Moderate-intensity Physical Activity Program Research Articles

Interventions to Improve Body Composition, Upper and Lower Extremity Muscle Strength, and Balance Ability of Older Female Adults: An Intervention Study.

The aim of the present study was to understand the effects of a moderate-intensity physical activity program on the changes observed in the body composition, upper and lower extremity muscle strength, as well as balance in elderly female adults in order to evaluate sarcopenia. In this study, 30 healthy elderly females were recruited and were randomly assigned to either the control group or the experimental group. The experimental group engaged in a moderate-intensity physical activity program twice a week for 8 weeks. Using a body composition analyzer, the senior fitness test, and handgrip strength and gait speed tests, all participants were tested in pre- and post-tests. The results of the study revealed changes in the overall body composition in the experimental group, with significant decreases in body mass index, body fat percentage, and body fat mass and substantial increases in the basal metabolic rate and skeletal muscle mass, while the upper and lower extremity muscle strength and balance ability also showed significant improvements. The moderate-intensity physical activity program also increased upper limb handgrip strength and lower limb gait speed, showing that the plan was able to effectively evaluate sarcopenia. The study concluded that using upper limb handgrip strength and lower limb walking speed to evaluate sarcopenia are useful diagnostic tools. Moderate-intensity physical activity is effective for improving muscle strength and reducing sarcopenia.

Adherence to a guided walking program with amelioration of cognitive functions in subjects with schizophrenia even during COVID-19 pandemic

BackgroundAim of the study was to enrol a group of individuals with schizophrenia in a long-term moderate-intensity physical activity program and to evaluate its effects on their cognitive functions and cardiovascular risk factors. An additional aim of the study was the comparison of the adherence to the physical activity program before and during the COVID-19 pandemic.MethodsForty sedentary patients diagnosed with schizophrenia (mean age 46.4 ± 9.6) followed by the Public Mental Health Department of Ferrara were included in the study. 28 of them followed a 1-year walking program consisting of two guided walking sessions/week, while 12 maintained their sedentary lifestyle and followed the usual Cognitive Rehabilitation program. To the participants following the walking program VO2 peak and walking speed were assessed at baseline and at the end of the program. All participants were evaluated on blood pressure and anthropometric variable. Cognitive functions were assessed with the Screen for Cognitive Impairment in Psychiatry (SCIP) and with the Frontal Assessment Battery (FAB) questionnaires.ResultsThe 20 participants completing the walking program displayed significant improvements in cognitive functions (dppc2 0.35 for SCIP and 0.26 for FAB), with a positive correlation between SCIP score and the number of sessions attended (R = 0.86, p < 0.001), evident in the patients attending to at least 75 of the 100 walking sessions. Walking speed and VO2peak increased significantly and a decrease of body weight, BMI, systolic and diastolic blood pressure was also observed. The adherence to the walking program registered during Covid-19 period did not differ from that observed before the pandemic. The 12 CG (Control Group) patients maintaining the sedentary lifestyle did not display improvements of cognitive functions.ConclusionsThe main finding of this study is the improvement of cognitive functions which is significantly related to the number of walking sessions attended by participants with schizophrenia. The walking program, guided by exercise specialists, proved to be an enjoyable activity for people with mental disorder feasible even during the COVID-19 pandemic.Trial registration Retrospectively registered on ISRCTN as non-randomized trial (n. ISRCTN14763786).

Influence of Physical Activity on the Regulation of Disease of Elderly Persons with Metabolic Syndrome.

Metabolic syndrome is a group of metabolic risk factors whose combination significantly contributes to the development of the risk of cardiovascular disease, diabetes, stroke, some cancers and is a clear indicator of morbidity rate. The aim of this study was to identify physical activity programs that can successfully influence the reduction of risk factors in metabolic syndrome of the elderly. Subjects were aged between 60 and 80 years, had three of five signs of metabolic syndrome, and were randomly divided into three groups of 20 subjects. The first group conducted a continuous cycling ergometer (55% VO2max), the second group a physical activity strength program and the third was a control group. Before and after the experimental treatment body composition, biochemical parameters, functional parameters, cardiovascular functions, metabolic and hematological system were determined. Significant differences between control and experimental groups were determined using MANOVA. The training effects of the experimental and control groups were determined using the ANOVA for repeated measurements with Bonfferoni correction. The results showed that a physical activity program of strength has a better effect on disease regulation in the elderly with metabolic syndrome than a moderate-intensity physical activity program which also has a significant change but in less variables.

Effect of 24-month physical activity on cognitive frailty and the role of inflammation: the LIFE randomized clinical trial

BackgroundWhether physical activity can reduce cognitive frailty—a relatively new “compound” phenotype proposed in 2013—and whether the effect of physical activity differs based on levels of inflammation are unknown. Therefore, this study aimed to evaluate the effect of physical activity on cognitive frailty and whether baseline interleukin-6 (IL-6) levels modified this effect.MethodsWe used data from the Lifestyle Interventions and Independence for Elders (LIFE) Study, a multicenter, single-blinded randomized trial conducted at eight US field centers between February 2010 and December 2013. The main outcome was cognitive frailty at 24 months, expressed as an ordinal variable based on the six combinations of its two components: frailty (non-frail, pre-frail, and frail) and mild cognitive impairment (yes, no). Frailty and cognition were assessed by the Study of Osteoporotic Fractures (SOF) index and the Modified Mini-Mental State Examination (3MSE) scale, respectively. Plasma IL-6 was measured at baseline. Of the 1635 original randomized sedentary participants (70–89 years), this study included 1298 participants with data on both cognitive frailty and IL-6 assessments at baseline.ResultsAfter adjusting for field center, sex, and baseline levels of cognitive frailty, the ordinal logistic regression model revealed that participants in the physical activity group had 21% lower odds (odds ratio, 0.79; 95% confidence interval, 0.64–0.98) of worsening cognitive frailty over 24 months than those in the health education group. The effect of physical activity on cognitive frailty did not differ according to baseline IL-6 levels (P for interaction = 0.919). The results did not change after additional adjustment for IL-6 subgroups and the inverse probability of remaining in the study. Comparable results were observed according to age, sex, ethnicity/race, and short physical performance battery score (P for interaction = 0.835, 0.536, 0.934, and 0.458, respectively).ConclusionsA 24-month structured, moderate-intensity physical activity program reduced cognitive frailty compared with a health education program in sedentary older persons, and this beneficial effect did not differ according to baseline levels of inflammatory biomarker IL-6. These findings suggest that the new cognitive frailty construct is modifiable and highlight the potential of targeting cognitive frailty for promoting healthy aging.Trial registrationClinicaltrials.gov, NCT01072500

Effect of Physical Activity on Frailty: Secondary Analysis of a Randomized Controlled Trial.

Limited evidence suggests that physical activity may prevent frailty and associated negative outcomes in older adults. Definitive data from large long-term randomized trials are lacking. To determine whether a long-term, structured, moderate-intensity physical activity program is associated with a lower risk for frailty and whether frailty status alters the effect of physical activity on the reduction in major mobility disability (MMD) risk. Multicenter, single-blind, randomized trial. 8 centers in the United States. 1635 community-dwelling adults, aged 70 to 89 years, with functional limitations. A structured, moderate-intensity physical activity program incorporating aerobic, resistance, and flexibility activities or a health education program consisting of workshops and stretching exercises. Frailty, as defined by the SOF (Study of Osteoporotic Fractures) index, at baseline and 6, 12, and 24 months, and MMD, defined as the inability to walk 400 m, for up to 3.5 years. Over 24 months of follow-up, the risk for frailty (n= 1623) was not statistically significantly different in the physical activity versus the health education group (adjusted prevalence difference, -0.021 [95% CI, -0.049 to 0.007]). Among the 3 criteria of the SOF index, the physical activity intervention was associated with improvement in the inability to rise from a chair (adjusted prevalence difference, -0.050 [CI, -0.081 to -0.020]). Baseline frailty status did not modify the effect of physical activity on reducing incident MMD (P for interaction= 0.91). Frailty status was neither an entry criterion nor a randomization stratum. A structured, moderate-intensity physical activity program was not associated with a reduced risk for frailty over 2 years among sedentary, community-dwelling older adults. The beneficial effect of physical activity on the incidence of MMD did not differ between frail and nonfrail participants. National Institute on Aging, National Institutes of Health.

The effect of intervening hospitalizations on the benefit of structured physical activity in promoting independent mobility among community-living older persons: secondary analysis of a randomized controlled trial

BackgroundAmong older persons, disability is often precipitated by intervening illnesses and injuries leading to hospitalization. In the Lifestyle Interventions and Independence for Elders (LIFE) Study, a structured moderate-intensity physical activity program, compared with a health education program, was shown to significantly reduce the amount of time spent with major mobility disability (MMD) over the course of 3.5 years. We aimed to determine whether the benefit of the physical activity program in promoting independent mobility was diminished in the setting of intervening hospitalizations.MethodsWe analyzed data from a single-blinded, parallel group randomized trial (ClinicalTrials.gov: NCT01072500). In this trial, 1635 sedentary persons, aged 70–89 years, who had functional limitations but were able to walk 400 m, were randomized from eight US centers between February 2010 and December 2013: 818 to physical activity (800 received intervention) and 817 to health education (805 received intervention). Intervening hospitalizations and MMD, defined as the inability to walk 400 m, were assessed every 6 months for up to 3.5 years.ResultsFor both the physical activity and health education groups, intervening hospitalizations were strongly associated with the initial onset of MMD and inversely associated with recovery from MMD, defined as a transition from initial MMD onset to no MMD. The benefit of the physical activity intervention did not differ significantly based on hospital exposure. For onset of MMD, the hazard ratios (HR) were 0.79 (95% confidence interval [CI] 0.58–1.1) and 0.77 (0.62–0.95) in the presence and absence of intervening hospitalizations, respectively (P-interaction, 0.903). For recovery of MMD, the magnitude of effect was modestly greater among participants who were hospitalized (HR 1.5, 95% CI 0.71–3.0) than in those who were not hospitalized (HR 1.2, 95% CI 0.88–1.7), but this difference did not achieve statistical significance (P-interaction, 0.670).ConclusionsIntervening hospitalizations had strong deleterious effects on the onset of MMD and recovery from MMD, but did not diminish the beneficial effect of the LIFE physical activity intervention in promoting independent mobility. To achieve sustained benefits over time, structured physical activity programs should be designed to accommodate acute illnesses and injuries leading to hospitalizations given their high frequency in older persons with functional limitations.Trial registrationClinicalTrials.gov identifier NCT01072500.

Effect of Physical Activity on Self-Reported Disability in Older Adults: Results from the LIFE Study.

To test the hypothesis that a long-term structured, moderate intensity physical activity (PA) program is more effective than a health education (HE) program in reducing the risk of s elf-reported dependency and disability in basic activities of daily living (BADLs), disability in instrumental ADLs (IADL), and mobility disability. The Lifestyle Interventions and Independence for Elders (LIFE) study was a multicenter, single-blinded randomized trial. University-based research clinic. Thousand six hundred and thirty five sedentary men and women aged 70-89 years, who had functional limitations, defined as a score ≤9 on the Short Physical Performance Battery. Participants were randomized to a structured, moderate intensity PA program (n = 818) that included aerobic, resistance, and flexibility exercises or to a HE program (n = 817). All outcomes were derived by self-report using periodic interviews that asked about the degree of difficulty and receipt of help during the past month. Dependency was defined as "receiving assistance" or "unable" to do ≥1 activities. Disability was defined as having "a lot of difficulty" or "unable" doing ≥1 activities. Severe disability was defined as reporting difficulty or being unable to perform ≥3 activities. Over an average follow-up of 2.6 years, the cumulative incidence of BADL dependency was 15.2% among PA and 15.1% among HE participants (HR = 1.0, 95% CI = 0.78-0.1.3). Intervention groups had similar rates of incident BADL disability, IADL disability and reported mobility disability. Reporting severe mobility disability (HR = 0.78, 95% CI = 0.64-0.96) and ratings of difficulty on mobility tasks were reduced in the PA group. A structured physical activity intervention reduces reported severe mobility disability and difficulty on mobility tasks, but not BADL and IADL disability in older adults with functional limitations.

Results of a nine month home-based physical activity intervention for people living with HIV

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The purpose of this investigation was to test the feasibility of a home-based moderate-intensity physical activity (MPA) program for people living with HIV/AIDS (PLWHA) currently taking antiretroviral therapy (ART).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 68 participants recruited for a 9-month home-based PA intervention aimed to reduce risk factors of cardiovascular disease for PLWHA taking ART. All participants received an educational weight loss workbook and a pedometer for self-monitoring of physical activity. The intervention group received elastic Therabands® for strength training in addition to telephone based behavioural coaching. Clinical assessments were conducted at baseline and each follow-up which also included psychometric questionnaires and PA levels via the SenseWear® armband accelerometer.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Of the 57 completing the study, 29 of those were in the intervention group and 28 were in the standard care group. Results show that the home-based PA intervention was not successful in increasing the total amount of MPA for PLWHA. However there was a trend (p=0.08) of decreasing sedentary time. In a secondary analysis those who increased PA by &amp;gt;10% observed decreases in waist circumference and improved functioning at 18 weeks. None of the changes observed were significant after controlling for all potential confounders. &lt;/p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; A home-based exercise approach with telephone-based coaching may not be a feasible method for increasing MPA among PLWHA. Slight decreases in sedentary time indicate some positive changes in activity habits. A possible strategy to improve studies similar to this is to incorporate a group based social interaction each week similar to that of a support group.

Effect of Online Training on Antenatal Physical Activity Counseling.

Objective: The objective of this study was to test the effect of an online education intervention on providers' attitudes, beliefs, knowledge, and practices pertaining to antenatal physical activity. Study design: A sample of 181 providers (ie, obstetricians, family medicine physicians, and certified nurse-midwives) was directed to view an online training on antenatal physical activity guidelines, counseling methods, and resources. Providers completed surveys before and 12 weeks after viewing the educational website material. Repeated-measures analyses were conducted to examine the effects of the online education. Results: A total of 164 providers (87.2%) completed baseline and follow-up surveys. After viewing the online training, participants more strongly agreed that it was their responsibility to encourage engagement in antenatal physical activity (P = .02) and believed that women would follow their advice about beginning antenatal physical activity (P = .01). Viewing the website material facilitated an increased confidence in ability to effectively talk with overweight and obese women about physical activity (P = .04) and more frequent advising to begin a moderate-intensity physical activity program for sedentary women (P = .02). Knowledge on antenatal physical activity guidelines also improved. Conclusion: Findings suggest that online educational interventions may be an effective tool in altering providers' knowledge and practices pertaining to antenatal physical activity.

Effect of structured physical activity on prevention of serious fall injuries in adults aged 70-89: randomized clinical trial (LIFE Study)

Objective To test whether a long term, structured physical activity program compared with a health education program reduces the risk of serious fall injuries among sedentary older people with functional...

Effect of a 24-Month Physical Activity Intervention vs Health Education on Cognitive Outcomes in Sedentary Older Adults: The LIFE Randomized Trial.

Epidemiological evidence suggests that physical activity benefits cognition, but results from randomized trials are limited and mixed. To determine whether a 24-month physical activity program results in better cognitive function, lower risk of mild cognitive impairment (MCI) or dementia, or both, compared with a health education program. A randomized clinical trial, the Lifestyle Interventions and Independence for Elders (LIFE) study, enrolled 1635 community-living participants at 8 US centers from February 2010 until December 2011. Participants were sedentary adults aged 70 to 89 years who were at risk for mobility disability but able to walk 400 m. A structured, moderate-intensity physical activity program (n = 818) that included walking, resistance training, and flexibility exercises or a health education program (n = 817) of educational workshops and upper-extremity stretching. Prespecified secondary outcomes of the LIFE study included cognitive function measured by the Digit Symbol Coding (DSC) task subtest of the Wechsler Adult Intelligence Scale (score range: 0-133; higher scores indicate better function) and the revised Hopkins Verbal Learning Test (HVLT-R; 12-item word list recall task) assessed in 1476 participants (90.3%). Tertiary outcomes included global and executive cognitive function and incident MCI or dementia at 24 months. At 24 months, DSC task and HVLT-R scores (adjusted for clinic site, sex, and baseline values) were not different between groups. The mean DSC task scores were 46.26 points for the physical activity group vs 46.28 for the health education group (mean difference, -0.01 points [95% CI, -0.80 to 0.77 points], P = .97). The mean HVLT-R delayed recall scores were 7.22 for the physical activity group vs 7.25 for the health education group (mean difference, -0.03 words [95% CI, -0.29 to 0.24 words], P = .84). No differences for any other cognitive or composite measures were observed. Participants in the physical activity group who were 80 years or older (n = 307) and those with poorer baseline physical performance (n = 328) had better changes in executive function composite scores compared with the health education group (P = .01 for interaction for both comparisons). Incident MCI or dementia occurred in 98 participants (13.2%) in the physical activity group and 91 participants (12.1%) in the health education group (odds ratio, 1.08 [95% CI, 0.80 to 1.46]). Among sedentary older adults, a 24-month moderate-intensity physical activity program compared with a health education program did not result in improvements in global or domain-specific cognitive function. clinicaltrials.gov Identifier: NCT01072500.

Effect Of Physical Activity On Self-reported Disability In Older Adults

PURPOSE: To test the hypothesis that a long-term structured physical activity program is more effective than a health education program in reducing the risk and progression of self-reported disability in basic activities of daily living (ADL’s), instrumental ADL’s (IADL’s) and mobility disability (e.g. bathing, doing light housework, walking a block). METHODS: The Lifestyle Interventions and Independence for Elders (LIFE) study was a multicenter, single-blinded randomized trial of 1,635 sedentary men and women aged 70-89 years, who had functional limitations, defined as a score < 10 on the Short Physical Performance Battery. Participants were randomized to a structured moderate intensity physical activity (PA) program (n=818) that included including aerobic, resistance and flexibility exercises or to a health education (HE) program (n=817). Outcomes were assessed with semi-annual interviews that asked about the degree of difficulty and receiving help during the past month in executing ADLs, IADLs and mobility activities. The first occurrence of receiving assistance or being unable to perform ≥ 1 ADLs served as the primary outcome. Secondary outcomes included the first occurrence of having a lot of difficulty or unable to do ≥ 1 activities in each of the three functional domains. Severe disability was defined as reporting difficulty or being unable to perform ≥ 3 activities in each of the three domains. RESULTS: Over an average follow-up of 2.56 years, the cumulative incidence of receiving assistance or being unable to perform ≥ 1 ADLs was 15.2% (120/787) of PA and 15.1% (120/793) of HE participants (HR=1.0, 95%CI=0.78-0.1.3, p=0.97). Similar results were found with incident IADL (HR=1.0, 95%CI=0.79-1.3, p=0.97) and mobility disability (HR=0.97, 95%CI=0.82-1.15, p=0.70). Severe mobility disability (HR=0.78, 95%CI=0.64-0.96, p=0.02), but not severe ADL (p=0.69) or IADL (p=0.52) disability was reduced with PA. CONCLUSIONS: A structured moderate intensity physical activity program, compared with a health education program, showed no effect on self-reported ADL or IADL disability. Self-report of severe mobility disability was reduced over 2.6 years of follow-up. These results support the effectiveness of a physical activity intervention designed to reduce severe mobility disability, but additional interventions are needed to prevent ADL and IADL disability in older adults with functional limitations.

Role of Fatigue on the Effectiveness of a Physical Activity Intervention Aimed at Preventing Mobility Disability

While physical activity (PA) is known to preserve mobility and functional capacity in older adults, greater self-reported fatigue is associated with slower gait speed and poorer mobility. The potential impact of initial fatigue levels in mitigating the effects of a physical activity intervention on major mobility disability (MMD) outcomes has yet to be explored. PURPOSE: To examine the impact of a PA intervention on the risk of MMD by baseline (BL) fatigue status in older adults at risk for mobility disability. METHODS: The Lifestyle Interventions and Independence for Elders (LIFE) Study was a randomized clinical trial of a structured, moderate-intensity PA program (mean duration=2.6 years) consisting primarily of walking compared to a successful aging health education (SA) program in 1635 older adults, mean age 78.9±5.2 years. Self-reported fatigue was assessed using the Trait version of the Exercise-Induced Feelings Inventory (EFI-T), a 6-item scale with each item scored 0 (none of the time) to 5 (all of the time). A total score was calculated by averaging the items and the median split was used to define BL fatigue status: higher fatigue ≥2 (N=876) and lower fatigue <2 (N=755). A usual-paced 400m walk was conducted every 6 months; MMD was defined as the loss of ability to walk the 400m within 15 min. Cox proportional hazard models were used for the analysis of MMD in the PA vs. SA groups according to baseline fatigue status. RESULTS: Time to walk 400m at BL was slower for those with higher fatigue (521.0±113.3 sec) compared to lower fatigue (494.6±112.8 sec), p<0.0001. Participants with higher BL fatigue who were randomized to the PA program had a 26% lower risk of MMD compared to those who self-reported higher BL fatigue in SA (hazard ratio [HR] 0.74 [95% CI, 0.59-0.92], p=0.006). For those with lower BL fatigue, there was no difference between intervention programs on MMD (HR 0.88 [95% CI, 0.66-1.17], p=0.39); p-value for BL fatigue by intervention interaction: 0.24. Results did not change after adjustment for BL 400m walk time. CONCLUSION: A long-term moderate intensity PA intervention may be particularly effective in preserving mobility in older adults at risk for MMD who self-reported higher levels of initial fatigue. Supported by U01AG22376 from the NIH.

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The effect of a 3-month moderate-intensity physical activity program on body composition in overweight and obese African American college females.

This study evaluated body composition outcomes following a 3-month exercise program for overweight/obese Black women. BMI decreased over the 3-month study despite an observed increase in body fat. Enhancements in bone marrow density and muscle density were also observed. Results show promising yet hypothesis-generating findings to explore in future research. Few studies have evaluated the relationship between aerobic physical activity (PA) and body composition among young adult overweight/obese African American (AA) women. The current study evaluated the effect of a 3-month moderate-intensity aerobic physical activity intervention for overweight and obese young adult women on bone, lean, and fat mass. Participants (n = 15) were a randomly selected subset of AA female college students (M age = 21.7 years; M BMI = 33.3) enrolled in a larger PA promotion pilot study (n = 31). Study protocol required participants to engage in four 30-60-min moderate-intensity aerobic PA sessions each week. Whole body composition was measured by dual-energy X-ray absorptiometry (DXA), and peripheral quantitative computed tomography (pQCT) was used to assess additional quantitative and qualitative assessment of the radius. BMI decreased over the duration of the study (P = .034), reflected by a marginal decrease in body weight (P = .057). However, unexpectedly, increases in adipose tissue measures were observed, including total body fat (P = .041), percent body fat (P = .044), trunk fat (P = .031), and percent trunk fat (P = .041). No changes in DXA-measured bone outcomes were observed (i.e., bone mineral density, P = .069; bone mineral content, P = .211). Results from the pQCT assessment showed that bone marrow density increased (P = .011), but cortical density remained stable (P = .211). A marginally significant increase in muscle density (P = .053) and no changes in muscle area (P = .776) were observed. A 3-month moderate-intensity PA program was associated with several promising findings, including increased bone marrow and stabilization of body weight. However, the increase in adipose tissue and trend for decreased bone mineral density were unexpected and indicate the need for future studies with larger samples to further explore these outcomes.

Effect of structured physical activity on prevention of major mobility disability in older adults: the LIFE study randomized clinical trial.

In older adults reduced mobility is common and is an independent risk factor for morbidity, hospitalization, disability, and mortality. Limited evidence suggests that physical activity may help prevent mobility disability; however, there are no definitive clinical trials examining whether physical activity prevents or delays mobility disability. To test the hypothesis that a long-term structured physical activity program is more effective than a health education program (also referred to as a successful aging program) in reducing the risk of major mobility disability. The Lifestyle Interventions and Independence for Elders (LIFE) study was a multicenter, randomized trial that enrolled participants between February 2010 and December 2011, who participated for an average of 2.6 years. Follow-up ended in December 2013. Outcome assessors were blinded to the intervention assignment. Participants were recruited from urban, suburban, and rural communities at 8 centers throughout the United States. We randomized a volunteer sample of 1635 sedentary men and women aged 70 to 89 years who had physical limitations, defined as a score on the Short Physical Performance Battery of 9 or below, but were able to walk 400 m. Participants were randomized to a structured, moderate-intensity physical activity program (n = 818) conducted in a center (twice/wk) and at home (3-4 times/wk) that included aerobic, resistance, and flexibility training activities or to a health education program (n = 817) consisting of workshops on topics relevant to older adults and upper extremity stretching exercises. The primary outcome was major mobility disability objectively defined by loss of ability to walk 400 m. Incident major mobility disability occurred in 30.1% (246 participants) of the physical activity group and 35.5% (290 participants) of the health education group (hazard ratio [HR], 0.82 [95% CI, 0.69-0.98], P = .03).Persistent mobility disability was experienced by 120 participants (14.7%) in the physical activity group and 162 participants (19.8%) in the health education group (HR, 0.72 [95% CI, 0.57-0.91]; P = .006). Serious adverse events were reported by 404 participants (49.4%) in the physical activity group and 373 participants (45.7%) in the health education group (risk ratio, 1.08 [95% CI, 0.98-1.20]). A structured, moderate-intensity physical activity program compared with a health education program reduced major mobility disability over 2.6 years among older adults at risk for disability. These findings suggest mobility benefit from such a program in vulnerable older adults. clinicaltrials.gov Identifier: NCT01072500.

Lifestyle Interventions and Independence for Elders Study: Recruitment and Baseline Characteristics

Recruitment of older adults into long-term clinical trials involving behavioral interventions is a significant challenge. The Lifestyle Interventions and Independence for Elders (LIFE) Study is a Phase 3 multicenter randomized controlled multisite trial, designed to compare the effects of a moderate-intensity physical activity program with a successful aging health education program on the incidence of major mobility disability (the inability to walk 400 m) in sedentary adults aged 70-89 years, who were at high risk for mobility disability (scoring ≤ 9 on the Short Physical Performance Battery) at baseline. Recruitment methods, yields, efficiency, and costs are described together with a summary of participant baseline characteristics. Yields were examined across levels of sex, race and ethnicity, and Short Physical Performance Battery, as well as by site. The 21-month recruiting period resulted in 14,812 telephone screens; 1,635 participants were randomized (67.2% women, 21.0% minorities, 44.7% with Short Physical Performance Battery scores ≤ 7). Of the telephone-screened participants, 37.6% were excluded primarily because of regular participation in physical activity, health exclusions, or self-reported mobility disability. Direct mailing was the most productive recruitment strategy (59.5% of randomized participants). Recruitment costs were $840 per randomized participant. Yields differed by sex and Short Physical Performance Battery. We accrued 11% more participant follow-up time than expected during the recruitment period as a result of the accelerated recruitment rate. The LIFE Study achieved all recruitment benchmarks. Bulk mailing is an efficient method for recruiting high-risk community-dwelling older persons (including minorities), from diverse geographic areas for this long-term behavioral trial.

Effect of an Exercise Program, on Hemodynamic, Metabolic and Inflammatory Markers in Obese Mexican Adolescents

Background: Obesity prevalence has increased in Mexican adolescents. This disease is associated with a chronic inflammatory response, which has been proposed to have an important role in cardiovascular disease. The aim of this study was to evaluate the short term effect of a moderate-intensity physical activity program on hemodynamic, metabolic, and inflammatory markers in obese adolescents. Findings: We performed a longitudinal study in 43 healthy obese adolescents (26 female and 17 male). The study was conducted at the Mexican Institute of Social Security in Leon, Mexico. Subjects were submitted to aerobic exercise training during 90 minutes for 16 weeks, 5 days per week. Before and after the intervention program, hemodynamic, metabolic and inflammatory parameters were measured. Body weight was reduced by 4%. Blood pressure, insulin, insulin resistance, C reactive protein, interleukine 6, intracellular adhesion molecule-1 and vascular cell adhesion molecule-1 serum levels significantly decreased independently of gender while adiponectin levels increased. In the multiple regression analysis, the increase in adiponectin levels and the decrease in body mass index were related to systolic blood pressure levels (R2= 0.26; p=0.001), while final maximum O2 consumption rate and final systolic blood pressure levels were related to decrease in C reactive protein levels (R2= 0.79; p=0.0001). Conclusions: A moderate-intensive exercise for 90 minutes a day at short term significantly diminished adiposity, hemodynamic, metabolic, and inflammatory markers in obese adolescents.

The Lifestyle Interventions and Independence for Elders Study: Design and Methods

Background.As the number of older adults in the United States rises, maintaining functional independence among older Americans has emerged as a major clinical and public health priority. Older people who lose mobility are less likely to remain in the community; demonstrate higher rates of morbidity, mortality, and hospitalizations; and experience a poorer quality of life. Several studies have shown that regular physical activity improves functional limitations and intermediate functional outcomes, but definitive evidence showing that major mobility disability can be prevented is lacking. A Phase 3 randomized controlled trial is needed to fill this evidence gap.Methods.The Lifestyle Interventions and Independence for Elders (LIFE) Study is a Phase 3 multicenter randomized controlled trial designed to compare a supervised moderate-intensity physical activity program with a successful aging health education program in 1,600 sedentary older persons followed for an average of 2.7 years.Results.LIFE's primary outcome is major mobility disability, defined as the inability to walk 400 m. Secondary outcomes include cognitive function, serious fall injuries, persistent mobility disability, the combined outcome of major mobility disability or death, disability in activities of daily living, and cost-effectiveness.Conclusions.Results of this study are expected to have important public health implications for the large and growing population of older sedentary men and women.

Physical Activity, Weight Control, and Breast Cancer Risk and Survival: Clinical Trial Rationale and Design Considerations

Substantial observational epidemiological evidence exists that physical activity and weight control are associated with decreased risk of postmenopausal breast cancer. Uncertainty remains regarding several aspects of these associations, including the effect of possible confounding factors on these associations. We present the rationale and design for two randomized controlled trials that can help resolve this uncertainty. In a 5-year prevention trial conducted among women at high risk of breast cancer, the primary endpoint would be breast cancer incidence. For a comparable survivorship trial, the primary endpoint would be the disease-free interval and secondary endpoints would be breast cancer recurrence-free interval, second primary breast cancer, and total invasive plus in situ breast cancer. A set of inclusion and exclusion criteria is proposed for both trials. Intervention goals are the same for both trials. Goals for the weight control intervention would be, for women whose body mass index (BMI) is greater than 25 kg/m(2), to lose 10% of body weight and, for women whose BMI is less than or equal to 25 kg/m(2), to avoid weight gain. The goal for the physical activity intervention would be to achieve and maintain regular participation in a moderate-intensity physical activity program for a total of 150-225 minutes over at least 5 days per week. Sample size calculations are based on alternative assumptions about hazard ratio, adherence, follow-up duration, and power and are presented for the primary prevention and survivorship trials. Although both studies could enhance our understanding of breast cancer etiology and benefit public health, practical considerations, including smaller sample size, ease of recruitment, and reduced likelihood of early termination, favor the survivorship trial at this time.