Barriers to exercise behavior among older adults: a focus-group study

Longer life expectancy, rapid population growth, and low exercise-participation rates of adults 65 and older justify the need for better understanding of older adults' exercise behavior. The objectives of this focus-group study were to determine barriers to the exercise behavior of older adults. Six focus groups, three with exercisers and three with nonexercisers, were conducted at various sites throughout Rhode Island. The majority (n = 57) of the 66 individuals who participated were women, and all stated that they were 65 and older. Results from the focus-group data identified 13 barriers to exercise behavior. The most significant barriers mentioned by nonexercisers were fear of falling, inertia, and negative affect. Exercisers identified inertia, time constraints, and physical ailments as being the most significant barriers to exercise. Implications from these focus-group data can be useful in the development of exercise interventions for older adults, which could increase exercise participation.     

Music listening: its effects in creating a healing environment

Older adults face challenges in function, cognition, and isolation as they age. Nurses are responsible for providing a healing environment to promote health and well-being. Music listening is an intervention that could be used to facilitate a healing environment. This article provides examples of evidence that music can improve the healing environment for older adults, both physiologically and psychologically. Music can connect individuals with their emotions and bring about a sense of self-awareness that improves the quality of life for older adults. Music is a safe, inexpensive, and easy-to-use intervention that nurses can implement independently to help older adults cope with pain, acute confusion, and functional deficits. Examples of ways nurses can use music to provide a healing environment are also included.     

Motives for and barriers to physical activity among older adults with mobility limitations

The purpose of this study was to investigate what older adults with severe, moderate, or no mobility limitation consider motives for and barriers to engaging in physical exercise. Community-dwelling adults (N=645) age 75-81 years completed a questionnaire about their motives for and barriers to physical exercise and answered interview questions on mobility limitation. Those with severely limited mobility more often reported poor health, fear and negative experiences, lack of company, and an unsuitable environment as barriers to exercise than did those with no mobility limitation. They also accentuated disease management as a motive for exercise, whereas those with no or moderate mobility limitation emphasized health promotion and positive experiences related to exercise. Information about differences in motives for and barriers to exercise among people with and without mobility limitation helps tailor support systems that support engagement in physical activity among older adults.     

Improving quality of life in old age: the role of regular physical activity

Physical activity in old age has been shown to produce considerable physiological, psychological and social benefits. However, many older adults take very little exercise. Lack of facilities or meaningful role models together with social and cultural expectations concerning the appropriateness of physical activity for older adults have been cited as reasons for lack of involvement. The development of intergenerational programs is suggested as a potential means of increasing the proportion of older individuals who participate in regular physical exercise.     

Synergistic effect of social support and self-efficacy on physical exercise in older adults

The purpose of the current study was to examine whether the effects of social support on physical exercise in older adults depend on individual perceptions of self-efficacy. Three hundred nine older German adults (age 65-85) were assessed at 3 points in time (3 months apart). In hierarchical-regression analyses, support received from friends and exercise self-efficacy were specified as predictors of exercise frequency while baseline exercise, sex, age, and physical functioning were controlled for. Besides main effects of self-efficacy and social support, an interaction between social support and self-efficacy emerged. People with low self-efficacy were less likely to be active in spite of having social support. People with low support were less likely to be active even if they were high in self-efficacy. This points to the importance of both social support and self-efficacy and implies that these resources could be targets of interventions to increase older adults' exercise.     

The effect of guided relaxation and exercise imagery on self-reported leisure-time exercise behaviors in older adults

The purpose of this study was to examine the effects of a 6-wk intervention that used guided relaxation and exercise imagery (GREI) to increase self-reported leisure-time exercise behavior among older adults. A total of 93 community-dwelling healthy older adults (age 70.38 ± 8.15 yr, 66 female) were randomly placed in either a placebo control group or an intervention group. The intervention group received instructions to listen to an audio compact disk (CD) containing a GREI program, and the placebo control group received an audio CD that contained 2 relaxation tracks and instructions to listen to music of their choice for 6 wk. Results revealed that listening to a GREI CD for 6 wk significantly increased self-reported leisure-time exercise behaviors (p = .03). Further exploration of GREI and its effects on other psychological variables related to perceived exercise behaviors may substantiate its effectiveness.     

Promoting self-management of urinary incontinence in a geropsychiatric day treatment program

As the number of older adults in the United States increases, the number of older adults with mental illnesses also will increase. There will be a corresponding increase in prevalence of UI and its associated problems--medical problems, loss of independence or need for institutionalized care, diminished quality of life, and increased costs. Psychiatric nurses are in a position to help older adults with mental illnesses improve their overall health and quality of life by preventing the problems associated with untreated UI. Within their practice, psychiatric nurses have the opportunity to ensure clients receive the comprehensive assessments needed to establish their functional, physical, behavioral, emotional, and social support status--information that forms the foundation for developing individualized treatment interventions. Psychiatric nurses have the expertise to integrate physical and mental health care for older adults with mental illnesses and co-occurring conditions, such as UI. Promoting self-management of UI among older adults with mental illnesses potentially will enable them to participate in psychiatric rehabilitation programs; improve their overall health and quality of life; prevent falls and fractures that often cause them to lose their independent community living status and to be admitted to long-term care facilities; and reduce the cost to mental health care providers of managing UI in the treatment setting.     

An integrated dementia intervention for Korean older adults

Called dotage in Korea, dementia is primarily characterized by cognitive impairments. Secondary manifestations include mental-emotional problems, including depression. This study was designed to examine the effects of an integrated dementia intervention for Korean older adults. The intervention is composed of cognitive stimulation training, exercise, music, art, and horticultural therapy. Participants included 38 older adults with mild dementia. Twenty were assigned to the experimental group and 18 to the control group. Participants in the experimental group attended 18 program sessions. Significant differences were found postintervention between the two groups in measures of cognitive function, depression levels, and mental-emotional health. The findings indicate that this integrated dementia intervention can be applied to help older adults with mild dementia.     

Effect of resistance-exercise training on cognitive function in healthy older adults: a review

Several studies have demonstrated that exercise helps reduce or prevent cognitive deterioration among older adults, and recent studies have further examined the effects of resistance-exercise training on cognition. The purpose of this review was to examine the role of resistance-exercise training on cognition in healthy older adults. Specifically, it describes the definition, health benefits, and the design of resistance-exercise training. The authors also review the research related to resistance exercises and cognition and found that this exercise modality may enhance specific cognitive performances. Next, they examine the potential mechanisms underlying resistance exercise and cognitive enhancement. Finally, they consider potential therapeutics and recommendations for further research on resistance-exercise training and cognition in older adults.     

A proposal for a new screening paradigm and tool called Exercise Assessment and Screening for You (EASY)

The Exercise Assessment and Screening for You (EASY) is a tool developed to help older individuals, their health care providers, and exercise professionals identify different types of exercise and physical activity regimens that can be tailored to meet the existing health conditions, illnesses, or disabilities of older adults. The EASY tool includes 6 screening questions that were developed based on an expert roundtable and follow-up panel activities. The philosophy behind the EASY is that screening should be a dynamic process in which participants learn to appreciate the importance of engaging in regular exercise, attending to health changes, recognizing a full range of signs and symptoms that might indicate potentially harmful events, and becoming familiar with simple safety tips for initiating and progressively increasing physical activity patterns. Representing a paradigm shift from traditional screening approaches that focus on potential risks of exercising, this tool emphasizes the benefits of exercise and physical activity for all individuals.     

Does physical exercise improve perceptual skills and visuospatial attention in older adults? A review

Neuroimaging studies suggest that when the brain ages, more areas are involved to perform a task in order to obtain the same results. This, together with the increase in crystalized intelligence and wisdom, is usually considered as a compensatory strategy. Research has demonstrated that physical activity might also act as a strategy and be one of the main factors that can slow down age-related perceptual and cognitive decline. Research also suggests that different types of physical exercise and sport lead to different changes in perceptual and cognitive skills as well as in several areas of the brain, especially those involving multiple domains, such as exergaming, dance or some sports. This review summarizes the findings of recent studies with older adults investigating the brain and cognitive benefits of different forms of physical exercise. Visuospatial attention, which plays a critical role in our daily lives, especially for older adults, is a central part of this analysis.     

Relationships Among Active Engagement in Life Activities and Quality of Life for Assisted-Living Residents

This cross-sectional research explored the relationships between active engagement in life activities (leisure, social, and instrumental activities of daily living) and quality of life for seniors aged 65 and older residing in assisted living facilities. It is increasingly recognized that active participation in diverse physical, cognitive, and social activities can promote older adults’ quality of life, including physical and mental health, but there is limited information about this in the population of residents in assisted living facilities. It is estimated that there are one million older adults residing in assisted living facilities, making assisted living facilities a rapidly growing segment of senior housing. Older adults who relocate to assisted living facilities commonly experience lifestyle changes, often related to their altered physical and social environment, reduced demands regarding household chores and meal preparation, and new opportunities for recreation and socialization. In this study, interviews were conducted with 131 ambulatory residents from assisted living facilities in the New York City metropolitan area using the 55-Item Activity Checklist, SF-36v2, Life Satisfaction Index-Z, and demographic questions. Results found significant low to moderate correlations between retained engagement in life activities (leisure, social, and instrumental activities of daily living) and life satisfaction, and several quality of life domains, including physical functioning, mental health, general health, and vitality. Older adults continued to engage in a greater percentage of everyday life activities they identified as important. This data supports exploration of client-centered activity programs to promote participation of residents in assisted living facilities in diverse activities to both maintain resident functional abilities and manage functional decline.     

Pilot study comparing physical and psychological responses in medical qigong and walking

Identifying alternative exercise modalities in an effort to stimulate and promote participation in physical activity, especially among older adults, is a critical health consideration. The purpose of this study was to compare physiological and psychological responses to medical qigong with self-paced brisk walking. Older women (55-79 years) performed 22 min of either qigong or walking on two separate days. During exercise performance, heart rate and ratings of perceived exertion were assessed. Psychological affect, blood pressure, and pulse rate were assessed before and after the exercise bouts. Heart-rate data indicated that both forms of exercise were at a moderate level of intensity. In addition, similar values were found for the physiological and psychological variables as a function of the two forms of exercise. Therefore, it was concluded that this form of medical qigong can be considered a moderate-intensity physical activity that should have both physiological and psychological benefits for older women.     

Community exercise program for older adults recovering from hip fracture: a pilot study

Community-based rehabilitative exercise programs might be an effective means to improve functional outcomes for hip-fracture patients. The purpose of this study was to evaluate the effectiveness of a community exercise program (CEP) for older adults recovering from hip fracture. Twenty-five older adults (mean age 80.0 +/- 6.0 years; 24 women; 71 +/- 23 days post-hip fracture) participated in this pilot study (17 exercise, 8 control). The CEP involved functional stepping and lower extremity-strengthening exercises. Control participants received only standard outpatient therapy. Measures of functional mobility, balance confidence, falls efficacy, lower extremity strength, and daily physical activity were evaluated at baseline and at 16 weeks. Improvements for self-reported physical activity, mobility, balance, and knee-extensor strength were observed for the CEP group. This study demonstrated that a CEP is beneficial for community-dwelling older adults post-hip fracture.     

Construct validity and physical performance of older adults in different hierarchical physical-disability level

The purpose of this study was to test the construct validity of the hierarchical levels of self-reported physical disability using health-related variables and physical-performance tests as criteria. The study participants were a community-based sample of 368 adults age 60 years or older. These older adults were grouped into 4 levels according to their physical-disability status (able, mildly disabled, moderately disabled, and severely disabled groups) based on their self-reported measures on the mobility, instrumented activity of daily living (IADL), and activities of daily living (ADL) domains. Health-related variables (body-mass index, number of comorbidities, depression status, mental status, and self-perceived health status) and eight performance-based tests demonstrated significant group differences. Self-reported measures of physical disability can be used to categorize older adults into different stages of physical functional decline.     

Reliability and validity of the Outcome Expectations for Exercise Scale-2

Development of a reliable and valid measure of outcome expectations for exercise for older adults will help establish the relationship between outcome expectations and exercise and facilitate the development of interventions to increase physical activity in older adults. The purpose of this study was to test the reliability and validity of the Outcome Expectations for Exercise-2 Scale (OEE-2), a 13-item measure with two subscales: positive OEE (POEE) and negative OEE (NOEE). The OEE-2 scale was given to 161 residents in a continuing-care retirement community. There was some evidence of validity based on confirmatory factor analysis, Rasch-analysis INFIT and OUTFIT statistics, and convergent validity and test criterion relationships. There was some evidence for reliability of the OEE-2 based on alpha coefficients, person- and item-separation reliability indexes, and R(2)values. Based on analyses, suggested revisions are provided for future use of the OEE-2. Although ongoing reliability and validity testing are needed, the OEE-2 scale can be used to identify older adults with low outcome expectations for exercise, and interventions can then be implemented to strengthen these expectations and improve exercise behavior.     

The impact of high-calorie-expenditure exercise on quality of life in older adults with coronary heart disease

The acceptability of a high-calorie-expenditure (HCE) exercise program in older coronary heart disease patients participating in a behavioral weight-control program was evaluated. Seventy-four overweight patients (median age 63 yr) were randomly assigned to a 5-mo intervention of HCE exercise (3,000-3,500 kcal/wk daily walking) or standard cardiac-rehabilitation (CR) exercise (700-800 kcal/wk). Both groups received counseling to achieve a dietary caloric deficit of 3,500 kcal/ wk. Assessments at baseline and 5 mo included self-reported measures of quality of life and psychosocial variables. The HCE group experienced significantly greater weight loss (8.2 ± 4 vs. 3.7 ± 5 kg, p < .001). Changes from baseline to 5 mo on scores of physical, emotional, and social functioning were greater for the HCE than CR group (p < .05). HCE exercise also resulted in greater positive change in exercise enjoyment (p = .05), which was mediated by weight change. Even high-risk older adults can be successful in an HCE exercise program and experience no adverse physical or emotional changes.     

Does Music Therapy Improve Mental Health in Adults? A Review

The current review provides a summarized synthesis and evaluation of studies addressing the effects of music therapy (MT) alone or MT added to standard care on mental health among adults. Potential studies were identified through electronic bibliographic databases and manual searches. Studies were included for review if (1) the study methodology involved a randomized control trial, (2) the study outcome included a measure of mental health, (3) the study sample included adults ages 18 and older, and (4) the study was published in an English language peer-reviewed journal since 2006. Applying these criteria, the search yielded 593 studies, 9 of which were ultimately retained for review. These studies generally found MT to be more effective than no treatment or than standard care alone. Long-term studies were few, and results suggest no meaningful differences over time.     

Ageing in a spectacular 'youth culture': continuity, change and community amongst older goths

This article explores the continuing involvement in youth music and style cultures of older participants through examination of the case study of the goth scene. It does so in the context of a widespread neglect, until recently, of what happens to participants of 'youth cultures' as they move beyond adolescence and also of a growing consensus about the broadening of youth itself as a life course period. Drawing on recent work on older participants in other music and style related groupings, the article uses original qualitative research to examine the developing lives and identities of goths as they become older. Rather than regarding continuing participation as a simple extension of youth, the focus is on the ways participation accompanied and was reconciled with material, domestic and physical elements of developing adult lives. Through reference to the case study, I emphasize the ways the experience of ageing for long-term music and style culture participants can constitute a collective experience.