Accelerometry analysis of physical activity and sedentary behavior in older adults: a systematic review and data analysis

Accelerometers objectively monitor physical activity and sedentary patterns and are increasingly used in the research setting. It is important to maintain consistency in data analysis and reporting, therefore, we: (1) systematically identified studies using accelerometry (ActiGraph, Pensacola, FL, USA) to measure moderate-to-vigorous physical activity (MVPA) and sedentary time in older adults, and (2) based on the review findings, we used different cut-points obtained to analyze accelerometry data from a sample of community-dwelling older women. We identified 59 articles with cut-points ranging between 574 and 3,250 counts/min for MVPA and 50 and 500 counts/min for sedentary time. Using these cut-points and data from women (mean age, 70 years), the median MVPA minutes per day ranged between 4 and 80 min while percentage of sedentary time per day ranged between 62 % and 86 %. These data highlight (1) the importance of reporting detailed information on the analysis assumptions and (2) that results can differ greatly depending on analysis parameters.     

Suitability of physical activity questionnaires for older adults in fall-prevention trials: a systematic review

The purpose of the study was to identify physical activity questionnaires for older adults that might be suitable outcome measures in clinical trials of fall-injury-prevention intervention and to undertake a systematic quality assessment of their measurement properties. PubMed, CINAHL, and PsycINFO were systematically searched to identify measurements and articles reporting the methodological quality of relevant measures. Quality extraction relating to content, population, reliability, validity, responsiveness, acceptability, practicality, and feasibility was undertaken. Twelve outcome measures met the inclusion criteria. There is limited evidence about the measures' properties. None of the measures is entirely satisfactory for use in a large-scale trial at present. There is a need to develop suitable measures. The Stanford 7-day Physical Activity Recall Questionnaire and the Community Health Activities Model Program for Seniors questionnaire might be appropriate for further development. The results have implications for the designs of large-scale trials investigating many different geriatric syndromes.     

The effects of physical activity and sedentary behavior on cognitive health in older adults

Physical activity has been shown to be positively associated with cognitive health, but the mechanisms underlying the benefits of physical activity on cognitive health are unclear. The present study simultaneously examined two hypotheses using structural equation modeling (SEM). The depression-reduction hypothesis states that depression suppresses cognitive ability and that physical activity alleviates dysphoric mood and thereby improves cognitive ability. The social-stimulation hypothesis posits that social contact, which is often facilitated by socially laden physical activities, improves cognitive functioning by stimulating the nervous system. Sedentary behavior in the absence of physical activity is expected to exert an inverse relationship on cognitive health through each of these hypotheses. Community-dwelling elders (N = 158) were administered a variety of measures of cognition, depression, social support, and physical activity. SEM techniques provided partial support for the social-stimulation hypothesis and depression-reduction hypothesis. Implications for treating depression and improving cognitive functioning are discussed.     

Outcomes of a multicomponent physical activity program for sedentary, community-dwelling older adults

This single-group repeated-measures pilot study evaluated the effects of a 10-wk, multicomponent, best-practice exercise program on physical activity, performance of activities of daily living (ADLs), physical performance, and depression in community-dwelling older adults from low-income households (N = 15). Comparison of pretest and posttest scores using a one-tailed paired-samples t test showed improvement (p < .05) for 2 of 3 ADL domains on the Activity Measure-Post Acute Care and for 6 physical-performance measures of the Senior Fitness Test. Repeated-measures ANOVA revealed significant main effects for 3 of 8 physical activity measures using the Yale Physical Activity Scale. Retention rate was 78.9%, and the adherence rate for group sessions was 89.7%. Results suggest that participation in a multicomponent, best-practice physical activity program may positively affect sedentary, community-dwelling older adults' physical activity, ADL performance, and physical performance.     

Assessment of physical activity in older people with and without cognitive impairment

The purpose of this study was to validate a new interview-administered physical activity questionnaire (Assessment of Physical Activity in Frail Older People; APAFOP) in older people with and without cognitive impairment. The authors assessed feasibility, validity, and test-retest reliability in 168 people (n = 78 with, n = 88 without cognitive impairment). Concurrent validity was assessed against an inertia-based motion sensor and an established questionnaire. Sensitivity to change was tested in an ongoing study in patients with mild to moderate dementia (n = 81). Assessment of physical activity by the APAFOP and the motion sensor correlated well in the total sample (TS; p = .705), as well as in the subsamples with cognitive impairment (CI; p = .585) and without CI (p = .787). Excellent feasibility with an acceptance rate of 100%, test-retest reliability (intraclass correlation coefficients ranging from .973 (TS) to .975 (CI) to .966 (no CI), and sensitivity to change (effect sizes: 0.35-1.47) were found in both subsamples.     

Impact of physical activity on activity of daily living in moderate to severe dementia: a critical review

The objectives of this study were to describe the different modalities of physical activity programs designed for moderate to severe dementia and to identify their impact on functional independence in activities of daily living (ADL). A critical review of randomized controlled trials related to the impact of physical activity programs in moderately to severely demented persons on ADL performance and meta-analysis of the identified studies were performed. Among the 303 identified articles, five responded to the selection criteria. Four out of the five studies demonstrated limited methodological quality. In one high-quality study, physical activity programs significantly delayed deterioration of ADL performance. The program components and ADL assessment tools vary widely across studies. Although the proposed treatments have not proven their efficiency in improving the ADL status of the patients, they were able to limit the decline in ADL functioning. Future research is warranted in order to identify clinically relevant modalities for physical activity programs for people with moderate to severe dementia.     

Effects of Pilates method in physical fitness on older adults. A systematic review

Pilates method is employed for physical and mental conditioning. Elderly people could be benefited from a patterned and regulated conditioning work based on Pilates method. We performed a systematic review to assess the evidence on the effects of Pilates method in physical fitness on older adults. Our search included the following databases: MEDLINE-PubMed, Scopus and CINAHL Plus with Full Text via EBSCO and SPORTDiscus databases (up to April 2014). A summary of the results was performed using a best evidence synthesis and was reported according to the systematic review method proposed by Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. The Physiotherapy Evidence Database (PEDro) scale was used to assess the methodology quality of selected studies. Seventeen experimental studies were included in this review. Fourteen were randomized controlled trials (RCT) and three clinical controlled trials (CCT). Quality scores according to PEDro indicate low quality of the included studies (range 1–6, mean 3.8?±?1.2). The most studied components related to physical fitness were neuromotor fitness (n?=?11), muscle strength (n?=?8), cardiorespiratory endurance (n?=?4), body composition (n?=?4) and flexibility (n?=?4). Results indicate that Pilates method seems to present positive effects in neuromotor fitness, especially in static and dynamic balance. Related to the other components of physical fitness (cardiorespiratory endurance, muscle strength, body composition and flexibility), contradictory results were observed. The Pilates method indicates to be an appropriate exercise modality in order to improve balance on older adults. Nevertheless, more intervention research is needed to build a solid knowledge base about the health benefits of Pilates method on older people, especially regarding the other components of physical fitness.     

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.

     

Neighborhood influences on physical activity in middle-aged and older adults: a multilevel perspective

Over the past few years, attention has been drawn to the importance of neighborhood influences on physical activity behavior and the need to consider a multilevel analysis involving not only individual-level variables but also social- and physical-environment variables at the neighborhood level in explaining individual differences in physical activity outcomes. This new paradigm raises a series of issues concerning systems of influence observed at different hierarchical levels (e.g., individuals, neighborhoods) and variables that can be defined at each level. This article reviews research literature and discusses substantive, operational, and statistical issues in studies involving multilevel influences on middle-aged and older adults' physical activity. To encourage multilevel research, the authors propose a model that focuses attention on multiple levels of influence and the interaction among variables characterizing individuals, among variables characterizing neighborhoods, and across both levels. They conclude that a multilevel perspective is needed to increase understanding of the multiple influences on physical activity.     

Neighborhood-level influences on physical activity among older adults: a multilevel analysis

There is a need for greater understanding of setting-specific influences on physical activity to complement the predominant research paradigm of individual-centered influences on physical activity. In this study, the authors used a cross-sectional multilevel analysis to examine a range of neighborhood-level characteristics and the extent to which they were associated with variation in self-reported physical activity among older adults. The sample consisted of 582 community-dwelling residents age 65 years and older (M = 73.99 years, SD = 6.25) recruited from 56 neighborhoods in Portland, OR. Information collected from participants and neighborhood data from objective sources formed a two-level data structure. These hierarchical data (i.e., individuals nested within neighborhoods) were subjected to multilevel structural-equation-modeling analyses. Results showed that neighborhood social cohesion, in conjunction with other neighborhood-level factors, was significantly associated with increased levels of neighborhood physical activity. Overall, neighborhood-level variables jointly accounted for a substantial variation in neighborhood physical activity when controlling for individual-level variables.     

The prevalence of elder abuse and neglect in Iran: a systematic review and meta-analysis

ABSTRACT

Objective: The aim of this study was to estimate the prevalence of elder abuse and neglect in Iran.

Methods: We searched PubMed, Embase, Scopus, and PsycINFO by the end of 2017. The prevalence was calculated based on the percentage or the amount reported in the studies. Heterogeneity was assessed by the I² statistic, and the data were combined using random effects model. The results were reported as the pooled estimates and the 95% confidence intervals (CIs). The review protocol was registered in PROSPERO (CRD42017070744).

Results: A total of 16 studies involving 6,461 participants aged 60 years and over were included. The pooled prevalence for overall elder abuse was 45.7% (95% CI: 27.3–64.1, p < .001).

Discussion: The prevalence of elder abuse and neglect is substantial in the Iranian population aged 60 years and over. More research is needed to investigate the actual prevalence of elder abuse at the national level.     

Leadership in physical activity groups for older adults: a qualitative analysis

The purpose of this study was to determine whether a theory-based framework could be used to deductively identify and understand the characteristics of motivational leaders of physical activity groups for older adults. Participants were 23 older adults (mean age = 78.5 +/- 8.0 years, 65% women). An interview-guide approach was employed to elicit older adults' thoughts on important characteristics of physical activity group leaders. The data suggested that effective leaders are those whom the participants feel are properly qualified, are able to develop a personal bond with participants, and can use their knowledge and the group to demonstrate collective accomplishments. It was concluded that the findings could be used to extend the leadership activities beyond the traditional technical performance and individual feedback to include activities of social integration. Furthermore, the conceptual framework identified can serve as a valuable tool in guiding future researchers in their examination of leadership in physical activity groups for older adults.     

Aging and well-being in French older adults regularly practicing physical activity: a self-determination perspective

The purpose of this study was to identify the motivational profiles of physically active older adults and to achieve a better understanding of their perceived motives to explain their regular physical activity behavior in relation to self-determination theory (SDT). To address these aims, this study used quantitative and qualitative approaches. Older adults (n = 92; M = 74.95, SD = 4.6) completed the French version of the Sport Motivational Scale. A cluster analysis showed two motivational profiles with differential motivational patterns. The first was named the high combined profile, with high scores on intrinsic motivation and introjected regulation and low levels of external regulation. The second profile was the low to moderate motivational profile, with low scores on intrinsic motivation and moderate scores on introjected regulation. The qualitative study's results demonstrate the usefulness of SDT in explaining the relationship between these motivational profiles and the intertwining of the three basic psychological needs.     

Gambling among culturally diverse older adults: a systematic review of qualitative and quantitative data

Culturally diverse older gamblers may face multiple jeopardies and socially structured challenges. In this first systematic review of empirical evidence of gambling in this population, the authors examined both quantitative and qualitative studies published between 1996 and June 2016. A thorough search of 7 databases yielded 18 articles with a total sample of 11,296 culturally diverse older adults. The review revealed contrary findings on the correlation between gender, education, income and gambling behaviour. Early onset was more frequently found among older adults who belonged to a culture that promoted tolerance of gambling activities; however, some developed a gambling habit after they had moved to a western society. Using an analytical framework, the authors demonstrate interrelated factors: enabling factors (cultural acceptance of gambling, supportive social networks, accessibility to gambling facilities and venues, and external cues); motivational factors (desire for excitement and winning money, coping with boredom, and stress due to structural issues); and buffering factors for culturally diverse older gamblers . Both environmental and personal factors could be triggered as buffers between gambling and culturally diverse older adults. In light of the motivational and enabling factors, practitioners and policy makers may need to step beyond focusing on ‘correction’ during intervention.     

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.

     

Mortality and physical functioning in epidemiologic studies of three older populations

Mortality experienced in the first three years of follow-up for three Established Populations for Epidemiologic Studies of the Elderly (EPESE) is examined in relation to the participants' self-reported functional ability. In East Boston, Massachusetts (N = 3,812), Iowa and Washington Counties, Iowa (N = 3,673), and New Haven, Connecticut (N = 2,812), noninstitutionalized persons aged 65 and older were asked a series of questions to determine their functional status. These measures, used in logistic regression analyses of the mortality data, showed that an increased number of reported disabilities significantly increased the risk of mortality over and above the effects of the age and sex of the participant, or the methodological differences among the sites. Disabilities in gross mobility (e.g., ability to walk a half mile, climb stairs, or perform heavy work around the house) were more strongly related to mortality than were measures of activities of daily living.     

Correlates of physical activity in a community sample of older adults in Appalachia

Although much has been learned about the global determinants of physical activity in adults, there has been a lack of specific focus on gender, age, and urban/rural differences. In this church-based community sample of Appalachian adults (N = 1,239), the primary correlates of physical activity included age, gender, obesity, and self-efficacy. Overall, 42% of all participants and 31% of adults age 65 years or older met recommended guidelines for physical activity, which suggests that most participants do not engage in adequate levels of physical activity. Of participants who met physical activity guidelines, the most common modes of moderate and vigorous activity were walking briskly or uphill, heavy housework or gardening, light strength training, and biking. These particular activities that focus on building self-efficacy might be viable targets for intervention among older adults in rural communities.     

Effect of age and physical activity level on functional fitness in older adults

It is difficult to distinguish between the effects of age and physical activity level in the functional fitness level of older adults. The objective of this study was to determine the effects of age and physical activity level on some functional fitness parameters in community-dwelling older adults.Two hundred twenty-nine elderly (111 female; 118 male) aged between 65–87 years living in the Balçova municipality region were divided into two groups: the young elderly (65–69 years old) and the elderly (70 years old or over). The “seven-day physical activity recall questionnaire” was used to estimate physical activity level (PAL). The functional fitness evaluation included the body mass index (BMI), the lower body strength (LBS), the dynamic balance, and the aerobic endurance. The young elderly were significantly worse with regard to BMI and significantly better with regard to LBS, dynamic balance, and aerobic endurance than the elderly; in contrast, PAL did not affect any of the functional fitness parameters. The young elderly showed worse BMI than the elderly when the age groups were less active. The young elderly showed better LBS and dynamic balance than the elderly when the age groups were more active. The young elderly showed significantly better aerobic endurance than the elderly in both the less and more active age groups. This study confirms that age affects functional fitness, whereas PAL generally does not. However, being more active is advantageous for the young elderly with regard to BMI, LBS, and dynamic balance.