Should physical activity programs be tailored when older adults have compromised function?

Dept. of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA.
Journal of aging and physical activity (Impact Factor: 1.97). 07/2009; 17(3):294-306.
Source: PubMed


The purpose of this study was to determine whether a walking program supplemented by tasks designed to challenge balance and mobility (WALK+) could improve physical function more than a traditional walking program (WALK) in older adults at risk for mobility disability. 31 community-dwelling older adults (M +/- SD age = 76 +/- 5 yr; Short Physical Performance Battery [SPPB] score = 8.4 +/- 1.7) were randomized to treatment. Both interventions were 18 sessions (1 hr, 3x/wk) and progressive in intensity and duration. Physical function was assessed using the SPPB and the 400-m-walk time. A subset of participants in the WALK group who had relatively lower baseline function showed only small improvement in their SPPB scores after the intervention (0.3 +/- 0.5), whereas a subset of participants in the WALK+ group with low baseline function showed substantial improvement in their SPPB scores (2.2 +/- 0.7). These preliminary data underscore the potential importance of tailoring interventions for older adults based on baseline levels of physical function.

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Available from: Anthony P Marsh, Oct 06, 2015
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    • "Several years ago, we conducted a small pilot study in which we randomized older adults with a range of function to either a standard walking program for 6 weeks or to one that involved walking combined with intermittent stations that challenged balance, coordination, and a combination of movement and executive cognition function – walk+.54 By virtue of the physical demands, participants had to consciously focus their awareness on coordinated movements and were fully absorbed in what they were attempting to accomplish. "
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    ABSTRACT: Considerable research over the past decade has garnered support for the notion that the mind is both embodied and relational. Jointly, these terms imply that the brain, physical attributes of the self, and features of our interpersonal relationships and of the environments in which we live jointly regulate energy and information flow; they codetermine how we think, feel, and behave both individually and collectively. In addition to direct experience, evidence supports the view that stimuli embedded within past memories trigger multimodal simulations throughout the body and brain to literally recreate lived experience. In this paper, we review empirical support for the concept of an embodied and relational mind and then reflect on the implications of this perspective for clinical interventions in aging individuals and populations. Data suggest that environmental influences literally "get under the skin" with aging; that musculoskeletal and visceral sensations become more prominent in activities of the mind due to aging biological systems and chronic disease. We argue that conceiving the mind as embodied and relational will grow scientific inquiry in aging, transform how we think about the self-system and well-being, and lead us to rethink health promotion interventions aimed at aging individuals and populations.
    Clinical Interventions in Aging 06/2013; 8:657-65. DOI:10.2147/CIA.S44797 · 2.08 Impact Factor
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    • "The research that has been done among older adults with chronic disease or low fitness has indicated that multicomponent programs (including endurance, strength, flexibility, and balance) focusing on physical activity only (versus multiple behavior targets such as activity, nutrition, and medication), building exercise slowly over time, and using behavior change principles (e.g., social support, health contracts, self-monitoring, goal-setting) help promote physical activity [96–100]. Effective physical activity programs among older adults target moderate intensity activities, are inexpensive, are convenient [80], can be done independently though with some instruction [101], and are tailored [102]. For women, particularly, inclusion of a social component can be important [80]. "
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    ABSTRACT: With the aging of the baby boomer population and their accompanying burden of disease, future disability rates are expected to increase. This paper summarizes the state of the evidence regarding physical activity and aging for individuals with mobility disability and proposes a healthy aging research agenda for this population. Using a previously published framework, we present evidence in order to compile research recommendations in four areas focusing on older adults with mobility disability: (1) prevalence of physical activity, (2) health benefits of physical activity, (3) correlates of physical activity participation, and, (4) promising physical activity intervention strategies. Overall, findings show a dearth of research examining physical activity health benefits, correlates (demographic, psychological, social, and built environment), and interventions among persons aging with mobility disability. Further research is warranted.
    Journal of aging research 06/2011; 2011:708510. DOI:10.4061/2011/708510
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    • "There is precedence for greater benefits of physical activity training among individuals with lower baseline functioning in other outcomes. For example, Marsh, et al. found baseline lower extremity functioning moderated the influence of two different walking programs on improvements in physical functioning [50]. Whereas those with higher levels of functioning responded more positively to a traditional walking program, the lower functioning participants responded more positively to a novel walking program that included more complex walking tasks, such as stepping over obstacles. "
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    ABSTRACT: The efficacy of non-pharmacological intervention approaches such as physical activity, strength, and cognitive training for improving brain health has not been established. Before definitive trials are mounted, important design questions on participation/adherence, training and interventions effects must be answered to more fully inform a full-scale trial. SHARP-P was a single-blinded randomized controlled pilot trial of a 4-month physical activity training intervention (PA) and/or cognitive training intervention (CT) in a 2 × 2 factorial design with a health education control condition in 73 community-dwelling persons, aged 70-85 years, who were at risk for cognitive decline but did not have mild cognitive impairment. Intervention attendance rates were higher in the CT and PACT groups: CT: 96%, PA: 76%, PACT: 90% (p=0.004), the interventions produced marked changes in cognitive and physical performance measures (p≤0.05), and retention rates exceeded 90%. There were no statistically significant differences in 4-month changes in composite scores of cognitive, executive, and episodic memory function among arms. Four-month improvements in the composite measure increased with age among participants assigned to physical activity training but decreased with age for other participants (intervention*age interaction p=0.01). Depending on the choice of outcome, two-armed full-scale trials may require fewer than 1,000 participants (continuous outcome) or 2,000 participants (categorical outcome). Good levels of participation, adherence, and retention appear to be achievable for participants through age 85 years. Care should be taken to ensure that an attention control condition does not attenuate intervention effects. Depending on the choice of outcome measures, the necessary sample sizes to conduct four-year trials appear to be feasible. Identifier: NCT00688155.
    BMC Geriatrics 05/2011; 11(1):27. DOI:10.1186/1471-2318-11-27 · 1.68 Impact Factor
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