Though patterns of PA may change with ageing,[ 31 ] and may differ between different populations, still walking remains as one of the most recommended and popular forms of PA among olderadults.[ 25 ] Since walking is the most prominent pattern of PA among the olderadults in Palestine; this study addresses PA in terms of walking as a MIA-PA based on the WHO recommendations.[ 8 ] Determining a precise measurement to assess PA in olderadults is very challenging due to physiological and cognitive changes that occur with aging.[ 47 ] This challenge can be more difficult in a circumstance where the available valid measures for assessing PA in olderadults [ 36 , 37 ] cannot be entirely applied according to different domains of PA within diverse cultural contexts.[ 24 ] Therefore, this study used an adapted questionnaire that considers social and cultural issues. Findings of the PA-SCAQ pilot testing revealed that walking was the most prevalent domain of PA among the olderadults Palestinians. Within the scope of this study, we believe that the PA-SCAQ had good face validity and enabled us to obtain the required descriptive statistics about PA domains among the olderadults in the West Bank/Palestine.
The study methods have been reported elsewhere [23,24]. In 2001 baseline information was obtained from a cohort of 4,000 persons representative of the non- institutionalized population age 60 and over in Spain. Study subjects were selected using probabilistic sampling within multistage clusters. The clusters were stratified by region of residence and size of town. Thereafter, cen- sus sections were selected at random in each cluster, followed by individual households where information was obtained from residents. Data were collected on a total of 420 census sections in Spain, with subjects being selected in sex and age strata. Subjects who could not participate after 10 failed visits by the interviewer or because of incapacity, death, institutionalization or refu- sal were replaced with other individuals selected with the same sampling procedure. Data were collected by home-based personal interview with subjects, followed by a physical examination, performed by trained and certified personnel.
Financial burden should not be the only factor encouraging the promotion of falls prevention; the quality of life and safety of aged individuals should be a priority in the health care system as the population ages. The risk of injury resulting from a fall increases with age, and falls can further limit independent living ability of a population already at risk for losing independence (Stevens & Sogolow 2005; Sterling, O’Connor, & Bonadies 2001; Alexander et al. 1992; Tinetti et al. 1988). The loss of independence for an elderly person can be mentally and emotionally devastating, but the addition of regular physicalactivity into a person’s life can reduce the risk of losing independence and mobility (Sherrington et al. 2004; Spirduso & Cronin 2001; Hirvensalo, Rantanen, & Heikkinen 2000). In a study conducted by the Association for the Advancement of Retired Persons (AARP), less than half of older American adults participated in exercise, and even fewer enjoyed it, so there is a need to introduce exercise programs in this patient population (Korczyk 2002).
cognitive and physicalfunctioning, and outcomes of questionnaires) were analysed using one-way analysis of variance (ANOVA). Chi-squared tests were applied for nominal data (e.g. gender, ethnicity, marital status, living ar- rangements, level of education, children, and employment status). For descriptive statistics, data were presented as means (M) and standard deviations (SD). Nominal data were presented as number (N) and percentage. Mixed be- tween (group) and within (time) repeated-measures ANO- VAs with post hoc comparisons were applied to investigate the effect of the intervention versus control on psychosocial outcomes (loneliness, social support, support networks, depression, anxiety, self-efficacy for exercise, satisfaction with level of social contacts), expected outcomes and bar- riers for exercise and accelerometer data. The accelerom- eter data were analysed using the ActivPAL software V7.1.18 (PAL technologies, Scotland, UK). Recorded data were downloaded to a computer, and data for average daily amount of stepping (step counts), average time lying and sitting (h) in increments of 15 s, average time standing (h), and energy expenditure (EE, MET/h) were analysed using mixed between (intervention group) and within (time) ANOVAs. For the Expected Outcomes and Barriers for Ha- bitual Exercise scale [ 55 ], additional test-retest reliability was calculated via correlation. In order to explore which outcome measures are likely to be most important for the main trial, Pearson’s correlations were performed between calculated change scores over time in the experimental group for all psychosocial outcomes (Lubben’s social net- works, loneliness and self-efficacy for exercise) and change scores for averaged daily physicalactivity (time lying/sitting (h), time standing (h), time stepping (h), step counts, sit to stand transitions (n) and energy equivalent (METs/h)). Stat- istical power and sample size estimation for a future large- scale RCT were calculated for meaningful outcomes (e.g. loneliness or social support) using the method based on the differences in means between the intervention and control group using the G-power software Version 3.1 [ 58 ].
In this study, it is plausible that grip strength was correlated with symptoms of anxiety because many parti- cipants had a preconceived notion that they would score poorly on this task. In addition, grip strength may not have been correlated with symptoms of depression because the physical and psychological effort involved in the measure- ment of grip strength was much less than the effort required to perform multiple trials of the 10MWT or TUG. Symptoms of depression, as measured by GDS, were found to have a direct, though minimal, association with the physical measures of the TUG (r = 0.255) and the 10MWT (r = − 0.255). Our data also show that the GDS was a small predictor of both the TUG ( β = 0.277) and 10MWT ( β = − 0.202). The relationship between depres- sion and physicalactivity has been examined frequently in the literature, and many studies have found that physicalactivity can be utilized as a treatment to decrease symp- toms of depression. 7,48-50 Brenes et al also found that depression is associated with increased disability (r = 0.10). 37 Correlations in our study were actually higher than in Brenes et al ’ s study, 37 which could be due to the fact that our study used objective measures of physical ability rather than self-report surveys, which obtain per- ceptions of ability rather than actual ability. 45,51 Therefore, individuals with symptoms of depression may have greater risks for decreased mobility performance, and this func- tional limitation may also lead to an increase in those symptoms.
Methods: A cross-sectional study was carried out from April to September 2014. The population sample was 1,252 olderadults (60 years) who were beneficiaries of the Mexican Institute of Social Security (IMSS) in Mexico City. Data were derived from the database of the “Cohort of Obesity, Sarcopenia and Frailty of Older Mexican Adults” (COSFOMA). Operationalization of the phenotype of frailty was performed using the criteria of Fried et al (weight loss, self-report of exhaustion, low physicalactivity, slow gait, and weakness). Adverse outcomes studied were limitation in basic activities of daily living (ADLs), falls and admission to emergency services in the previous year, and low quality of life (WHOQOL-OLD).
an independent predictor for reduced CVD, however, leisure time physicalactivity did not. This finding is interesting as most of the evidence documenting the benefits of physicalactivity in CVD risk reduction has focused on leisure time physicalactivity (Sattelmair et al. 2011, Koolhaas et al. 2016). However, the literature has been dominated by studies using middle aged and olderadults combine. The findings here may be explained by the different types of physical activities undertaken by middle aged and olderadults. For example, middle aged adults may be more active in leisure time while olderadults may be physically active through domestic type activities. However, very few studies particularly in olderadults have assessed the benefits of total physicalactivity in olderadults. In a national survey, Kim et al. (2017) assessed the total physicalactivity levels of Korean communitydwellingadults aged 20 years and older (n = 26,294). The authors showed fully adjusted (≥ 65 years, hypertension, diabetes mellitus, sex, and smoking) risk reductions of 18% and 34% for moderate and high levels of physicalactivity groups, respectively (Kim et al 2017). Similarly, Kubota et al. (2017) investigated the associationbetween total physicalactivity and CVD in a prospective study of middle-aged and elderly Japanese adults (n = 74,913). The authors documented maximum risk reductions for CVD in adults who achieved moderate levels of total physicalactivity. Recently, Lear et al. (2017) recognised that recreational and non- recreational physicalactivity was associated with a lower risk of mortality and CVD events in a study from 17 countries utilising a large sample of 130,843 adults aged between 30 – 80 years old. This is supported by representative sample (n = 4232) of 60 year old Swedish adults who were followed over 12.5 years (Ekblom-Bak et al. 2014). Regardless of exercise behaviour, the authors noted that those who were physically active had approximately 30% lower risk of CVD and all- cause mortality.
Using the best available scientific evidence [7,8], public health messages from the Centers for Disease Control  and the National Institute on Aging  encourage older persons to increase physicalactivity levels in order to maintain functional independence. However, there are some important gaps in the scientific underpinnings of these public health messages. First, there is a pau- city of longitudinal studies examining the association of physicalactivity and development of disability in community-dwelling persons over the age of 80 . Second, a recent critical appraisal  highlighted in- consistencies in the evidence regarding increased late- life physicalactivity and disability. Most [13-15], but not all , longitudinal studies of community-dwelling, olderadults have shown an association. One reason that these studies may have produced mixed results is the use of self-report measures of physicalactivity. In older persons, self-report measures may be affected by recall bias due to cognitive function changes and may not capture the full extent of movement throughout the course of a day.
NOS, Newcastle-Ottawa Scale for cross-sectional studies (score 0-9); CerebroVaD, cerebrovascular disease including stroke, transient ischemic attack and other vascular circulatory disease; SE Status, socio-economic status; PA, physicalactivity; Sig Ass, significant association in study p value <0.05; MMSE, Mini-Mental State Examination (0-30); RCPM, Ravens Coloured Progressive Matrices; AVLT, Auditory Verbal Learning Test; CPBA, Competitive protein binding assay; RIA, radioimmunoassay; TICS, Telephone Interview for Cognitive Status; EBMT, East Boston Memory Test; Q, Quartiles; T, Tertiles; GDS, Geriatric Depression Scale; CDR, Cognitive Drug Research; DVT, Digit Vigilance Task; CI, confidence interval; WLT, Word Learning Test; TMT, Trail Making Task; LC-MS/MS, Liquid Chromatography–Mass Spectrometry; SENECA, Survey in Europe on Nutrition and the Elderly; a Concerted Action; DSMT, Digit Symbol Matching Test; BDT, Block Design Test; 3MS, Modified Mini-Mental State Examination (0-100); DSST, Digit symbol substitution test; NHANES, National Health and Nutrition Examination Survey; ZENITH, Zinc Effects in Nutrient/Nutrient Interactions and Trends in Health and Ageing; CANTAB, Cambridge Neuropsychological Testing Automated Battery; PRM, pattern recognition memory; SWM, spatial working memory; ELISA, Enzyme linked immunosorbent assay.
Our study was the first to examine the association be- tween a variety of factors and ME and reveal characteris- tics of the no ME group among community-dwelling elderly Japanese. The findings that community-dwelling elderly with no ME were less willing to cooperate with the survey, rarely had physical checkups, generally smoked and drank more often, did less exercise, had lower dietary variety, and practiced poor dental health behaviors suggested that they are less interested in their health and have unhealthier lifestyle behaviors, which could include not visiting doctors. Prior studies demon- strated that ME was significantly increased among obese people [15, 16] and reduced among people who spent a longer time walking . Similar findings were con- firmed in our study population, but lifestyle habits, in- cluding oral hygiene, were worst in the no ME group, with the exception of walking. A Germany study of adults aged 35 years or older  reported that higher health check attendance was associated with non- smoking, brisker physicalactivity, higher fruit and vege- table intake, and higher use of ambulatory care; not re- ceiving health checks was thought to be a reflection of an unhealthy lifestyle choice, which supports our find- ings. Therefore, we propose that community-dwelling elderly with no ME require more intervention regarding their lifestyle habits.
phase (phase I), modelling phase (phase II), exploratory trial (phase III), randomized controlled trial (phase IV), and long-term implementation (phase V). In the theoret- ical phase, we performed two systematic reviews. The first review deals with instruments for measurement of frailty. In this review, we concluded that numerous measurement instruments exist, but none of them has been developed as an outcome measure . Therefore, we subsequently developed an outcome instrument on frailty; the Evaluative Frailty Index for PhysicalActivity (EFIP) . In a second article, we review the literature on the effect of physical exercise therapy in olderadults who have problems with physicalfunctioning and/or have to deal with co-morbidity . The included litera- ture was evaluated in meta-analyses and we concluded that mobility and physicalfunctioning are positively in- fluenced by physical exercise therapy. Strength training also seemed to be of great importance and a personal- ized approach may result in long-term positive effects (>12 months). No positive effects on quality of life and the level of physicalactivity could be found, which con- firms that an exercise intervention does not necessarily bring about changes in level of physicalactivity.
We used a trichotomous classification of physical func- tion developed from our baseline data. The results of the MANOVA analyses showed significant trends across the three categories of physical function for several phy- sical health-related variables, including general health, BMI, PCS, physical function, role-physical, and physicalactivity, supporting the validity of these categories. The magnitude of difference between the categories for each of these physical health-related variables is compara- tively small, and it is unknown if these differences are clinically important. However, the consistency of the dif- ferences across these several variables supports the exis- tence of a real, albeit very modest, difference. Nonetheless, the inclusion of an intermediate classifica- tion may be useful in identifying persons who have pre- clinical physical function impairment. This is important, because there is increasing evidence for a period termed “ preclinical disability ” where individuals experience some physical function limitation, but are not disabled [20-22,64,65]. During this “ preclinical ” phase of the downward trajectory in the disablement process, persons may modify physical tasks such as slowing walking speed, resting while climbing stairs, or perform activities while sitting rather than standing, and/or they may restrict or avoid activities where they experience some difficulty . Often, because of these compensatory actions, the physical function limitations may not be readily apparent. However, being able to identify these persons who are at high risk of becoming disabled and who may be responsive to interventions could be critical in preventing or delaying disability [21,22]. Self report methods have validity in identifying “ preclinical disabil- ity ” and future disability, and some tests of physical function have been able to predict future disability in
In the United Kingdom, the recommendations for physicalactivity for protection against chronic conditions such as cardiovascular disease, type II diabetes, cancer and obesity state that a minimum of 30 minutes of at least moderate intensity physicalactivity on at least 5 days of the week should be undertaken to achieve substantive health benefits (Department of Health, 2004). This is consistent with recommendations from other health organizations (Department of Health and Ageing, 1999; Swiss Federal Office of Sports et al., 2000; World Health Organization et al., 2003). Regular physicalactivity has also been proposed as one method of preventing falls and therefore fall-related injuries in olderadults (Kannus, 1999), and higher levels of physicalactivity are associated with a decreased risk of recurrent falling (Peeters et al., 2010). Furthermore, physicalactivity interventions have been investigated with the aim of reducing the risk factors associated with falling (Lord et al., 1995; Lan et al., 1998; Li et al., 2004). It has also been estimated that if the whole population adopted the physicalactivity recommendations, health care costs for hip fractures alone could be reduced by 50% (Nicholl et al., 1994). However, most studies have investigated the effects of physicalactivity on risk factors for falls rather than falls themselves, and no study has as yet evaluated the impact of lifetime adherence to generic physicalactivity recommendations on fall occurrence.
For the direct measurement of PA, participants were instructed to wear an accelerometer (ActiGraph wGT3X- BT) on the right hip for seven consecutive days during waking hours. Published recommendations for acceler- ometer data collection (100Hz, 10-second epochs), data processing (ActiLife Software 6, ActiGraph, LLC) and reporting were followed. 40 Non-wearing periods, de ﬁ ned as 90 min of continuous zero counts times, were removed before analysis. 41 Four to seven days with each at least 6 hours of wear time were included. Energy expenditure was calculated by the Freedson Combination Algorithm for uniaxial counts per minute (cpm). 27 Two different cut- points were used to determine the amount of MVPA, a general model by Freedson et al (MVPA ≥ 1952 cpm) 27 and a speci ﬁ c model for olderadults by Copeland and Esliger (MVPA ≥ 1041 cpm). 28 Any activity above the thresholds was counted as MVPA irrespective of the bout length. Sedentary time was de ﬁ ned by a signal <100 cpm. 42
A major strength of this study is the use of accelerometers and GPS devices, which supplies high quality data. Accelerometers and GPS devices provide objective information on PA and are used to overcome limitations of self-report (e.g. recall bias, socially desirable answers) [ 12 , 14 ]. However, inaccuracy might occur in GPS devices due to surrounding obstacles, and ac- celerometers are less accurate in measuring upper body movements. This study has some limi- tations, such as the identification of frailty, the relatively small sample size, data loss, and possible selection bias. To identify non-frail, and frail olderadults, the ISAR-HP instrument was used. As the ISAR-HP focuses on patients, this might not be the best instrument to deter- mine frailty in community-dwellingolderadults. There are other frailty measures, e.g. the Til- burg Frailty Indicator or Fried’s Phenotype, using a broader set of indicators to assess frailty. However, it is unclear whether the use of another measure would have changed the findings of the current study.
The main limitation of this study is the lack of a follow-up. This prevents us from studying the effect of this intervention on actual rates of falling. In addition, subjects with certain medical conditions, who may have a higher risk of fall, were excluded from the study. We recognize that actual clinical relevance must be demonstrated definitively via future ran- domized controlled trials in high-risk older populations. In addition, cognitive function was not measured in this study. The positive gait outcomes in our study may suggest that the exercise intervention would benefit the cognitive function in older people. Previous studies have found the positive change in gait ability associated with the improvement in cognitive function, 42 and concluded that regular physicalactivity is
In a study of more than 4500 adults aged 50+ physicalactivity and executive function were closely interlinked. This association remained after controlling for demographic and health character- istics. Furthermore, in strictly controlled fixed effects analyses we demonstrated that dynamic within-person changes in executive function corresponded with parallel changes in physicalactivity. Critically, our analyses showed that the magnitude of the relation- ship betweenphysicalactivity and neurocognitive performance appeared to be strongest in the direction from executive func- tion to physicalactivity. Previously, strong executive abilities have been found to prospectively predict high levels of physicalactivity in children ( Riggs et al., 2010; Pentz and Riggs, 2013 ) and exer- cise adherence in olderadults ( McAuley et al., 2011 ). The current study suggests that executive abilities may have favorable effects on activity levels at the population level in olderadults. This is in line with temporal self-regulation theory ( Hall and Fong, 2007 ) which proposes that pre-potent response inhibition (a key facet of executive functioning) will be essential for the enactment of
Every year, 10% of adults aged 75 years and older become dependent because they cannot complete daily activities . Avoiding falls and being physically able to complete tasks necessary for everyday living are essential compo- nents of independent living with ageing . One in three community-dwellingadults aged 65 years or older fall each year, and about one-half suﬀer from multiple falls . Among olderadults, falls are the main cause of fractures, hospital admissions for trauma, loss of independence, and injury-related deaths . Falls injuries cause distress, pain, and significant impact on quality of life due to isolation, disability, and a loss of confidence . Falls can also have a financial impact from associated health care costs . Many olderadults are afraid of falling , and this fear becomes more common as people age, even among those who have not yet fallen. Falling and fear of falling are also potential
Background: Falls in older people are a leading causes of unintentional injury. Due to an ageing population, injuries are likely to increase unless more is done to reduce older people’s falls risk. In clinical trials, the Falls Management Exercise (FaME) programme has reduced the rate of falls and falls-related injuries in community-dwellingolderadults. However, the commissioning of FaME is inconsistent across England, potentially due to a lack of evidence that FaME can be delivered effectively in a ‘real world’ setting. The PHISICAL study is designed to study the implementation of FaME in a range of different settings in England.
This cross-sectional study involved 140 community-dwellingolderadults (46 men and 94 women) aged 60–82 years (mean: 65.77 years, SD: 4.61), who were ambulating independently with or without assistive device. Participants were recruited through flyers and posters at a senior citizens club in Kuala Lumpur, Malaysia. Participants who were unable to compre- hend and follow instructions with a mini-mental state exami- nation score ,23; having known acute illnesses, current or recent fractures, ear infection, or vestibular disorders; taking drugs that could affect muscle strength and balance; unable to hold shoulder at 90 ° flexion; unstable chronic diseases such as unstable diabetes mellitus and uncompensated heart failure; medical conditions such as malignancy and musculoskeletal disorders; and neurological problems such as Parkinson and stroke were excluded from the study. Ethical approval was obtained from the Secretariat for Research and Ethics of Universiti Kebangsaan, Kuala Lumur, Malaysia.