Exercise Adherence In Older Adults Research Articles

Age and Gender Differences in Long-Term Exercise Behavior for Older Adults with Heart Disease

Exercise decreases mortality and hospital admissions. Exercise adherence is challenging, and little is known about exercise adherence especially in older adults with heart disease. To gain an understanding of long-term exercise behaviors in older adults we conducted a cross-sectional study of individuals diagnosed between 2016-2020 with myocardial infarction (MI)/angina. Emails were sent in 2020 to recruit participants. Exercise adherence was measured using the Exercise Adherence Rating Scale (EARS), Godin’s Leisure-Time Activity Scale (GLTEQ) for exercise intensity, and self-report for impact of COVID-19. Descriptive statistics and t-tests were used to analyze data. Eight-hundred and seven individuals (x ® age 67.3) responded to the on-line survey. The majority were males (68.8%), married, (68.9%), and retired (59.3%). Co-morbidities included hypertension (32%), hyperlipidemia (21%), diabetes (12%), and depression (6.2%). Long-term exercise behaviors were independently observed in participants ≥65yr (n=526) and <65yr (n=281). Females ≥65yo demonstrated higher exercise adherence scores compared with males ≥65yo (1.66 ± 1.1 vs. 1.30 ± 21.7; t = -2.59, p=.010). Conversely, males scored higher in exercise intensity (34.4 ± 24.7 vs. 22.6 ± 21.7; t = 3.84, p=.000). Gender related exercise adherence and exercise intensity did not differ significantly in <65yo (p=.278 & p=.282, respectively). Exercise frequency decreased in both age groups after COVID-19 Pandemic started, however the decrease was significant only in older adults (p=.014) indicating they were at greater risk for exercise problems when faced with environmental barriers. Additional research is recommended as to the impact of environmental factors on exercise adherence in older adults and potential interventions.

Cognitive Function and Functional Mobility Predict Exercise Adherence in Older Adults Who Fall

Introduction: Strength and balance exercises prevent falls. Yet, exercise adherence is often low. To maximize the benefit of exercise on falls prevention, we aimed to identify baseline cognitive and mobility factors that predict adherence to the Otago Exercise Program (OEP) – a home-based exercise program proven to prevent falls. Methods: We conducted a secondary longitudinal analysis of data from a randomized clinical trial (RCT) (OEP compared with usual care) among 172 participants who were assigned to the OEP intervention of the RCT. Adherence to the OEP was calculated as a percent score (i.e., [frequency of strength and balance retraining session per week/3 strength and balance retraining sessions per week] × 100). Executive function (i.e., mental flexibility) was measured using the Trail Making Tests (Part A and B: TMT B – TMT A) and the Digit Symbol Substitution Test (DSST). Short-term memory and encoding was measured using the Verbal Digits Forward test. Executive function (i.e., inhibition and working memory) was measured using the Stroop Color-Word Test and the Verbal Digits Forward minus Verbal Digits Backward test. Mobility was assessed using the Short Performance Physical Battery and the Timed Up and Go test. We used general estimation equations analysis to determine the predictors of adherence to the OEP. Results: Better set shifting (β = −0.06, z = −2.43, [SE = 0.02] p = 0.018] predicted greater OEP adherence. Greater attention and short-term memory (β = −6.99, z = −2.37 [SE = 2.95]) predicted poorer OEP adherence. Response inhibition, processing speed, working memory, and mobility assessed by the SPPB were not associated with adherence. Poorer baseline Timed Up and Go (β = 1.48 z = 1.94, [SE = 0.76]; p < 0.001), predicted better OEP adherence. Conclusion: Specific cognitive processes (i.e., executive function of set shifting, attention, and short-term memory) and functional mobility predicted exercise adherence. Further research needs to explore the pathways that explain why better attention and short-term memory predicted lower adherence and why poorer functional mobility led to better OEP adherence.

Modifiable facilitators and barriers to exercise adherence in older adults with MCI/dementia using the Theoretical Domains Framework: a systematic review protocol

IntroductionExercise has multiple benefits on maintaining or improving cognitive function for people with mild cognitive impairment (MCI)/dementia. However, many older adults with MCI/dementia are not sufficiently active to achieve these...

Factors Influencing Walking and Exercise Adherence in Healthy Older Adults Using Monitoring and Interfacing Technology: Preliminary Evidence.

Background: Monitoring and interfacing technologies may increase physical activity (PA) program adherence in older adults, but they should account for aspects influencing older adults’ PA behavior. This study aimed at gathering preliminary wrist-based PA adherence data in free-living and relate these to the influencing factors. Methods: Ten healthy older adults (4 females, aged 70–78 years) provided health, fatigue, activity levels, attitude towards pacing, and self-efficacy information and performed a 6 min-walk test to assess their fitness. After a baseline week they followed a two-week walking and exercise intervention. Participants saw their progress via a purposely designed mobile application. Results: Walking and exercise adherence did not increase during the intervention (p = 0.38, p = 0.65). Self-efficacy decreased (p = 0.024). The baseline physical component of the Short Form Health Survey was the most predictive variable of walking adherence. Baseline perceived risk of over-activity and resting heart rate (HRrest) were the most predictive variables of exercise adherence. When the latter two were used to cluster participants according to their exercise adherence, the fitness gap between exercise-adherent and non-adherent increased after the intervention (p = 0.004). Conclusions: Risk of over-activity and HRrest profiled short-term exercise adherence in older adults. If confirmed in a larger and longer study, these could personalize interventions aimed at increasing adherence.

Benefits of a transtheoretical model-based program on exercise adherence in older adults with knee osteoarthritis: A cluster randomized controlled trial.

Benefits of a transtheoretical model-based exercise program on exercise adherence (primary outcome) and secondary outcomes (self-efficacy, decisional balance, knee osteoarthritis symptoms, and physical function) were assessed among older adults with knee osteoarthritis. A two-arm, superiority, assessor-blinded, cluster randomized trial with randomization at the community level. Participants were recruited from 14 communities in Beijing between April - October 2018 (N=189). The intervention was a 24-week transtheoretical model-based exercise program and the control group underwent a non-theory-based exercise program. Exercise adherence was collected every 4weeks and secondary outcomes were measured at baseline, 12weeks, and 24weeks. An independent t test and repeated-measures ANOVA were the main statistical tests. Most participants were women (92.5%), married (81.4%), with high-school education (36.0%), with both knees affected (50.3%), and did not make use of a walker (93.8%). There were no significant differences between groups in any of the outcome measures at baseline. Repeated-measures ANOVA indicated that there was a significant difference in the trend of adherence scores between the two groups from 0-24weeks. The independent t test showed that scores in the intervention group were significantly better than in the control group at 16, 20, and 24weeks. Improvements in the intervention group were also significantly greater in all secondary outcomes than in the control group. A theory-based exercise program could improve exercise adherence, self-efficacy, decisional balance, knee osteoarthritis symptoms, and physical functioning in older adults with knee osteoarthritis. Chinese Clinical Trials Registry number ChiCTR1800015458. Registered 31 March 2018. The 24-week theory-based exercise program could improve exercise adherence, self-efficacy, decisional balance, symptoms of knee osteoarthritis, and physical functioning in older adults with knee osteoarthritis. The theory-based exercise program could help older adults with knee osteoarthritis to improve their symptoms and knee function.

Effects of three home-based exercise programmes regarding falls, quality of life and exercise-adherence in older adults at risk of falling: protocol for a randomized controlled trial

BackgroundFall prevention interventions with home-based exercise programmes are effective to reduce the number and the rate of falls, by reducing risk factors. They improve balance, strength, function, physical activity, but it is known that older adults’ exercise adherence declines over time. However, it is unclear which delivery-modalities of the home-based exercise programmes show the best adherence and the largest effect.We created a new home-based exercise programme, the Test-and-Exercise (T&E) programme, based on the concepts of self-efficacy and empowerment. Patients learn to build their own exercise programme with a mobile application, a brochure and cards, as well as with eight coaching sessions by physiotherapists.The main objective of this study is to compare the T&E programme with the Otago Exercise Programme and the recommendation-booklet and exercise-cards of Helsana regarding incidence of falls. Other outcomes are severity of falls, functional capacities, quality of life and exercise-adherence.MethodsThe design of this study is a Swiss multicentre assessor blind randomized controlled trial. A block-randomization, stratified in groups for age and risk of fall categories, will be used to allocate the participants to three groups. The targeted study sample consists of 405 older adults, ≥ 65 years of age, living in the community and evaluated as at “risk of falling”. Experimental group will receive the T&E programme (N = 162). Second group will receive the Otago programme (N = 162) and the third group will receive the Helsana programme (N = 81). All interventions last six months. Blinded assessors will assess participants three times: at baseline before the start of the intervention, after six months of intervention and a final assessment after twelve months (six months of follow up).DiscussionAlthough home-based exercises programmes show positive effects in fall prevention in elderly persons, existing programmes do often not include patients in the decision-making process about exercise selection. In our programme the physiotherapist and the older adult work together to select the exercises; this collaboration helps to increase health literacy, pleasure of exercising, and empowers patients to be more autonomy.Trial registrationClinicalTrials.gov: NCT02926105, First Posted: October 6, 2016, Last Update: November 11, 2016: Enrolment of the first participant.

Adherence to Exercise Programs in Older Adults: Informative Report.

This informative report focuses on filling information gaps regarding adherence to physical activity and exercise in the health care spectrum of older adults (OA) and an overview of the benefits of physical activity for OA. Healthy People 2000, 2010, and 2020 are public health programs from the U.S. Department of Health and Human Services that set national goals and objectives for promoting health and preventing disease. The programs include 10 leading health indicators that reflect major health problems, which concern OA. Exercise and physical activity are among the most important factors affecting health and longevity, but exercise adherence is a significant hindrance in achieving health goals in the OA. Exercise adherence in OA is a multifactorial problem encompassing many biopsychosocial factors. Factors affecting adherence in the OA include socioeconomic status, education level, living arrangements, health status, pacemakers, physical fitness, and depression. Improving adherence could have a significant impact on longevity, quality of life, and health care costs.

Health condition and physical function as predictors of adherence in long-term strength and balance training among community-dwelling older adults

AimStrength and balance training (SBT) has remarkable health benefits, but little is known regarding exercise adherence in older adults. We examined the adherence to strength and balance training and determinants of adherence among ≥75 year old adults. Methods182 community-dwelling individuals (aged 75–98 years, 71% female) began group-based SBT as part of a population-based Geriatric Multidisciplinary Strategy for the Good Care of the Elderly study. Training was offered once a week for 2.3 years. Adherence was defined as the proportion of attended sessions relative to offered sessions. Participants were classified based on their adherence level into low (≤33.3%), moderate (33.4–66.5%) and high (≥66.6%) adherers. ResultsThe mean length of training was 19±9 months, and 68% continued participation for at least two years. The mean training adherence was 55±29% for all participants and 18%, 53% and 82% for low, moderate and high adherers, respectively. High adherence was predicted by female sex; younger age; better cognition; independence in Instrumental Activities of Daily Living; higher knee extension strength; faster walking speed; and better performance on the Berg Balance Scale and Timed Up and Go tests. Poorer self-perceived health and the use of a walking aid were related to low adherence. ConclusionsLong-term continuation of training is possible for older community-dwelling adults, although poorer health and functional limitations affect training adherence. Our findings have implications for tailoring interventions and support for older adults to optimize their exercise adherence.

The Brunel Music Rating Inventory-2 is a reliable and valid instrument for older cardiac rehabilitation patients selecting music for exercise

Music with motivating qualities might support exercise adherence in older adults with cardiac disease. The Brunel Music Rating Inventory-2 (BMRI-2), a 6-item scale with motivational quotients ranging from 6 to 42 developed to facilitate music selection for exercise, has been validated with young adults. However, the suitability of the BMRI-2 for older adults is unknown. We tested reliability (internal consistency, test-retest reliability, and measurement error) and validity (content and construct) of the BMRI-2 with older adults in cardiac rehabilitation. Eleven men and 9 women (M age = 71.6 years, SD = 8.9) selected two pieces of music and used the BMRI-2 to rate the motivational quality of these for a walking task. BMRI-2 ratings demonstrated high internal consistency. Test-retest reliability and levels of measurement error were acceptable. Content was evaluated as relevant and comprehensive. There was convergence with flow scales, and discrimination between music selections with differing motivational quotients ( p &lt; .01). The BMRI-2 demonstrates acceptable psychometric properties for older adult cardiac rehabilitation patients.

Self-Regulatory Processes and Exercise Adherence in Older Adults: Executive Function and Self-Efficacy Effects

Self-efficacy and the use of self-regulatory strategies are consistently associated with physical activity behavior. Similarly, behavioral inhibition and cognitive resource allocation-indices of executive control function-have also been associated with this health behavior. The purpose of this study was to examine the hypothesis that self-efficacy mediates the relationship between self-regulatory processes, such as executive function, and sustained exercise behavior. Older adults (N=177, mean age=66.44 years) completed measures of executive function, self-reported use of self-regulatory strategies, and self-efficacy prior to and during the first month of a 12-month exercise intervention. Percentage of exercise classes attended over the following 11 months was used to represent adherence. Data were collected from 2007 to 2010 and analyzed in 2010-2011. Structural equation models were tested examining the effect of executive function and strategy use on adherence via efficacy. As hypothesized, results showed significant direct effects of two elements of executive function and of strategy use on self-efficacy and of efficacy on adherence. In addition, there were significant indirect effects of strategy use and executive function on adherence via self-efficacy. Higher levels of executive function and use of self-regulatory strategies at the start of an exercise program enhance beliefs in exercise capabilities, which in turn leads to greater adherence.

Toward Monitoring and Increasing Exercise Adherence in Older Adults by Robotic Intervention: A Proof of Concept Study

Socially assistive robots have the potential to improve the quality of life of older adults by encouraging and guiding their performance of rehabilitation exercises while offering cognitive stimulation and companionship. This study focuses on the early stages of developing and testing an interactive personal trainer robot to monitor and increase exercise adherence in older adults. The robot physically demonstrates exercises for the user to follow and monitors the user's progress using a vision-processing unit that detects face and hand movements. When the user successfully completes a move, the robot gives positive feedback and begins the next repetition. The results of usability testing with 10 participants support the feasibility of this approach. Further extensions are planned to evaluate a complete exercise program for improving older adults' physical range of motion in a controlled experiment with three conditions: a personal trainer robot, a personal trainer on-screen character, and a pencil-and-paper exercise plan.

Is Exercise Behavior Related to Positive Subjective Feelings in Older Adults?

0365 Introduction: Successful aging includes the positive or optimistic feelings that are often associated with routine exercise behavior, such as reduced levels of fatigue and psychological distress. This study was conducted in order to gain a deeper understanding of the relationship between exercise behavior and the subjective feelings experienced after exercise in a group of older adults. Methods: One hundred seventy-five older adults (mean age 71.9, SD 5.2; 75% female; 95.6% White) participated in 2 weeks (3x/wk) of exercise instruction followed by 8 weeks (1x/wk) of exercise training progression. Exercise training involved endurance (walking), strength (Therabands), and flexibility. Participants were encouraged to exercise on their own. Six months after the 8-week exercise-training period, exercise adherence data (frequency, intensity, duration, and type) were obtained via phone interview. In addition, participants received by mail the Subjective Exercise Experiences Scale and the Exercise-Induced Feeling Inventory to complete after an exercise experience. Results: Results showed that older adults with higher exercise behavior reported higher positive wellbeing [strong, great, positive, terrific (r = .26, p = .001)], higher positive engagement [enthusiastic, upbeat, happy (r = .21, p = .005)], higher revitalization [energetic, refreshed, revived (r = .26, p = .000)], and lower physical exhaustion [fatigued, worn out, tired (r = −.17, p = .028)] and tended to report lower psychological distress [crummy, awful, miserable, discouraged (r = −.14, p = .058)] and higher tranquility [calm, peaceful, relaxed (r = .13, p = .077)]. Conclusions: Older adults who report higher exercise behavior report more positive subjective feeling experiences than those with lower exercise behavior. Implications: Health care professionals should consider promoting enhanced well-being and revitalization as opposed to only the physical benefits resulting from routine exercise in order to improve exercise adherence in older adults.

The effects of life events and interpersonal loss on exercise adherence in older adults.

Associations of life events and interpersonal loss with participation in home- and group-based exercise were studied in 97 older adults (64 % women, 70.2 +/- 4.1 years). Life events were assessed with a modified Social Readjustment Rating Scale at baseline and 6 and 12 months. Exercise logs and class-attendance records documented exercise participation. Participants experienced 3.62 +/- 3.56 unique life events over the course of the study, and 28 participants reported an interpersonal loss (5 men, 23 women). Number of life events was negatively associated with home-based exercise participation (p <.05); among women, this association approached significance (p =.06) for class-based exercise. Women who experienced an interpersonal loss had lower class-based participation than those who did not (p =.02), but home-based participation rates were unaffected. Life events, particularly interpersonal loss, appear to have a negative impact on exercise in women, and this effect appears greater for class-based than for home-based exercise.