Enhancing motivation for initiation and continuation of physical activity in older adults using sensory augmentation devices: a preliminary pre–post study

Measuring Physical Activity in Younger and Older Adults with Sickle Cell Disease Using Accelerometers

<p dir="ltr">Background</p><p dir="ltr">Physical inactivity and functional decline represent significant challenges for aging populations, warranting effective intervention strategies and reliable assessment methodologies. This thesis investigated test-retest reliability of physical activity and fitness measurements in older adults, examined effects of structured exercise, and assessed longitudinal recovery trajectories in hip osteoarthritis patients following total hip arthroplasty (THA).</p><p dir="ltr">Methods</p><p dir="ltr">Four studies were conducted. Study I (n=78, age 70.9+4.7 years) evaluated accelerometer measurement reliability and monitored physical activity changes following an 8-week exercise intervention (twice-weekly, 60-minute combined training). Study II (n=1,407, age 65-84 years) assessed test-retest reliability of a comprehensive field-based fitness test battery and post an 8-week exercise period across multiple age groups. Study III (n=265, age 71.4+4.7 years) examined sustained and cumulative effects of identical 8-week exercise programs performed in consecutive years. Study IV (n=78, age 74.0+4.5 years) investigated physical fitness and activity patterns in hip osteoarthritis patients undergoing THA, with two assessments pre-operative, 4 months, and 1-year post-surgery.</p><p dir="ltr">Results</p><p dir="ltr">Physical activity parameters demonstrated good to excellent test-retest reliability. Similarly, field-based fitness tests generally showed good reliability across age and sex strata. The 8-week exercise intervention produced significant improvements in physical activity pattens and multiple physical fitness tests. Most fitness test parameters remained stable during the 9-month inter-intervention period, with declines observed in trunk strength endurance. Hip osteoarthritis patients exhibited pre-operative deficits compared to healthy controls in several fitness tests and in moderate- to vigorous physical activity, whereas post-operative improvements at 1-year follow-up were observed for a multitude of physical fitness parameters and exceeding the recommended physical activity levels.</p><p dir="ltr">Conclusions</p><p dir="ltr">This thesis established good test-retest reliability of accelerometer-measured physical activity and most included fitness assessments for monitoring older adults. Structured exercise generated physical activity and fitness benefits in healthy older adults. Moreover, substantial functional and activity improvements were seen following total hip arthroplasty without structured post-operative intervention. These findings underscore the importance of exercise engagement and appropriate surgical intervention to improve both functional capacity and physical activity in older adult populations.</p><h3>List of scientific papers</h3><p dir="ltr">This thesis includes four papers, these will be referenced using their Roman numerals listed below:</p><p dir="ltr">I. <b>Manne Godhe</b>, Marjan Pontén, Johnny Nilsson, Lena Kallings & Eva Andersson. Reliability of the accelerometer to control the effects of physical activity in older adults. Plos One, 17(9), e0274442. (2022). <br><a href="https://doi.org/10.1371/journal.pone.0274442">https://doi.org/10.1371/journal.pone.0274442</a><br><br></p><p dir="ltr">II. <b>Manne Godhe</b>, Gustaf Rönquist, Johnny Nilsson, Örjan Ekblom, Lillemor Nyberg, Gustav Edman, & Eva Andersson Reliability in Novel Field-Based Fitness Measurements and Postexercise Scores from a Physical Fitness Test Battery in Older Adults. Gerontology, 70(6), 639-660. (2024). https://doi.org/10.1159/000538446<br><a href="https://doi.org/10.1159/000538446">https://doi.org/10.1159/000538446</a><br><br></p><p dir="ltr">III. <b>Manne Godhe</b>, Johnny Nilsson, & Eva Andersson. Short-and Long-Term Effects on Physical Fitness in Older Adults: Results from an 8-Week Exercise Program Repeated in Two Consecutive Years. Geriatrics, 10(1), 15. (2025). https://doi.org/10.3390/geriatrics10010015<br><a href="https://doi.org/10.3390/geriatrics10010015">https://doi.org/10.3390/geriatrics10010015</a><br><br></p><p dir="ltr">IV. <b>Manne Godhe</b>, Anders Stålman, Johnny Nilsson & Eva Andersson. Physical fitness Improvements and Achievement of Recommended Physical Activity Levels One Year After Total Hip Arthroplasty: A Longitudinal Study of Physical Function and Activity Patterns [Manuscript]</p><p dir="ltr">Papers I & III were published under Creative Commons CC BY license. Paper II is reproduced in this thesis with permission from Karger Publishers. Paper IV is in manuscript form.</p>

<p dir="ltr">Background</p><p dir="ltr">Physical inactivity and functional decline represent significant challenges for aging populations, warranting effective intervention strategies and reliable assessment methodologies. This thesis investigated test-retest reliability of physical activity and fitness measurements in older adults, examined effects of structured exercise, and assessed longitudinal recovery trajectories in hip osteoarthritis patients following total hip arthroplasty (THA).</p><p dir="ltr">Methods</p><p dir="ltr">Four studies were conducted. Study I (n=78, age 70.9+4.7 years) evaluated accelerometer measurement reliability and monitored physical activity changes following an 8-week exercise intervention (twice-weekly, 60-minute combined training). Study II (n=1,407, age 65-84 years) assessed test-retest reliability of a comprehensive field-based fitness test battery and post an 8-week exercise period across multiple age groups. Study III (n=265, age 71.4+4.7 years) examined sustained and cumulative effects of identical 8-week exercise programs performed in consecutive years. Study IV (n=78, age 74.0+4.5 years) investigated physical fitness and activity patterns in hip osteoarthritis patients undergoing THA, with two assessments pre-operative, 4 months, and 1-year post-surgery.</p><p dir="ltr">Results</p><p dir="ltr">Physical activity parameters demonstrated good to excellent test-retest reliability. Similarly, field-based fitness tests generally showed good reliability across age and sex strata. The 8-week exercise intervention produced significant improvements in physical activity pattens and multiple physical fitness tests. Most fitness test parameters remained stable during the 9-month inter-intervention period, with declines observed in trunk strength endurance. Hip osteoarthritis patients exhibited pre-operative deficits compared to healthy controls in several fitness tests and in moderate- to vigorous physical activity, whereas post-operative improvements at 1-year follow-up were observed for a multitude of physical fitness parameters and exceeding the recommended physical activity levels.</p><p dir="ltr">Conclusions</p><p dir="ltr">This thesis established good test-retest reliability of accelerometer-measured physical activity and most included fitness assessments for monitoring older adults. Structured exercise generated physical activity and fitness benefits in healthy older adults. Moreover, substantial functional and activity improvements were seen following total hip arthroplasty without structured post-operative intervention. These findings underscore the importance of exercise engagement and appropriate surgical intervention to improve both functional capacity and physical activity in older adult populations.</p><h3>List of scientific papers</h3><p dir="ltr">This thesis includes four papers, these will be referenced using their Roman numerals listed below:</p><p dir="ltr">I. <b>Manne Godhe</b>, Marjan Pontén, Johnny Nilsson, Lena Kallings & Eva Andersson. Reliability of the accelerometer to control the effects of physical activity in older adults. Plos One, 17(9), e0274442. (2022). <br><a href="https://doi.org/10.1371/journal.pone.0274442">https://doi.org/10.1371/journal.pone.0274442</a><br><br></p><p dir="ltr">II. <b>Manne Godhe</b>, Gustaf Rönquist, Johnny Nilsson, Örjan Ekblom, Lillemor Nyberg, Gustav Edman, & Eva Andersson Reliability in Novel Field-Based Fitness Measurements and Postexercise Scores from a Physical Fitness Test Battery in Older Adults. Gerontology, 70(6), 639-660. (2024). https://doi.org/10.1159/000538446<br><a href="https://doi.org/10.1159/000538446">https://doi.org/10.1159/000538446</a><br><br></p><p dir="ltr">III. <b>Manne Godhe</b>, Johnny Nilsson, & Eva Andersson. Short-and Long-Term Effects on Physical Fitness in Older Adults: Results from an 8-Week Exercise Program Repeated in Two Consecutive Years. Geriatrics, 10(1), 15. (2025). https://doi.org/10.3390/geriatrics10010015<br><a href="https://doi.org/10.3390/geriatrics10010015">https://doi.org/10.3390/geriatrics10010015</a><br><br></p><p dir="ltr">IV. <b>Manne Godhe</b>, Anders Stålman, Johnny Nilsson & Eva Andersson. Physical fitness Improvements and Achievement of Recommended Physical Activity Levels One Year After Total Hip Arthroplasty: A Longitudinal Study of Physical Function and Activity Patterns [Manuscript]</p><p dir="ltr">Papers I & III were published under Creative Commons CC BY license. Paper II is reproduced in this thesis with permission from Karger Publishers. Paper IV is in manuscript form.</p>

Background: Aging increased the risks of cognitive impairment and depression. Then, these conditions can lead to poor quality of life by reducing one’s ability to perform activities of daily living. Recently, it is established that physical activity can decrease the cognitive decline and the risk of depression in older adults. Moreover, regular physical activity can improve physical and mental functions in populations of all ages. However, level and speed of cognitive decline occurs varies greatly among individual especially the difference between middle-aged and older adults. Objective: This study aimed to focus on the comparison of physical activity, cognitive function and depression between older and middle-aged adults, which has never been done before. Moreover, the associations of physical activity with cognitive impairment and depression were also investigated in older and middle-aged adults. The information in this study will provide an understanding regarding the design of physical activity program for different age groups. Methods: All participants were divided into two groups of 50 middle-aged adults and 50 older adults. The assessments of physical activity, cognitive function, and level of depression were conducted for all participants. Results: The total level of physical activity and cognitive function in older adults was decreased when compared with middle-aged ones. Moreover, each work and transportation domain of physical activity in older adults also was decreased when compared with that in middle-aged ones. However, the leisure domain of physical activity in older adults was increased via a decreasing depression level. In addition, the level of physical activity associated with both cognitive function and depression and depression alone in middle-aged and older adults, respectively. Conclusion: We suggested that total level of physical activity in older adults can increase via stimulating work and transportation activities in physical activity program. Moreover, the level of physical activity associated with both cognitive function and depression and depression alone in middle-aged and older adults, respectively.

Physical activity to prevent or reverse disability in sedentary older adults

Physical activity and depression in older adults: the knowns and unknowns

Introduction Lack of physical activity (PA) is prevalent and leads to multiple chronic conditions in older adults. Understanding factors contributing to low PA may help develop effective and sustainable PA interventions and promote health in older adults. Depressive symptoms and poor sleep quality have been linked with low PA in older adults. Depression can lead to sleep disturbances. In this study, we tested the association between depression and physical activity in community-dwelling older adults and the possible mediating role of sleep quality in the association. Methods We used baseline data collected from an ongoing randomized clinical trial that aims to improve cognitive health in community-dwelling older adults. Participants’ depressive symptoms and level of PA were assessed using the Geriatric Depression Scale Short Form (GDS) and Physical Activity Scale for the Elderly (PASE). Sleep quality and insomnia symptoms were measured by the Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI), respectively. Multiple regression models were used to test the associations between the variables. Baron and Kenny’s approach and the Sobel test were used to examine the mediation effects of participants’ self-reported sleep quality and insomnia symptoms on the association of depression and PA. Results The study sample (n=143) had a mean age of 70 years (SD=6), most were female (n=117, 82%), White (n=77, 54%), and had multiple comorbidities (n=98, 69%). After adjusting for covariates (age, sex, education, income, race, and Body Mass Index [BMI]), higher GDS score was associated with lower PASE (β=-3.58, 95% Confidence Interval [CI]: -7.08, -0.79). Mediation analyses showed that both sleep quality (indirect effect: B=-1.98, CI: -3.80, -0.15) and insomnia symptoms (indirect effect: B=-1.97, CI: -3.94, 0.00) significantly mediated the relationship between depression and PA. Conclusion Depressive symptoms were associated with reduced PA among older adults. Self-reported sleep significantly mediated this association. Older adults with more depressive symptoms had worse sleep quality and more insomnia symptoms, which were associated with decreased PA. Our findings suggest we pay more attention to sleep health in older adults, and people with depression may benefit from sleep-focused interventions to promote PA and health. Support (if any) R00NR016484

Physical activity is an important risk factor for disease and functional outcomes with aging. Measurement of objective physical activity by accelerometry has become common in recent years and is often reported as total or average daily physical activity. However, a better understanding of the diurnal patterns of physical activity may elucidate the associations among physical activity, disease, and functional outcomes in older adults. PURPOSE: To evaluate the relationship between disease burden and objectively measured physical activity, overall and by time-of-day. METHODS: Physical activity (PA) was measured using wrist-worn ActiGraph Link accelerometers continuously over 7 days in 63 older participants (31 women, aged 68±10 yrs) of the Longitudinal Aging Study at Towson (LAST). Data was smoothed into one minute intervals and expressed as the average counts per minute across the three axes. Diurnal patterns of activity were modeled as the average activity counts over six 4-hour time bins. Number of chronic diseases was determined using a health history questionnaire and calculated as the sum of eight different diseases (hypertension, high cholesterol, heart disease, diabetes, arthritis, respiratory disease, gastrointestinal disease, and psychological well-being). Disease burden was categorized as either low (0-2 chronic diseases) or high (3 or more). The association between the mean of the log-transformed activity counts and disease burden was modeled overall and across each time bin using linear regression, adjusting for age, sex, and BMI. RESULTS: Total 24-h PA (counts) was lower in those with high disease burden compared to those with low disease burden (3.2x106±0.9x106 vs. 3.8x106±1.0x106 counts, p = 0.01). When examining diurnal patterns, early morning (4:00 am-8:00 am), afternoon (noon-4:00 pm), and early evening (4:00 pm-8:00 pm) PA was lower in those with high disease burden compared to individuals with low disease burden (p < 0.05 for each period). CONCLUSIONS: PA is lower in older adults with high chronic disease burden, particularly in the late afternoon and evening. Interventions aimed at increasing PA in older adults with multiple chronic conditions should consider targeting daily nadirs of activity by promoting PA during the afternoon and evening when their activity is typically lowest.

How negative self-perceptions of aging relate to physical activity (PA) in older adults with arthritis is unclear. We examined whether general health mediated the relationship between Awareness of Age-Related change (AARC) losses and PA. We analyzed baseline data from a randomized controlled trial of a PA intervention for adults ≥60 years who self-reported PA, AARC, general health, pain, and social support. We evaluated point-biserial correlations between PA and other factors in participants with self-reported arthritis and developed a mediation model incorporating AARC losses, general health, and PA. We observed significant correlations between PA and general health, social support, and AARC losses in this physically active sample. General health mediated the effect of AARC losses on PA. While negative self-perceptions of aging were associated with less PA in older adults with arthritis, their impact was attenuated by general health. PA interventions for this population may benefit by targeting perceived general health.

BackgroundThis study examines the association of both pain severity and within-person pain variability with physical activity (PA) in older adults with osteoarthritis (OA).MethodsData from the European Project on OSteoArthritis were used. At baseline, clinical classification criteria of the American College of Rheumatology were used to diagnose OA in older adults (65–85 years). At baseline and 12–18 months follow-up, frequency and duration of participation in the activities walking, cycling, gardening, light and heavy household tasks, and sports activities were assessed with the Longitudinal Aging Study Amsterdam Physical Activity Questionnaire. Physical activity was calculated in kcal/day, based on frequency, duration, body weight and the metabolic equivalent of each activity performed. At baseline and 12–18 months follow-up, pain severity was assessed using the pain subscales of the Western Ontario and McMaster Universities OA Index and the Australian/Canadian Hand OA Index. Within-person pain variability was assessed using two-week pain calendars that were completed at baseline, 6 months follow-up and 12–18 months follow-up.ResultsOf all 669 participants, 70.0% were women. Sex-stratified multiple linear regression analyses showed that greater pain severity at baseline was cross-sectionally associated with less PA in women (Ratio = 0.95, 95% CI = 0.90–0.99), but not in men (Ratio = 0.99, 95% CI = 0.85–1.15). The longitudinal analyses showed a statistically significant inverse association between pain severity at baseline and PA at follow-up in women (Ratio = 0.94, 95% CI = 0.89–0.99), but not in men (Ratio = 1.00, 95% CI = 0.87–1.11). Greater pain variability over 12–18 months was associated with more PA at follow-up in men (Ratio = 1.18, 95% CI = 1.01–1.38), but not in women (Ratio = 0.94, 95% CI = 0.86–1.03).ConclusionsGreater pain severity and less pain variability are associated with less PA in older adults with OA. These associations are different for men and women. The observed sex differences in the various associations should be studied in more detail and need replication in future research.

Physical activity in older adults in a combined functional circuit and walking program

The Physical Activity Guidelines for Americans (Guidelines) advises older adults to be as active as possible. Yet, despite the well documented benefits of physical activity just 12.8% of those ages 65 and older meet the Guidelines. To address this, the U.S. Department of Health and Human Services (HHS) developed a Midcourse Report focused on effective strategies to improve older adult physical activity behaviors. The first step in this process was a systematic literature review. A literature review team was contracted to examine the evidence on key settings and effective behavioral intervention strategies, as well as effective policy, systems, and environmental (PSE) approaches, to improve physical activity among older adults. The PSE search employed an equity-centered framework adapted to researching PSE approaches for improving physical activity outcomes in older adults. Sixteen thousand eight hundred and eighty-three titles and abstracts were screened, and 734 full articles were reviewed for inclusion. Of those, 64 original research articles were included for the final review to answer two questions, one (plus 5 sub-questions) focused on Settings/Strategies literature (45 studies) and one (plus 2 sub-questions) focused on PSE literature (19 studies). The literature review process identified key settings and evidence-based strategies to support older adults in becoming more physically active, and provides a foundation for the Physical Activity Guidelines for Americans Midcourse Report: Implementation Strategies for Older Adults. More research is needed to address how factors related to equity and psychosocial constructs influence physical activity behaviors among older adults.

Background Nowadays, self-reported assessments (SA) and accelerometer-based assessments (AC) are commonly used methods to measure daily life physical activity (PA) in older adults. SA is simple, cost-effective, and can be used in large epidemiological studies, but its reliability and validity have been questioned. Accelerometer measurement has proven valid to provide accurate and reliable measurement of everyday life physical activities regarding frequency, duration, and intensity in older populations, but is expensive and requires a long-time measurement. Here is, furthermore, a lack of well-defined and reliable accelerometer cut-off points to measure PA among older adults. Therefore, there is a need to develop a simple and reliable method to complement/replace self-assessment methods of daily life physical activity and facilitate the future development of cut-off points to measure daily life physical activities among older adults. In this study, we explore how skeleton avatar technology (SAT) can be used to measure PA among older adults. Objectives 1. To explore the association between accelerometer data and self-reported assessment data of daily life physical activities in older adults, and 2. To explore how the SAT of a standardized functional (balance) test can be used to measure daily life physical activity among older adults. Method The correlation analysis was used to explore the association between response variables, and deep neural networks were used to predict the response variables (AC and SA outcomes). Results The results indicate that there is a moderate (r = 0.31) significant (p = 0.029) correlation between AC of PA and SA of PA. The functional balance test assessed with SAT was able to predict AC with 3.89% Mean Absolute Error (MAE), and SA with 11.07% MAE. Conclusion Overall, these results indicate that one functional balance test measured with SAT can be used to predict PA outcomes measured with accelerometer devices. SAT can predict PA outcomes better than SA outcomes within the same population. More research is needed to explore the ability of SAT predicting PA among older adults with various functional abilities, and how SAT can be developed using 2D recordings, such as mobile phone recordings, to predict PA efficiently.

BackgroundThe promotion of active and healthy ageing is becoming increasingly important as the population ages. Physical activity (PA) significantly reduces all-cause mortality and contributes to the prevention of many chronic illnesses. However, the proportion of people globally who are active enough to gain these health benefits is low and decreases with age. Social support (SS) is a social determinant of health that may improve PA in older adults, but the association has not been systematically reviewed.This review had three aims: 1) Systematically review and summarise studies examining the association between SS, or loneliness, and PA in older adults; 2) clarify if specific types of SS are positively associated with PA; and 3) investigate whether the association between SS and PA differs between PA domains.MethodsQuantitative studies examining a relationship between SS, or loneliness, and PA levels in healthy, older adults over 60 were identified using MEDLINE, PSYCInfo, SportDiscus, CINAHL and PubMed, and through reference lists of included studies. Quality of these studies was rated.ResultsThis review included 27 papers, of which 22 were cross sectional studies, three were prospective/longitudinal and two were intervention studies. Overall, the study quality was moderate. Four articles examined the relation of PA with general SS, 17 with SS specific to PA (SSPA), and six with loneliness. The results suggest that there is a positive association between SSPA and PA levels in older adults, especially when it comes from family members. No clear associations were identified between general SS, SSPA from friends, or loneliness and PA levels. When measured separately, leisure time PA (LTPA) was associated with SS in a greater percentage of studies than when a number of PA domains were measured together.ConclusionsThe evidence surrounding the relationship between SS, or loneliness, and PA in older adults suggests that people with greater SS for PA are more likely to do LTPA, especially when the SS comes from family members. However, high variability in measurement methods used to assess both SS and PA in included studies made it difficult to compare studies.

A limited number of studies have used objective measures to examine the associations between the built environment and physical activity (PA) among older adults. This study aimed to examine geographic information systems-derived neighborhood walkability attributes and accelerometer measured PA in older adults. Data were collected from 124 older Taiwanese adults aged over 60 years (mean age: 69.9). Adjusted multiple linear regression was performed to explore the associations between five neighborhood walkability factors (population density, street connectivity, sidewalk availability, access to destinations, and public transportation) and five metrics of accelerometer-measured physical activity (total PA, moderate-to-vigorous PA, light PA, long moderate-to-vigorous PA bouts, and daily step counts). After adjusting for potential confounders, we found that greater sidewalk availability was positively associated with daily step counts in older adults (β = 0.165; 95% confidence interval: 0.006, 0.412; P = 0.043). No associations between other neighborhood environment attributes and PA metrics were observed. In conclusion, high sidewalk availability in the neighborhood may be supportive for older adults’ daily step counts. Further longitudinal research is needed to establish the causality between the built environment and objectively measured PA in older adults.