Nancy M Gell

• PT MPH PhD
• Professor (Assistant) at University of Vermont

Exercise is recommended for healthy aging and to counteract long term effects of cancer and cancer treatment. Older cancer survivors living in rural communities face unique challenges to accessing exercise opportunities including fewer in-person program options, transportation barriers, and lack of safe, outdoor infrastructure. Remotely delivered e...

Rural older adults experience a high burden of chronic pain from osteoarthritis and other chronic conditions. Exercise is a first-line treatment for many painful conditions, but access to evidence-based programs is limited in rural areas. Remotely delivered programs, including Enhance®Fitness (Tele-EF), has high potential to expand access. Therefor...

Older adults with a cancer history may be at greater fall risk as activity-limiting symptoms from cancer and cancer treatment often persist, even after treatment has ended. Therefore, we aimed to prospectively determine the effects of pain, fatigue, and sleep difficulty on fall risk in older adults with a cancer history. Data from the National Heal...

Purpose: The study aimed to determine the test-retest reliability and concurrent validity of the Ratings of Perceived Stability (RPS) scale as a measure of balance exercise intensity in persons with multiple sclerosis (MS). Methods: Twenty participants with MS (mean age: 58.1 ± 15.29; 60% female) performed 14 balance tasks on two separate occasi...

Background: Despite the key role family caregivers play in the US healthcare system, they are not systematically identified and tracked, limiting our knowledge about this important group. Objective: Our objective was to identify caregiver characteristics and barriers to service delivery in a primarily rural state. Methods: As part of a quality impr...

Background and Objectives Social participation is associated with increased quality of life and well-being but declines following onset of dementia. Informal caregivers may facilitate social participation among people with dementia. This study aims to identify characteristics of informal caregivers associated with social participation of people wit...

Background: Cognitively stimulating sedentary behavior (SB) may positively impact cognition. This study aimed to (1) describe participation across types of SB among older adults with and without cognitive impairment and (2) examine how baseline SB participation impacts cognition, longitudinally. Methods: We used National Health and Aging Trends Stu...

Purpose: Older adults with communication disabilities (CDs) experience barriers to receiving care and face a paucity of accommodations for their disability. Utilizing someone that supports communication with healthcare providers (communication support persons) may be a way that this group self-supports their disability. We examined if this utiliza...

Background: Torture can result in impaired function, reduced quality of life, and chronic pain. Physical therapy (PT) is recommended for wholistic care of survivors of torture (SOT), however there are limited evidenced-based guidelines. We conducted a scoping review to identify and describe the approach and gaps in knowledge around the PT treatment...

Introduction Mobile applications (apps) for exercise prescription may enhance communication between healthcare providers and patients while addressing common barriers to exercise among people with osteoarthritis. However, little is known about preferences and barriers to the use of mobile apps by physical therapists or people aging with osteoarthri...

Older adults spend 80% of their waking hours performing sedentary behaviors (SBs) that are either mentally active (e.g., using computers, socializing, and completing hobbies) or passive (e.g., television viewing and resting). Cross-sectional studies report an association between passive SB participation and cognitive impairments. However, longitudi...

Background: Despite physical activity being a major component of managing chronic low back pain, < 50% of patients receive physical activity interventions. Electronic Health Records can deepen our understanding about this clinical gap. Objective: We aimed to: 1) develop and test a data abstraction form that captures physical activity documentati...

Background: Previous studies identified physical function limitations in older cancer survivors, but few have included objective measures and most focused on breast and prostate cancer survivors. The current study compared patient-reported and objective physical function measures between older adults with and without a cancer history. Methods: O...

Background: Despite the extensive evidence supporting physical activity (PA) for managing chronic low back pain (CLBP), little is known about PA prescription by physical therapists treating patients with CLBP. Objective: 1) Explore how PA prescriptions provided by outpatient physical therapists treating patients with CLBP align with PA guideline...

We aimed to examine exercise intensity among older adults participating from home in remotely delivered EnhanceFitness (Tele-EF). Exercise intensity was assessed through Fitbit-measured heart rate and the Borg 10-point rating of perceived exertion over 1 week of a 16-week exercise program. Outcomes included mean minutes spent at or above the heart...

Introduction: Identifying the population-level prevalence of a disability group is a prerequisite to monitoring their inclusion in society. The prevalence and sociodemographic characteristics of older adults with communication disabilities (CDs) are not well established in the literature. In this study we sought to describe the prevalence and soci...

Purpose The study aimed to determine the feasibility of remotely delivered exercise (tele-exercise) for older, rural cancer survivors and to explore the effects of tele-exercise on physical function, physical activity, and patient-reported outcomes. Methods Participants were rural cancer survivors age \documentclass[12pt]{minimal} \usepackage{amsm...

Objectives Poor nutritional status is a risk factor for falls and impedes recovery from falls in older adults. The primary objective of this study was to investigate the relationship between nutrition status and fall risk over time in a cohort of older adults. Methods Using an observational analytic study design, we collected demographic, fall ris...

Introduction: COVID-19 policies such as quarantining, social isolation, and lockdowns are an essential public health measure to reduce the spread of disease but may lead to reduced physical activity. Little is known if these changes are associated with changes in physical or mental health. Methods: Between September 2017 and December 2018 (basel...

Background: Despite the benefits of physical activity (PA), especially related to aging, physical therapists do not perform regular PA prescriptions secondary to various barriers, including lack of tools. Therefore, we developed the Inventory of Physical Activity Barriers (IPAB). Objective: Explore potential solutions that could address the curr...

The purpose of the pilot study was to determine the effectiveness of wearable activity trackers alone or in combination with behaviour change strategies for promoting physical activity (PA) among individuals with pre-hypertension or hypertension. A sample of 44 adults (68% female and mean age 55) were randomized to receive either a Fitbit Charge HR...

Background: The Inventory of Physical Activity Barriers (IPAB) assesses physical activity participation barriers. Development, refinement, and psychometric evaluation of the IPAB occurred via an electronic format. However, various circumstances may require using a pen-and-paper format. As instrument formats are not always interchangeable, the auth...

Aims 1) Gain insight into PA prescription by United States-based physical therapists treating patients 50 years and older, and 2) Explore the contextual factors that impact PA prescription. Methods We integrated ethnographic study data, including a questionnaire, observations, and semi-structured interviews. Results Our nine participants with 24....

Objective: EnhanceFitness (EF) is an evidence-based exercise program recommended for management of osteoarthritis (OA). However, access to EF is limited in rural areas. Accordingly, we evaluated the feasibility and acceptability of remotely delivered EF (tele-EF) in rural, community-dwelling older adults with symptomatic knee OA. Methods: A sing...

Objective: We examined changes in PA from pre-COVID-19 to during the COVID-19 pandemic and the factors associated with reduced PA levels among adults 50 years and older. Design: Participants of a validation study were stratified into being "less active than before" or "equally or more active than before" COVID-19. Multivariable manual backwards...

Addressing physical activity (PA) barriers is an essential component of increasing PA among the 56-73% of community-dwelling adults 50 years and older who are not performing the recommended 150 minutes of moderate-to-vigorous PA. As there is no feasible, multi-factorial tool to assess PA barriers among this population, we developed and validated a...

Understanding patterns in the types of activities older adults engage in during physical activity and sedentary time could help shape intervention designs. Few studies have adequately described the physical activity and sedentary pursuits older adults undertake, including during the COVID-19 pandemic. To answer these questions, this symposium uses...

Enhance Fitness (EF) is an evidence-based, group exercise program for older adults. When COVID-19 halted in-person EF classes nationally, we adapted EF for remote delivery (tele-EF) by engaging key stakeholders. To determine feasibility and acceptability of tele-EF, we conducted a mixed methods study among 42 older adults (≥65 years) with knee oste...

Little is known about whether older adults meet the recommended physical activity (PA) guidelines, including aerobic, strength, and balance components. Given this gap, we examined self-report PA data from 1,352 older adult participants of the Adult Changes in Thought (ACT) study. We classified participants as meeting some components, meeting the fu...

Background and Objectives Due to health consequences associated with insufficient physical activity (PA), particularly among aging adults, healthcare providers should assess and address lack of PA participation. Addressing lack of PA means developing individualized PA prescriptions that incorporate solutions to PA participation barriers. Assessing...

Though it is known that most older adults do not meet the recommended physical activity (PA) guidelines, little is known regarding their participation in balance activities or the full guidelines. Therefore, we sought to describe PA patterns among 1,352 community-dwelling older adult participants of the Adult Changes in Thought study, a longitudina...

Background Tele-exercise has emerged as a means for older adults to participate in group exercise during the COVID-19 pandemic. However, little is known about the technology support needs of older adults for accessing tele-exercise. Objective This study aims to examine the needs of older adults for transition to tele-exercise, identify barriers to...

Background: Early mitigation orders for COVID-19 halted participation in community-based programs. We examined the early impact of “Stay Home, Stay Healthy” orders on functioning in older adults participating in a behavioral intervention study involving community-based exercise. Methods: A quasi-natural experiment, using mixed methods (n = 39). Par...

Enhance®Fitness (EF) is an evidence-based exercise program recommended for management of osteoarthritis (OA). However, access to EF is limited in rural areas. Accordingly, we evaluated the feasibility and acceptability of remotely delivered EF in rural, community-dwelling older adults with symptomatic knee OA. A single arm pilot trial of remotely d...

Objectives Falls are a leading cause of injury, death, functional impairment, and a driver of health costs and utilization in older adults. However, falls among older adults are mostly preventable and therefore fall risk reduction is a high value target for intervention. Poor nutritional status is a risk factor for falls and impedes recovery from f...

Objectives The aim of this study was to evaluate the accuracy of three consumer-based activity monitors, Fitbit Charge 2, Fitbit Alta, and the Apple Watch 2, all worn on the wrist, in estimating step counts, moderate-to-vigorous minutes (MVPA), and heart rate in a free-living setting. Methods Forty-eight participants (31 females, 17 males; ages 18...

Background: Health care providers, including physical therapists, need to identify the reasons for insufficient physical activity (PA) to assist the 56% to 73% of community-dwelling adults 50 years of age and older who are not performing the recommended 150 minutes of moderate to vigorous PA. Currently, there is no feasible, multifactorial tool to...

Background Extremity weakness, fatigue, and postural instability often contribute to mobility deficits in persons after stroke. Wearable technologies are increasingly being utilized to track many health-related parameters across different patient populations. The purpose of this systematic review was to identify how wearable technologies have been...

Although homebound older adults face high risk for falls, they are unable to utilize community-based fall prevention programs due to their mobility limitations. In this article, we report a feasibility study of a four-session, multicomponent fall prevention program for low-income homebound older adults using pre, post, mixed-method design. The manu...

BACKGROUND Tele-exercise has emerged as a way for older adults to participate in group exercise during the COVID-19 pandemic. Yet, little is known about the technology support needs of older adults for accessing tele-exercise. OBJECTIVE Examine the interests and needs of older adults for transition to tele-exercise, 2) Identify barriers and facili...

Objectives We aimed to evaluate if malnutrition and rurality are associated with fall risk and future falls in community-dwelling older adults.DesignProspective Cohort.SettingCommunity, Vermont.ParticipantsOlder adults receiving home support services who completed a health risk assessment (n=3,300; Mean age 79.6 years ±8.4, 75% female). Additional...

Go beyond aging theories and examine the physiological and physical impacts of aging. Exercise and Physical Activity for Older Adults takes a close look at the physical implications of the aging process and how health, physical activity, and exercise interact in aging adults. With an international team of contributors composed of leading experts fr...

Inactivity levels among community-dwelling adults 50 years and older is a healthcare concern, particularly when examining the association between increasing age, inactivity, and risk of non-communicable diseases. To confront this concern, healthcare providers need to address the reasons for inactivity. Unfortunately, limited tools exist to address...

Decreasing fall risk and maintaining independence is vital for community dwelling older adults. Nutritional status and rural residence may be independent predictors of falls. The aim of this study was to evaluate if nutritional status and rurality are positively associated with fall risk and predictive of future falls in community-dwelling older ad...

Pain interference (PI) is an indicator of pain impact and is associated with physical performance (PP). However, factors associated with PI among older adults are not well described, including associations with PP and racial differences. This study explored PI among older adults by race. Data were obtained from the 2013 Pain Supplement of the Natio...

Home- and community-based services (HCBS) can reduce caregiver burden. We compared the prevalence of HCBS unmet needs among caregivers in rural and urban areas and identified factors associated with unmet HCBS needs. We used 2015-2018 Behavioral Risk Factor Surveillance System data, including the optional Caregiver Module, from 44 states, District...

Messaging through mobile apps and texts are a common feature of technology-based physical activity interventions. We aimed to examine perspectives of mid-life and older cancer survivors on message content, timing, and two-way communication. We conducted qualitative interviews with 14 participants (Mean 59.9 years, Range 52-79) who completed a remot...

Objectives: To describe the prevalence of bathroom modifications, clutter, and tripping hazards in the homes of US older adults and to examine changes after an incident fall. Methods: We used data from the 2015–2017 National Health and Aging Trends Study (n = 7499). Outcomes were the prevalence of bathroom modifications, clutter, and tripping hazar...

Purpose Physical activity minimizes the side effects of cancer; yet, participation rates among cancer survivors are low. Technological innovations are promoted as efficient means for communication and remote monitoring, but little is known about acceptability among female cancer survivors. The purpose of this study was to examine female cancer surv...

Purpose We aimed to determine the effect of a health coach, text message, and Fitbit intervention on moderate-to-vigorous physical activity (MVPA) maintenance in cancer survivors following a supervised exercise program compared to provision of a Fitbit alone. Methods Participants were recruited during the last month of an exercise-based oncology r...

Vermont continues to have one of the nation’s highest fall rates and its rurality may be a contributing factor. The purpose of our study was to compare fall history and nutritional risk (a fall risk factor also associated with rurality) in participants from rural and metropolitan areas. We collected data at statewide community-based fall risk scree...

Previous studies have reported associations of sedentary time with worse health outcomes in older adults. Yet, little is known about the relationships between the contexts of sedentary time and health outcomes. The purpose of this study was to examine associations of physical function with time spent in a variety of sedentary behavior domains. We a...

Objectives Late-life depression, falls, and fall worry are public health problems. While previous research confirms the cross-sectional relationship between depression and fall worry, few longitudinal studies have examined whether changes in fall worry are associated with changes in depressive illness and vice versa. This study examined longitudina...

Background and purpose: Falls are the leading cause of morbidity and mortality among US older adults and result in considerable medical and social consequences. Community-based screenings are a type of intervention that provides accessible fall risk screening and education at no cost to the participants. However, little is known about whether or h...

Objectives To determine the prevalence and impact of common co‐occurring symptoms among community‐dwelling older adults in the United States. Design The National Health and Aging Trends Study is a nationally representative, prospective study with annual data collection between 2011 and 2017. Setting Community‐based, in‐person interviews (survey r...

Clinical practice guidelines promote screening to identify and implement fall risk reduction strategies. However, little is known about behavioral changes after screening. We investigated adherence with recommendations among older adults who participated in community-based fall risk screenings. Participants were 123 older adults (78.1 years ±7.5) f...

Accumulating evidence suggests that pain is a risk factor for falls. Considering that pain is more common in community-dwelling older adults with dementia, we investigated the effects of pain and dementia on falls risk. Data collected annually on 7,601 community-dwelling Medicare beneficiaries aged ≥65 years who participated in the 2011–2015 Nation...

Objectives To characterize rehabilitation services use of older adults according to fall‐risk classification based on screening guidelines. Design Cross‐sectional analysis of 2015 National Health and Aging Trends Study. Setting Study participants’ homes. Participants National sample of 7,440 community‐dwelling Medicare beneficiaries. Measuremen...

Introduction Current research indicates that health care professionals' biased attitudes toward people with disabilities (PWDs) may contribute to increased health care disparities and poorer quality of care. Targeted disability competence education may improve this situation. The 4 specific purposes of this study were to identify (1) the disability...

The size of the population classified as people with disabilities or older adults is increasing globally. The World Health Organization estimates that the average prevalence of disability is around 18% among adults age 18 and older. People with disabilities and older adults have lower levels of physical activity and experience significant barriers...

Objectives: To characterize rehabilitation service use among community-dwelling older adults in the United States by identifying predictors of rehabilitation utilization, patient-reported functional improvement and rehabilitation goal attainment. Design: Cross-sectional analysis of the 2015 National Health and Aging Trends Study, which used an a...

Purpose: Physical activity is known to minimize the long-term side effects of cancer treatment. Yet, rates of physical activity participation by cancer survivors are significantly lower compared to the general population. The purpose of this pilot study was to examine the efficacy, feasibility, and acceptability of a technology-based intervention...

Objective: The effect of oral contraceptive (OC) use on risk of fracture remains unclear, and use during later reproductive life may be increasing. To determine the association between OC use during later reproductive life and risk of fracture across the menopausal transition, we conducted a population-based case-control study in a Pacific Northwe...

Objective: To examine whether self-reported sitting time is related to various health indicators, health costs, and utilization in adults over age 65. Methods: A retrospective cross-sectional cohort study was conducted using the electronic health record (EHR) from an integrated health system in Washington State. Members who completed an online h...

To examine the prevalence of mobility device use in community-dwelling older adults in the United States and to investigate the incidence of falls and worry about falling according to type and number of mobility devices used. Analysis of cross-sectional and longitudinal data from the 2011-12 National Health and Aging Trends Study. In-person intervi...

A bias in perceived risk for health outcomes, including fracture, exists. We compared perceived risk and biases in perceived risk for fracture to fracture preventive behavior. Women over age 55 (n = 2874) completed a survey five times over 5 years, and data was pulled from the medical record. Perceived risk was measured by asking women to rate thei...

Overweight and obese older adults have high sedentary time. We tested the feasibility and preliminary effects of a sedentary time reduction intervention among adults over age 60 with a body mass index over 27 kg/m(2) using a nonrandomized one-arm design. Participants (N = 25, mean age = 71.4, mean body mass index = 34) completed an 8-week theory-ba...

Objectives: Multimorbidity, the presence of multiple chronic medical conditions, is particularly prevalent in older adults. We examined the relationship of multimorbidity with mental health, social network and activity limitations in the National Health and Aging Trends Study, a nationally representative, age-stratified sample of older adults. Me...

Background/Aims Sedentary time (ST) is independently associated with cardio-metabolic conditions and mortality. Older adults have the highest levels of ST of all age groups. Little is known about how ST relates to BMI, health conditions, and health costs in older adults. Our aim was to use electronic health records (EHR) to better explore these rel...

Background: The study evaluated the effects of a text message intervention on physical activity in adult working women. Methods: Eighty-seven participants were randomized to an intervention (n = 41) or control group (n = 46). Pedometer step counts and measures of self-efficacy were collected at baseline, 12 weeks, and 24 weeks. Intervention part...

To identify factors that facilitate adherence to physical activity among employed women. Participants were 103 employed women (Mean 44.4 years ±11.8). Measures included physical activity by accelerometry, location by global positioning systems, and psychosocial constructs, perception of worksite policies and the built environment by questionnaire....

Purpose of the Study: The purpose of this study was to describe prevalence of technology use among adults ages 65 and older, particularly for those with disability and activity-limiting symptoms and impairments. Data from the 2011 National Health and Aging Trends Study, a nationally representative sample of community-dwelling Medicare beneficiaries...

Introduction: We used data from Global Positioning Systems (GPS) to describe active transportation (AT) and recreational walking (RW; i.e. in a park) trips among older adults with mobility disabilities (i.e. that use assistive devices). Little is known about these patterns in this growing segment of the population. Methods: Participants (N = 35;...

With the growing need for children from underserved populations to be physically active it is imperative to create developmentally appropriate and enjoyable physical education programs that promote physical activity. The purpose of this study was to determine the effects of mastery and performance climates on physical activity during physical educa...

BACKGROUND—With the growing need for children from underserved populations to be physically active it is imperative to create developmentally appropriate and enjoyable physical education programs that promote physical activity. The purpose of this study was to determine the effects of mastery and performance climates on physical activity during phy...

Introduction: Preliminary evidence shows text messaging to be a potential new means for health education, however, few studies have applied text messaging to physical activity promotion programs. The purpose of this project was to evaluate the role of mobile phone text messaging as a low cost, motivational tool for increasing physical activity in w...

The objective of this study was to determine the relative contributions of work activity (time spent standing, walking or sitting), floor surface characteristics, weight, BMI, age, foot biomechanics, and other demographic and medical history factors to the prevalence of hip disorders. A cross-sectional observational study design was used to engine...

Work-related fatigue of the lower extremities is a known cause of lost productivity and significant employer costs. Common workplace solutions to reduce fatigue levels include anti-fatigue matting, shoe orthoses, or sit/stand work stations. However, assessment of these anti-fatigue measures within the workplace has been limited. This was a cross se...

Jobs that necessitate prolonged standing and walking activities are commonly associated with worker's complaints of foot and ankle pain. The objective of this study was to determine the relative contributions of work activity (time spent standing, walking, or sitting), floor surface characteristics, weight, BMI, age, foot biomechanics, and other de...

This study evaluated inter-worker variability in lower body posture and work activity during highly-structured assembly line work. Data were collected from 79 unique assembly line workstations in an engine manufacturing plant. Because the plant utilized work teams, 4-8 workers rotated through each workstation. At least 30 min of videotape was colle...

The objective of this study was to determine the relative contributions of work activity (time spent standing, walking, or sitting), floor surface characteristics, weight, body mass index, age, foot biomechanics, and other demographic and medical history factors to the prevalence of plantar fasciitis. A cross-sectional observational study design wa...

This study defined the incidence rate of carpal tunnel syndrome (CTS) among active assembly workers and evaluated risk factors. This study followed 189 automobile assembly workers over 1 year. Incident cases were defined as workers who had no current or prior history of CTS and were subsequently diagnosed with CTS by means of active surveillance du...

Lateral and medial epicondylitis associated with work activity is a common upper extremity musculoskeletal disorder with a prevalence of 4-30% depending upon the work setting and diagnostic criteria. The influence of treatment, ergonomic factors, medical history, psychosocial variables, and aging on the improvement of symptoms has not been well def...

This study followed 279 auto assembly workers over 1 year to identify which factors influenced whether a worker would visit the plant medical department because of an upper-extremity musculoskeletal problem. Incident cases were defined as involving workers who had not gone to the plant medical department in the preceding 6 months and then subsequen...

Upper extremity tendonitis (UET) associated with work activity is common but the true incidence and risk factors can best be determined by a prospective cohort study. This study followed a cohort of 501 active workers for an average of 5.4 years. Incident cases were defined as workers who were asymptomatic at baseline testing and had no prior histo...

This study followed workers over an extended period of time to identify factors which may influence the onset of Carpal Tunnel Syndrome (CTS). The purpose was to evaluate incidence of CTS and to create a predictive model of factors that play a role in the development of CTS. This prospective study followed 432 industrial and clerical workers over 5...

Upper extremity discomfort associated with work activity is common with a prevalence of over 50% in many settings. This study followed a cohort of 501 active workers for an average of 5.4 years. Cases were defined as workers who were asymptomatic or had a low discomfort score of 1 or 2 at baseline testing and went on to report a discomfort score of...

Upper extremity musculoskeletal disorders are common among dental professionals. The natural history of these disorders is not well-understood. These disorders are more common in older workers, but the prevalence among younger workers has not been well-studied. The objective of this study was to determine if dental/dental hygiene students had a sim...

To determine whether nocturnal splinting of workers identified through active surveillance with symptoms consistent with carpal tunnel syndrome (CTS) would improve symptoms and median nerve function as well as impact medical care. Randomized controlled trial. A Midwestern auto assembly plant. Active workers with symptoms suggestive of CTS based on...

The purpose of the study was to determine whether abnormal median sensory nerve conduction among asymptomatic workers was predictive of future symptoms suggestive of carpal tunnel syndrome (CTS). This was a prospective study involving 77 workers who were identified as asymptomatic cases with electrodiagnostic findings of median mononeuropathy compa...