Gentle Physical Activity Research Articles

INTERPROFESSIONAL CO-LEARNING AT MULTIPLE LEVELS OF LTSS: PRO-HOME PROGRAMS AND RESEARCH

Abstract Promoting Seniors’ Health with Home Care Aides (Pro-Home), a randomized controlled trial (RCT) of a gentle physical activity program delivered by home care aides (HCAs) for their older clients in English or Spanish, provided unprecedented opportunities for collaboration and co-learning across multiple disciplines and professions (public health, health services research, sociology, medicine, physical/occupational therapy, kinesiology, social work, psychology, economics, medicine, nursing; frontline care workers, leaders and staff members of state and home care agencies, , social service agencies, researchers, undergraduate and graduate students). The turbulent long-term services and supports (LTSS) environment, which culminated in the COVID-19 pandemic, provided the study participants (HCAs and their older clients), multiple levels of LTSS stakeholders and the research team with rapidly evolving new contexts for the RCT. This paper presents how the Pro-Home project developed into a learning organization where individuals and organizations learn from each other to pivot at every new turn in the environment, focusing on the development of a novel interactive training for HCAs in-person or remotely. The initial training activities were conducted in-person. After adapting the material for remote delivery, we provided the latter sessions via phone with digital and physical tools. For each training session, we assessed outcome quality using an exit survey and other methods capturing HCAs’ program delivery. The presentation concludes with implications for research and practice in LTSS.

PRO-HOME: AN IMPLEMENTATION SCIENCE FRAMEWORK FOR MULTILEVEL BARRIERS AND FACILITATORS IN LTSS

Abstract Promoting Seniors’ Health with Home Care Aides (Pro-Home) is a randomized controlled trial (RCT) of a gentle physical activity program for frail older adults conducted in a community-based long-term services and supports (LTSS) delivery setting. Pro-Home is a hybrid effectiveness-implementation study, which aims to examine (1) the effectiveness of the program delivered by home care aides (HCAs) in maintaining physical function in older homecare recipients, and (2) how the intervention works in a real-world Medicaid-funded LTSS system. This paper describes barriers and facilitators that have long existed or evolved during the Pro-Home development, using quantitative/qualitative data from the mixed-method study informed by an implementation science framework. Facilitators include the knowledge and partnerships that resulted from multiple preliminary studies that illuminated HCAs’ work/life-related stressors, coping resources, and underutilized capacity and motivation to promote the health of clients and HCAs themselves in the context of the LTSS system. Another facilitator has been the physical activity program developed in another state’s LTSS service setting (not in an academic setting). The program was easy to learn and adapt into a program to be delivered by HCAs (as opposed to care managers). Barriers included turbulent LTSS environments (e.g., rapidly growing managed care presence, COVID-19). Those barriers have been addressed through partnership with stakeholders at multiple levels. Having completed the intervention and data collection phases, we found the project’s planning and implementation challenging but rewarding. Pro-Home has produced rich information that will have many implications for research, practice, and LTSS services delivery and financing systems.

Protocol for a randomized controlled trial of low-intensity physical activity for frail older adults: Promoting seniors' health with home care aides (Pro-Home)

Regular participation in physical activity benefits older adults physically and mentally. However, the availability and assessment of physical activity programs that are safe and appropriate for homebound older adults at risk for nursing home admission are limited. Here we describe the protocol for a randomized controlled trial that examines the effectiveness of a gentle physical activity program. Delivered by home care aides who regularly help hard-to-reach older home care clients with housekeeping and routine personal care services in the home, this program is implemented in a real-world context of caregiver-client dyads in a Medicaid-funded home care program. The trial uses a two-group repeated measures design (baseline, Month 4, and Month 8) with 300 pairs of eligible home care clients and their home care aides. The results from this trial could provide evidence and guidelines for a new model of home care, which would facilitate the working together of older home care clients and their home care aides to maintain or improve the functional status of nursing home-eligible older adults.

Physical Activity, Outcome Expectations, and Social Support in Dyads of Frail Older Adults and Their Home Care Aides

Frail community-dwelling older adults increasingly receive home care and continue to face barriers to participating in physical activity (PA) that could help maintain their function. Home care aides (HCAs) are well-positioned to promoting PA among older home care recipients because of their established relationship and regular interpersonal exchanges; yet, the role of HCAs in promoting and supporting PA in home care settings is seldomly studied. Using the quantitative and qualitative data from a 4-month home-based gentle PA intervention delivered by HCAs to their clients in a Medicaid-funded home care setting, the current study examined whether outcome expectations for exercise (OEE) held by HCAs led to client PA outcomes (i.e. functional limitations and physical performance) through social support for exercise (SSE) provided by HCAs. Longitudinal mediation analysis of 46 HCA-client dyads showed that higher baseline OEE held by HCAs were related to greater SSE reported by clients after the intervention (p<.05; bootstrapped standard errors), controlling for client-level covariates, including baseline OEE, age, gender, comorbidity, and whether HCA was client’s family member. Unexpectedly, SSE did not have significant association with client PA outcomes nor mediated the relationship between OEE held by HCAs and client PA outcomes. Qualitative data suggested alternative factors may explain the results, such as clients’ family beliefs in the intervention and clients’ participation experiences (such as expectation fulfillment). Future research should consider older home care clients’ family contexts to enhance our understanding of HCAs’ roles in preserving the function of growing numbers of older home care recipients.

PHYSICAL ACTIVITY INTERVENTION IN HOME CARE: COMPARING FAMILY AND NON-FAMILY CAREGIVING DYADS

An increasing number of states pay family members who care for older adults in Medicaid-funded home care. Previous research documented pros and cons of hiring family members as home care providers. However, little is known about whether family and non-family caregiving dyads function differently when they participate in health promotion interventions in home care. Using data collected in a pilot study of a gentle physical activity program delivered by home care workers in a Medicare home care program, this study compared 18 family and 32 non-family caregiving dyads in client outcomes (self-reported and performance-based function) and process outcomes (exercise-related social support provided by home care aides) before and after the intervention. Linear mixed models indicated that client outcomes improved after the 4-month intervention (p<0.05), controlling for clients’ age, gender, and number of chronic conditions. Compared to family caregiving dyads, greater improvement in exercise-related support was observed in non-family caregiving dyads (p<0.05), where care providers offered less exercise-related support at baseline. The intervention program was received well by both family and non-family dyads, as expressed by one of the caregivers: “It makes my client feel good about herself. I also feel good for my client.” Results suggest that empowering caregivers with health promotion skills is a promising strategy, especially in non-family caregiving dyads. Further research is warranted to produce evidence-based health promotion programs for family and non-family caregiving dyads in home care.

Gentle Physical Activity Intervention Led by Caregivers in a Medicaid Home Care Program: Do Outcomes Differ Between Family and Nonfamily Caregiving Dyads?

Background and ObjectivesCaregiving dyads are fertile contexts for health promotion such as physical activity. However, previous physical activity interventions in caregiving dyads paid limited attention to care recipients’ outcomes and rarely involved paid caregivers. Home care aides (HCAs) provide nonmedical care for older family members or nonfamily clients in publicly funded home care programs in the United States. This study examined whether family and nonfamily HCA–client dyads differed in the outcomes of a 4-month gentle physical activity pilot program led by HCAs in a Medicaid home care program.Design and MethodsA single-group prepost design was used to assess changes in clients’ function (self-reported and performance-based) and process outcomes (exercise-related social support provided by HCAs) in 18 family and 32 nonfamily HCA–client dyads. Repeated measures analysis controlled for clients’ demographic and health characteristics. Clients’ and HCAs’ motivation to continue the program beyond the intervention period was examined using quantitative and qualitative data.ResultsClient outcomes and exercise-related social support provided by HCAs improved, especially in nonfamily dyads. Both family and nonfamily dyads had high levels of motivation to continue the program, supporting the program’s sustainability for both clients and HCAs.Discussion and ImplicationsEmpowering HCAs to engage in health promoting activities with their clients is a promising strategy to improve the lives of caregiving dyads.

Enhancing Accessibility of Physical Activity During Pregnancy: A Pilot Study on Women's Experiences With Integrating Yoga Into Group Prenatal Care.

Introduction:Health guidelines suggest that pregnant women should participate in daily physical activity, yet rarely do they meet these guidelines. Means to enhance accessibility of physical activity for pregnant women are required, and yoga has been suggested as a possible method to enhance women’s sense of confidence and competence with physical activity. In this pilot study, our primary aim is to evaluate pregnant women’s perceptions about their lived experience of an intervention which integrates a low-intensity form of physical activity, yoga, into prenatal care; our secondary aim is to evaluate changes in participants’ self-efficacy for physical activity and time spent in physical activity over time.Methods:Held in an outpatient obstetrics department of an urban hospital system in the United States, this pilot study enrolled 16 pregnant women to participate in the intervention throughout their pregnancy. We explored participants’ lived experience of the intervention using qualitative methods (phenomenology). Means, variances, and covariances were calculated for the 2 measures (self-efficacy and time spent in physical activity) over the intervention period.Results:Qualitative findings from focus groups suggest that it is acceptable for prenatal yoga to be integrated into group prenatal care classes and women reported increased confidence with physical activity during pregnancy. Participants did not consider the intervention to fit within the traditional definition of exercise. Women reported increased amounts of time spent in physical activity from baseline to the end of pregnancy, but there were no statistically significant changes in self-efficacy over time.Discussion:The integration of gentle physical activity into the group prenatal care model warrants further attention for potential benefits with regard to maternal physical and mental wellness.

Cultural engagement and incident depression in older adults: evidence from the English Longitudinal Study of Ageing.

There is a recognised need for the identification of factors that might be protective against the development of depression in older adults. Over the past decade, there has been growing research demonstrating the effects of cultural engagement (which combines a number of protective factors including social interaction, cognitive stimulation and gentle physical activity) on the treatment of depression, but as yet not on its prevention.AimsTo explore whether cultural engagement in older adults is associated with a reduced risk of developing depression over the following decade. Working with data from 2148 adults in the English Longitudinal Study of Ageing who were free from depression at baseline, we used logistic regression models to explore associations between frequency of cultural engagement (including going to museums, theatre and cinema) and the risk of developing depression over the following 10 years using a combined index of the Centre for Epidemiological Studies Depression Scale (CES-D) and physician-diagnosed depression. There was a dose-response relationship between frequency of cultural engagement and the risk of developing depression independent of sociodemographic, health-related and social confounders. This equated to a 32% lower risk of developing depression for people who attended every few months (odds ratio (OR) = 0.68, 95% CI 0.47-0.99, P = 0.046) and a 48% lower risk for people who attended once a month or more (OR = 0.52, 95% CI 0.34-0.80, P = 0.003). Results were robust to sensitivity analyses exploring reverse causality, subclinical depressive symptoms and alternative CES-D thresholds. Cultural engagement appears to be an independent risk-reducing factor for the development of depression in older age.Declaration of interestNone.

PO-254 Progression in rehabilitation of Upper Crossed Syndrome

PO-254 Progression in rehabilitation of Upper Crossed Syndrome

Role of yoga therapy on lipid profile in patients of hypertension and prehypertension

Background: Hypertension and dyslipidemia are one of the most prevalent cardiovascular disorders affecting 20% of world’s population. There is emerging data that yoga therapies may be useful in managing modest elevations in BP. Yoga, specific yogic exercise (Sudarshan kriya) taught as a training protocol under Art of living course (AOL), is especially attractive as a candidate therapy in the management of elevated BP because of its combination of gentle physical activity. Hence, this study was undertaken to compare the effects of SDK on blood lipid levels.Methods: A total of 300 patients of hypertension and prehypertension were taken in the study where control group were given drugs treatment and life style modification and yoga group additionally had undergone yoga training. Lipid levels were estimated in both groups at entry, 06 months and 12 months and analyzed.Results: Lipid levels at entry were same in both while the yoga therapy group showed decrease in TG, LDL and VLDL at six months and 12 months but decrease was not significant. HDL levels showed significant increase in yoga group (P&lt;0.05) at six months which was maintained at 12 months more so in diabetic patients.Conclusions: Yoga therapy has beneficial effect on serum lipid levels and should be included in therapy along with other measures.

Vestibular Adaptations Induced by Gentle Physical Activity Are Reduced Among Older Women.

The aim of this study was to compare the ability of older individuals to maintain an efficient upright stance in contexts of vestibular sensory manipulation, according to their physical activity status. Two groups of healthy older women (aged over 65) free from any disorders (i.e., neurological, motor and metabolic disorders) and vestibular disturbances, participated in this study. One group comprised participants who regularly practiced gentle physical activities, i.e., soft gym, aquarobic, active walking, ballroom dancing (active group, age: 73.4 (5.8) years, n = 17), and one group comprised participants who did not practice physical activities (non-active group, age: 73.7 (8.1) years, n = 17). The postural control of the two groups was compared in a bipedal reference condition with their eyes open and two vestibular sensory manipulation conditions (i.e., bipolar binaural galvanic vestibular stimulation (GVS) at 3 mA, in accordance with two designs). The main results indicate that there was no difference between the active and the non-active groups in all the conditions. It is likely that the aging process and the type of physical practice had limited the ability of the active group to counteract the effects of vestibular sensory manipulation on postural control more efficiently than the non-active group.

Building Health Promotion into the Job of Home Care Aides: Transformation of the Workplace Health Environment.

Home care aides (HCAs), predominantly women, constitute one of the fastest growing occupations in the United States. HCAs work in clients’ homes that lack typical workplace resources and benefits. This mixed-methods study examined how HCAs’ work environment was transformed by a pilot workplace health promotion program that targeted clients as well as workers. The intervention started with training HCAs to deliver a gentle physical activity program to their older clients in a Medicaid-funded home care program. Older HCAs aged 50+ reported increased time doing the types of physical activity that they delivered to their clients (stretching or strengthening exercise) (p = 0.027). Almost all (98%) HCAs were satisfied with the program. These quantitative results were corroborated by qualitative data from open-ended survey questions and focus groups. HCAs described how they exercised with clients and how the psychosocial work environment changed with the program. Building physical activity into HCAs’ job is feasible and can effectively promote HCAs’ health, especially among older HCAs.

Yoga for Chronic Depressive Symptoms in Pregnancy: A Commentary and Call to Action

Women with depressive symptoms during pregnancy are in great need of safe, inexpensive, non-pharmacologic, accessible, and effective adjunctive therapies to enhance well-being, reduce the burden of symptoms both during their pregnancy and into the postpartum period, and prevent chronic sequelae. Because maternal depressive symptoms are associated with a variety of poor maternal-child outcomes (e.g., poor maternal health behaviors, suicide, poor maternal-fetal/child attachment, intrauterine growth restriction, adult-onset chronic illnesses in offspring, among others), a focus on adequate symptom management during pregnancy is an urgent clinical and research priority. Prenatal yoga is a promising modality which involves gentle physical activity, breathing practices, and relaxation practices that may empower women to self-manage symptoms, enhance well-being, and reduce symptom burden during pregnancy and into the postpartum period. Continued high-quality research is warranted which uses established theoretical frameworks and which builds on my team’s and others’ preliminary research studies which have demonstrated that pregnant women prefer to play an active role in symptom management and that they view prenatal yoga as an accessible, preferred form of mindful physical activity. Yoga for depression in pregnancy 3.

Restless legs syndrome

SummaryRestless legs syndrome (RLS) is characterised by an uncontrollable urge to move, in particular the lower limbs, often accompanied by discomfort or a painful sensation that occurs typically at night. It is categorized under the ICD-Classification of extrapyramidal and movement disorders. As patients often suffer from insomnia due to the involuntary nocturnal leg movements and irritable sensations in the legs, RLS is also classified as a sleep-related movement disorder. The incidence of a mild form of RLS is frequent, although it often remains undiagnosed.After the exclusion of other diseases by differential diagnosis, RLS is diagnosed on the basis of a clinical test administering a single dose of levodopa. There are two forms of RLS: idiopathic and secondary. The secondary form is encountered in an astonishing number of diseases, including renal insufficiency, diabetes, chronic obstructive pulmonary disease (COPD) and iron deficiency. The treatment of RLS is complex and the benefits and risks of pharmacotherapy should be considered carefully. Non-ergoline dopamine agonists (e.g. ropinirole, pramipexole) are the first-line treatment in severe cases of RLS. Transdermal rotigotine is also a promising treatment option. Opioids in combination with naloxone are recommended for patients suffering from severe pain. In mild cases of RLS, patients benefit from a balanced lifestyle with gentle physical activity and avoiding the excessive consumption of caffeine or alcohol.

OP36 A Cross-Sectional Assessment of the Effect of the Free Older Persons’ Bus Pass On Active Travel and Regular Walking Among Adults ≥60 Years in England Using Data from the National Travel Survey 2005-2008

BackgroundThe benefits of physical activity for all age groups is well-documented and there is increasing interest in the promotion of incidental physical activity, such as active transport, which includes walking,...

Yoga & cancer interventions: a review of the clinical significance of patient reported outcomes for cancer survivors.

Limited research suggests yoga may be a viable gentle physical activity option with a variety of health-related quality of life, psychosocial and symptom management benefits. The purpose of this review was to determine the clinical significance of patient-reported outcomes from yoga interventions conducted with cancer survivors. A total of 25 published yoga intervention studies for cancer survivors from 2004–2011 had patient-reported outcomes, including quality of life, psychosocial or symptom measures. Thirteen of these studies met the necessary criteria to assess clinical significance. Clinical significance for each of the outcomes of interest was examined based on 1 standard error of the measurement, 0.5 standard deviation, and relative comparative effect sizes and their respective confidence intervals. This review describes in detail these patient-reported outcomes, how they were obtained, their relative clinical significance and implications for both clinical and research settings. Overall, clinically significant changes in patient-reported outcomes suggest that yoga interventions hold promise for improving cancer survivors' well-being. This research overview provides new directions for examining how clinical significance can provide a unique context for describing changes in patient-reported outcomes from yoga interventions. Researchers are encouraged to employ indices of clinical significance in the interpretation and discussion of results from yoga studies.

Characterization of osteogenic response to mechanical stimulation in cancellous bone of rat caudal vertebrae.

We have recently developed an experimental model in which pins, inserted into the 7th and 9th caudal vertebrae of 13-wk-old rats, are used to load the 8th caudal vertebra in compression. We have now applied this model to assess the responsiveness of rat cancellous bone to mechanical stimulation. We found that daily exposure to loads that induce strains similar to those observed in bone during relatively gentle physical activity, for 30 cycles/day, increased the rate of lamellar bone formation on cancellous surfaces by up to 140-fold. Bone formation rate showed a highly significant (P < 0.0001) correlation with the number of days for which the bones were loaded and with the size of the load. A single loading episode of 300 cycles, representing a 10-min period of loading, increased bone formation to 24 times that in nonloaded controls. Indexes of bone resorption were essentially the inverse of the bone formation parameters. These experiments show that rat cancellous bone is exquisitely sensitive to mechanical stimulation and suggest that the mechanical environment is a major determinant of the physiological behavior of mammalian cancellous bone.