PHYSICAL CULTURE AS A SYSTEM-FORMING TECHNOLOGY FOR MAINTAINING THE HEALTH AND PERFORMANCE OF MATURE INDIVIDUALS

Review Question/Objective The objective of this systematic review is to synthesise the best available evidence on the effectiveness of physical leisure time activities on glycaemic control in adult patients with diabetes type 2. The specific review question is: What is the effectiveness of physical leisure time activities on glycaemic control in patients with diabetes type 2? Types of participants This review will consider adults over 18 years old diagnosed with type 2 diabetes mellitus according to 2003 American Diabetes Association criteria. Patients receiving oral or insulin medicine treatment will be considered for inclusion, regardless of severity of diabetes or other treatment regimes, but patients who had recently undergone serious operations or who had myocardial infarction, stroke, severe liver or kidney diseases, or any illness limiting participation in the physical activity program, or who were participating in a physical exercise program at the same time will be excluded from the study. Types of Interventions Regular physical leisure time activities for people with type 2 diabetes are defined as at least 150 minutes of moderate-intensity physical activity (50-70% of maximum heart rate) per week, or at least 90 minutes of vigorous-intensity physical activity (>70% of maximum heart rate) per week.26 The minimum duration of the intervention will be at least two months. The review will include the following forms of moderate or vigorous leisure time activities: (1) tai chi exercise (2) walking (3) swimming (4) gardening (5) gigong (an ancient Chinese breathing exercise that combines aerobics, isometric, and isotonic movements and meditation) (6) jogging (7) riding a bicycle (8) dancing. Types of outcomes The outcome measures will include long-term and short-term glycaemic control indicators to reflect the patients’ immediate and two to three months blood sugar changing condition. Therefore, haemoglobin A1c (HbA1c), fasting plasma glucose (FPG), and postprandial plasma glucose (PPG) indicators will be included in this study.

Physical activity and health

To describe leisure participation in adolescents with congenital heart defects (CHD) and identify factors associated with intensity of participation. Eighty adolescents with CHD were recruited (39 males, 41 females; mean age [SD] 15y 8mo [1y 8mo] range 11y 5mo-19y 11mo) of whom 78 completed the Children's Assessment of Participation and Enjoyment (CAPE) outcome measure of leisure participation. The measure has five subscales: recreational, active-physical, social, skill-based, and self-improvement. Associations between the CAPE and age, sex, and development were examined. Motor ability (Movement Assessment Battery for Children, Second Edition), cognition (Leiter International Performance Scale-Revised), behavior (Strengths and Difficulties Questionnaire), and motivation (Dimensions of Mastery Questionnaire) were assessed. Participants exhibited impaired motor (43.5%), behavioral (23.7%), and cognitive (29.9%) development. The most intense participation was in social (mean [SD] 3.3 [0.99]) and recreational (2.9 [0.80]) activity types on the CAPE. Male sex (p<0.05) and younger age were associated with greater physical activity (<15y: 1.87; ≥15y: 1.31, p<0.05). Greater engagement in social activities was related to better cognition (r=0.28, p<0.05), higher motor function (r=0.30-0.36, p<0.01), and fewer behavioral difficulties (r=-0.32 to -0.47, p<0.01). Cognitive ability (r=0.27, p<0.05), dexterity and aiming/catching (r=0.27-0.33, p<0.05), and behavior problems (r=0.38-0.49, p=0.001) were correlated with physical activity participation. Persistence in tasks, an aspect of motivation, correlated with physical (r=0.45, p<0.001) and social activity involvement (r=0.28, p<0.05). Ongoing developmental impairments in adolescents with CHD are associated with decreased active-physical and social engagement, putting them at risk of poor physical and mental health. Health promotion strategies should be considered. Adolescents with congenital heart defects (CHD) have limited engagement in active-physical leisure activities. Cognitive, motor, and behavioral impairments are associated with decreased participation in leisure in children with CHD. Female sex and older age are associated with less engagement in leisure. Mastery motivation correlates with participation, suggesting an avenue for intervention.

Implication of frailty and disability prevention measures during the COVID-19 pandemic.

Risk of Increased Physical Inactivity During COVID-19 Outbreak in Older People: A Call for Actions.

Physical Activity and Older People: A Walk A Day Keeps the Doctor Away

IntroductionThe health benefits of physical activity are well established; however, most older people are not sufficiently physically active. Despite the availability of various physical activity interventions and programs, implementation of effective prevention strategies to reduce older people’s physical inactivity are lacking. The ENJOY IMP-ACT project is an implementation research project, based on a previous evidence-based physical and social activity program utilising specialised outdoor exercise equipment (the Seniors Exercise Park) for older people. The ENJOY IMP-ACT aims to increase participation in physical activity to improve health outcomes for older people in Victoria, Australia.MethodThe ENJOY IMP-ACT is a hybrid II implementation-effectiveness pre-post mixed method study design. Five local governments (6 public sites/parks) will undergo a 3-month control period followed by 9-months implementation intervention (TERM framework intervention: Training, Engagement, Resources development, Marketing and promotion), and a maintenance phase (3 months). Various methodologies will be employed throughout the project at each site and will include direct observations of park users, intercept surveys with park users, online access monitor platform (using an online app), interviews with stakeholders and exercise program leaders, a process evaluation of physical activity programs, a social return-on-investment analysis, and other related activities.DiscussionThrough the implementation framework design, the ENJOY IMP-ACT is uniquely placed to translate an evidenced-based physical and social activity program into real world settings and increase physical activity among older people. If successful, this program will inform scale up across Australia with the goal of improving the health and wellbeing of older people.Trial registrationThis registration trial is prospectively registered with the Australian New Zealand Clinical Trials Registry. Trial number ACTRN12622001256763. Date registered 20/09/2022.

Background and Study Aim. The World Health Organization has recognized that insufficient physical activity is a serious public health problem. A large number of studies are devoted to improving livelihoods and increasing life expectancy of the population through the formation of guidelines for a healthy lifestyle. Regular physical activity is one of the most important components of maintaining health and healthy aging. Many European countries already have well-developed social programs to support physical activity among older people. This includes the organization of sporting events, financial support for clubs for seniors, as well as infrastructure that promotes an active lifestyle (active parks, walking and cycling paths, a sufficient number of swimming pools, etc.). Therefore, the purpose of the study was to identify the effectiveness of complex motor training on the morphofunctional and psycho-emotional state of elderly people from different countries of Europe and Asia. Material and Methods. The study involved 240 (30 men and 30 women each from Poland, Kazakhstan, Kyrgyzstan and Ukraine) elderly people (the average age of the study participants was 68.24±3.01 years). The groups were homogeneous in age, gender, social status, interests, level of physical fitness, functionality and motivation. The study participants followed a developed physical activity program for older people. Classes lasted a year, 3 times a week, lasting 60 minutes each. The program included theoretical and practical parts. Theoretical material concerned the benefits of physical activity, motor mode and dosage of exercise for older people. The practical part included the most common types of physical education and health activities among older people (swimming, Nordic walking, health tourism). The study involved assessing the morphofunctional state of older people by determining body mass indexes, functional changes and Robinsonal, as well as the Skibinsky and Rufier tests, and the assessment of well-being, activity and mood (WAM) was carried out using a questionnaire Results. During the study, we measured morphofunctional indicators and determined the psycho-emotional state of elderly people from Poland, Kazakhstan, Kyrgyzstan and Ukraine, who were engaged in a developed program using various types of physical activity, namely: swimming, Nordic walking, health tourism Conclusions. The results obtained indicate the effectiveness of using a comprehensive physical activity program among older women and men from different countries of Europe and Asia. All participants showed positive changes in all indicators. Minor changes over the course of a year of training according to the developed program in the indicators of the morphofunctional and psycho-emotional state of elderly people from Poland indicate that a healthy lifestyle is being popularized in the European Union country and conditions are being created for regular physical activity of the population, including older people.

Physical activity and arterial stiffness in older adults of the SAPALIDA 3 cohort study

From the May Issue of JAMDA

Physical activity plays an essential role in preventing diseases and improving overall health. Promoting physical activity has become an important intervention against low physical fitness and chronic diseases in older adults. This study aimed to determine whether telling older people their predictive physical fitness age prompts physical activity. Two hundred and fifty-three older Chinese people were assigned single-blindly to either an intervention group (n=140) or control group (n=113) in this quasi-experimental study. Participants in the intervention group were informed of the predictive physical fitness age and taught the difference from their chronological age while participants in the control group were not. Participants in both groups were encouraged to get more physical activities each day. The primary outcome was physical activity, and the secondary outcome was the change in physical fitness age. Results showed that for older adults with low physical fitness, all physical activity parameters (vigorous physical activity, moderate physical activity, walking, total physical activity and sitting) showed a significant difference between intervention and control groups after 2 and 12weeks (p<0.05). Moreover, physical fitness age was improved remarkably after 12weeks compared to the control group (73.57±5.75 vs. 66.85±6.33years, p<0.05). For older adults with normal physical fitness, a remarkable difference was observed in moderate physical activity, total physical activity, and sitting between intervention and control groups after 2weeks (p<0.05), but the difference disappeared after 12weeks. For older adults with high physical fitness, no significant changes were found between groups (p>0.05). The findings suggest that telling older people their predictive physical fitness age can become a viable motivational tool to promote physical activity especially for those with low physical fitness, thereby improving their physical fitness age and overall health.

Identifying protective factors or effective prevention strategies for dementia would result in considerable benefits by prolonging quality of life and reducing social burden. Current data suggests that participation in physical leisure activities may lower the risk of dementia by improving cognitive reserves. The objective of this review was to determine the best available evidence in relation to physical leisure activities in preventing dementia among older adults. Types of studies Randomised controlled trials (RCTs) and other experimental designs were considered for inclusion into the review. In the absence of clinical trials, other study designs such as cohort, case controlled and cross-sectional were considered. Only articles published in the English language were included with no publication date restriction.Types of participants Participants of interest were adults aged 60 and older with or without a clinical diagnosis of dementia, living in the community or residential care setting.Types of intervention This review considered studies that evaluated the effectiveness of any physical leisure activity in the prevention of dementia. Physical activities included gardening, playing sports, exercises, sightseeing and any other activities that required active movement of the body.Types of outcome measures The review considered studies that indicated the presence or absence of dementia as determined by cognitive function tests, mental examination scores, DSM classification (Diagnostic and Statistical Manual of Mental Disorders), and other valid dementia diagnostic tools. A search for published and unpublished literature in the English language was conducted using all major electronic databases. There was no publication date restriction. A three-step search strategy was developed using MeSH terminology and keywords to ensure that all material relevant to the review was captured. The methodological quality of included studies was assessed by two reviewers, who appraised each study independently, using standardised Joanna Briggs Institute (JBI) critical appraisal tools. Data was extracted from the studies that were identified as meeting the criteria for methodological quality using the standard JBI data extraction tools. Due to the heterogeneity of populations and interventions, results are presented in narrative form. Seventeen longitudinal studies were included in the review. Studies were grouped by stage of adult life participation when interventions were undertaken i.e. early-middle adulthood and late life. The evidence regarding the relationship between participation in physical activities during midlife and later life and the prevention of dementia was equivocal. The majority of studies showed limited benefits in engaging in physical activities and results indicated that some activities might be more beneficial than others. IMPLICATIONS FOR RESEARCH.

BackgroundPhysical activity is important to maintain health in older age, with physical activity in the outdoors providing mental and physical health benefits for all age groups. One way by which older people can engage in physical activity in the outdoors is through using suitable age-friendly outdoor exercise equipment, the Seniors Exercise Park. The ENJOY MAP for HEALTH aims to evaluate the effect of the Seniors Exercise Park installation and associated capacity building activities on park visitation, park-based physical activity by older people and delivery of community physical activity programs.MethodThis study is a quasi-experimental (natural experiment) with pre and post study design evaluating the effect of age-friendly outdoor spaces with specialised outdoor exercise equipment on older people’s physical activity and wellbeing in six Victorian municipalities (local governments/councils). Each council will undergo four stages (site construction and development, promotion and marketing, capacity building and training, evaluation and sustainability). Several activities and methods will be employed from stage one through stage four to evaluate the potential impact of the age-friendly outdoor spaces on physical activity and wellbeing and will comprise the following elements: site observation and equipment utilisation, face to face intercept surveys, development of an online access monitor and community building activities.DiscussionThe project is expected to result in a significant change in the physical outdoor environment for the participating councils and communities whereby older people and other community members will be able to engage in safe physical and social activity programs, socialise more and hence improve the overall wellbeing of older people.Trial registrationThis trial is retrospectively registered with the Australian New Zealand Clinical Trials Registry. Trial registration number ACTRN12621000965808. Date registered 23/07/2021.

The study investigated the role of physical activity, from midlife to older age, in relation to lung function in older age. In order to increase the understanding of the relationship between physical activity and lung function, the relationship between physical activity in midlife and physical activity in older age was also studied. Two Swedish studies based on nationally representative samples were used in this study, the Level of Living Survey, LNU, and the Swedish Panel Study of Living Conditions of the Oldest Old, SWEOLD. The participants were interviewed on three occasions; at the mean ages of 53 years, 61 years, and 81 years. The average follow-up time from the last to the first interview was 24-30 years. The results show that more physical activity in late midlife (mean age of 61 years) was associated with better lung function in older age. The association persists but attenuates when physical activity in older age was included in the analyses. There was also a strong association between physical activity in older age and better lung function in older age. Physical activity in late midlife had a positive association with physical activity in older age. This study shows the importance of physical activity in late midlife and in older ages to maintain good lung function in older ages. To invest in preventive actions in the form of physical activity are vital to be able to promote healthy aging, and should include the oldest old (76+).

Identification of individual-level barriers associated with decreased activity in older age is essential to inform effective strategies for preventing the health outcomes associated with high sedentary behavior and lack of physical activity during aging. To assess cross-sectional and prospective associations of a large set of factors with objectively assessed sedentary time and physical activity at older age. This population-based cohort study was conducted among participants in the Whitehall II accelerometer substudy with accelerometer data assessed in 2012 to 2013. Among 4880 participants invited to the accelerometer substudy, 4006 individuals had valid accelerometer data. Among them, 3808 participants also had factors assessed in 1991 to 1993 (mean [SD] follow-up time, 20.3 [0.5] years), 3782 participants had factors assessed in 2002 to 2004 (mean [SD] follow-up time, 9.1 [0.3] years), and 3896 participants had factors assessed in 2012 to 2013 (mean follow up time, 0 years). Data were analyzed from May 2020 through July 2021. Sociodemographic factors (ie, age, sex, race and ethnicity, occupational position, and marital status), behavioral factors (ie, smoking, alcohol intake, and fruit and vegetable intake), and health-related factors (ie, body mass index, 36-Item Short Form Health Survey (SF-36) physical and mental component summary scores [PCS and MCS], and number of chronic conditions) were assessed among 3808 individuals in 1991 to 1993; 3782 individuals in 2002 to 2004; and 3896 individuals in 2012 to 2013. High alcohol intake was defined as more than 14 units of alcohol per week, and high fruit and vegetable intake was defined as twice daily or more. Accelerometer-assessed time spent in sedentary behavior, light-intensity physical activity (LIPA), and moderate to vigorous physical activity (MVPA) in 2012 to 2013 were analyzed in 2021 using multivariate linear regressions. A total of 3896 participants (986 [25.3%] women; age range, 60-83 years; mean [SD] age, 69.4 [5.7] years) had accelerometer data and exposure factors available in 2012 to 2013. Older age, not being married or cohabiting, having overweight, having obesity, more chronic conditions, and poorer SF-36 PCS, assessed in midlife or later life, were associated with increased sedentary time at the expense of time in physical activity. Mean time differences ranged from 9.8 min/d (95% CI, 4.1 to 15.6 min/d) of sedentary behavior per 10-point decrease in SF-36 PCS to 51.4 min/d (95% CI, 37.2 to65.7 min/d) of sedentary behavior for obesity vs reference range weight, from -6.2 min/d (95% CI, -8.4 to -4.1 min/d) of LIPA per 5 years of age to -28.0 min/d (95% CI, -38.6 to -17.4 min/d) of LIPA for obesity vs reference range weight, and from -5.3 min/d (95% CI, -8.2 to -2.4 min/d) of MVPA per new chronic condition to -23.4 min/d (95% CI, -29.2 to -17.6 min/d) of MVPA for obesity vs reference range weight in 20-year prospective analyses for men. There was also evidence of clustering of behavioral factors: high alcohol intake, high fruit and vegetable consumption, and no current smoking were associated with decreased sedentary time (mean time difference in cross-sectional analysis in men: -12.7 min/d [95% CI, -19.8 to -5.5 min/d]; -6.0 min/d [95% CI, -12.3 to -0.2]; and -37.4 min/d [95% CI, - 56.0 to -18.8 min/d], respectively) and more physical activity. This study found a large range of individual-level barriers associated with a less active lifestyle in older age, including sociodemographic, behavioral, and health-related factors. These barriers were already evident in midlife, suggesting the importance of early implementation of targeted interventions to promote physical activity and reduce sedentary time.