelings and emotions and confidence improvements, therapist and group relationships dynamics and activity related reasons.

Conclusions

We conclude that institutionalized older people living with dementia, even those who are physically frail, incontinent and/or have mild dementia can demonstrate certain level of exercise adherence, and therefore can respond positively to exercise programs. Tailored, individually-adjusted and supported physical activity, led by a knowledgeable, engaging and well communicating therapist/facilitator improves the adherence to group exercise interventions of institutionalized older people living with dementia.

     

An exploratory study on the impact of daily activities on the pleasure and physical activity of older adults

Background

Pleasure is one determinant of intrinsic motivation and yet a dimension often forgotten when promoting physical activity among the older population. In this study we investigate the relation between daily activities and physical activity, experience of pleasure, and the interaction between pleasure and physical activity in the daily lives of community-dwelling older adults.

Methods

Participants carried a hip-worn accelerometer during 30 consecutive days resulting in a total of 320 days of data collection. Current activity, location, companion and experience of pleasure during each activity were assessed through experience sampling on a smartphone every 1–2 h. Between- and within-individual differences were analysed with multi-level models and 10xN?=?1 regression analysis.

Results

Outdoor activities were associated with higher physical activity than indoor activities (p?<?0.001). Performing leisure activities, outdoors and not alone significantly predicted pleasure in daily life (all p’s?<?0.05). Being more active while performing leisure activities resulted in higher experiences of pleasure (p?<?0.001). However, when performing basic activities of daily living (e.g. commuting or households) this relation was inverted. Results provide meaningful indication for individual variance. The 30 days of data collected from each participant allow for identification of individual differences.

Conclusions

Daily activities and their contexts do influence the experience of pleasure and physical activity of older adults in daily life of older adults, although similar research with larger population is recommended. Results are in accordance with the literature, indicating that the method adopted (accelerometry combined with experience sampling) provides reliable representation of daily life. Identification of individual differences can eventually be automatically performed through data mining techniques. Further research could look at innovative approaches to promote Active Ageing using mobile technology in the daily life, by promoting physical activity through recommendation of pleasurable activities, and thus likely to increase the intrinsic motivation to become physically active.

     

Effects of 10-week walking and walking with home-based resistance training on muscle quality,muscle size,and physical functional tests in healthy older individuals

Background

Older individuals have been shown to present muscle atrophy in conjunction with increased fat fraction in some muscles. The proportion of fat and connective tissue within the skeletal muscle can be estimated from axial B-mode ultrasound images using echo intensity (EI). EI was used to calculate the index of muscle quality. Walking, home-based weight-bearing resistance training, and its combinations are considered simple, easy, and practical exercise interventions for older adults. The purpose of this study was to quantify the effects of walking and walking with home-based resistance training on muscle quality of older individuals.

Methods

Thirty-one participants performed walking training only (W-group; 72?±?5?years) and 33 participants performed walking and home-based resistance training (WR-group; 73?±?6?years). This study was a non-randomized controlled trial with no control group. All participants were instructed to walk 2 or 3 sets per week for 10?weeks (one set: 30-min continuous walking). In addition, the WR-group performed home-based weight-bearing resistance training. EI was measured as a muscle quality index using axial B-mode ultrasound images of the rectus femoris and vastus lateralis of the mid-thigh. We further averaged these parameters to obtain the EI of the quadriceps femoris (QF). Participants further performed five functional tests: sit-ups, supine up, sit-to-stand, 5-m maximal walk, and 6-min walk.

Results

QF EI was significantly decreased in both groups after training (W-group 69.9?±?7.4?a.u. to 61.7?±?7.0?a.u., WR-group 64.0?±?9.5?a.u. to 51.1?±?10.0?a.u.; P?<?0.05), suggesting improved muscle quality. QF EI was further decreased in the WR-group compared with the W-group. The sit-up test in both groups and the sit-to-stand and 5-m maximal walk tests in the W-group were significantly improved after training.

Conclusion

These results suggest that training-induced stimulation is associated with a decrease in EI in some thigh regions. Furthermore, the addition of home-based resistance training to walking would be effective for a greater reduction of EI.

     

Association between handgrip strength,walking, age-related illnesses and cognitive status in a sample of Portuguese centenarians

Background

Centenarians are a growing population in Europe and present significant variability in motor and cognitive functions. The aim of our study was to characterize health status, as well as cognitive and motor functions in a group of Portuguese centenarians. In addition, our study also aimed at analyzing the relationship between cognitive functions and the burden of diseases affecting the elderly.

Methods

Fifty-two centenarians were evaluated using the Mini-Mental State Examination, short version. Walking-related parameters (velocity and time spent in the 3 m walk test), grip strength and number of age-related illnesses were also measured. The relationship between cognitive scores and time spent in the three metre walk test, velocity, grip strength and number of diseases was analysed.

Results

Cognitive scores showed a positive correlation with both handgrip strength and time spent in the three metre walk. In contrast, no association was found between cognitive scores and the presence/absence of disease, walking velocity or number of diseases present.

Conclusions

These results suggest that in centenarians, cognitive functions may be related with motor functions.

     

Changes in health-related quality of life in elderly men after 12 weeks of strength training

Background

Muscular strength is associated with functional ability in elderly, and older adults are recommended to perform muscle-strengthening exercise. Understanding how improved muscle strength and -mass influence general and specific domains of quality of life is important when planning health promotion efforts targeting older adults. The aims of the present study were to describe changes in health-related quality of life (HRQOL) in older men participating in 12 weeks of systematic strength training, and to investigate whether improvements in muscle strength and muscle mass are associated with enhancements in HRQOL.

Methods

We recruited 49 men aged 60–81 years to participate in an intervention study with pre-post assessment. The participants completed a 12-week strength training program consisting of three sessions per week. Tests and measurements aimed at assessing change in HRQOL, and changes in physical performance (maximal strength) and physiological characteristics. HRQOL was measured using the 12-item short-form survey (SF-12). Muscle mass was assessed based on changes in lean mass (leg, trunk, arm, and total), and strength was measured as one-repetition maximum in leg extension, leg press, and biceps curl.

Results

Two of the eight HRQOL SF-12 scores, role physical and general health, and the physical component summary scores, increased significantly during the intervention period. Small significant positive correlations were identified between improvements in muscle strength, and better physical and social function. Moreover, a significant increase in total muscle mass was seen during the intervention period.

Conclusions

The positive, findings from this study would suggest that systematic strength training seems to be a beneficial intervention to improve HRQOL, muscle strength and muscle mass in older men.

     

Kinect-based choice reaching and stepping reaction time tests for clinical and in-home assessment of fall risk in older people: a prospective study

Background

Quick protective reactions such as reaching or stepping are important to avoid a fall or minimize injuries. We developed Kinect-based choice reaching and stepping reaction time tests (Kinect-based CRTs) and evaluated their ability to differentiate between older fallers and non-fallers and the feasibility of administering them at home.

Methods

A total of 94 community-dwelling older people were assessed on the Kinect-based CRTs in the laboratory and were followed-up for falls for 6 months. Additionally, a subgroup (n?=?20) conducted the Kinect-based CRTs at home. Signal processing algorithms were developed to extract features for reaction, movement and the total time from the Kinect skeleton data.

Results

Nineteen participants (20.2 %) reported a fall in the 6 months following the assessment. The reaction time (fallers: 797?±?136 ms, non-fallers: 714?±?89 ms), movement time (fallers: 392?±?50 ms, non-fallers: 358?±?51 ms) and total time (fallers: 1189?±?170 ms, non-fallers: 1072?±?109 ms) of the reaching reaction time test differentiated well between the fallers and non-fallers. The stepping reaction time test did not significantly discriminate between the two groups in the prospective study. The correlations between the laboratory and in-home assessments were 0.689 for the reaching reaction time and 0.860 for stepping reaction time.

Conclusion

The study findings indicate that the Kinect-based CRT tests are feasible to administer in clinical and in-home settings, and thus represents an important step towards the development of sensor-based fall risk self-assessments. With further validation, the assessments may prove useful as a fall risk screen and home-based assessment measures for monitoring changes over time and effects of fall prevention interventions.

     

Effects of 12 weeks of Nordic Walking and XCO Walking training on the endurance capacity of older adults

Background

Several studies have already examined the positive effects of various forms of endurance training in patient groups and in healthy adults up to 60 years old. The aim of this study was to analyse the effects of Nordic Walking (NW) and XCO Walking (XCO) training on endurance capacity in healthy older adults, aged 60 years and older.

Methods

Twenty-three older participants (mean age: 69.9 ± 5.4 years) were randomly assigned to either the NW group or the XCO group. All participants were measured before and after the 12 weeks of endurance training (2 sessions/week) to examine oxygen uptake (VO₂) and energy consumption during an outdoor field test. In addition, heart rates were recorded and lactate samples were collected.

Results

NW mainly demonstrated some significant (p < 0.05) decreases in heart rate, lactate concentration at lower to moderate walking speeds, whereas XCO Walking revealed significant (p < 0.05) decreases in lactate concentration and VO₂ at low to higher walking speeds.

Conclusions

NW as well as XCO training increase the efficiency of the cardio-vascular system in older subjects. Both training approaches are suitable options for endurance training, which may serve to counteract age- and inactivity-related decreases in cardio-vascular functioning as well as aid in maintaining overall performance in older adults.

     

Influence of socioeconomic status on changes in body size and physical activity in ageing black South African women

Background

The increasing prevalence of obesity in sub-Saharan African women is not well understood, and black South African women in the region are particularly vulnerable. This study aimed to examine whether the relationship of socioeconomic status (SES) with changes in body mass index (BMI) and waist circumference (WC) is mediated by physical activity in ageing African women.

Methods

In a longitudinal analysis of the 518 caregivers associated with the Birth to Twenty Plus study, the role of SES associated with 10-year changes in BMI and WC was tested using structural equation modelling (SEM). The degree of mediation of moderate-vigorous physical activity (MVPA) and sitting time in this association was also assessed.

Results

The prevalence of obesity increased significantly from baseline to follow-up (p?<?0.0001). In the SEM models, baseline SES had a direct positive effect on changes in BMI (β, 95% CI, 0.02 (0.005 to 0.04), and a direct negative effect on changes in MVPA (β, 95% CI, ??3.81 (??6.92 to ??0.70). Baseline MVPA had a direct negative effect (β, 95% CI, ??0.002 (??0.003 to ??0.0003) and indirect positive effect via change in MVPA (β, 95% CI, 0.01 (0.0001 to 0.001) on change in WC.

Conclusions

Our study demonstrates the role and interaction of sociodemographic and behavioural predictors of obesity, and suggests a multifaceted approach to management of the crisis in communities of ageing urban African women.

     

Implementing Cognitive Behavioral Intervention for Trauma in Schools (CBITS) with Latino Youth

Objective

Many Latino youth are often unable to access mental health services and support following exposure to traumatic and stressful events. This study assesses the benefits and effectiveness of utilizing Cognitive Behavioral Intervention for Trauma in Schools (CBITS), a school based intervention, with Spanish speaking, Latino youth residing in New Orleans, Louisiana, in effort to address presenting symptoms of trauma and depression.

Method

Twenty three children and adolescents ages 10 to 14, in fifth, sixth and seventh grades, presenting with symptoms of trauma and depression, participated in a 10 week program of CBITS which was primarily conducted in Spanish.

Results

Children who participated in CBITS reported significantly fewer symptoms of trauma and depression following the intervention; however, no differences were noted between genders. Significant differences were observed between older boys and girls (12–14), as they were more likely to report higher levels of exposure to trauma than younger boys and girls (10–11). The effect sizes for the intervention were large.

Conclusions

Findings of this study suggest that CBITS is a practical and effective school based intervention available to mental health providers as a resource to be used with Spanish speaking, Latino youth who have been exposed to different forms of stress and trauma.

     

Physical activity does not alter prolactin levels in post-menopausal women: results from a dose-response randomized controlled trial

Background

Increased circulating levels of prolactin have been associated with increased risk of both in situ and invasive breast cancer. We investigated whether or not physical activity had a dose–response effect in lowering plasma levels of prolactin in postmenopausal women.

Methods

Four hundred previously inactive but healthy postmenopausal women aged 50–74 years of age were randomized to 150 or 300 min per week of aerobic physical activity in a year-long intervention. Prolactin was measured from fasting samples with a custom-plex multiplex assay.

Results

A high compared to moderate volume of physical activity did not reduce plasma prolactin levels in intention-to-treat (Treatment Effect Ratio (TER) 1.00, 95% Confidence Interval (CI) 0.95 – 1.06) or per-protocol analyses (TER 1.02, 95% CI 0.93 – 1.13).

Conclusions

It is unlikely that changes in prolactin levels mediate the reduced risk of breast cancer development in post-menopausal women associated with increased levels of physical activity.

Trial registration

clinicaltrials.gov identifier: NCT01435005.

     

Lower bone mineral density in older female endurance skiers – a cross-sectional,observational study

Background

Physical activity (PA) is generally beneficial for bone health, but the effect of high levels of PA over many years, in older women, is unknown.

Methods

T-score from Dual-energy X-ray absorptiometry (DXA), and self-reported baseline characteristics were recorded for 24 female, cross-country-skiing-competitors, aged 68–76?years, from the Birkebeiner Ageing Study. Data from 647 women in the same age range from the Tromso-6 population study, with recorded DXA findings, were used for comparison.

Results

The athletes reported a median(range) of 9(1–34) participations in the 54?km, yearly ski-race, indicating long-term PA. They also reported more moderate and high levels of PA than women in the general population (52% vs. 12 and 30% vs. 0%, respectively). The athletes had lower body mass index (BMI) than the controls (mean BMI 21.7 vs 26.9?kg/m², p?<?0.001). As many as 22/24(92%) of the athletes and 477/647(74%) of the controls had a low bone mineral density (BMD) (T-score?<???1), p 0.048, Pearson chi square test. Odds ratio (OR) of low BMD was 3.9 in athletes vs. controls (p 0.048, logistic regression), but adjusting for BMI largely diminished the effect estimate, which was no longer statistically significant (aOR 1.81, p 0.432). The proportion of self-reported fractures was the same in the two groups.

Conclusions

This pilot study suggests that long-term, high levels of PA are associated with low bone mineral density in older women, and the finding might be due to differences in BMI. Despite the lower bone mineral density the athletes did not report more fractures.

     

Exploring user experience and technology acceptance for a fall prevention system: results from a randomized clinical trial and a living lab

Background

Falls are common in older adults and can result in serious injuries. Due to demographic changes, falls and related healthcare costs are likely to increase over the next years. Participation and motivation of older adults in fall prevention measures remain a challenge. The iStoppFalls project developed an information and communication technology (ICT)-based system for older adults to use at home in order to reduce common fall risk factors such as impaired balance and muscle weakness. The system aims at increasing older adults’ motivation to participate in ICT-based fall prevention measures. This article reports on usability, user-experience and user-acceptance aspects affecting the use of the iStoppFalls system by older adults.

Methods

In the course of a 16-week international multicenter study, 153 community-dwelling older adults aged 65+ participated in the iStoppFalls randomized controlled trial, of which half used the system in their home to exercise and assess their risk of falling. During the study, 60 participants completed questionnaires regarding the usability, user experience and user acceptance of the iStoppFalls system. Usability was measured with the System Usability Scale (SUS). For user experience the Physical Activity Enjoyment Scale (PACES) was applied. User acceptance was assessed with the Dynamic Acceptance Model for the Re-evaluation of Technologies (DART). To collect more detailed data on usability, user experience and user acceptance, additional qualitative interviews and observations were conducted with participants.

Results

Participants evaluated the usability of the system with an overall score of 62 (Standard Deviation, SD 15.58) out of 100, which suggests good usability. Most users enjoyed the iStoppFalls games and assessments, as shown by the overall PACES score of 31 (SD 8.03). With a score of 0.87 (SD 0.26), user acceptance results showed that participants accepted the iStoppFalls system for use in their own home. Interview data suggested that certain factors such as motivation, complexity or graphical design were different for gender and age.

Conclusions

The results suggest that the iStoppFalls system has good usability, user experience and user acceptance. It will be important to take these along with factors such as motivation, gender and age into consideration when designing and further developing ICT-based fall prevention systems.

     

Whole-body vibration training improves balance control and sit-to-stand performance among middle-aged and older adults: a pilot randomized controlled trial

Background

Aging is associated with decreased balance, which increases falling risk. The objective of the current study was to determine the feasibility and effects of whole-body vibration (WBV) training on knee extensor muscle power, limits of stability, and sit-to-stand performance among community-dwelling middle-aged and older adults in the United States.

Methods

A randomized pilot study with participant blinding was conducted. Feasibility outcomes included recruitment and compliance rate. Twenty-nine community-dwelling older adults were randomly assigned to perform body-weight exercises with either an individualized vibration frequency and amplitude, a fixed vibration frequency and amplitude, or no vibration. Isokinetic knee extensor power, limits of stability, and sit-to-stand tests were conducted before beginning the exercises (baseline) and after 8 weeks of training.

Results

With a favorable recruitment rate (58%) and compliance rates (attrition 9%; adherence 85%), the intervention was deemed feasible. The limits of stability endpoint excursion score for the individualized frequency–amplitude group was increased by 8.8 (12.9%; P = 0.025) after training, and that group’s maximum excursion score was increased by 9.2 (11.5%; P = 0.006) after training. The average weight transfer time score was significantly decreased by 0.2 s in the fixed group. The participants in the individualized group demonstrated a significant increase (3.2%) in weight rising index score after 8 weeks of WBV training.

Conclusions

WBV training is feasible for use with elderly people, and this study achieved good recruitment and compliance. The present paper suggests that 8 weeks of WBV training improves limits of stability and sit-to-stand performance. Future studies must determine whether WBV training improves other factors that affect posture control.

Trial registration

This study was registered at the Texas Woman’s University Institutional Review Board [TWU IRB 17632] on the 3rd of November 2014.

     

Effects of physical,virtual reality-based,and brain exercise on physical,cognition, and preference in older persons: a randomized controlled trial

Background

Physical exercise (PE), virtual reality-based exercise (VRE), and brain exercise (BE) can influence physical and cognitive conditions in older persons. However, it is not known which of the three types of exercises provide the best effects on physical and cognitive status, and which exercise is preferred by older persons. This study compared the effects of PE, VRE, and BE on balance, muscle strength, cognition, and fall concern. In addition, exercise effort perception and contentment in older persons was evaluated.

Methods

Eighty-four older persons (n?=?84) were randomly selected for PE, VRE, BE, and control groups. The exercise groups received 8-week training, whereas the control group did not. Balance was assessed by Berg Balance Scale (BBS) and Timed Up and Go test (TUG), muscle strength by 5 Times Sit to Stand (5TSTS) and left and right hand grip strength (HGS), cognition by Montreal Cognitive Assessment (MoCA) and Timed Up and Go test Cognition (TUG-cog), fall concern by Fall Efficacy Scale International (FES-I), exercise effort perception by Borg category ratio scale (Borg CR-10), and exercise contentment by a questionnaire.

Results

After exercise, PE significantly enhanced TUG and 5TSTS to a greater extent than VRE (TUG; p?=?0.004, 5TSTS; p?=?0.027) and BE (TUG; p?=?0,012, 5TSTS; p?<?0.001). VRE significantly improved MoCA (p?<?0.001) and FES-I (p?=?0.036) compared to PE, and 5TSTS (p?<?0.001) and FES-I (p?=?0.011) were improved relative to BE. MoCA was significantly enhanced by BE compared to PE (p?<?0.001) and both MoCA and TUG-cog were improved compared to VRE (p?=?0.04). PE and VRE significantly (p < 0.001) increased Borg CR-10 in all exercise sessions, whereas BE showed a significant improvement (p?< 0.001) in the first 4 sessions. Participants had a significantly greater satisfaction with BE than controls (p?=?0.006), and enjoyed VRE and BE more than PE (p?< 0.001). Subjects in all exercise groups exhibited benefits compared to the control group (p?< 0.001).

Conclusions

PE provided the best results in physical tests, VRE produced measurable improvements in physical and cognition scores, while BE enhanced cognition ability in older persons. Older persons preferred VRE and BE compared to PE. Both exercises are suggested to older persons to improve physical and cognitive conditions.

     

The FARSEEING real-world fall repository: a large-scale collaborative database to collect and share sensor signals from real-world falls

Background

Real-world fall events objectively measured by body-worn sensors can improve the understanding of fall events in older people. However, these events are rare and hence challenging to capture. Therefore, the FARSEEING (FAll Repository for the design of Smart and sElf-adaptive Environments prolonging Independent livinG) consortium and associated partners started to build up a meta-database of real-world falls.

Results

Between January 2012 and December 2015 more than 300 real-world fall events have been recorded. This is currently the largest collection of real-world fall data recorded with inertial sensors. A signal processing and fall verification procedure has been developed and applied to the data. Since the end of 2015, 208 verified real-world fall events are available for analyses. The fall events have been recorded within several studies, with different methods, and in different populations. All sensor signals include at least accelerometer measurements and 58 % additionally include gyroscope and magnetometer measurements. The collection of data is ongoing and open to further partners contributing with fall signals. The FARSEEING consortium also aims to share the collected real-world falls data with other researchers on request.

Conclusions

The FARSEEING meta-database will help to improve the understanding of falls and enable new approaches in fall risk assessment, fall prevention, and fall detection in both aging and disease.

     

How an aging society affects the economic costs of inactivity in Germany: empirical evidence and projections

Background

Aging societies represent a major challenge for health care systems all over the world. As older people tend to be more physically inactive, economic costs of inactivity are likely to increase notably. The present study aims to investigate this relationship between an aging society and economic costs of inactivity using the example of Germany.

Methods

Using data from the German Socio-Economic Panel, this study applied the comparative risk assessment method developed by the WHO to estimate the direct costs of inactivity for the period 2001–2013 differentiated by gender-specific age-groups (15–29; 30–44; 45–64; 65+). Based on population statistics predicting the aging of the German population for the years 2014–2060, this research projects the development of future costs of inactivity and potential effects of interventions promoting physical activity among the German population.

Results

The results reveal an increase in the level of physical activity during the observed period (2001–2013) which compensated the negative effect of aging and resulted in a decline of inactivity costs. The projections for the years 2014–2060 indicate a constant increase in direct per capita costs until 2060 because of an aging society. Scenarios indicating how a short-term reduction of physical inactivity impacts costs of inactivity reveal the crucial role of the oldest age-group in this context.

Conclusion

The findings indicate that the aging of the German population demands further actions and initiatives to promote physical activity, especially for the oldest age-group.

     

Influence of a home-based exercise program on the urine pH in elderly female subjects: a secondary analysis of a randomized controlled trial

Background

A low urine pH is a characteristic metabolic feature of metabolic syndrome and type 2 diabetes. The purpose of the current study was to investigate the effects of a 12-week home-based bench step exercise on the urine pH status of elderly female subjects.

Methods

The current study is a secondary analysis of a randomized controlled trial (RCT) in which 59 postmenopausal female subjects were randomized to either the exercise group (n?=?29) or the control group (n?=?30). The subjects in the exercise group were instructed to perform home-based exercises using a bench step at the anaerobic threshold (AT), with a goal of performing ≥140 min/week at home for 12 weeks. The subjects in the control group were instructed to not change their normal lifestyle. Urine was collected after overnight fasting, and the urine pH was measured using a urinary test strip. The inter-group-differences at baseline and the pre-post changes within groups were assessed using the Mann-Whitney U test and Wilcoxon’s signed-rank test, respectively. Additionally, the difference in the post-intervention urine pH levels of the two groups, adjusted for the pre-intervention values (the estimated effect size) and the precision (95% confidence intervals) were investigated using an analysis of covariance.

Results

The pre-post comparison of the urine pH data using Wilcoxon’s signed-rank test showed a significant increase in the urine pH levels of the exercise group (p?<?0.05); there was no significant change in the urine pH levels of the control group. However, the estimated effect size (0.15) was small and the confidence interval straddled 0 (?0.25–0.55).

Conclusions

Based on the results of the current secondary analysis of an RCT, we could not clearly conclude that exercise has a beneficial effect on the urine pH. Further well-designed RCTs should be conducted to determine whether aerobic exercise is truly able to ameliorate urine acidification.

Trial registration

The study was retrospectively registered in the University Hospital Medical Information Network (UMIN) as “Effect of step exercise on aerobic fitness and progression of atherosclerosis in the elderly” under the registration number UMIN 000026743 (the date of registration: March 28, 2017).