Functional Ability In Older Adults Research Articles

Four-year reciprocal relationships between personality and functional ability in older adults with and without sensory impairment: focus on neuroticism and agreeableness

ABSTRACTObjectives: Personality traits have been found to influence health and functional ability (FA) via multiple pathways. However, personality traits may also change in reaction to constraints in FA, particularly in more vulnerable individuals with high risk of decline in independent functioning in daily life (e.g. older adults with sensory impairment). Therefore, conceptually anchored in the World Health Organization's International Classification of Functioning, Disability and Health (ICF model), this study investigated reciprocal relationships between personality, focusing on neuroticism and agreeableness, and indicators of FA (i.e. activities of daily living and subjective autonomy) as well as the potentially moderating role of sensory impairment status.Method: The study sample consisted of 387 older adults (mean age at T1: M = 82.50 years, SD = 4.71 years) who were either sensory impaired (SI; i.e. visually or hearing impaired) or sensory unimpaired (UI). A total of 168 individuals were reassessed four years later.Results: Depending on sensory status, personality acted both as predictor and as outcome of FA. Neuroticism was more strongly related with later FA outcomes in SI than in UI individuals. FA variables, in turn, were significant predictors of later neuroticism in UI older adults only and of later agreeableness in SI individuals only.Conclusion: These findings suggest that the late-life personality-FA interplay needs to be considered bidirectional, and the direction of associations varies systematically as a function of sensory impairment status.

Study protocol: effect of playful training on functional abilities of older adults - a randomized controlled trial

BackgroundLoss of functional capabilities due to inactivity is one of the most common reasons for fall accidents, and it has been well established that loss of capabilities can be effectively reduced by physical activity. Pilot studies indicate a possible improvement in functional abilities of community dwelling elderly as a result of short-term playing with an exergame system in the form of interactive modular tiles. Such playful training may be motivational to perform and viewed by the subjects to offer life-fulfilling quality, while providing improvement in physical abilities, e.g. related to prevent fall accidents. The RCT will test for a variety of health parameters of community-dwelling elderly playing on interactive modular tiles.MethodsThe study will be a single blinded, randomized controlled trial with 60 community-dwelling adults 70+ years. The trial will consist an intervention group of 30 participants training with the interactive modular tiles, and a control group of 30 participants that will receive the usual care provided to non-patient elderly. The intervention period will be 12 weeks. The intervention group will perform group training (4–5 individuals for 1 h training session with each participant receiving 13 min training) on the interactive tiles twice a week. Follow-up tests include 6-min Walk Test (6MWT), the 8-ft Timed Up & Go Test (TUG), and the Chair-Stand Test (CS) from the Senior Fitness Test, along with balancing tests (static test on Wii Board and Line Walk test). Secondary outcomes related to adherence, motivation and acceptability will be investigated through semi-structured interviews. Data will be collected from pre- and post-tests. Data will be analyzed for statistically significant differences by checking that there is a Gaussian distribution and then using paired t-test, otherwise using Wilcoxon signed-rank test. “Intention to treat” analysis will be done.DiscussionThe trial tests for increased mobility, agility, balancing and general fitness of community-dwelling elderly as a result of playing, in this case on modular interactive tiles. A positive outcome may help preventing loss of functional capabilities due to inactivity.Trial registrationClinicalTrials.gov: Nr. NCT02496702, Initial Release date 7/7–2015.

Effect of a dual task on quantitative Timed Up and Go performance in community‐dwelling older adults: A preliminary study

The Timed Up and Go test (TUG) is used as a measure of functional ability in older adults; however, the method of measurement does not allow us to determine which aspects of the test deficits occur in. The aim of the present study was to examine the ability of the quantitative TUG (QTUG) to measure performance during the TUG test under three different conditions - single task, motor task and cognitive dual task - and to compare performance between fallers and non-fallers in high-functioning community-dwelling older adults. A total of 37 community-dwelling older adults, 16 with a self-reported falls history in the previous year, were recruited. Participants underwent a falls risk assessment with a physiotherapist including the QTUG under three conditions (single task, motor task, cognitive dual-task). A total of 10 clinical parameters were chosen for analysis using mancova and a series of ancova, with age, sex and body mass index included as covariates. The mancova analysis showed a significant difference across the three task conditions (Wilk's Lambda F20,186 = 3.37, P < 0.001. No overall significant difference between faller and non-faller groups (Wilk's Lambda F10,96 = 1.469, P = 0.163) or significant interaction between task and faller status (Wilk's Lambda F20,192 = 1.131, P = 0.321) was found. ancova results for each of the parameters showed overall differences between single, motor and cognitive tasks for all of the variables, except time in double support. When faller and non-faller differences were explored, cadence and stride velocity was greater, and stride time longer in those with a prior history of falls. In community-dwelling older adults, these preliminary results show that a cognitive dual-task significantly (P < 0.025) affects QTUG performance in almost all parameters, with a significant (P < 0.025) reduction in time-to-stand observed with a motor task. Although no statistical difference was found between fallers and non-fallers for many of the parameters, cadence, stride time and stride velocity were statistically different (P < 0.05). A larger sample size and more assessment points might lead to more definitive findings. These results highlight the need for further research to examine QTUG performance under dual-task conditions between fallers and non-fallers in this population, and to look at the ability of dual-task QTUG assessment to measure change longitudinally and the effectiveness of therapeutic interventions. Geriatr Gerontol Int 2017; 17: 1176-1182.

Executive function subcomponents and their relations to everyday functioning in healthy older adults

ABSTRACTEveryday functioning and its executive functioning cognitive correlates (i.e., switching, inhibition, and updating) were investigated in healthy older adults (HOAs) using multiple methods of functional status. In addition to whether computerized experimental tasks would better dissociate these subcomponents than neuropsychological measures of executive functioning, we were also interested in the contributions of both experimental and neuropsychological measures of executive function subcomponents to functional abilities. Seventy HOAs (45 young-old and 25 old-old) and 70 younger adults completed executive function and neuropsychological tests. In addition to self- and informant questionnaires of functional abilities, HOAs completed two performance-based measures. An aging effect was found on all executive function measures. Old-old older adults and their informants did not report more functional difficulties but demonstrated more difficulties on performance-based measures than did young-old participants. For the HOAs, after controlling for age and education, the neuropsychological measures of executive functioning, but not experimental measures, explained a significant amount of variance in the informant-report and both performance-based measures. Updating measures differentially predicted performance-based measures, while switching was important for questionnaire and performance-based measures. The contribution of executive functioning to functional status when measured with experimental measures specifically designed to isolate the executive subcomponent was not as strong as hypothesized. Further research examining the value of isolating executive function subcomponents in neuropsychological assessment and the prediction of functional abilities in older adults is warranted.

Handgrip strength, quadriceps muscle power, and optimal shortening velocity roles in maintaining functional abilities in older adults living in a long-term care home: a 1-year follow-up study.

PurposeTo assess the relative role of handgrip strength (HGS), quadriceps muscle power (Pmax), and optimal shortening velocity (υopt) in maintaining functional abilities (FAs) in older adults living in a long-term care home over a 1-year follow-up.Subjects and methodsForty-one inactive older institutionalized adults aged 69.8±9.0 years participated in this study. HGS, Pmax, υopt, cognitive function using the Mini-Mental State Examination, depressive symptoms using the Geriatric Depression Scale, nutritional status using the Mini Nutritional Assessment (MNA), and physical activity (PA) using the Seven-Day Physical Activity Recall Questionnaire were assessed at baseline and at 1-year follow-up. FAs were assessed with activities of daily living (ADL), instrumental ADL, and Timed Up & Go test.ResultsBoth at baseline and at follow-up, FAs were related to age, HGS, Pmax/kg, υopt, MNA, and PA. These associations were generally similar in both sexes. As revealed in multiple regression analysis, υopt was the strongest predictor of FA, followed by Pmax/kg, PA, and MNA. FA deteriorated after 1 year as measured by ADL and Timed Up & Go test. Pmax and υopt, but not HGS, also decreased significantly after 1 year. Nevertheless, 1-year changes in FAs were not related to changes in HGS, Pmax, υopt, or PA.ConclusionThe 1-year period of physical inactivity among older institutionalized adults was found to have a negative effect on their FAs, Pmax, and υopt. The present study demonstrates that Pmax and, especially, υopt correlated with FAs of older adults more than HGS, both at baseline and at follow-up. Despite this, 1-year natural fluctuations of PA, Pmax, and υopt are not significant enough to influence FAs in inactive institutionalized older adults.

Resistance Training For Older Adults

Resistance training (RT) has been shown to increase muscular strength and concurrently improve functional ability in older adults (OA). However, there is relatively little research available regarding the impact of RT on confidence and quality of life in older adults. PURPOSE: The aim of this study was to examine the impact of a 10-week RT intervention on strength, ROM, balance, balance confidence, and quality of life in OA. METHODS: 15 subjects (mean 82.4 yrs) were recruited for this study, 12 of which were female. The following outcome measures were assessed prior to, and immediately following the intervention: balance, using the Berg Balance Scale (BBS), balance confidence, using the Activities Specific Balance Confidence Scale (ABC), quality of life using the SF-36 questionnaire, grip strength using a hand dynamometer, and sagittal plane ROM for both hips, ankles, and shoulders using a digital inclinometer. Participants trained twice a week for 10 weeks, for a total of 20 sessions. Each session consisted of the following 10 exercises: squat, bent over row, forward lunge, diagonal shoulder raise, step-ups, hammer curls, knee extensions, calf raises, toe raises, and a standing balance progression, each of which was done for a total of 15 repetitions on each limb. Pre- and post-intervention data were compared using paired t-tests, with an alpha set at P < 0.05. RESULTS: Following the 10-week intervention a significant increase was found for left hand grip strength, ROM at both hips, and scores for the BBS, ABC and SF-36 tests. CONCLUSION: The findings from this study indicate that participation in a 10-week RT intervention may lead to enhanced balance, balance confidence and quality of life for OA, in addition to strength and range of motion. Therefore OA should be encouraged to participate in RT as it may enhance characteristics thought to reduce falls and facilitate greater longevity.

Developing a system that can automatically detect health changes using transfer times of older adults.

BackgroundAs gait speed and transfer times are considered to be an important measure of functional ability in older adults, several systems are currently being researched to measure this parameter in the home environment of older adults. The data resulting from these systems, however, still needs to be reviewed by healthcare workers which is a time-consuming process.MethodsThis paper presents a system that employs statistical process control techniques (SPC) to automatically detect both positive and negative trends in transfer times. Several SPC techniques, Tabular cumulative sum (CUSUM) chart, Standardized CUSUM and Exponentially Weighted Moving Average (EWMA) chart were evaluated. The best performing method was further optimized for the desired application. After this, it was validated on both simulated data and real-life data.ResultsThe best performing method was the Exponentially Weighted Moving Average control chart with the use of rational subgroups and a reinitialization after three alarm days. The results from the simulated data showed that positive and negative trends are detected within 14 days after the start of the trend when a trend is 28 days long. When the transition period is shorter, the number of days before an alert is triggered also diminishes. If for instance an abrupt change is present in the transfer time an alert is triggered within two days after this change. On average, only one false alarm is triggered every five weeks. The results from the real-life dataset confirm those of the simulated dataset.ConclusionsThe system presented in this paper is able to detect both positive and negative trends in the transfer times of older adults, therefore automatically triggering an alarm when changes in transfer times occur. These changes can be gradual as well as abrupt.

SUN-PP079: Iron Status and Its Association with Cognition, Mood and Functional Ability in Older Adults: A Cross-Sectional Study

SUN-PP079: Iron Status and Its Association with Cognition, Mood and Functional Ability in Older Adults: A Cross-Sectional Study

Between-domain cognitive dispersion and functional abilities in older adults

Objective: Within-person variability in cognitive performance is related to neurological integrity, but the association with functional abilities is less clear. The primary aim of this study was to examine the association between cognitive dispersion, or within-person variability, and everyday multitasking and the way in which these variables may influence performance on a naturalistic assessment of functional abilities. Method: Participants were 156 community-dwelling adults, age 50 or older. Cognitive dispersion was calculated by measuring within-person variability in cognitive domains, established through principal components analysis. Path analysis was used to determine the independent contribution of cognitive dispersion to functional ability, mediated by multitasking. Results: Results of the path analysis revealed that the number of subtasks interweaved (i.e., multitasked) mediated the association between cognitive dispersion and task sequencing and accuracy. Although increased multitasking was associated with worse task performance in the path model, secondary analyses revealed that for individuals with low cognitive dispersion, increased multitasking was associated with better task performance, whereas for those with higher levels of dispersion multitasking was negatively correlated with task performance. Conclusion: These results suggest that cognitive dispersion between domains may be a useful indicator of multitasking and daily living skills among older adults.

Functional Ability Of Older Adults Following A Rehabilitation Program

In the U.S., the number of people over the age of 65 is growing. Hospitalization rates have also increased among older adults. Research has shown that during hospitalization, functional decline can occur within days in this population. Following discharge from a hospital, older adults may enter a Medicare rehabilitation unit. The goal of these rehabilitative services is to achieve independence and return the individuals to their prior living situation. PURPOSE: The aim of this study was to evaluate functional ability of individuals following a rehabilitation program in a retirement community. METHODS: Forty-nine participants (mean age: 83.5 ± 11.2 yrs) who admitted at a Medicare rehabilitation unit completed functional tests at baseline and pre-discharge. Each participant completed the following assessments: 8-foot up and go, 30-sec arm bicep curl (right and left arm), chair sit and reach, one leg balance, and 30-sec chair stand. In addition, each participant completed a walking test using a virtual reality assessment tool. The participants were instructed to complete the test as fast as possible with minimal errors. All participants completed a rehabilitation program by licensed physical and occupational therapists at the skilled nursing facility. Before discharge, participants’ functional ability was assessed using the above tests. Paired t test was used to evaluate differences between baseline and pre-discharge assessments. Significance was established at p < 0.05. RESULTS: The average stay of the participants at the rehabilitation unit was 2 weeks. Statistical analysis revealed significant differences between baseline and pre-discharge measurements for the 8-foot up and go (30.1 ± 18.9 vs. 20.1 ± 8.7; p < 0.01), 30-sec arm curl (p < 0.05), and 30-sec chair stand (4.5 ± 3.4 vs. 6.4 ± 4.4; p = 0.01) tests. Even thought the rest of the assessments indicated that participants improved their functionality at pre-discharge, the differences were not statistically significant. CONCLUSIONS: These results indicate that rehabilitation post-hospitalization improves the functional ability of older adults. These results also indicate that 2 weeks are sufficient to observe statistical improvements in functionality, but it is unclear if these improvements are sufficient for independence. Furthermore, more research is needed to determine if these improvements are maintained after discharge.

Avaliação do impacto do processo de envelhecimento sobre a capacidade funcional de adultos mais velhos fisicamente ativos

Objetivos: Verificar o impacto do processo de envelhecimento sobre a capacidade funcional de adultos mais velhos, fisicamente ativos. Métodos: Vinte e quatro indivíduos com idade acima de 50 anos, fisicamente ativos, realizaram dois testes ergométricos (TE) máximos, cujo intervalo variou entre dois e dez anos (média de 4,013,74 anos). As variáveis analisadas nos dois TEs foram: consumo de oxigênio no pico do esforço (VO2pico), frequência cardíaca pico (FCpico) e índice de massa corporal (IMC). Resultados: Não foi observada diferença estatisticamente significativa nos valores de VO2pico, FCpico e IMC entre o primeiro e o segundo TE, com intervalo médio entre eles de aproximadamente quatro anos. Além disso, não foi identificada nenhuma associação entre o VO2pico e a idade (p&gt;0,05). Conclusão: A capacidade funcional de indivíduos com mais de 50 anos, que se exercitavam regularmente, foi mantida em detrimento ao processo de envelhecimento.

A-17 * Delay and Probability Discounting are Markers of Functional Ability in Community-Dwelling Older Adults

Objective: To investigate the predictive value of behavioral economic task performance on functional ability in older adults. It was hypothesized that decrements in instrumental activities of daily living (IADLs) would be associated with greater: (1) delay discounting (DD) impulsivity, (2) probability discounting (PD) risk-proneness, and (3) response inconsistency. Method: 64 older adults were recruited from the community (65–85 years, mean age = 76.25, 76.60% female). Exclusionary criteria included history of neurological illness, substance dependency within past 5 years, score of ≤ 20 on the Mini-Mental Status Examination. Discounting tasks were comprised of dichotomous choices between smaller, immediate/guaranteed and larger, and delayed/probabilistic monetary values. Impulsivity and risk-proneness were operationalized as area-under-the-curve (AUC), while response (in)consistency was based on contradictory selections. The Direct Assessment of Functional Status—Revised (DAFS-R) was employed as the performance-based assessment of IADLs. Hierarchical regression analyses evaluated whether discounting performance accounts for variance in IADLs above and beyond relevant variables that significantly correlated with IADLs in our sample, including education level, intellectual functioning, and income. Results: Demographic characteristics were significant predictors of functional ability (p = .001; R2 = .237). Significant additional variance was accounted for by PD AUC (p = .014; ΔR2 = .075), PD response (in)consistency (p = .046; ΔR2 = .050), and DD response (in)consistency (p = .010; ΔR2 = .081). DD AUC did not add significantly (p = .861). Conclusion(s): Discounting risk-proneness and response (in)consistency hold potential to predict functional decline, likely due to the deterioration of relevant brain regions and cognitive abilities.

Executive function moderates the role of muscular fitness in determining functional mobility in older adults

Both physical and cognitive factors are known to independently predict functional mobility in older people. However, the combined predictive value of both physical fitness and cognitive factors on functional mobility has been less investigated. The aim of the present study was to assess if cognitive executive functions moderate the role of physical fitness in determining functional mobility of older individuals. Fifty-seven 65- to 75-year-old healthy participants performed tests of functional mobility (habitual and maximal walking speed, maximal walking speed while picking up objects/stepping over obstacles), physical fitness (peak power, knee extensors torque, back/lower limb flexibility, aerobic fitness), and executive function (inhibition and cognitive flexibility). Maximal walking speeds were predicted by physical fitness parameters and their interaction with cognitive factors. Knee extensor torque emerged as the main predictor of all tested locomotor performances at maximal speed. The effect of peak power and back/lower limb flexibility was moderated by executive functions. In particular, inhibition and cognitive flexibility differed in the way in which they moderate the role of fitness. High levels of cognitive flexibility seem necessary to take advantage of leg power for walking at maximal speed. In contrast, high levels of inhibitory capacity seem to compensate for low levels of back/lower limb flexibility when picking up movements are added to a locomotor task. These findings may have important practical implications for the design and implementation of multi-component training programs aimed at optimizing functional abilities in older adults.

Cognitive and Functional Ability in Older Adults with Schizophrenia

Cognitive deficits are among the strongest predictors of function in younger adults with schizophrenia. The objective of this study is to assess the extent to which cognition also predicts functional abilities in older adults with schizophrenia.

Dog Ownership, Functional Ability, and Walking in Community-Dwelling Older Adults

Regular walking improves overall health and functional ability of older adults, yet most are sedentary. Dog ownership/pet responsibility may increase walking in older adults. Goals of this study were to identify factors that influence older adult walking and compare physical activity, functional ability and psychosocial characteristics by dog ownership status. In this cross-sectional study, older adults (65-95 years of age, n = 1091) completed and returned questionnaires via postal mail. Measures included: Physical Activity Scale for the Elderly, Physical Functioning Questionnaire and Theory of Planned Behavior Questionnaire. Dog owner/dog walkers (n = 77) reported significantly (P < .05) more total walking, walking frequency, leisure and total physical activity and higher total functional ability than dog owner/nondog walkers (n = 83) and nondog owners (n = 931). Dog owner/nondog walkers reported lower intention and perceived behavioral control and a less positive attitude than dog owner/dog walkers (P < .05). Dog owner/ dog walkers were significantly different than the nondog walker groups in nearly every study variable. Many dog owners (48.1%) reported walking their dogs regularly and the dog owner/dog walkers participated in nearly 50% more total walking than the 2 nondog walking groups, suggesting that pet obligation may provide a purposeful activity that motivates some older dog owners to walk.

Remote monitoring and assessment of daily activities in the home environment

Background/PurposeQuantitative analysis of daily activities measured by home monitoring systems can be helpful to assess objectively the health-related living behavior and functional ability of older adults. Advances in sensors and telecommunication technologies have prompted the concept and development of implementing diverse sensors and intelligent algorithms to monitor human/environment interactions. This paper presents the remote monitoring and assessment of daily activities of older adults living alone at home, assuming that comprehensive profiles of daily activities at home can be captured by using simple and low-cost sensors in a less diverse modality. MethodsA passive home monitoring system with a minimal set of sensing modalities, namely human infrared and electric current, was developed and used for continuous and unobtrusive monitoring of daily activities of an elderly woman for over 6 months. Four movement detectors were deployed in different indoor locations to detect active movements, and an appliance usage detector detected television use. A set of activity features that measure the intensity, regularity and abnormalities of activity patterns is defined and demonstrated to quantify the characteristics and rhythms of daily activities of the subject. ResultsDifferent rhythms of daily activities can be estimated from different locations at home, and distinct behaviors were shown between weekdays and holidays. Unusual activities have been detected by the system, too. The system setup did not require modification of home furnishings that could obstruct the subject's daily living or cause any discomfort or displeasure to the subject. ConclusionThis study suggests that daily activities of an older adult living alone at home can be measured by means of low-cost sensors in a less-diverse sensor modality, and daily rhythms can be quantified with a simple estimation method. The activity features developed in this study are built into a home telehealth system for telecare applications.

The Use of Exercise-Based Videogames for Training and Rehabilitation of Physical Function in Older Adults: Current Practice and Guidelines for Future Research

Declines in physical or cognitive function are associated with age-related impairments to overall health. Functional impairment resulting from injury or disease contribute to parallel declines in self-confidence, social interactions and community involvement. Fear of a major incident such as a stroke or a bone-breaking fall can lead to the decision to move into a supported environment, which can be viewed as a major step in the loss of independence and quality of life. Novel use of videogame console technologies are beginning to be explored as a commercially available means for delivering training and rehabilitation programs to older adults in their own homes. We provide an overview of the main videogame console systems (Nintendo Wii™, Sony Playstation® and Microsoft Xbox®) and discuss some scenarios where they have been used for rehabilitation, assessment and training of functional ability in older adults. In particular, we focus on two issues that significantly impact functional independence in older adults, injury and disability resulting from stroke and falls.

The perception of meaningfulness and performance of instrumental activities of daily living from the perspectives of the medically at-risk older adults and their caregivers.

The purpose of the study was to understand the impact of chronic disability on the functional ability of older adults. Thirty older adult participants and their caregivers were asked to identify which instrumental activities of daily living (IADL) are most meaningful and how their disability affected performance. Data collected through individual analysis indicated that the most important IADL tasks were driving and managing medication. Both older adult participants and their caregivers similarly perceived the health condition as significantly affecting the performance of all of the IADLs. However, there was a difference in the perception of the prior level of functioning for managing medication (z = 2.45, p = .024) and phone use (z = 2.26, p = .014). Results arrived at, and to be discussed, were in agreement with previous research findings indicating that complex tasks of daily living, particularly driving, are significant to the older adult's quality of life.

The Effects of a Short Term Novel Aquatic Exercise Program on Functional Strength and Performance of Older Adults

The purpose of this study was to determine the effects of a short-term novel multidimensional aquatic exercise program on functional abilities of healthy older adults. Twenty-six men and women (mean age 76.33 + 5.55 years) were recruited and assigned to an aquatic- (n = 15) or land-based (n = 11) training group. The aquatic training group completed a multidimensional water exercise program that incorporated resistance training, functional exercise movements and rudimentary aquatic plyometric activities. The active control group participated in a supervised land-based fitness program. Each exercise intervention was conducted over an 8-week period (16 sessions of 30 - 40 minutes) with the training load progression adjusted equally between groups using the 6 - 20 Rating of Perceived Exertion Scale (RPE). Prior to and immediately following the intervention, both groups were evaluated with select components of the Senior Fitness Test. The 30-second chair stand, 30-second arm curl, and 8 foot up and go were selected as measures of strength and functional abilities. The results of an independent t-test indicated that the control and experimental groups were matched for functional abilities prior to the intervention. A 2 (group) x 2 (time) analysis of covariance (ANCOVA) with repeated measures revealed significant differences in the pre- to post-testing measures for the aquatic training program for the arm curl (p &lt; 0.01) and the 8 foot up and go (p = 0.02). Analysis of the active control revealed no pre-post differences for any measure. Thus, a short-term aquatic exercise program with multidimensional intervention strategies will significantly enhance functional abilities in older adults when compared to a functionally matched active control group.

The adaptive neuroplasticity hypothesis of behavioral maintenance.

Physical activity is a seemingly simple and clinically potent method to decrease morbidity and mortality in people with coronary heart disease (CHD). Nonetheless, long-term maintenance of physical activity remains a frustratingly elusive goal for patients and practitioners alike. In this paper, we posit that among older adults with CHD, recidivism after the initiation of physical activity reflects maladaptive neuroplasticity of malleable neural networks, and people will revert back to learned and habitual physical inactivity patterns, particularly in the setting of stress or depression. We hypothesize that behavioral interventions that successfully promote physical activity may also enhance adaptive neuroplasticity and play a key role in the maintenance of physical activity through the development of new neuronal pathways that enhance functional ability in older adults. Conversely, without such adaptive neuroplastic changes, ingrained maladaptive neuroplasticity will prevail and long-term maintenance of physical activity will fail. In this paper we will: (1) describe the enormous potential for neuroplasticity in older adults; (2) review stress and depression as examples of maladaptive neuroplasticity; (3) describe an example of adaptive neuroplasticity achieved with a behavioral intervention that induced positive affect in people with CHD; and (4) discuss implications for future work in bench to bedside translational research.