scholarly journals Lessons Learned in the Delivery of Live Remote Group Weight Loss and Physical Activity Interventions for Older Adults

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 281-281
Author(s):  
Jason Fanning ◽  
Barbara Nicklas
Keyword(s):  
Older Adults ◽  
Weight Loss ◽  
Exercise Program ◽  
Health Behavior Change ◽  
Careful Consideration ◽  
Lessons Learned ◽  
Technology Selection ◽  
Exercise Interventions ◽  
Aerobic Activity ◽  
Effective Group

Abstract Social connection lies at the root of lasting health behavior change, and as such most effective interventions are built around social tools. Group leaders and peers provide education, and act as models of successful change and collaborators in addressing common barriers to behavioral adoption and maintenance. Unfortunately, many older adults do not have access to high quality group programs due to factors such as limited transport options, lack of local availability, or worries over personal safety. Importantly, developing effective, synchronous remote group programming is not as simple as delivering an in-person session via teleconference software. Instead, careful consideration must be paid to technology selection, fostering effective group communication, and developing confidence for use of remote intervention tools. This symposium provides key lessons learned from three group-based activity and weight loss interventions for older adults that focused on live, remote interaction. Jason Fanning will share lessons from the MORPH study, which paired remote group-mediated behavioral counseling with dietary weight loss and the accumulation of aerobic activity across the day. Christina Hugenschmidt will share her experiences adapting a group program involving improvisational dance or social gaming for remote delivery. Kushang Patel will present results from a mixed-methods study on the feasibility and acceptability of a remotely-delivered exercise program for older adults with knee osteoarthritis. Finally, Barbara Nicklas will place these experiences in the context of the development of exercise interventions for older adults over time, and highlighting vital next steps for ensuring more older adults have access to this important behavioral medicine.

scholarly journals Implementation of Remote Interventions in Older Adults: Lessons Learned During COVID-19 Isolation

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 950-950
Author(s):  
Jamie Rincker ◽  
Jessica Wallis ◽  
Angela Fruik ◽  
Alyssa King ◽  
Kenlyn Young ◽  
...  
Keyword(s):  
Older Adults ◽  
Weight Loss ◽  
Nutrition Education ◽  
Underserved Populations ◽  
Smart Phone ◽  
Dropout Rate ◽  
Lessons Learned ◽  
Drop Out ◽  
Electronic Submission ◽  
Weight Loss Interventions

Abstract Recommendations for older adults to socially isolate during the COVID-19 pandemic will have lasting impacts on body weight and physical activity. Due to the pandemic, two in-person RCT weight-loss interventions in obese older adults with prediabetes, Veterans Achieving Weight Loss and Optimizing Resilience-Using Protein (VALOR-UP, n=12) and the Egg-Supplemented Pre-Diabetes Intervention Trial (EGGSPDITE, n=7), were converted to remote formats and weekly nutrition (EGGSPDITE and VALOR-UP) and exercise (VALOR-UP only) classes were delivered using synchronous videoconference technology (Webex); classes were accessed via tablet/desktop/laptop or smart phone. Steps taken to transition participants to remote formats included technology training, implementation of staff tech-support, and delivery of nutrition education, tablets, scales, and exercise bands. The time to successfully transition participants was 1 week for early adopters (n=10) and up to 4 weeks for those with significant technology barriers (n=9); their difficulties included internet access, camera and microphone access and use, and electronic submission of weight and food records. Even with these challenges, in the first 3 months of remote delivery, participant dropout rate was low (10.5%, n=2), attendance was high (87.6% nutrition class (n=19); 76.4% exercise class (VALOR-UP, n=12)), and weight loss was successful (>2.5% loss (n=13); >5% loss (n=8)), showing that lifestyle interventions can be successfully adapted for remote delivery. Remote interventions also have potential for use in non-pandemic times to reach underserved populations who often have high drop-out rates due to caretaker roles, transportation limitations, and work schedules. These barriers were significantly reduced using a virtual intervention platform.

scholarly journals Determinants of participation in a post-hospitalization physical exercise program for older adults

2020 ◽  
Author(s):  
Miriam Urquiza ◽  
Iñaki Echeverria ◽  
Ariadna Besga ◽  
Maria Amasene ◽  
Idoia Labayen ◽  
...  
Keyword(s):  
Older Adults ◽  
Physical Exercise ◽  
Nutritional Status ◽  
Physical Function ◽  
Multivariate Regression ◽  
Older Patients ◽  
Exercise Program ◽  
Cognitive Status ◽  
Exercise Interventions ◽  
Poor Nutritional Status

Abstract BACKGROUND: Older patients often experience a decline in physical function and cognitive status after hospitalization. Although interventions involving physical exercise are effective in improving functional performance, participation in physical exercise interventions among older individuals is low. We aimed to identify factors that contribute to exercise refusal among post-hospitalized older patients.METHODS: A cross-sectional study of recruitment data from a randomized controlled trial was conducted involving 495 hospitalized people ≥70 years old. Sociodemographic and clinical data were obtained from the Basque Public Health System database. We determined physical function with the Short Physical Performance Battery (SPPB), nutritional status with the Mini-Nutritional Assessment, frailty according to the Fried phenotype criteria, and cognitive function with the Short Portable Mental Status Questionnaire (SPMSQ). Student’s t, Mann-Whitney U, or chi-squared tests were applied for bivariate analysis. Parameters significantly associated with participation were introduced in a logistic multivariate regression model.RESULTS: Among the analyzed patients, 88.8% declined participation in the physical exercise program. Multivariate regression revealed that older age (OR: 1.13; 95% CI: 1.07 - 1.19), poor nutritional status (OR: 0.81; 95% CI: 0.69 - 0.95), and reduced home accessibility (OR: 0.27; 95% CI: 0.08 - 0.94) were predictors of participation refusal. Moreover, patients who declined participation had worse performance on the SPPB (P < 0.05) and its tests of balance, leg strength, and walking speed (P < 0.05). No differences were found between groups in other variables. CONCLUSIONS: This study confirms low participation of older adults in a post-hospitalization physical exercise program. Non-participation was associated with increased age, poor nutritional status, and reduced home accessibility. Our findings support the need for intervention design that accounts for these factors to increase older patient participation in beneficial exercise programs.TRIAL REGISTRATION: ACTRN12619000093189 (retrospectively registered): Registered January 22, 2019.

scholarly journals COVID-19 Pandemic and Beyond: Considerations and Costs of Telehealth Exercise Programs for Older Adults With Functional Impairments Living at Home—Lessons Learned From a Pilot Case Study

2020 ◽  
Vol 100 (8) ◽  
pp. 1278-1288 ◽  
Author(s):  
Addie Middleton ◽  
Kit N Simpson ◽  
Janet Prvu Bettger ◽  
Mark G Bowden
Keyword(s):  
Older Adults ◽  
At Risk ◽  
Physical Therapist ◽  
Exercise Program ◽  
Business Case ◽  
Lessons Learned ◽  
Activity Based Costing ◽  
Functional Impairments ◽  
Exercise Programs ◽  
Social Distancing

Abstract Objective The purpose of this study was to describe the process and cost of delivering a physical therapist–guided synchronous telehealth exercise program appropriate for older adults with functional limitations. Such programs may help alleviate some of the detrimental impacts of social distancing and quarantine on older adults at-risk of decline. Methods Data were derived from the feasibility arm of a parent study, which piloted the telehealth program for 36 sessions with 1 participant. The steps involved in each phase (ie, development, delivery) were documented, along with participant and program provider considerations for each step. Time-driven activity-based costing was used to track all costs over the course of the study. Costs were categorized as program development or delivery and estimated per session and per participant. Results A list of the steps and the participant and provider considerations involved in developing and delivering a synchronous telehealth exercise program for older adults with functional impairments was developed. Resources used, fixed and variable costs, per-session cost estimates, and total cost per person were reported. Two potential measures of the “value proposition” of this type of intervention were also reported. Per-session cost of $158 appeared to be a feasible business case, especially if the physical therapist to trained assistant personnel mix could be improved. Conclusions The findings provide insight into the process and costs of developing and delivering telehealth exercise programs for older adults with functional impairments. The information presented may provide a “blue print” for developing and implementing new telehealth programs or for transitioning in-person services to telehealth delivery during periods of social distancing and quarantine. Impact As movement experts, physical therapists are uniquely positioned to play an important role in the current COVID-19 pandemic and to help individuals who are at risk of functional decline during periods of social distancing and quarantine. Lessons learned from this study’s experience can provide guidance on the process and cost of developing and delivering a telehealth exercise program for older adults with functional impairments. The findings also can inform new telehealth programs, as well as assist in transitioning in-person care to a telehealth format in response to the COVID-19 pandemic.

Effects of Resistance- and Flexibility-Exercise Interventions on Balance and Related Measures in Older Adults

2009 ◽  
Vol 17 (4) ◽  
pp. 444-454 ◽  
Author(s):  
Marie-Louise Bird ◽  
Keith Hill ◽  
Madeleine Ball ◽  
Andrew D. Williams
Keyword(s):  
Older Adults ◽  
Resistance Training ◽  
Exercise Program ◽  
Step Test ◽  
Balance Performance ◽  
Timed Up And Go ◽  
Exercise Interventions ◽  
Sit To Stand ◽  
Lower Limb Strength ◽  
Flexibility Training

This research explored the balance benefits to untrained older adults of participating in community-based resistance and flexibility programs. In a blinded randomized crossover trial, 32 older adults (M = 66.9 yr) participated in a resistance-exercise program and a flexibility-exercise program for 16 weeks each. Sway velocity and mediolateral sway range were recorded. Timed up-and-go, 10 times sit-to-stand, and step test were also assessed, and lower limb strength was measured. Significant improvements in sway velocity, as well as timed up-and-go, 10 times sit-to-stand, and step test, were seen with both interventions, with no significant differences between the 2 groups. Resistance training resulted in significant increases in strength that were not evident in the flexibility intervention. Balance performance was significantly improved after both resistance training and standing flexibility training; however, further investigation is required to determine the mechanisms responsible for the improvement.

scholarly journals Building on Lessons Learned in a Mobile Intervention to Reduce Pain and Improve Health (MORPH): Protocol for the MORPH-II Trial (Preprint)

2021 ◽  
Author(s):  
Jason Fanning ◽  
Amber K Brooks ◽  
Katherine L Hsieh ◽  
Kyle Kershner ◽  
Joy Furlipa ◽  
...  
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Chronic Pain ◽  
Weight Loss ◽  
Pilot Study ◽  
Cognitive Theory ◽  
Lessons Learned ◽  
Control Group ◽  
Intervention Package ◽  
Improve Health

BACKGROUND Engaging in sufficient levels of physical activity, guarding against sustained sitting, and maintaining a healthy body weight represent important lifestyle strategies for managing older adults’ chronic pain. Our first Mobile Health Intervention to Reduce Pain and Improve Health (MORPH) randomized pilot study demonstrated that a partially remote group-mediated diet and daylong activity intervention (ie, a focus on moving often throughout the day) can lead to improved physical function, weight loss, less pain intensity, and fewer minutes of sedentary time. We also identified unique delivery challenges that limited the program’s scalability and potential efficacy. OBJECTIVE The purpose of the MORPH-II randomized pilot study is to refine the MORPH intervention package based on feedback from MORPH and evaluate the feasibility, acceptability, and preliminary efficacy of this revised package prior to conducting a larger clinical trial. METHODS The MORPH-II study is an iteration on MORPH designed to pilot a refined framework, enhance scalability through fully remote delivery, and increase uptake of the daylong movement protocol through revised education content and additional personalized remote coaching. Older, obese, and low-active adults with chronic multisite pain (n=30) will be randomly assigned to receive a 12-week remote group-mediated physical activity and dietary weight loss intervention followed by a 12-week maintenance period or a control condition. Those in the intervention condition will partake in weekly social cognitive theory–based group meetings via teleconference software plus one-on-one support calls on a tapered schedule. They will also engage with a tablet application paired with a wearable activity monitor and smart scale designed to provide ongoing social and behavioral support throughout the week. Those in the control group will receive only the self-monitoring tools. RESULTS Recruitment is ongoing as of January 2021. CONCLUSIONS Findings from MORPH-II will help guide other researchers working to intervene on sedentary behavior through frequent movement in older adults with chronic pain. CLINICALTRIAL ClinicalTrials.gov NCT04655001; https://clinicaltrials.gov/ct2/show/NCT04655001 INTERNATIONAL REGISTERED REPORT PRR1-10.2196/29013

scholarly journals Effect of muscle power training on fall risk in older adults: A systematic review and meta-analysis

2021 ◽  
Author(s):  
Daniel Jiménez-Lupión ◽  
◽  
Daniel Jerez-Mayorga ◽  
Luis Javier Chirosa-Ríos ◽  
Darío Martínez-García
Keyword(s):  
Older Adults ◽  
Fall Risk ◽  
Muscle Power ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Exercise Program ◽  
Lower Limbs ◽  
Power Training ◽  
Eligibility Criteria ◽  
Exercise Interventions

Review question / Objective: P: Older adults; I: Power training; C: Other type of exercise program; O: Fall Risk. Objective: To describe the effectiveness of muscle power training on fall risk in older adults. Condition being studied: Healthy older adults or those with different pathologies who undergo a muscle power training program for the prevention of falls. Eligibility criteria: Inclusion Criteria: Randomized Controlled Trial (RCT); Adults over 60 years of age, living independently in the community without disabilities and other diseases that make them unsuitable for exercise interventions; muscle power training of the lower limbs, without combining it with other types of exercise; Outcome: Fall Risk. Exclusion Criteria: Studies that used ergogenic drugs or aids; studies that manipulated diet; conference presentations, theses, books, editorials, review articles, and expert opinions; missing full text or incomplete data on outcome indicators.

scholarly journals Determinants of participation in a post-hospitalization physical exercise program for older adults

2020 ◽  
Author(s):  
Miriam Urquiza ◽  
Iñaki Echeverria ◽  
Ariadna Besga ◽  
Maria Amasene ◽  
Idoia Labayen ◽  
...  
Keyword(s):  
Older Adults ◽  
Physical Exercise ◽  
Nutritional Status ◽  
Physical Function ◽  
Multivariate Regression ◽  
Older Patients ◽  
Exercise Program ◽  
Cognitive Status ◽  
Exercise Interventions ◽  
Poor Nutritional Status

Abstract BACKGROUND: Older patients often experience a decline in physical function and cognitive status after hospitalization. Although interventions involving physical exercise are effective in improving functional performance, participation in physical exercise interventions among older individuals is low. We aimed to identify factors that contribute to exercise refusal among post-hospitalized older patients.METHODS: A cross-sectional study of recruitment data from a randomized controlled trial was conducted involving 495 hospitalized people ≥70 years old. Sociodemographic and clinical data were obtained from the Basque Public Health System database. We determined physical function with the Short Physical Performance Battery (SPPB), nutritional status with the Mini-Nutritional Assessment, frailty according to the Fried phenotype criteria, and cognitive function with the Short Portable Mental Status Questionnaire (SPMSQ). Student’s t, Mann-Whitney U, or chi-squared tests were applied for bivariate analysis. Parameters significantly associated with participation were introduced in a logistic multivariate regression model.RESULTS: Among the analyzed patients, 88.8% declined participation in the physical exercise program. Multivariate regression revealed that older age (OR: 1.13; 95% CI: 1.07 - 1.19), poor nutritional status (OR: 0.81; 95% CI: 0.69 - 0.95), and reduced home accessibility (OR: 0.27; 95% CI: 0.08 - 0.94) were predictors of participation refusal. Moreover, patients who declined participation had worse performance on the SPPB (P < 0.05) and its tests of balance, leg strength, and walking speed (P < 0.05). No differences were found between groups in other variables. CONCLUSIONS: This study confirms low participation of older adults in a post-hospitalization physical exercise program. Non-participation was associated with increased age, poor nutritional status, and reduced home accessibility. Our findings support the need for intervention design that accounts for these factors to increase older patient participation in beneficial exercise programs.TRIAL REGISTRATION: ACTRN12619000093189 (retrospectively registered): Registered January 22, 2019.

scholarly journals Determinants of participation in a post-hospitalization physical exercise program for older adults

2020 ◽  
Author(s):  
Miriam Urquiza ◽  
Iñaki Echeverria ◽  
Ariadna Besga ◽  
Maria Amasene ◽  
Idoia Labayen ◽  
...  
Keyword(s):  
Older Adults ◽  
Physical Exercise ◽  
Nutritional Status ◽  
Multivariate Regression ◽  
Older Patients ◽  
Exercise Program ◽  
Mini Nutritional Assessment ◽  
Cognitive Status ◽  
Exercise Interventions ◽  
Poor Nutritional Status

Abstract BACKGROUND: Older patients often experience a decline in functional and cognitive status after hospitalization. Although interventions involving physical exercise are effective in improving functional performance, participation in physical exercise interventions among older individuals is low. We aimed to identify the factors that contribute to exercise refusal among post-hospitalized older patients.METHODS: A cross-sectional study of recruitment data from a randomized controlled trial was conducted involving 495 hospitalized people ≥70 years old. Sociodemographic and clinical data were obtained from the Basque Public Health System database. We determined physical function with the Short Physical Performance Battery (SPPB), nutritional status with the Mini-Nutritional Assessment, frailty according to the Fried phenotype criteria, and cognitive function with the Short Portable Mental Status Questionnaire (SPMSQ). Student’s t, Mann-Whitney U, or chi-squared tests were applied for bivariate analysis. Parameters significantly associated with participation were introduced in a logistic multivariate regression model.RESULTS: Among the analyzed patients, 88.8% declined participation in the physical exercise program. Multivariate regression revealed that older age (OR: 1.13; 95% CI: 1.07 - 1.19), poor nutritional status (OR: 0.81; 95% CI: 0.69 - 0.95), and reduced home accessibility (OR: 0.27; 95% CI: 0.08 - 0.94) were predictors of participation refusal. Moreover, patients who declined participation had worse performance on the SPPB (P < 0.05) and its tests of balance, leg strength, and walking speed (P < 0.05). No differences were found between groups in other variables. CONCLUSIONS: This study confirms low participation of older adults in a post-hospitalization physical exercise program. Non-participation was associated with increased age, poor nutritional status, and reduced home accessibility. Our findings support the need for intervention design that accounts for these factors to increase older patient participation in beneficial exercise programs.TRIAL REGISTRATION: ACTRN12619000093189 (retrospectively registered): Registered January 22, 2019.

scholarly journals A Weight Loss Intervention Augmented by a Wearable Device in Rural Older Adults With Obesity: A Feasibility Study

2020 ◽  
Vol 76 (1) ◽  
pp. 95-100 ◽  
Author(s):  
John A Batsis ◽  
Curtis L Petersen ◽  
Matthew M Clark ◽  
Summer B Cook ◽  
Francisco Lopez-Jimenez ◽  
...  
Keyword(s):  
Older Adults ◽  
Weight Loss ◽  
Rural Areas ◽  
Physical Therapist ◽  
Outcome Measurement ◽  
Patient Reported Outcome ◽  
Wearable Device ◽  
Measurement Information ◽  
Aerobic Activity ◽  
Patient Reported

Abstract Background Older persons with obesity aged 65+ residing in rural areas have reduced access to weight management programs due to geographic isolation. The ability to integrate technology into health promotion interventions shows a potential to reach this underserved population. Methods A 12-week pilot in 28 older rural adults with obesity (body mass index [BMI] ≥ 30 kg/m2) was conducted at a community aging center. The intervention consisted of individualized, weekly dietitian visits focusing on behavior therapy and caloric restriction with twice weekly physical therapist-led group strengthening training classes in a community-based aging center. All participants were provided a Fitbit Flex 2. An aerobic activity prescription outside the strength training classes was provided. Results Mean age was 72.9 ± 5.3 years (82% female). Baseline BMI was 37.1 kg/m2, and waist circumference was 120.0 ± 33.0 cm. Mean weight loss (pre/post) was 4.6 ± 3.2 kg (4.9 ± 3.4%; p &lt; .001). Of the 40 eligible participants, 33 (75%) enrolled, and the completion rate was high (84.8%). Objective measures of physical function improved at follow-up: 6-minute walk test improved: 35.7 ± 41.2 m (p &lt; .001); gait speed improved: 0.10 ± 0.24 m/s (p = .04); and five-times sit-to-stand improved by 2.1 seconds (p &lt; .001). Subjective measures of late-life function improved (5.2 ± 7.1 points, p = .003), as did Patient-Reported Outcome Measurement Information Systems mental and physical health scores (5.0 ± 5.7 and 4.4 ± 5.0, both p &lt; .001). Participants wore their Fitbit 93.9% of all intervention days, and were overall satisfied with the trial (4.5/5.0, 1–5 low–high) and with Fitbit (4.0/5.0). Conclusions A multicomponent obesity intervention incorporating a wearable device is feasible and acceptable to older adults with obesity, and potentially holds promise in enhancing health.

scholarly journals Determinants of Participation in A Post-Hospitalization Physical Exercise Program for Older Adults

2020 ◽  
Author(s):  
Miriam Urquiza ◽  
Iñaki Echeverria ◽  
Ariadna Besga ◽  
Maria Amasene ◽  
Idoia Labayen ◽  
...  
Keyword(s):  
Older Adults ◽  
Physical Exercise ◽  
Nutritional Status ◽  
Multivariate Regression ◽  
Older Patients ◽  
Exercise Program ◽  
Mini Nutritional Assessment ◽  
Cognitive Status ◽  
Exercise Interventions ◽  
People Participation

Abstract BACKGROUND: In older patients, functional and cognitive status often decline after hospitalization. Although interventions based on physical exercise can revert these effects, participation in physical exercise interventions is low. This study aimed to identify determinants of refusal to participate in a physical exercise program in post-hospitalized older patients. METHODS: Cross-sectional study of recruitment data from a randomized controlled trial. A total of 509 hospitalized people ≥70 years old participated in this study. Sociodemographic and clinical data were obtained from the Basque Public Health System database. We measured physical function with the Short Physical Performance Battery (SPPB), nutritional status by the Mini-Nutritional Assessment, frailty according to the Fried phenotype criteria, and cognitive function by the Short Portable Mental Status Questionnaire (SPMSQ). Student’s t, Mann-Whitney U or chi-squared tests were applied for bivariate analysis. Parameters significantly associated with participation were introduced in a logistic multivariate regression model. RESULTS: Of evaluated patients, 10.8% declined physical exercise program participation. Multivariate regression revealed that older age (OR: 1.13; 95% CI: 1.06 - 1.18), poor nutritional status (OR: 0.82; 95% CI: 0.69 - 0.96), and worse home accessibility (OR: 0.26; 95% CI: 0.07 - 0.9) were predictors of lower participation. Moreover, patients who declined participation had worse performance in SPPB ( p < 0.05) and its three tests: balance, leg strength and walking speed ( p < 0.05). No differences were found between groups in other variables. CONCLUSIONS: This study confirms low participation of older adults in a post-hospitalization physical exercise program. Non-participation was associated with higher age, poorer nutritional status, and reduced home accessibility. Our findings support the need to design interventions accounting for these determinants to increase older patient participation. TRIAL REGISTRATION: ACTRN12619000093189 (retrospectively registered): Registered January 22, 2019. KEY WORDS Physical exercise, older people, participation, post-hospitalization

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