12-month Physical Activity Intervention Research Articles

Health Promotion with Long-Term Physical Activity Program for Adults with Autism Spectrum Disorder.

Individuals with autism spectrum disorder (ASD) are at higher risk for developing common chronic diseases. Engagement in physical activity (PA) can prevent health issues; however, people with ASD are known to engage in lower levels of PA in comparison to their peers. This study evaluated the effect of a long-term, 12-month PA intervention on the fitness and quality of life of adults with ASD. A quantitative approach was implemented to assess participants' fitness, functional ability, quality of life, and participation in a range of PA classes at three different time points. Qualitative data were collected via in-depth, semi-structured interviews with three participants with ASD and three staff members. A total of 34 adults with ASD (mean age 39.76 + 7.27) participated in the quantitative part of the study. Approximately 53% of the participants exhibited perseverance and conducted adequate PA each month. Significant improvements were found in one fitness component and two quality-of-life components. Factors revealed for the program's success were the individuals' free choice of the PA classes and supporting people and a budget that tailored the project. Policymakers who plan health promotion programs for adults with ASD should consider long-term PA programs, with freedom of choice among PA modalities and schedules.

O2-2 Should I stay or should I go? A mixed-methods, longitudinal investigation of predictors, barriers and enablers of adherence to REACT, a 12-month group-based, active-ageing programme

BackgroundPhysical activity (PA) programmes targeting older adults often report relatively low attendance rates which limits impact. Research into barriers and enablers of PA adherence is often qualitative and rarely tests outcomes against objectively monitored adherence to assess whether what people say is actually reflected in what they do. This study adopts a rare, mixed methods, longitudinal perspective identifying subjective and objective predictors of and associations with adherence to REtirement in ACTion (REACT), a 12-month physical activity intervention for frail or pre-frail older adults.MethodsSemi-structured interviews conducted at six (n = 17) and 12 months (n = 10) explored barriers and enablers to adherence. Thematic analysis led to ten adherence related research hypotheses. These were tested by examining correlations between REACT programme attendance and physical function (Short Physical Performance Battery), self-rated physical function (mobility assessment tool-short form (MAT-sf)), dominant hand grip strength assessed by digital dynamometer, Ageing Well profile (social scale), process evaluation data at baseline (n = 411) and six-months (n = 348) and open-ended participant feedback at six-months (n = 307). Each participant response was scored -1) for a negative comment, 1 for positive or zero for no comment or balancing negative and positive comments.ResultsHigher adherence correlated with younger age (r=-0.162, p > 0.001), better physical function, both objectively measured (r = 0.118, p > 0.05) and self-rated (r = 0.134, p > 0.01), greater grip strength (r = 0.118, p > 0.05) and having less social contact (r=-0.134, p > 0.01), at baseline. It also correlated with an improvement in objectively measured physical function between baseline and six months (r = 0.200, p > 0.001). At 6-months enjoyment of the programme (r = 0.263, p > 0.001), specifically enjoyment of muscle-strengthening exercises (r = 0.142, p > 0.027), perception of positive social interactions (from questionnaire data (r = 0.212, p > 0.001) and open-ended feedback (r = 0.157, p > 0.01)) and perceptions of an autonomy-supportive teaching style (r = 0.213, p > 0.001) all correlated with higher adherence.ConclusionsPA programmes for older adults should encourage the development of social connections and group cohesion but should take a flexible approach to avoid negatively affecting adherence amongst those with pre-existing high levels of social contact. Building confidence in PA and physical function as these improve during the programme, promoting enjoyment and utilising an autonomy-supportive leader teaching style are important in order to support adherence.

Hippocampal maintenance after a 12-month physical activity intervention in older adults: The REACT MRI study

BackgroundPhysical activity interventions have had varying results on modifying hippocampal volume. MethodsThe Retirement in Action (REACT) study conducted a randomised-controlled trial of a 12-month physical activity and behaviour maintenance intervention in older adults at risk of mobility impairments. The physical activity sessions were delivered twice weekly for the first twelve weeks, and then reduced to once weekly, to groups of 15 participants. Activities included cardiovascular, strength, balance and flexibility exercises. A sub-sample of participants in the physical activity (N = 54) and control arms (N = 48) underwent a 3 T MRI brain scan and cognitive assessments at baseline, 6- and 12-months (mean age = 76.6 years, 6.8 SD). It was hypothesised that the intervention would lead to a reduced rate of decline in hippocampal volume. Group differences in changes in cognition were also examined. ResultsAs hypothesised, we found a maintenance in left hippocampal volume in the intervention arm, in comparison with the control arm after 12 months (p = 0.027). In a secondary analysis, this effect was attenuated after including age, sex and education level as covariates (p = 0.057). There was no significant between-group difference in the right hippocampus (p = 0.405). Contrary to our hypothesis, we did not find a beneficial effect of the intervention on cognitive outcomes. ConclusionsOur findings suggest that a community-based physical activity intervention can significantly ward-off hippocampal atrophy in older adults. While the lack of effects on cognition may limit the interpretability of our results, our findings of hippocampal maintenance are promising given the potential clinical relevance of protecting the hippocampus from age-related decline.

Design and Rationale for the Deep South Interactive Voice Response System-Supported Active Lifestyle Study: Protocol for a Randomized Controlled Trial.

BackgroundThe rates of physical inactivity and related cancer incidence and mortality are disproportionately high in the Deep South region in the United States, a rural, medically underserved region with a large African American population compared with the rest of the nation. Given this region’s lower rates of literacy and internet access, interactive voice response (IVR) system–automated telephone-based interventions have the potential to help overcome physical activity intervention barriers (literacy, internet access, costs, and transportation) but have yet to be extended to rural, underserved populations, such as in the Deep South. Thus, extensive formative research is being conducted to develop and beta test the Deep South IVR System–Supported Active Lifestyle intervention in preparation for dissemination in rural Alabama counties.ObjectiveThis paper aims to describe the design and rationale of an ongoing efficacy trial of the Deep South IVR System–Supported Active Lifestyle intervention.MethodsA two-arm randomized controlled trial will be conducted to compare a 12-month physical activity intervention versus a wait-list control condition in 240 underactive adults from 6 rural Alabama counties. The Deep South IVR System–Supported Active Lifestyle intervention is based on the Social Cognitive Theory and includes IVR-automated physical activity–related phone counseling (daily in months 0-3, twice weekly in months 4-6, and weekly in months 7-12) and support from local rural county coordinators with the University of Alabama O’Neal Comprehensive Cancer Center Community Outreach and Engagement Office. The primary outcome is weekly minutes of moderate- to vigorous-intensity physical activity (7-day physical activity recall; accelerometry) at baseline, 6 months, 12 months, and 18 months. Rural Active Living Assessments will be conducted in each rural county to assess walkability, assess recreational amenities, and inform future environment and policy efforts.ResultsThis study was funded in March 2019 and approved by the institutional review board of the University of Alabama at Birmingham in April 2019. As of February 2020, start-up activities (hiring and training staff and purchasing supplies) were completed. Study recruitment and assessments began in September 2020 and are ongoing. As of February 2021, a total of 43 participants have been enrolled in Dallas County, 42 in Sumter County, and 51 in Greene County.ConclusionsIVR-supported phone counseling has great potential for addressing physical activity barriers (eg, culture, literacy, cost, or transportation) and reducing related rural health disparities in this region.Trial RegistrationClinicalTrials.gov NCT03903874; https://clinicaltrials.gov/ct2/show/NCT03903874.International Registered Report Identifier (IRRID)DERR1-10.2196/29245

Association Of Cognitive Function With BMI And Physical Function In Older Adults: The CogEx Study

Aging negatively impacts cognitive function and physical function in older adults. Physical activity may protect or improve the brain and physical functions that are crucial for multiple health outcomes in older adults, whereas obesity may negatively impact these outcomes. PURPOSE: To examine the association between cognitive function with BMI and physical function in underactive older adults. METHODS: Baseline data were examined from sedentary older adults (N=31; age=70.3±3.7 years; BMI=28.8±4.6 kg/m2) prior to engaging in a 12-month physical activity intervention. Assessments included height, weight, physical function, and cognitive function. Cognitive function was assessed using the Modified Mini-Mental State (3MS) examination and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Physical function performance was assessed using the time to complete the 400-Meter Walk Test (minutes). RESULTS: Average time to complete the 400-meter walk was 6.3±1.0 minutes, which was modestly associated with BMI (r=0.312, p=0.088). The 3MS Total Score (94.7±3.7) was not significantly correlated with BMI (r=-.158; p=.397) or 400-Meter Walk Test performance (r=-.152; p=.415). Similarly, the RBANS Sum of Index Score (209.0±21.1) was not significantly correlated with BMI (r=-.297; p=.105) or 400-Meter Walk Test performance (r=-.164; p=.378). When examining this relationship by cognitive domain, a higher BMI was associated with a poorer RBANS Immediate Memory Index Score (r=-.412; p=.021). We also observed that worse performance on the 400-Meter Walk Test was associated with poorer RBANS Immediate Memory Index Score (r=-.314; p=.08). Neither BMI nor 400-Meter Walk performance were significantly associated with RBANS Visuospatial/Constructional Index, Language Index, Attention Index, or Delayed Memory Index scores. CONCLUSION: Findings reveal that RBANS Immediate Memory Index score was inversely associated with both BMI and physical function in sedentary older adults. This may suggest that both obesity and poor physical function negatively impact immediate memory performance in older adults. Future studies to investigate whether and how physical therapeutics may enhance short-term memory function in older adults are warranted. Supported by UPMC Enterprises

The effect of physical activity on cognition relative to APOE genotype (PAAD-2): study protocol for a phase II randomized control trial

BackgroundBy 2050, the prevalence of Alzheimer’s disease (AD) in the United States is predicted to reach 13.8 million. Despite worldwide research efforts, a cure for AD has not been identified. Thus, it is critical to identify preventive strategies that can reduce the risk of or delay the onset of AD. Physical activity (PA) has potential in this regard. This randomized clinical trial aims to (a) test the causal relationship between PA and AD-associated cognitive function for persons with a family history of AD (FH+), (b) determine the moderating role of apolipoprotein epsilon 4 (APOE4) carrier status on cognition, and (c) assess cerebral structure, cerebral function, and putative biomarkers as mediators of the effects of PA on cognition.MethodsWe are recruiting cognitively normal, middle aged (40–65 years) sedentary adults with FH+. Participants are randomly assigned to a 12-month PA intervention for 3 days/week or to a control group maintaining their normal lifestyle. Saliva samples are taken at pre-test to determine APOE genotype. At pre-, mid-, and post-tests, participants complete a series of cognitive tests to assess information-processing speed, verbal and visual episodic memory, constructional praxis, mnemonic discrimination, and higher-order executive functions. At pre- and post-tests, brain imaging and blood biomarkers are assessed.DiscussionWe hypothesize that 1) the PA group will demonstrate improved cognition compared with controls; 2) PA-derived cognitive changes will be moderated by APOE4 status; and 3) PA-induced changes in neural and blood biomarkers will contribute to cognitive changes and differ as a function of APOE4 status. Our results may provide important insights into the potential of PA to preserve neurocognitive function in people with a heightened risk of AD due to FH+ and as moderated by APOE4 status. By using sophisticated analytic techniques to assess APOE as a moderator and neurobiological mechanisms as mediators across trajectories of cognitive change in response to PA, we will advance our understanding of the potential of PA in protecting against AD.Trial registrationClinicalTrials.gov NCT03876314. Registered March 15, 2019.

Changes In Cortical Gray Matter Following A 12-month Physical Activity Intervention In Older Adults

Changes In Cortical Gray Matter Following A 12-month Physical Activity Intervention In Older Adults

Racial Differences in Program Evaluation of a Lifestyle Physical Activity Randomized Controlled Trial.

The purpose of this study was to compare program evaluation responses between African American and Caucasian caregivers of persons with Alzheimer's disease and related dementias who completed a lifestyle physical activity randomized controlled trial. The aim was to determine if African Americans evaluated the study differently than Caucasians. Family caregivers (N = 211) were randomly assigned to a 12-month physical activity intervention or a control condition. Upon intervention completion (n = 114), caregivers responded to an 11-item questionnaire using Likert-type scale responses and three open-ended questions about the overall intervention quality. Findings indicated that African American caregivers evaluated both conditions more favorably than Caucasian caregivers (p = .02). Content analysis of the narrative responses revealed five major qualitative themes: support, resources, responsibility, adjusting, and time These findings suggest the value of both access to resources, and support for African American caregivers who participate in intervention research.

Long-term Surveillance of Physical Activity Habits of Latinas Enrolled in a 12-Month Physical Activity Intervention.

Long-term physical activity surveillance has not been conducted among Latinas. This study explored the variability of daily physical activity habits of inactive adult Latinas participating in a 12-month physical activity intervention. We collected objective physical activity data (pedometer) from 139 Spanish speaking Latinas (age = 41.6 ± 10.1 years; BMI = 29.6 ± 4.3 kg/m2) enrolled in a 12-month physical activity intervention. Total and aerobic steps (>100 steps/minute) were computed by year, season, month, day of week, time of day, and hour. Participants walked an average of 6509 steps/day of which 1303 (20%) were aerobic steps. Significant physical activity differences were observed for subgroups including generational status, education, employment, income, marital status and health literacy. Significant and similar differences were observed for both total steps and aerobic steps for day of the week (weekdays > weekends) and season (summer > spring > fall > winter). Opposing trends were observed over the course of the day for total steps (early afternoon > late morning > late afternoon > early morning > evening) and aerobic steps (early morning > evening > late morning > late afternoon > early afternoon). Both seasonality and week day predicted physical activity habits of Latinas. This is the first long-term study to track daily physical activity habits of Latinas. These data have potential to inform the design of future physical activity interventions targeting Latinas.

Effects of a 12-Month Physical Activity Intervention on Prevalence of Metabolic Syndrome in Elderly Men and Women

There is a lack of information on whether exercise training alone can reduce the prevalence of metabolic syndrome (MetS) in elderly men and women. This study was an ancillary to the Lifestyle Interventions and Independence for Elders Pilot Study, a four-site, single-blind, randomized controlled clinical trial comparing a 12-month physical activity (PA) intervention (N = 180) with a successful aging intervention (N = 181) in elderly (70-89 years) community-dwelling men and women at risk for physical disability. The PA intervention included aerobic, strength, and flexibility exercises, with walking as the primary mode. MetS was defined using the National Cholesterol Education Program criteria. There was no significant change in body weight or fat mass after either intervention. The trend of MetS prevalence over the intervention period was similar between PA and successful aging groups (p = .77). Overall, the prevalence of MetS decreased significantly from baseline to 6 months (p = .003) but did not change further from 6- to 12-month visits (p = .11). There were no group differences in any individual MetS components (p > .05 for all group by visit interactions). However, in individuals not using medications at any visit to treat MetS components, those in the PA intervention had lower odds of having MetS than those in the successful aging group during follow-up (odds ratio = 0.28, 95% confidence interval = 0.08-0.96). In this sample, a 12-month PA intervention did not reduce the prevalence of MetS more than a successful aging intervention, perhaps due to the large proportion of individuals taking medications for treating MetS components.

Long-term Physical Activity and Inflammatory Biomarkers In Older Adults

PURPOSE: To determine the effects of a 12-month physical activity intervention on inflammatory biomarkers in elderly men and women. METHODS: 424 elderly (aged 70-89 years), nondisabled, community-dwelling men and women at risk for physical disability were enrolled in a multicenter, single-blind, randomized controlled-trial. Participants were randomized to participate in either a 12-month moderate-intensity physical activity (PA) intervention or a successful aging (SA) health education intervention. Biomarkers of inflammation (IL-6sR, IL-1sRII, sTNFRI, sTNFRII, IL-8, IL-15, adiponectin, IL-1ra, IL-2sRa, and TNF-a) were measured at baseline, 6 and 12 months. RESULTS: After adjustment for gender, clinic site, diabetes status, and baseline outcome measure, IL-8 was the only inflammatory biomarker affected by the PA intervention (p=0.03). The adjusted mean IL-8 at month 12 was 9.9% (0.87 pg/mL) lower in the PA compared to the SA group. Secondary interaction analyses between baseline biomarker status and treatment showed one significant interaction (p=0.02) such that the PA intervention reduced IL-15 concentrations in participants with a baseline IL-15 above the median value of 1.67 g/mL. However, these associations were no longer significant after consideration for multiple comparisons. CONCLUSIONS: Overall, this study does not provide definitive evidence for an effect of regular exercise for altering systemic concentrations of the measured inflammatory biomarkers in older adults.

Geographic Correlates of Fitness and Cardiovascular Health in a Training Intervention Among Older Adults

0511 Where a person lives is not usually thought of as an important predictor of their health. Lifestyle and genetic explanations predominateFinevertheless, where someone lives may differ in many aspects potentially related to health. Purpose: To determine differences between access to physical activity facilities, and changes in VO2max, systolic blood pressure (SBP) and BMI following a 12-month community-based physical activity intervention (STEP). Methods: Geographic Information Systems (GIS) was used to map subject dwelling and community physical activity facilities for 41 older (x age = 73+/−3 y; 19 male; 22 female) adults who completed a 12-month physical activity intervention as part of a larger RCT (Step Test Exercise Prescription) of 360 older adults across Canada. Physical activity facilities (parks, walking paths, health clubs etc) were identified on digitized maps for the city of London, Ontario and corroborated by telephone directory and GPS. All distances were compared to primary clinical outcomes including VO2max, SBP and BMI. Subjects were grouped according to whether they maintained/improved (responders) or declined (non-responders) in fitness compared to the group mean change after 12-months. Results: At baseline, subjects who were closer than the group mean to aggregate facilities tended to have higher VO2max, lower SBP and BMI while no pattern for individual facilities was observed. After the STEP intervention, Responders tended to show a smaller increase in SBP and BMI and were closer to aggregate facilities, walking paths and open playing fields. Conclusion: Subjects with closer proximity to physical activity facilities showed higher VO2max and favorable SBP and BMI profile while those who improved VO2max, had less SBP and BMI increase following a 12- month intervention tended to live closer to physical activity opportunities.Table

Geographic Correlates of Fitness and Cardiovascular Health in a Training Intervention Among Older Adults

0511 Where a person lives is not usually thought of as an important predictor of their health. Lifestyle and genetic explanations predominateFinevertheless, where someone lives may differ in many aspects potentially related to health. Purpose: To determine differences between access to physical activity facilities, and changes in VO2max, systolic blood pressure (SBP) and BMI following a 12-month community-based physical activity intervention (STEP). Methods: Geographic Information Systems (GIS) was used to map subject dwelling and community physical activity facilities for 41 older (x age = 73+/−3 y; 19 male; 22 female) adults who completed a 12-month physical activity intervention as part of a larger RCT (Step Test Exercise Prescription) of 360 older adults across Canada. Physical activity facilities (parks, walking paths, health clubs etc) were identified on digitized maps for the city of London, Ontario and corroborated by telephone directory and GPS. All distances were compared to primary clinical outcomes including VO2max, SBP and BMI. Subjects were grouped according to whether they maintained/improved (responders) or declined (non-responders) in fitness compared to the group mean change after 12-months. Results: At baseline, subjects who were closer than the group mean to aggregate facilities tended to have higher VO2max, lower SBP and BMI while no pattern for individual facilities was observed. After the STEP intervention, Responders tended to show a smaller increase in SBP and BMI and were closer to aggregate facilities, walking paths and open playing fields. Conclusion: Subjects with closer proximity to physical activity facilities showed higher VO2max and favorable SBP and BMI profile while those who improved VO2max, had less SBP and BMI increase following a 12- month intervention tended to live closer to physical activity opportunities.Table