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AIM The aim of this study was to explore the factors that contribute to health promotion in the oldest old and the barriers that prevent it . METHOD A non-r and om sample ( n = 52 ) of people aged 80 and older participated in a descriptive correlational study . Respondents completed a series of two Likert-type question naires . The  Health Promoting Lifestyle Profile II  ( Walker et al 1995 ) and  Barriers to Health Promoting Activities  for Disabled Persons Scale ( Becker et al 1991 ) were used to measure health behaviours . RESULTS Differences were noted between the age groups ( 80 - 90 and 91 - 101 ) for health responsibility , physical activity and nutrition . Impairment was the major barrier to health promotion . CONCLUSION To foster optimal living , the health , illness , function and motivation as well as age of older adults must be considered . They should be encouraged to pursue physical , social and intellectual activity , which can enable them to have active and fulfilling lives Abstract Background Little is known about which behavior change strategies motivate older adults to increase their physical activity . Purpose The purpose of this study was to assess the relative effects of two sets of behavior change strategies to motivate increased physical activity among older adults :  interpersonal and intrapersonal . Methods Community-dwelling older adults ( N = 102 , mean age = 79 ) were r and omized in a 2 × 2 factorial experiment to receive interpersonal ( e.g. , social support , friendly social comparison ; no , yes ) and /or intrapersonal ( e.g. , goal setting , barriers management ; no , yes ) behavior change strategies , combined with an evidence -based , physical activity protocol ( Otago exercise program ) and a physical activity monitor ( Fitbit One ™ ) . Results Based on monitor data , participants who received interpersonal strategies , compared to those who did not , increased their average minutes of total physical activity ( light , moderate , vigorous ) per week , immediately ( p = .006 ) and 6 months ( p = .048 ) post-intervention . Similar , increases were observed on measures of functional strength and balance , immediately ( p = .012 ) and 6 months ( p = .003 ) post-intervention . The intrapersonal strategies did not elicit a significant increase in physical activity or functional strength and balance . Conclusions Findings suggest a set of interpersonally oriented behavior change strategies combined with an evidence -based physical activity protocol can elicit modest , but statistically and clinical ly significant , increases in older adults ’ physical activity and functional strength and balance . Future research should replicate these findings and investigate the sustained quantity of physical activity elicited by these strategies and their impact on older adults ’ quality of life and falls . Trial Registration The Clinical Trials.gov registration identifier is NCT02433249 Background Physical activity promotes health in older adults but participation rates are low . Interactive video dance games can increase activity in young persons but have not been design ed for use with older adults . The purpose of this research was to evaluate healthy older adults ’ interest and participation in a dance game adapted for an older user . Methods Healthy older adults were recruited from 3 senior living setting s and offered three months of training and supervision using a video dance game design ed for older people .  Before and after the program , data was collected on vital signs , physical function and self reported quality of life . Feedback was obtained during and after training . Results Of 36 persons who entered ( mean age 80.1 + 5.4 years , 83 % female ) , 25 completed the study . Completers were healthier than noncompleters . Completers showed gains in narrow walk time , self-reported balance confidence and mental health . While there were no serious adverse events , 4 of 11 noncompleters withdrew due to musculoskeletal complaints . Conclusions Adapted Interactive video dance is feasible for some healthy older adults and may help achieve physical activity goals Background Reaction time , coordination , and cognition performance typically diminish in older adults , which may lead to gait impairments , falls , and injuries . Regular strength – balance exercises are highly recommended to reduce this problem and to improve health , well-being , and independence in old age . However , many older people face a lack of motivation in addition to other strong barriers to exercise . We developed ActiveLifestyle , an information technology (IT)-based system for active and healthy aging aim ing at improving balance and strength . ActiveLifestyle is a training app that runs on a tablet and assists , monitors , and motivates older people to follow personalized training plans autonomously at home . Objective The objectives were to ( 1 ) investigate which IT-mediated motivation strategies increase adherence to physical exercise training plans in older people , ( 2 ) assess the impact of ActiveLifestyle on physical activity behavior change , and ( 3 ) demonstrate the effectiveness of the ActiveLifestyle training to improve gait speed . Methods A total of 44 older adults followed personalized , 12-week strength and balance training plans . All participants performed the exercises autonomously at home . Question naires were used to assess the technological familiarity and stage of behavior change , as well as the effectiveness of the motivation instruments adopted by ActiveLifestyle . Adherence to the exercise plan was evaluated using performance data collected by the app and through information given by the participants during the study . Pretests and posttests were performed to evaluate gait speed of the participants before and after the study . Results Participants were 75 years ( SD 6 ) , predominantly female ( 64 % ) , held a trade or professional diploma ( 54 % ) , and their past profession was in a sitting position ( 43 % ) . Of the 44 participants who enrolled , 33 ( 75 % ) completed the study . The app proved to assist and motivate independently living and healthy older adults to autonomously perform strength – balance exercises ( median 6 on a 7-point Likert scale ) . Social motivation strategies proved more effective than individual strategies to stimulate the participants to comply with the training plan , as well as to change their behavior permanently toward a more physically active lifestyle . The exercises were effective to improve preferred and fast gait speed . Conclusions ActiveLifestyle assisted and motivated independently living and healthy older people to autonomously perform strength – balance exercises over 12 weeks and had low dropout rates . The social motivation strategies were more effective to stimulate the participants to comply with the training plan and remain on the intervention . The adoption of assistive technology devices for physical intervention tends to motivate and retain older people exercising for longer periods of time BACKGROUND Regular physical activity in older adults can facilitate healthy aging , improve functional capacity , and prevent disease . However , factors associated with physical inactivity in older population s are poorly understood . This study attempts to identify social-cognitive and perceived environmental influences associated with physical activity participation in older population s. METHODS In a r and omly selected sample of 449 Australian adults age 60 and older , we assessed self-reported physical activity and a range of social-cognitive and perceived environmental factors . Respondents were classified as sufficiently active and inactive based on energy expenditure estimates ( kcal/week ) derived from self-reported physical activity . Two logistic regression models , with and without self-efficacy included , were conducted to identify modifiable independent predictors of physical activity . RESULTS Significantly more males than females were physically active . Physical activity participation was related to age with a greater proportion of those age 65 - 69 being active than those age 60 - 64 or 70 or older .  High self-efficacy , regular participation of friends and family , finding footpaths safe for walking , and access to local facilities were significantly associated with being active . CONCLUSION Identifying predictors of physical activity in older population s , particularly social support , facility access , and neighbourhood safety , can inform the development of policy and intervention strategies to promote the health of older people BACKGROUND The Task Force on Community Preventive Services strongly recommends environmental interventions that include enhanced access to opportunities for physical activity , such as walking and cycling trails . Although accumulating evidence indicates that trails can be effective in increasing physical activity , little is known about trail users . METHODS Cross-sectional analysis of a national sample of 3717 adults from the HealthStyles and ConsumerStyles surveys using logistic regression to determine physical activity patterns and sociodemographic correlates related to trail use , and to identify support regarding trail development policies . RESULTS Almost 13 % ( 12.7 % ) of the sample reported using trails at least once a month and 24.3 % at least once a week . People who reported using trails at least once a week were twice as likely than people who reported rarely or never using trails to meet physical activity recommendations ( odds ratio=2.3 , 95 % confidence interval=1.9 - 2.8 ) . Nearly half ( 43.6 % ) of the non-trail users supported exp and ed public spaces for people to exercise , and 36.4 % of the non-trail users reported that they would be willing to pay more taxes to build more parks and trails in their community . CONCLUSIONS Community trails facilitate physical activity , and almost half of frequent trail users report that access to trails and other green space is important in choosing a place to live . These results support the need for prospect i ve research on whether newly built trails promote physical activity in previously inactive people OBJECTIVE Many physical activity interventions do not reach those people who would benefit the most from them . The Groningen Active Living Model ( GALM ) was successful in recruiting sedentary and underactive older adults . METHOD In the fall of 2000 older adults in three municipalities in the Netherl and s received written information , were visited at home and , if eligible according to the GALM recruitment criteria , filled in the Stages of Change question naire and the Voorrips physical activity question naire . RESULTS By using the strategy we succeeded in including 12.3 % of the older adults ( 315 of the 2551 qualifying participants ) , 79.4 % of whom could be indeed regarded as sedentary or underactive . These results can be considered in line with results described in the literature . The cost of successfully recruiting an older adult was estimated at $ 84 . CONCLUSIONS The GALM recruitment strategy is a potentially useful and effective method for reaching community-dwelling sedentary and underactive older adults Background Despite its well-known benefits for health and well-being physical activity levels are insufficient and declining with age in Germany . Physical activity promotion programs for older adults are often not successful , one reason is insufficient relevance of intervention measures for the study population . Community-based participatory research ( CBPR ) is a possible key strategy for tailoring more meaningful intervention programs to a specific community . However , evidence for the effectiveness of CBPR in the general population is scarce . This study aims to formally evaluate the efficacy of a CBPR approach for developing and implementing an outdoor physical activity program for older adults . Methods / design The OUTDOOR ACTIVE intervention trial is a cluster-r and omised intervention study carried out in a r and om sample of eight subdistricts in the city of Bremen , Germany . The eight subdistricts are grouped into four homogenous pairs with regard to socioeconomic level and l and use mix of the subdistrict . Within the pairs , the subdistricts are assigned r and omly to the two study arms : participatory development and implementation of a community-based program to promote outdoor physical activity ( intervention ) versus no intervention ( controls ) . For evaluation , a survey is carried out before ( baseline ) and after ( follow-up ) the intervention period . The measurements include 7-day accelerometer measurement , physical fitness test , blood pressure , basic anthropometry , and self-administered question naire . Discussion The OUTDOOR ACTIVE intervention trial will provide detailed information on PA intervention for older adults in an urban setting . Through the participatory nature of the study it will provide valuable insights into drivers and barriers to PA in this group , and it will inform policy makers and other stakeholders how to benefit from the results .Trial registration German Clinical Trials Register DRKS00015117 ( Date of registration 17 - 07 - 2018 ) Background The construct of total wellness includes a holistic approach to the body , mind and spirit components of life . While the health benefits of reducing sedentary behavior and increasing physical activity are well documented , little is known about the influence on total wellness of an internet-based physical activity monitor design ed to help people to achieve higher physical activity levels . Purpose The purpose of this four-week , personal activity monitor-based intervention program was to reduce sedentary behavior and increase physical activity levels in daily living for sedentary adults and to determine if these changes would also be associated with improvement in total wellness . Methods Twenty-two men and 11 women ( 27 years ± 4.0 ) were r and omly assigned to either an intervention ( n = 18 ) or control group ( n = 15 ) . The intervention group interacted with an online personal activity monitor ( Gruve Solution ™ ) design ed to reduce sedentary time  and increase physical activity during activities of daily living . The control group did not interact with the monitor , as they were asked to follow their normal daily physical activities and sedentary behavior routines . The Wellness Evaluation of Lifestyle ( WEL ) inventory was used to assess total wellness . Sedentary time , light , walking , moderate and vigorous intensity physical activities were assessed for both intervention and control groups at baseline and at week-4 by the 7-day Sedentary and Light Intensity Physical Activity Log ( 7-day SLIPA Log ) and the International Physical Activity Question naire ( IPAQ ) . Results Significant increases in pre-post total wellness scores ( from 64 % ± 5.7 to 75 % ± 8.5 ) ( t ( 17 ) = -6.5 , p < 0.001 ) were observed in the intervention group by the end of week four . Intervention participants decreased their sedentary time ( 21 % , 2.3 hours/day ) and increased their light ( 36.7 % , 2.5 hours/day ) , walking ( 65 % , 1057 MET-min/week ) , moderate ( 67 % , 455 MET-min/week ) and vigorous intensity ( 60 % , 442 MET-min/week ) physical activity ( all p < 0.001 ) . No significant differences for total wellness were observed between the groups at baseline and no pre-post significant differences were observed for any outcome variable in the control group . Conclusion Total wellness is improved when sedentary , but sufficiently physically active adults , reduce sedentary time and increase physical activity levels ( i.e. light , waking , moderate and vigorous ) Background Healthy ageing is an important concern for many societies facing the challenge of an ageing population . Physical activity ( PA ) is a major contributor to healthy ageing ; however insufficient PA levels are prevalent in old age in Germany .  Community capacity building and community involvement are often recommended as key strategies to improve equitable access to prevention and health promotion . However , evidence for the effectiveness of these strategies is scarce . This study aims to assess the community readiness for PA promotion in local environments and to analyse the utility of strategies to increase community readiness for reaching vulnerable groups . Methods / Design We design ed a mixed method intervention trial comprising three study modules . The first module includes an assessment of  community readiness for PA interventions in older adults . The assessment is carried out in a sample of 24 municipalities in the Northwest of Germany using structured key informant interviews . In the second module , eight municipalities with the low community readiness are selected from the sample and r and omly assigned to one of two study groups : active enhancement of community readiness ( intervention ) versus no enhancement ( control ) . After enhancing community readiness in the active enhancement group , older adults in both study groups will be recruited for participation in a PA intervention .  Participation rates are compared between the study groups to evaluate the effects of the intervention . In addition , a cost-effectiveness analysis is carried out calculating recruitment costs per person reached in the two study groups . In the third module , qualitative interviews are conducted with participants and non- participants of the PA intervention exploring reasons for participation or non-participation . Discussion This study offers the potential to contribute to the evidence base of reaching vulnerable older adults for PA interventions and provide ideas on how to reduce participation barriers . Its findings will inform governmental authorities , professionals , academics , and NGOs with an estimate of re sources necessary to achieve equitable access to physical activity programs for vulnerable older adults . Trial registration German Clinical Trials Register DRKS00009564 ( Date of registration 03 - 11 - 2015 Little information is available on the provision of physical fitness and intervention program among people with intellectual disabilities . The aim of this study is to provide information of examining the effectiveness of healthy physical fitness programs on people with intellectual disabilities living in a disability institution . There were 146 participants with intellectual disabilities ( age 19 - 67 years ) were recruited in the study . We collected information on disability condition ( type and level ) , height , weight , BMI , and physical fitness status ( includes V-shape sit and reach test , sit-up 30s , sit-up 60s , and shuttle run ) at the beginning and 6 months later of the program intervention . The results show that there were statistical decreases in individual 's weight , BMI score , BMI category , and positive improvement in V-shape sit and reach test , sit-up in 30s and 60s tests after 6-month interventions . However , the shuttle run test did not improve at the post-test among people with intellectual disabilities . The results also showed that the mild disability level group has the highest effectiveness on the healthy fitness program on decreasing body weight . Generally speaking , the preliminary study found the healthy exercise program has positive fitness effects on people with intellectual disabilities . To maximize the benefits of regular physical activity on people with ID , there is a need to evaluate the long-term effect of the intervention program and then to initiate the healthy exercise strategies in institution for this group of people Abstract Background Evidence from a limited number of short-term trials indicates the difficulty in achieving population -level improvements in physical activity ( PA ) through community-wide interventions ( CWIs ) . We sought to evaluate the effectiveness of a 5-year CWI for promoting PA in middle-aged and older adults using a cluster r and omized design . Methods We r and omized 12 communities in Unnan , Japan , to either intervention ( 9 ) or control ( 3 ) . Additionally , intervention communities were r and omly allocated to three subgroups by different PA types promoted . R and omly sample d residents aged 40–79 years responded to the baseline survey ( n = 4414 ; 74 % ) and were followed at 1 , 3 and 5 years ( 78–83 % response rate ) . The intervention was a 5-year CWI using social marketing to promote PA . The primary outcome was a change in recommended levels of PA . Results Compared with control communities , adults achieving recommended levels of PA increased in intervention communities [ adjusted change difference = 4.6 percentage points ( 95 % confidence interval : 0.4 , 8.8 ) ] . The intervention was effective for promoting all types of recommended PAs , i.e. aerobic ( walking , 6.4 % ) , flexibility ( 6.1 % ) and muscle-strengthening activities ( 5.7 % ) . However , a bundled approach , which attempted to promote all forms of PAs above simultaneously , was not effective ( 1.3–3.4 % , P ≥ 0.138 ) . Linear dose – response relationships between the CWI awareness and changes in PA were observed ( P ≤ 0.02 ) . Pain intensity decreased in shoulder ( intervention and control ) and lower back ( intervention only ) but there was little change difference in all musculoskeletal pain outcomes between the groups . Conclusions The 5-year CWI using the focused social marketing strategy increased the population -level of PA BACKGROUND Regular physical activity has been shown to have many health benefits . However , many older people are physically inactive . OBJECTIVE To investigate why older people are reluctant to participate in leisure time physical activity and to identify strategies to encourage increased activity . DESIGN Cross-sectional survey . SETTING 16 general practice s in Dundee , Scotl and . METHODS 409 r and omly selected older people ( 65 - 84 years ) who lived independently were interviewed at home . Forty-six percent of those invited to take part were recruited into the study . RESULTS Levels of knowledge about the specific health benefits of physical activity were high . Almost all participants ( 95 % ) believed that physical activity was beneficial and 79 % believed that they did enough to keep healthy . However , 36 % did no leisure time physical activity and a further 17 % did less than 2 hours per week . Regression modelling identified 11 factors that exerted significant independent effects on levels of leisure time physical activity .  The most powerful deterrent was lack of interest ( OR = 7.8 ) . Other factors included lack of daily access to a car , shortness of breath , joint pain , dislike of going out alone or in the evening , perceived lack of fitness , lack of energy , doubting that exercise can lengthen life , not belonging to a group and doubting that meeting new people is beneficial . CONCLUSIONS Increasing leisure time physical activities poses major challenges . Beliefs about desirable levels of activity in older people would need to be changed . Action would be needed to relieve physical symptoms and address fears about perceived ability to undertake physical activity . Finally , easily accessible facilities would be needed to encourage participation in physical activity Background This study aim ed to estimate the cost-effectiveness of a universal strategy to promote physical activity in primary care . Methods Data were analysed for a cohort of participants from the general practice research data base . Empirical estimates informed a Markov model that included five long-term conditions ( diabetes , coronary heart disease , stroke , colorectal cancer and depression ) . Simulations compared an intervention promoting physical activity in healthy adults with st and ard care . The intervention effect on physical activity was from a meta- analysis of r and omised trials . The annual cost of intervention , in the base case , was one family practice consultation per participant year . The primary outcome was net health benefit in quality adjusted life years ( QALYs ) . Results A cohort of 262,704 healthy participants entered the model . Intervention was associated with an increase in life years lived free from physical disease . With 5 years intervention the increase was 52 ( 95 % interval −11 to 115 ) per 1,000 participants entering the model ( probability increased 91.9 % ) ; with 10 years intervention the increase was 102 ( 42–164 ) per 1,000 ( probability 99.7 % ) . Net health benefits at a threshold of £ 30,000 per QALY were 3.2 ( −11.1 to 16.9 ) QALYs per 1,000 participants with 5 years intervention ( probability cost-effective 64.7 % ) and 5.0 ( −9.5 to 19.3 ) with 10 years intervention ( probability cost-effective 72.4 % ) . Conclusions A universal strategy to promote physical activity in primary care has the potential to increase life years lived free from physical disease . There is only weak evidence that a universal intervention strategy might prove cost-effective The objectives were to investigate in older adults ( 1 ) whether regular preventive home visits are associated with change or stability in physical activity and ( 2 ) whether education of home visitors influences stability and change in physical activity . The design was a prospect i ve controlled r and omised follow-up study with r and omization at municipality level ( 17 intervention and 17 control municipalities ) and outcomes measured at individual level . Visitors in the intervention-municipalities received regular education during 3 years . The effect of the intervention was measured by a question naire survey among 1,913 old persons living in the 34 municipalities at baseline and 4½-year follow-up  . Changes in physical activity were measured through self-reported frequencies of vigorous physical activity . All logistic regression analyses were stratified by sex and age group ( 75 and 80 years old ) . There was no effect of receiving preventive home visits on change in physical activity among the men and among the 75-year-old women . Among the physically active 80-year-old women those who accepted and received more than four preventive home visits were more likely to go on being physically active compared to women who did not receive preventive home visits . Among the sedentary 80-year-old women those living in the intervention municipalities tended to increase their physical activity compared to the control women . These results were not seen in the old men . Preventive home visits as part of daily routine in primary care and education of home visitors and general practitioners may promote physical activity in older women BACKGROUND Little is known about the correlates of physical activity among African-American women living in the southeastern United States . The purpose of this study was to assess the relationship of personal , social , cultural , environmental , and policy variables with physical activity among women in ethnic minority groups . METHODS The Women and Physical Activity Survey was used in a telephone interview of 917 African-American women living in two counties in South Carolina . The sample of women was selected by r and om-digit dialing . RESULTS Approximately one third ( 34.1 % ) of the women met current recommendations for moderate or vigorous physical activity , 49.4 % were insufficiently active , and 16.5 % were inactive . Meeting the recommendations or engaging in insufficient activity ( versus inactive ) was related to attaining higher educational levels , being married or with a partner ; being in excellent or very good health , having greater self-efficacy , seeing people exercise in the neighborhood , having more favorable ratings of women who exercise ( social issues score ) , having lower social role strain , and reporting the presence of sidewalks or lighter traffic in the neighborhood . CONCLUSION Multiple factors influence physical activity . Interventions to increase physical activity should use multilevel approaches that incorporate the personal , social environmental , and physical environmental factors related to participation in physical activity AIM Cognitive functions can decline with age , and interventions focusing on stimulating them may have positive results . Previous studies have shown that square-stepping exercise ( SSE ) has a good influence on balance , but this exercise also seems to promote cognitive stimulation . Therefore , the purpose of the present study was to analyse the effect of 16 weeks of SSE on cognitive functions in non-demented community-dwelling older people . METHODS This was a longitudinal , non-r and omized study . Forty-one older adults ( 60 years and older ) were recruited , and 21 participated in the SSE group ( practised only SSE sequences ) and 20 were in the control group ( continued with their activities of daily living ) . Both groups were evaluated using the Mini-Mental State Examination , the Digit Span test , the Toulouse-Pierón Attention Test and the Modified Card Sorting Test . RESULTS The SSE group showed a significant improvement in global cognitive status , concentrated attention and mental flexibility after 16 weeks of the SSE intervention . CONCLUSION Evidence shows that SSE is a physical activity that positively influences cognitive functions in non-demented older people There is ample evidence of the benefits of exercise for older people . Less is known about the most effective strategies for promoting the participation of older people in exercise regimes . An approach whereby practice nurses  used motivational interviewing , based on Prochaska and Di Clemente 's model of behaviour change , was piloted in two general practice s. The strategy appeared feasible and will be tested further in a large controlled trial Purpose There is a growing population of older people living alone within the context of dramatic population ageing and changing living arrangements . However , little is known about the quality of life ( QoL ) of older people living alone in Mainl and China . This study aim ed to investigate QoL and its related factors among Chinese older people who live alone . Methods A stratified r and om cluster sample of 521 community-dwelling older people living alone in Shanghai completed a structured question naire through face-to-face interviews .  QoL was measured using the  Older People ’s Quality of Life Question naire . Other data collected included self-rated health , physical health , cognitive function , depression , functional ability , loneliness , social support , physical activity , health services satisfaction , satisfaction with overall dwelling conditions and socio-demographic variables . Results Older people living alone in Mainl and China rated social relationships and financial circumstances as sources of low satisfaction within their QoL. Multiway analysis of variance showed that satisfaction with overall dwelling conditions , self-rated health , functional ability , depression , economic level , social support , loneliness , previous occupation and health services satisfaction were independently related to QoL , accounting for 68.8 % of the variance . Depression and previous occupation had an interaction effect upon QoL. Conclusions This study identified nine factors influencing the QoL of older people living alone in Mainl and China . Interventions to increase satisfaction with dwelling conditions , improve economic level , social support and functional ability , decrease loneliness and depression and improve health services satisfaction appear to be important for enhancing their Background Home-based exercise programs can improve physical functioning and health status of elderly people . Successful implementation of exercise interventions for older people presents major challenges and supporting elderly people properly while doing their home-based exercises is essential for training success . We developed a tablet-based system — ActiveLifestyle — that offers older adults a home-based strength-balance training program with incorporated motivation strategies and support features . Objective The goal was to compare 3 different home-based training programs with respect to their effect on measures of gait quality and physical performance through planned comparisons between ( 1 ) tablet-based and brochure-based interventions , ( 2 ) individual and social motivation strategies , and ( 3 ) active and inactive participants . Methods A total of 44 autonomous-living elderly people ( mean 75 , SD 6 years ) were assigned to 3 training groups : social ( tablet guided , n=14 ) , individual ( tablet guided , n=13 ) , and brochure ( brochure guided , n=17 ) . All groups joined a 12-week progressive home-based strength-balance training program . Outcome measures were gait performance under single and dual task conditions , dual task costs of walking , falls efficacy , and physical performance as measured by the Short Physical Performance Battery ( SPPB ) . Furthermore , active ( ≥75 % program compliance ) and inactive ( < 75 % program compliance ) individuals were compared based on their characteristics and outcome measures . Results The tablet groups showed significant improvements in single and dual task walking , whereas there were no significant changes observable in the brochure group . Between-groups comparisons revealed significant differences for gait velocity ( U=138.5 ; P=.03 , r=.33 ) and cadence ( U=138.5 , P=.03 r=.34 ) during dual task walking at preferred speed in favor of the tablet groups . The brochure group had more inactive participants , but this did not reach statistical significance ( U=167 , P=.06 , r=.29 ) . The active participants outperformed the inactive participants in single and dual task walking , dual task costs of walking , and SPPB scores . Significant between-groups differences were seen between the tablet groups and the brochure group , in favor of the tablet groups . Conclusions A tablet-based strength-balance training program that allows monitoring and assisting autonomous-living older adults while training at home was more effective in improving gait and physical performance when compared to a brochure-based program . Social or individual motivation strategies were equally effective . The most prominent differences were observed between active and inactive participants . These findings suggest that in older adults a tablet-based intervention enhances training compliance ; hence , it is an effective way to improve gait OBJECTIVES To test the efficacy of a multicomponent intervention to reduce functional difficulties , fear of falling , and home hazards and enhance self-efficacy and adaptive coping in older adults with chronic conditions . DESIGN A prospect i ve , two-group , r and omized trial . Participants were r and omized to a treatment group or no-treatment group . SETTING Urban community-living older people . PARTICIPANTS Three hundred nineteen community-living adults aged 70 and older who reported difficulty with one or more activities of daily living . INTERVENTION Occupational and physical therapy sessions involving home modifications and training in their use ; instruction in strategies of problem-solving , energy conservation , safe performance , and fall recovery techniques ; and balance and muscle strength training . MEASUREMENTS Outcome measures included self-rated functional difficulties with ambulation , instrumental activities of daily living , activities of daily living , fear of falling , confidence performing daily tasks , and use of adaptive strategies . Observations of home hazards were also conducted . RESULTS At 6 months , intervention participants had less difficulty than controls with instrumental activities of daily living ( P=.04 , 95 % confidence interval (CI)=-0.28 - 0.00 ) and activities of daily living ( P=.03 , 95 % CI=-0.24 to -0.01 ) , with largest reductions in bathing ( P=.02 , 95 % CI=-0.52 to -0.06 ) and toileting ( P=.049 , 95 % CI=-0.35 - 0.00 ) . They also had greater self-efficacy ( P=.03 , 95 % CI=0.02 - 0.27 ) , less fear of falling ( P=.001 , 95 % CI=0.26 - 0.96 ) , fewer home hazards ( P=.05 , 95 % CI=-3.06 - 0.00 ) , and greater use of adaptive strategies ( P=.009 , 95 % CI=0.03 - 0.22 ) . Benefits were sustained at 12 months for most outcomes . CONCLUSION A multicomponent intervention targeting modifiable environmental and behavioral factors results in life quality improvements in community-dwelling older people who had functional difficulties , with most benefits retained over a year Abstract Objectives : To examine any association between social , productive , and physical activity and 13 year survival in older people . Design : Prospect i ve cohort study with annual mortality follow up . Activity and other measures were assessed by structured interviews at baseline in the participants ' homes Proportional hazards models were used to model survival from time of initial interview . Setting : City of New Haven , Connecticut , United States . Participants : 2761 men and women from a r and om population sample of 2812 people aged 65 and older . Main outcome measure : Mortality from all causes during 13 years of follow up . Results : All three types of activity were independently associated with survival after age , sex , race/ethnicity , marital status , income , body mass index , smoking , functional disability , and history of cancer , diabetes , stroke , and myocardial infa rct ion were controlled for . Conclusions : Social and productive activities that involve little or no enhancement of fitness lower the risk of all cause mortality as much as fitness activities do . This suggests that in addition to increased cardiopulmonary fitness , activity may confer survival benefits through psychosocial pathways . Social and productive activities that require less physical exertion may complement exercise programmes and may constitute alternative interventions for frail elderly people . Key messages Little is known about predictors of survival among elderly people Physical activity is clearly good for health , but the potential benefits of social activities have not been studied Social and productive activities are as effective as fitness activities in lowering the risk of death Enhanced social activities may help to increase the quality and length of BACKGROUND Regular physical activity reduces falls , hip fractures , and all-cause mortality , but physical activity levels are low in older age groups . AIM To evaluate two exercise programmes promoting physical activity among older people . DESIGN AND SETTING Pragmatic three-arm , parallel- design cluster r and omised controlled trial involving 1256 people aged ≥65 years ( of 20 507 invited ) recruited from 43 general practice s in London , Nottingham , and Derby . METHOD Practice s were r and omised to the class-based Falls Management Exercise programme ( FaME ) , the home-based Otago Exercise Program ( OEP ) , or usual care . The primary outcome was the proportion reaching the recommended physical activity target 12 months post-intervention . Secondary outcomes included falls , quality of life , balance confidence , and costs . RESULTS In total , 49 % of FaME participants reached the physical activity target compared with 38 % for usual care ( adjusted odds ratio 1.78 , 95 % confidence interval [ CI ] = 1.11 to 2.87 , P = 0.02 ) . Differences between FaME and usual care persisted 24 months after intervention . There was no significant difference comparing those in the OEP ( 43 % reaching target at 12 months ) and usual-care arms . Participants in the FaME arm added around 15 minutes of moderate-to-vigorous physical activity per day to their baseline level ; this group also had a significantly lower rate of falls ( incident rate ratio 0.74 , 95 % CI = 0.55 to 0.99 , P = 0.042 ) . Balance confidence was significantly improved in both intervention arms . The mean cost per extra person achieving the physical activity target was £ 1740 . Attrition and rates of adverse reactions were similar . CONCLUSION The FaME programme increases self-reported physical activity for at least 12 months post-intervention and reduces falls in people aged ≥65 years , but uptake is low . There was no statistically significant difference in reaching the target , or in falls , between the OEP and usual-care arms Background Pedometers have become common place in physical activity promotion , yet little information exists on who is using them . The multi- strategy , community-based 10,000 Steps Rockhampton physical activity intervention trial provided an opportunity to examine correlates of pedometer use at the population level . Methods Pedometer use was promoted across all intervention strategies including : local media , pedometer loan schemes through general practice , other health professionals and libraries , direct mail posted to dog owners , walking trail signage , and workplace competitions . Data on  pedometer use were collected during the 2-year follow-up telephone interviews from r and om population sample s in Rockhampton , Australia , and a matched comparison community ( Mackay ) . Logistic regression analyses were used to determine the independent influence of interpersonal characteristics and program exposure variables on pedometer use . Results Data from 2478 participants indicated that 18.1 % of Rockhampton and 5.6 % of Mackay participants used a  pedometer  in the previous 18-months . Rockhampton  pedometer  users ( n = 222 ) were more likely to be female ( OR = 1.59 , 95 % CI : 1.11 , 2.23 ) , aged 45 or older ( OR = 1.69 , 95 % CI : 1.16 , 2.46 ) and to have higher levels of education ( university degree OR = 4.23 , 95 % CI : 1.86 , 9.6 ) . Respondents with a BMI > 30 were more likely to report using a pedometer  ( OR = 1.68 , 95 % CI : 1.11 , 2.54 ) than those in the healthy weight range . Compared with those in full-time paid work , respondents in ' home duties ' were significantly less likely to report  pedometer use ( OR = 0.18 , 95 % CI : 0.06 , 0.53 ) . Exposure to individual program components , in particular seeing 10,000 Steps street signage and walking trails or visiting the website , was also significantly associated with greater  pedometer use . Conclusion  Pedometer use varies between population subgroups , and alternate strategies need to be investigated to engage men , people with lower levels of education and those in full-time ' home duties ' , when using pedometers in community-based physical activity promotion initiatives Background Large-scale RCTs comparing different types of exercise training in institutionalised older people are scarce , especially regarding effects on habitual physical activity and constipation . This study investigated the effects of different training protocol s on habitual physical activity and constipation of older adults living in long-term care facilities . Methods A r and omized controlled trial with 157 participants , aged 64 to 94 years , who were r and omly assigned to 1 ) resistance training ; 2 ) all-round functional-skills training ; 3 ) both ; or 4 ) an ' educational ' control condition .  Habitual physical activity was assessed with a physical activity question naire and accelerometers . Constipation was assessed by a question naire . Measurements were performed at baseline and after six months of training . Results At baseline the median time spent sitting was 8.2 hr/d , the median time spent on activity of at least moderate intensity was 32 min/d . At baseline , about 22 % of the subjects were diagnosed with constipation and 23 % were taking laxatives . There were no between-group differences for changes in habitual physical activity or constipation over 6-months . ConclusionS ix months of moderate intensity exercise training neither enhances habitual physical activity nor affects complaints of constipation among older people living in long-term care facilities BACKGROUND Despite well-known benefits of physical activity for older adults , about two thirds are underactive . Community-based programs are needed to facilitate increased physical activity . We examine the effectiveness of CHAMPS II , an inclusive , choice-based physical activity promotion program to increase lifetime physical activity levels of seniors . CHAMPS guided participants to choose activities that took into account their health , preferences , and abilities . It offered information on ways for them to exercise safely , motivate themselves , overcome barriers , and develop a balanced exercise regimen . METHODS A 1-year r and omized controlled trial was conducted with physically underactive seniors in a multispecialty group practice . Changes in self-reported physical activity by group were evaluated using ANCOVA , controlling for age and sex . RESULTS Of 173 r and omized subjects , 164 ( 95 % ) completed the trial . Subjects were aged 65 to 90 years ( M = 74 , SD = 6 ) ; 66 % were female . The intervention group increased estimated caloric expenditure by 487 calories/week in moderate ( or greater ) intensity activities ( MET > /= 3.0 ; p < .001 ) and by 687 calories/week in physical activities of any intensity ( p < .001 ) . Control group changes were negligible . Between-group analyses found that the changes were significantly different in both measures ( p values < .05 ) . Overweight persons especially benefited from this program . The program was as effective for women , older adults ( 75 + ) , and those who did not set aside time to exercise at baseline . CONCLUSIONS The program led to meaningful physical activity increases . Individually tailored programs to encourage lifestyle changes in seniors may be effective and applicable to health care and community setting Background : Intervention trials with self-selected participants have shown that mailed stage-targeted print material s can increase participation in physical activity in the short term . We examined the effects of a mailed stage-targeted print intervention design ed to promote physical activity , in a r and om sample of adults living in a regional city . Method : Participants ( n = 462 , 40–60 years of age ) were r and omly allocated to an intervention in - 227 ) or control group ( n - 235 ) . Measures included vali date d 2-week physical activity recall and stage of motivational readiness for physical activity . The intervention consisted of a single mailing of a letter and full-color stage-targeted booklets ( specific to precontemplation , contemplation , preparation , and action/maintenance ) 1 week postbaseline . Follow-up interviews were conducted at 2 and 6 months postbaseline . Results : After 2 months , participants in the intervention group were significantly More likely to meet the current American College of Sports Medicine/Centers for Disease Control and Prevention recommendation for sufficient physical activity than those in the control group ( adjusted odds ratio [ OR ] - 2.40 ; 95 % confidence interval [ CI ] = 1.44–3.99 ) . After 6 months , intervention participants who reported receiving and reading the intervention material s were significantly more likely to be meeting the sufficient physical activity criterion compared with the control group ( adjusted OR = 2.03 ; 95 % Cl = 1.16–3.56 ) . Conclusions : The stage-targeted print intervention was effective in promoting short-term increases in physical activity and was most effective for participants who recognized and used the material s. This low-cost , generalizable intervention has demonstrated potential as a practical population -based physical activity promotion strategy . Further research is required before widespread dissemination would be justified , as additional strategies may be required to ensure sustained change A cluster r and omized study was conducted using a convenience sample of four Christian faith communities from which 27 African American women 60 and older were recruited . The purpose was to determine whether African American women receiving a physical activity intervention with spiritual strategies compared to a control group would demonstrate differences over time in physical activity behaviors and biomarkers , in self-efficacy for physical activity , and in barriers to physical activity . Results with baseline and 12-week measurements included significant between-group findings at 12 weeks on muscle strength activity ( minutes per week , z = -3.269 , p = 0.001 ; days per week , z = -3.384 , p = 0.001 ) , favoring the intervention group . There were significant between-group findings in 6-minute walk change scores ( z = -2.546 , p = 0.009 ) , favoring the intervention group . Barriers were significantly reduced within the intervention group ( z = -2.184 , p = 0.029 ) . Evidence suggests a physical activity intervention with spiritual strategies increases physical activity behavior . The Health Promotion Model can be used to develop physical activity interventions with spiritual strategies for older African American women in faith communities , thus , supporting Healthy People 2020 goals Although dietary nitrate ( NO3- ) ingestion appears to enhance exercise capacity and performance in young individuals , inconclusive findings have been reported in older people . Therefore , we conducted a double-blind , crossover r and omized clinical trial using beetroot juice in older healthy participants , who were classified as normal weight and overweight . We tested whether consumption of beetroot juice ( a rich source of NO3- ) for 1 week would increase nitric oxide bioavailability via the nonenzymatic pathway and enhance ( 1 ) exercise capacity during an incremental exercise test , ( 2 ) physical capability , and ( 3 ) free-living physical activity .  Twenty nonsmoking , healthy participants between 60 and 75 years of age and with a body mass index of 20.0 to 29.9 kg/m2 were included . Presupplementation and postsupplementation resting , submaximal , maximal , and recovery gas exchanges were measured . Physical capability was measured by h and -grip strength , time-up- and -go , repeated chair rising test , and 10-m walking speed . Free-living physical activity was assessed by triaxal accelerometry . Changes in urinary and plasmaNO3-concentrations were measured by gas chromatography-mass spectrometry . Nineteen participants ( male-to-female ratio , 9:10 ) completed the study .Beetroot  juice increased significantly both plasma and urinary NO3-concentrations ( P<.001 ) when compared with placebo . Beetroot juice did not influence resting or submaximal and maximal oxygen consumption during the incremental exercise test . In addition , measures of physical capability and physical activity levels measured in free-living conditions were not modified by beetroot juice ingestion . The positive effects of beetroot juice ingestion on exercise performance seen in young individuals were not replicated in healthy , older adults . Whether aging represents a modifier of the effects of dietary NO3-on muscular performance is not known , and mechanistic studies and larger trials are needed to test this hypothesis There is compelling evidence supporting the benefits of increased regular physical activity in older adults . The Experience Corps program in Baltimore MD was design ed in part as a community based approach to increasing physical activity that would also appeal to older adults who have historically not utilized health promotion programs . The Baltimore Experience Corps program places older volunteers in public elementary schools for 15 h a week in roles design ed to improve the academic outcomes of children and , simultaneously , increase the physical , cognitive and social activity of volunteers . This paper reports on the change in physical activity levels among older adults associated with participation in the Baltimore Experience Corps . In a pilot r and omized controlled evaluation , older adults were r and omly assigned to  Experience Corps ( EC participants ) or a waiting list control group . Ages ranged from 59–86 years , 96 % were African American , 94 % were women , and 84 % had annual incomes less than $ 15,000 . EC participants were required to serve ≥15 h a week . At follow-up after 4–8 months , an analysis of 113 r and omized volunteers revealed 53 % of the EC participants were more  active than the previous year by self-report , as compared to 23 % of the controls ( p<0.01 ) . When adjusted for age , gender and education , there was a trend toward increased physical activity in the EC participants as calculated by a kilocalorie per week increase of 40 % , versus a 16 % decrease in the controls ( p=0.49 ) . EC participants who reported “ low activity ” at baseline experienced an average 110 % increase in their physical activity at follow-up . Among the controls who were in the “ low activity ” group at baseline , there was , on average , only a 12 % increase in physical activity ( p=0.03 ) . Among those who were previously active , there was no significant difference ( p=0.30 ) . The pilot results suggest that a high intensity volunteer program that is design ed as a health promotion intervention can lead , in the short-term , to significant improvements in the level of physical activity of previously inactive older adult volunteers BACKGROUND Regular physical activity is known to help prevent chronic disease and promote healthy aging . Yet , most older women are not regularly active . This study attempts to identify objective ly measured attributes of the neighborhood environment that may be associated with physical activity levels in older women . METHODS Sociodemographics and  physical activity level , as measured by pedometer , were assessed in 158 overweight Caucasian and African-American postmenopausal women from southwestern Pennsylvania at the baseline evaluation of a r and omized clinical trial in 2002 - 2003 .  Geographic information systems technology was used to obtain neighborhood-level data , including  neighborhood socioeconomic status  ( SES ) indicators , the median year that homes were built ( as a proxy measure for urban form ) , and proximity to businesses and facilities . Multiple linear regression was used to test associations between individuals ' physical activity level and neighborhood characteristics . RESULTS After controlling for individual age , race/ethnicity , education , smoking status , and body mass index , indicators of low neighborhood SES , living in a neighborhood with homes built between 1950 and 1969 ( representing an urban form that is more pedestrian-friendly than after 1969 ) , and living within walking distance ( 1500 m ) of specific types of businesses and facilities were positively associated with individuals ' physical activity level measured by pedometer ( p < 0.05 ) . CONCLUSIONS Results suggest that certain aspects of the neighborhood environment may have an important influence on the physical activity levels of postmenopausal women . Results warrant future research to clarify the role of these environmental attributes in other population Abstract Objectives to test whether an occupation-based lifestyle intervention can sustain and improve the mental well-being of adults aged 65 years or over compared to usual care , using an individually r and omised controlled trial . Participants 288 independently living adults aged 65 years or over , with normal cognition , were recruited from two UK sites between December 2011 and November 2015 . Interventions lifestyle Matters is a National Institute for Health and Care Excellence recommended multi-component preventive intervention design ed to improve the mental well-being of community living older people at risk of decline . It involves weekly group sessions over 4 months and one to one sessions . Main outcome measures the primary outcome was mental well-being at 6 months ( mental health ( MH ) dimension of the SF-36 ) . Secondary outcomes included physical health dimensions of the SF-36 , extent of depression ( PHQ-9 ) , quality of life ( EQ-5D ) and loneliness ( de Jong Gierveld Loneliness Scale ) , assessed at 6 and 24 months . Results data on 262 ( intervention = 136 ; usual care = 126 ) participants were analysed using intention to treat analysis . Mean SF-36 MH scores at 6 months differed by 2.3 points ( 95 CI : −1.3 to 5.9 ; P = 0.209 ) after adjustments . Conclusions analysis shows little evidence of clinical or cost-effectiveness in the recruited population with analysis of the primary outcome revealing that the study participants were mentally well at baseline . The results pose questions regarding how preventive interventions to promote well-being in older adults can be effectively targeted in the absence of proactive mechanisms to identify those who at risk of decline . Trial Registration IS RCT N67209155 Sport and exercise can have several health benefits for people living with HIV . These benefits can be achieved through different types of physical activity , adapting to disease progression , motivation and social-ecological options . However , physical activity levels and adherence to exercise are generally low in people living with HIV . At the same time , high drop-out rates in intervention studies are prevalent ; even though they often entail more favourable conditions than interventions in the natural setting s. Thus , in the framework of an intervention study , the present study aims to explore social-ecological , motivational and volitional correlates of South African women living with HIV with regard to physical activity and participation in a sport and exercise health promotion programme . The qualitative data was produced in the framework of a non-r and omised pre-post intervention study that evaluated structure , processes and outcomes of a 10-week sport and exercise programme .  All 25 participants of the programme were included in this analysis , independent of compliance . Data was produced through question naires , participatory group discussion s , body image pictures , research diaries and individual semi-structured interviews . All participants lived in a low socioeconomic , disadvantaged setting . Hence , the psychological correlates are context ualised and social-ecological influences on perception and behaviour are discussed . The results show the importance of considering social-cultural and environmental influences on individual motives , perceptions and expectancies , the fear of disclosure and stigmatisation , sport and exercise-specific group dynamics and self-supporting processes . Opportunities and strategies to augment physical activity and participation in sport and exercise programmes in the context of HIV are discussed BACKGROUND The efficacy of physical activity with a healthful diet to reduce obesity is established ; however , little is known about the translation of effective lifestyle strategies for obesity reduction in primary care setting s. METHODS We assessed the effectiveness of a 2-year behaviorally based physical activity and diet program implemented entirely within clinical practice s to reduce obesity . A total of 490 sedentary , obese adults were r and omized to usual care ( n = 241 ) or to the behavioral intervention ( n = 249 ) . The usual care group received advice from their physicians about lifestyle as a strategy for obesity reduction . The behavioral intervention included individual counseling from health educators to promote physical activity with a healthful diet . The primary outcome was change in waist circumference ( WC ) . RESULTS A total of 396 participants completed the trial ( 80.8 % ) . A significant main effect was observed for WC change within the intervention compared with usual care ( P < .001 ) that was sustained at 24 months ( mean [ SE ] , -0.9 [ 0.4 ] vs 0.2 [ 0.4 ] cm ; P = .05 ) . Secondary analyses revealed significant main effects for change in WC in men ( P = .009 ) and women ( P = .02 ) . In men , the mean ( SE ) reduction in WC at 24 months was greater with behavioral intervention compared with usual care ( -1.6 [ 0.6 ] vs 0.1 [ 0.6 ] cm ; P = .049 ) . In women , the behavioral intervention was associated with differences in WC compared with usual care at 6 and 12 months ( P ≤ .01 ) but not at 24 months ( P = .10 ) . CONCLUSIONS Behavioral intervention in clinical setting s is associated with modest reductions in WC during a 2-year study in obese patients . However , the effectiveness of the intervention is restricted to men . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00665158 The sustainability of health and social care systems is threatened by a growing population of older persons with heterogeneous needs related to multimorbidity , frailty , and increased risk of functional impairment . Since disability is difficult to reverse in old age and is extremely burdensome for individuals and society , novel strategies should be devised to preserve adequate levels of function and independence in late life . The development of mobility disability , an early event in the disablement process , precedes and predicts more severe forms of inability . Its prevention is , therefore , critical to impede the transition to overt disability . For this reason , the Sarcopenia and Physical fRailty IN older people : multi-componenT Treatment strategies ( SPRINTT ) project is conducting a r and omized controlled trial ( RCT ) to test a multicomponent intervention ( MCI ) specifically design ed to prevent mobility disability in high-risk older persons . SPRINTT is a phase III , multicenter RCT aim ed at comparing the efficacy of a MCI , based on long-term structured physical activity , nutritional counseling/dietary intervention , and an information and communication technology intervention , versus a healthy aging lifestyle education program design ed to prevent mobility disability in 1500 older persons with physical frailty and sarcopenia who will be followed for up to 36 months . The primary outcome of the SPRINTT trial is mobility disability , operationalized as the inability to walk for 400 m within 15 min , without sitting , help of another person , or the use of a walker . Secondary outcomes include changes in muscle mass and strength , persistent mobility disability , falls and injurious falls , disability in activities of daily living , nutritional status , cognition , mood , the use of healthcare re sources , cost-effectiveness analysis , quality of life , and mortality rate . SPRINTT results are expected to promote significant advancements in the management of frail older persons at high risk of disability from both clinical and regulatory perspectives . The findings are also projected to pave the way for major investments in the field of disability prevention in old age Although telephone and mail are often used to promote physical activity adoption , their ability to produce long-term maintenance is unclear . In this study , 140 men and women aged 50 - 65 years received 1 year of telephone counseling  to adopt higher ( i.e. , more vigorous ) versus lower intensity ( i.e. , moderate ) exercise . After 1 year , participants were rer and omized to a 2nd year of contact via ( a ) telephone and mail or ( b ) predominantly mail . Participants who were prescribed higher intensity exercise and received predominantly mail had better exercise adherence during the maintenance year than those who received telephone and mail . Both strategies were similarly effective in promoting maintenance in the lower intensity condition . Results suggest that after successful adoption of physical activity with the help of telephone counseling , less intensive interventions are successful for physical activity maintenance in older adults Women living in socioeconomically disadvantaged neighbourhoods are at heightened risk for physical inactivity , but little is known about the correlates of physical activity among this group . Using a social-ecological framework , this study aim ed to determine the individual , social and neighbourhood environmental correlates of physical activity amongst women living in such neighbourhoods . During 2007 - 2008 women ( n = 4108 ) aged 18 - 45 years r and omly selected from urban and rural neighbourhoods of low socioeconomic status in Victoria , Australia completed the International Physical Activity Question naire ( long ) . They reported on individual ( self-efficacy , enjoyment , intentions , outcome expectancies , skills ) , social ( childcare , social support from family and friends/colleagues , dog ownership )  and  neighbourhood environmental ( neighbourhood cohesion , aesthetics , personal safety , ' walking environment ' )  factors . Multinomial logistic regression was used to examine the odds of increasing categories of  leisure time physical activity ( LTPA ) and transport-related physical activity ( TRPA ) for each individual , social and environmental factor . In partially adjusted analyses , all individual , social and environmental variables were positively associated with LTPA , while all individual factors , family and friend support and the walking environment were positively associated with TRPA . In fully adjusted multivariable models , all individual and social factors remained significantly associated with LTPA , while self-efficacy , enjoyment , intentions , social support , and neighbourhood ' walking environment ' variables remained significantly associated with TRPA . In conclusion , individual and social factors were most important for LTPA , while individual , social and neighbourhood environmental factors were all associated with TRPA . Acknowledging the cross-sectional design , the findings highlight the importance of different levels of potential influence on physical activity in different domains , which should be considered when developing strategies to promote physical activity amongst women living in socioeconomically disadvantaged neighbourhoods BACKGROUND The physical activity level of older adults with intellectual disabilities ( ID ) is extremely low , and their fitness levels are far beneath accepted norms for older people with normal intelligence and comparable with frail older people . A physical activity programme , including an education programme , was developed for older adults with ID using behaviour change techniques . The programme aim ed at improving or maintaining adequate levels of physical activity ( primary outcome measure ) and motor fitness , cardio respiratory fitness , morphologic and metabolic fitness , activities of daily living , cognitive functioning and depressive symptoms ( secondary outcome measures ) . METHOD The programme 's efficacy was evaluated in a cluster-r and omised clinical trial among people aged 43 years and over with mild-moderate levels of ID . Five day-activity centres were r and omised to the participation group . In these centres , 81 older adults participated in groups of 8 to 10 in the programme , three times a week during 8 months . The programme was executed by physical activity instructors and staff of day-activity centres . Five other day-activity centres were r and omised to the control group ; 70 older adults in these centres received care as usual . The generalised linear model with mixed effects was used to test the programme 's effectiveness . RESULTS Significant effects were found on physical activity , muscle strength , systolic and diastolic blood pressure , serum cholesterol level and cognitive functioning , in favour of the programme 's participants . No significant improvements were found on balance , serum glucose , weight , waist circumference , walking speed , mobility , depression or instrumental activities of daily living . CONCLUSIONS The physical activity and fitness programme has established small but significant effects in this sample , but generalising the findings to other setting s is difficult due to significant participant dropout . Implementation of evidence -based physical activity programmes among older adults with ID is recommended . Further research is needed to investigate the effectiveness of physical activity on daily life functioning and the development on chronic diseases in the long run BACKGROUND Regular physical activity reduces the risk for chronic diseases among older adults . Older adults are likely to be seen by primary care clinicians who can play a role in promoting physical activity among their patients . DESIGN In this r and omized controlled trial ( 1998 - 2003 ; data analyzed 2004 - 2005 ) , we compared the effects of brief advice to exercise from a clinician supplemented by telephone-based counseling by health educators ( extended advice ) to brief advice from a clinician alone ( brief advice ) . SETTING / PARTICIPANTS A total of 100 primary care patients ( 63.2 % female , 14.7 % minority , mean age=68.5 years ) participated in the trial . INTERVENTIONS The extended-advice intervention consisted of clinician advice plus exercise counseling via telephone provided by research staff , and the brief advice condition consisted of clinician advice alone . Both interventions focused on promoting moderate-intensity physical activity . MAIN OUTCOME MEASURES Self-reported physical activity using the 7-Day Physical Activity Recall instrument and objective activity monitoring using Biotrainers were assessed at baseline , and at 3 and 6 months . RESULTS Participants in the extended-advice arm reported significantly greater participation in moderate-intensity physical activity than the brief-advice group at 3 months ( + 57.69 minutes vs 12.45 minutes ; 3.84 kcal/week vs 0.83 kcal/week ) and 6 months ( + 62.84 minutes vs 16.60 minutes ; 4.19 kcal/week vs 1.1 kcal/week ) . Objective activity monitoring also showed significantly increased physical activity among extended-advice versus brief-advice participants at both time points ( + 50.79 vs -11.11 ; + 42.39 vs -24.18 , respectively ) . CONCLUSIONS These data indicate that clinician advice with follow-up counseling can promote adoption of moderate-intensity physical activity among older , primary care patients Background Limited data are available on the development , implementation and evaluation processes of physical activity promotion programmes among older adults . More integrative insights into interventions describing the planned systematic development , implementation and evaluation are needed . Methods and design The purpose of this study is to give an integrative insight into the development of the Active plus programme applying the six-step Intervention Mapping protocol . The Active plus programme consisted of two theory- and evidence -based tailored physical activity promotion interventions , both comprising three tailored letters delivered over four months and aim ed at raising awareness of insufficient physical activity , and stimulating physical activity initiation and maintenance among the over-fifties . The first intervention , the basic tailored intervention , provided tailored letters that intervened on the psychosocial determinants of physical activity . The second intervention , the intervention plus , provided the same tailored information but additionally provided tailored information about physical activity opportunities in the specific environment in which the older adults lived . This environment-based component also provided access to a forum and e-buddy system on a website . A plan for implementation and evaluation is also described . Discussion The planned development of the Active plus programme result ed in two theory- and evidence -based tailored physical activity interventions targeted at the over-fifties . Trial Registration Dutch Trial Register NTR Abstract Objective . To investigate the efficacy of a guided and grade d home-based exercise program for improving a range of physical outcomes in older people . Design . Controlled clinical trial of 16 weeks Setting . Two geographical areas in Gent , Belgium Participants . 66 independent-living older people ( age : 71 - 98 ) with a history of falls and moderate physical impairment Intervention . Twenty-four 30-minute training sessions were given by a trained physiotherapist over a period of 16 weeks in the participant ’s home . Different types of exercises on balance , aerobic performance , flexibility , and muscle strength were provided . Main outcome measures . Muscle strength , static and dynamic balance , aerobic performance , activities in daily living , fear of falling and avoidance of daily activities were assessed at baseline and after 16 weeks intervention . Results : At baseline , there were no significant differences in the measured variables between exercise and control groups . After 16 weeks , the exercise group showed significantly improved ankle muscle strength , balance performance and aerobic capacity , and decreased fear of falling , dependency in daily activities and avoidance of daily activities compared to the control group . The improvements in knee muscle strength , timed chair st and s , and functional reach were not significant . Conclusion : The home-based , individualized exercise program was effective in reducing several physical factors associated with falls in community-dwelling older people with moderate physical impairment . The decrease in fear of falling and other behavioural variables needs to be considered with care and needs further investigation PURPOSE People are now living longer , but disability may affect the quality of those additional years of life . We undertook a trial to assess whether case finding reduces disability among older primary care patients . METHODS We conducted a cluster-r and omized trial of the Brief Risk Identification Geriatric Health Tool ( BRIGHT ) among 60 primary care practice s in New Zeal and , assigning them to an intervention or control group . Intervention practice s sent a BRIGHT screening tool to older adults every birthday ; those with a score of 3 or higher were referred to regional geriatric services for assessment and , if needed , service provision . Control practice s provided usual care . Main outcomes , assessed in blinded fashion , were residential care placement and hospitalization , and secondary outcomes were disability , assessed with Nottingham Extended Activities of Daily Living Scale ( NEADL ) , and quality of life , assessed with the World Health Organization Quality of Life scale , abbreviated version ( WHOQOL-BREF ) . RESULTS All 8,308 community-dwelling patients aged 75 years and older were approached ; 3,893 ( 47 % ) participated , of whom 3,010 ( 77 % ) completed the trial . Their mean age was 80.3 ( SD 4.5 ) years , and 55 % were women . Overall , 88 % of the intervention group returned a BRIGHT tool ; 549 patients were referred . After 36 months , patients in the intervention group were more likely than those in the control group to have been placed in residential care : 8.4 % vs 6.2 % ( hazard ratio = 1.32 ; 95 % CI , 1.04–1.68 ; P = .02 ) . Intervention patients had smaller declines in mean scores for physical health-related quality of life ( 1.6 vs 2.9 points , P = .007 ) and psychological health-related quality of life ( 1.1 vs 2.4 points , P = .005 ) . Hospitalization , disability , and use of services did not differ between groups , however . CONCLUSIONS Our case-finding strategy was effective in increasing identification of older adults  with disability  , but there was little evidence of improved outcomes . Further research could trial stronger primary care integration strategies OBJECTIVES : Human Immunodeficiency Virus ( HIV ) infection worsens the frailty of elderly people , compromising their quality of life . In this study we prospect ively evaluated eleven patients living with HIV and 21 controls older than 60 years and without prior regular physical activity , who engaged in a one-year progressive resistance exercise program  to compare its effects on muscular strength , physical fitness and body composition . METHODS : Exercises for major muscular groups were performed 2 times/week , under professional supervision . Strength increase was evaluated bimonthly , while body composition , lipid and glycaemic profiles ( only of those living with HIV ) and physical fitness were evaluated before and after the one-year training . RESULTS : The participants living with HIV were lighter , had smaller Body Mass Index and were initially much weaker than controls . However , their strength increased more ( 1.52 - 2.33 times the baseline values for those living with HIV x 1.21 - 1.48 times for controls , p<0.01 ) , nullifying the differences initially seen . These effects were seen independently of gender , age or baseline physical activity . In addition , those living with HIV improved their fasting glucose levels and showed a tendency to improve their lipids after the one year training program . These effects were slightly more pronounced among those not using protease inhibitors , although not significantly . CONCLUSIONS : Resistance exercise safely increased the strength of older patients living with HIV adults , allowing them to achieve performance levels observed among otherwise healthy controls . These findings favor the recommendation of resistance exercise for elderly adults living with HIV adults AIM This paper reports a study comparing , over a 5-month period , two different methods of increasing physical activity : a traditional exercise programme and one based on motivational interviewing . BACKGROUND Chronic heart failure is associated with poor quality of life that can be improved by increased physical activity . Patients who are directed to engage in physical activity have a record of low compliance . METHOD Sixty older aged heart failure patients were r and omly assigned to st and ard care , motivational interviewing or both treatments . The primary outcome was physical activity ( kcal/kg/day ) , with the 6-minute walk test as a secondary outcome . FINDINGS At entry , no significant differences were observed between the three groups . Following treatment , the ' motivational interviewing ' and ' both treatments ' groups reported an increase in their level and type of activities , whereas the ' st and ard care ' group did not . All groups significantly increased their 6-minute walk distance . CONCLUSIONS Motivational interviewing , which incorporates established behaviour change principles and a flexible approach to promotion of activity , increases reported physical activity in older patients with heart failure over a short period . In terms of level and type of activity , this approach gives a better outcome than st and ard care , and nurses should explore alternative strategies to promote health in this population CONTEXT Preventing the development of disability in activities of daily living is an important goal in older adults , yet relatively little is known about the disabling process . OBJECTIVES To evaluate the relationship between 2 types of intervening events ( hospitalization and restricted activity ) and the development of disability and to determine whether this relationship is modified by the presence of physical frailty . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve cohort study , conducted in the general community in greater New Haven , Conn , from March 1998 to March 2003 , of 754 persons aged 70 years or older , who were not disabled ( ie , required no personal assistance ) in 4 essential activities of daily living :  bathing , dressing , walking inside the house , and transferring from a chair . Participants were categorized into 2 groups according to the presence of physical frailty ( defined on the basis of slow gait speed ) and were followed up with monthly telephone interviews for up to 5 years to ascertain exposure to intervening events and determine the occurrence of disability . MAIN OUTCOME MEASURE Disability , defined as the need for personal assistance in bathing , dressing , walking inside the house , or transferring from a chair . RESULTS During the 5-year follow-up period , disability developed among 417 ( 55.3 % ) participants , 372 ( 49.3 % ) were hospitalized and 600 ( 79.6 % ) had at least 1 episode of restricted activity . The multivariable hazard ratios for the development of disability were 61.8 ( 95 % confidence interval [ CI ] , 49.0 - 78.0 ) within a month of hospitalization and 5.54 ( 95 % CI , 4.27 - 7.19 ) within a month of restricted activity . Strong associations were observed for participants who were physically frail and those who were not physically frail . Hospital admissions for falls were most likely to lead to disability . Intervening events occurring more than a month prior to disability onset were not associated with the development of disability . The population -attributable fractions associated with new exposure to hospitalization and restricted activity , respectively , were 0.48 and 0.19 ; 0.40 and 0.20 , respectively , for frail participants and 0.61 and 0.16 , respectively , for nonfrail participants . CONCLUSIONS Illnesses and injuries leading to either hospitalization or restricted activity represent important sources of disability for older persons living in the community , regardless of the presence of physical frailty . These intervening events may be suitable targets for the prevention of disability R egular physical activity has been shown to have beneficial effects on both physical and mental health.i4 The Centers for Disease Control and the American College of Sports Medicine have suggested that adults should accumulate at least 30 minutes of moderate physical activity during the course of most days . * In the elderly population , moderate physical activity , such as walking , is associated with improved health outcomes .*5 Nevertheless , the majority of older people are sedentary . Results from the 1985 National Health Interview Survey show that two-thirds of those ages 65 and over do not exercise regularly.‘j The benefits of physical activity for elderly women include decreased risk of osteoporosis , decreased incidence of depression , and increased functional status.‘~7W’0 Despite these findings , the Behavioral Risk Factor Surveillance System reported that in 1990 , 86.7 % of women surveyed ages 65 and over were sedentary.i ’ Yet , little is known about the determinants of exercise behavior in this population . Interventions to increase physical activity in the elderly include public education campaigns , formal education , and training programs.‘2-‘4 These efforts have been unsuccessful at maintaining the adoption of this behavior.‘2-‘4 Dishman et all3 report that 50 % of those who participate in organized exercise programs such as aerobics classes will drop out during the first 3 - 6 months . An individual ’s knowledge , attitude , and demographics are some factors that research ers have found to influence exercise habits.13 Among elderly women , physical and health problems , time constraints , personal issues such as inclement weather , lack of companionship , safety concerns , and lack of motivation interfere with regular exercise.15 Our objective was to use telecommunications technology to underpin an intervention that would be effective , easy to use , convenient , and inexpensive BACKGROUND Many American adults remain sedentary despite many known health benefits . Research on the determinants of physical activity have indicated that social support is one of the strongest correlates , but little is known about this relation in important subgroups of middle and older-aged women . OBJECTIVE The purpose of this study was to assess the association of physical activity-related social support on several measures of physical activity in a national sample of minority women . A unique aspect of these measures is the inclusion of vigorous household tasks and occupational physical activities . METHODS The US Women 's Determinants Study was conducted in 1996 - 1997 . The survey was a modified-r and om sample , telephone survey of 2912 Black , Hispanic , American Indian/Alaskan Native , and White women age 40 and older . A composite score of  physical activity social support ( PASS ) was analyzed as the independent variable in logistic regression analyses . Four measures of physical activity levels served as the dependent variables . A separate analysis was done to distinguish PASS from friends versus PASS from relatives . The potential confounding effect of race/ethnicity , marital status , age , income and education were evaluated and adjusted in the models . RESULTS Hispanic women were more likely to have high PASS scores than the other racial/ethnic groups . Odds ratios indicate that subjects with high levels of PASS were significantly less likely to be sedentary than those with low support , even after adjusting for race/ethnicity . While there were significant associations among levels of social support and physical activity , this was not true for the measure of " regular exercise .  " There was no significant difference between the contribution of " friend " support versus " family " support on all four measures on physical activity . DISCUSSION Based on our results , enhancing social support may be an important aspect of interventions aim ed at increasing physical activity in a population of sedentary women of various racial/ethnic background s. Also , " regular exercisers " in this population appear to be less reliant social support to maintain their behavior BACKGROUND Physical and cognitive activity seems to be an effective strategy by which to promote age-sensitive fluid cognitive abilities in older adults . METHOD In this r and omized controlled trial , 70 healthy senior citizens ( age 60 - 75 ) were allocated to a physical , cognitive , combined physical plus cognitive , and waiting control group . The trial assessed information processing speed , short-term memory , spatial relations , concentration , reasoning , and cognitive speed . RESULTS In contrast to the control group , the physical , cognitive , and combined training groups enhanced their concentration immediately after intervention . Only the physical training group showed improved concentration 3 months later . The combined training group displayed improved cognitive speed both immediately and three months after intervention . The cognitive training group displayed improved cognitive speed 3 months after intervention . CONCLUSIONS Physical , cognitive , and combined physical plus cognitive activity can be seen as cognition-enrichment behaviors in healthy older adults that show different rather than equal intervention effects Background The physical activity ( PA ) levels of many children and adolescents in Australia are currently insufficient to promote health benefits . Physical education ( PE ) programs aim to promote PA and reach nearly all school-aged children , but PA levels within PE lessons are often low . PE teachers may influence children ’s motivation to be physically active in PE lessons , but little is known about teacher strategies that effectively motivate children to participate in PA , and few intervention studies have examined motivational strategies in PE . The purpose of this study was to compare the effect of three motivational strategies , each based on Self-Determination Theory ( SDT ) , on PA levels , and their hypothesized antecedents , during year 8 PE lessons . Methods / design This study employed a cluster-r and omized controlled trial design . Following a familiarization session , PA levels and hypothesized PA antecedents were measured during a baseline lesson and a post-intervention or control lesson .  Teachers ( n = 16 ) and their classes from five secondary schools in Sydney , Australia were r and omly assigned into four blocks and instructed to provide one of four 20-min lesson teaching strategy conditions : ( 1 ) explaining the relevance of activities ; ( 2 ) providing choice from PA options selected by the teacher ; ( 3 ) providing equipment and free choice of activities ; or ( 4 ) usual practice . The primary outcomes were lesson time spent in moderate-to-vigorous PA , and motivation towards the lesson . Secondary outcomes were perceptions of teacher behavior , psychological needs satisfaction , and lesson time spent in sedentary behavior . PA and sedentary behavior were measured during baseline and post-intervention lessons with waist-mounted Actigraph GT3X accelerometers . Teacher behavior , psychological needs satisfaction , and motivation were assessed via question naires at the end of each lesson . Linear mixed-model analyses will be run on all outcomes , with students nested within teachers as a r and om effect . Discussion Study findings will inform the development of effective SDT-based teaching strategy interventions to enhance students ’ psychological needs satisfaction , motivation , and PA levels . More effective teaching strategies may be identified that are capable of improving  adolescents ’ PA levels , and thereby provide beneficial population health outcomes .Trial registration This trial is registered with Current Controlled Trials and is traceable as IS RCT N07038258 Background Physical activity contributes to older adults ’ autonomy , mobility , and quality of life as they age , yet fewer than 1 in 5 engage in activities as recommended . Many older adults track their exercise using pencil and paper , or their memory . Commercially available physical activity monitors ( PAM ) have the potential to facilitate these tracking practice s and , in turn , physical activity . An assessment of older adults ’ long-term experiences with PAM is needed to underst and this potential . Objective To assess short and long-term experiences of adults > 70 years old using a PAM ( Fitbit One ) in terms of acceptance , ease-of-use , and usefulness : domains in the technology acceptance model . Methods This prospect i ve study included 95 community-dwelling older adults , all of whom received a PAM as part of r and omized controlled trial piloting a fall-reducing physical activity promotion intervention . Ten-item surveys were administered 10 weeks and 8 months after the study started . Survey ratings are described and analyzed over time , and compared by sex , education , and age . Results Participants were mostly women ( 71/95 , 75 % ) , 70 to 96 years old , and had some college education ( 68/95 , 72 % ) . Most participants ( 86/95 , 91 % ) agreed or strongly agreed that the  PAM  was easy to use , useful , and acceptable both 10 weeks and 8 months after enrolling in the study . Ratings dropped between these time points in all survey domains : ease-of-use ( median difference 0.66 points , P=.001 ) ; usefulness ( median difference 0.16 points , P=.193 ) ; and acceptance ( median difference 0.17 points , P=.032 ) . Differences in ratings by sex or educational attainment were not statistically significant at either time point . Most participants 80 + years of age ( 28/37 , 76 % ) agreed or strongly agreed with survey items at long-term follow-up , however their ratings were significantly lower than participants in younger age groups at both time points . Conclusions Study results indicate it is feasible for older adults ( 70 - 90 + years of age ) to use PAMs when self-tracking their physical activity , and provide a basis for developing recommendations to integrate PAMs into promotional efforts . Trial Registration Clinical trials.gov NCT02433249 ; https:// clinical trials.gov/ct2/show/NCT02433249 ( Archived by WebCite at http://www.webcitation.org/6gED6eh0I Although physical activity is an effective way to cope with ageing-related impairments , few older people are motivated to turn their sedentary lifestyle into an active one . Recent evidence suggests that walking can be more effectively promoted in older adults with positive messages about the benefits of walking than with negative messages about the risks of inactivity . This study examined motivation and memory as the supposed mechanisms underlying the greater effectiveness of positively framed compared to negatively framed messages for promoting activity . Older adults ( N = 53 , age 60–87 years ) were introduced to six physical activity programmes that were r and omly paired with either positively framed or negatively framed messages . Participants indicated how motivated they were to participate in each programme by providing ratings on attractiveness , suitability , capability and intention . They also completed surprise free recall and recognition tests . Respondents felt more motivated to participate in physical activity programmes paired with positively framed messages than in those with negatively framed ones . They also had better recognition memory for positively framed than negatively framed messages , and misremembered negatively framed messages to be positively framed . Findings support the notion that socioemotional selectivity theory — a theory of age-related changes in motivation — is a useful basis for health intervention design PURPOSE Prolonged sitting has emerged as a risk factor for early mortality , but the extent of benefit realized by replacing sitting time with exercise or activities of everyday living ( i.e. , nonexercise activities ) is not known . METHODS We prospect ively followed 154,614 older adults ( 59 - 82 yr ) in the National Institutes of Health-AARP Diet and Health Study who reported no major chronic diseases at baseline and reported detailed information about sitting time , exercise , and nonexercise activities .  Proportional hazard models were used to estimate adjusted hazard ratios and 95 % confidence intervals ( HR ( 95 % confidence interval ) ) for mortality . An isotemporal modeling approach was used to estimate associations for replacing sitting time with specific types of physical activity , with separate models fit for less active and more active participants to account for nonlinear associations . RESULTS During 6.8 yr ( SD , 1.0 ) of follow-up , 12,201 deaths occurred . Greater sitting time ( ≥12 vs < 5 h·d(-1 ) ) was associated with increased risk for all-cause and cardiovascular mortality . In less active adults ( < 2 h·d(-1 ) total activity ) , replacing 1 h·d(-1 ) of sitting with an equal amount of activity was associated with lower all-cause mortality for both exercise ( HR , 0.58 ( 0.54 - 0.63 ) ) and nonexercise activities ( HR , 0.70 ( 0.66 - 0.74 ) ) , including household chores , lawn and garden work , and daily walking . Among more active participants ( 2 + h·d(-1 ) total activity ) , replacement of sitting time with purpose ful exercise was associated with lower mortality ( HR , 0.91 ( 0.88 - 0.94 ) ) but not with nonexercise activity ( HR , 1.00 ( 0.98 - 1.02 ) ) . Similar results were noted for cardiovascular mortality . CONCLUSIONS Physical activity intervention strategies for older adults often focus on aerobic exercise , but our findings suggest that reducing sitting time and engaging in a variety of activities is also important , particularly for inactive adults BACKGROUND Currently there is a great deal of interest in multi strategy community-based approaches to changing physical activity or health behaviors . The aim of this article is to describe the effectiveness of the physical activity promotion project " 10,000 Steps Ghent " after 1 year of intervention . METHODS A multi strategy community-based intervention was implemented in 2005 with follow-up measurements in 2006 to promote physical activity to adults . A local media campaign , environmental approaches , the sale and loan of pedometers , and several local physical activity projects were concurrently implemented . In 2005 , 872 r and omly selected subjects ( aged 25 to 75 ) , from the intervention community Ghent and 810 from a comparison community , participated in the baseline measurements . Of these , 660 intervention subjects and 634 comparison subjects completed the follow-up measurements in 2006 . Statistical analyses were performed in 2006 . RESULTS After one year there was an increase of 8 % in the number of people reaching the " 10,000 steps " st and ard in Ghent , compared with no increase in the comparison community . Average daily steps increased by 896 ( 95 % CI=599 - 1192 ) in the intervention community , but there was no increase in the comparison community ( mean change -135 [ 95 % CI= -432 to 162 ] ) ( F time x community=22.8 , p<0.001 ) . Results are supported by self-reported International Physical Activity Question naire ( IPAQ ) data . CONCLUSIONS The " 10,000 steps/day " message reached the Ghent population and the project succeeded in increasing pedometer-determined physical activity levels in Ghent , after 1 year of intervention This study examined the feasibility and effectiveness for increasing physical activity of a print-based intervention , and a print- plus telephone-mediated intervention among mid-life and older Australian adults . A r and omised controlled trial study design was used . In mid-2002 , 66 adults ( 18 men , 48 women ) aged 45 - 78 years , who identified themselves as underactive , were recruited through advertisements and word-of-mouth at two sites ( Melbourne and Brisbane ) , and r and omised to either the  print or print-plus-telephone mediated intervention group . Participants in both groups attended an initial briefing session , and over the 12-week intervention period received an instructional newsletter and use of a pedometer ( both groups ) , and individualised telephone calls ( print-plus-telephone group only ) . Self-reported physical activity data were collected at baseline , 12 and 16 weeks . Measures of self-reported global physical activity , moderate-vigorous intensity activity and walking all showed increases between baseline and 12 weeks for both intervention groups . These increases were generally maintained by 16 weeks , although participants in the print-plus-telephone group maintained slightly higher levels of global reported activity and walking ( by approximately 30 mins/wk ) than those in the print group . These interventions show potential for promoting initial increases in physical activity among mid-life and older Australian adults , and should be evaluated across more extended time periods The promotion of physical activity is encouraged in people living with HIV and AIDS ( PLWHA ) as a means of promoting wellness and health . Adherence to programmes that promote exercise is often reduced , and home-based programmes are suggested to improve adherence . This study investigated the personal and environmental factors that cause barriers and facilitators of physical activity in a home-based pedometer walking programme as a means of highlighting adherence challenges . An observational study nested in a r and omised controlled trial was conducted in a cohort of South African PLWHA on antiretroviral therapy over a six-month period . Descriptive analysis and qualitative content analysis of 42 participants who underwent physical activity modification assisted with data review . The mean age of the sample was 38.7 ( ±8.9 ) years , consisted mostly of women ( n = 35 ; 83.3 % ) who were employed ( n = 19 ; 45.2 % ) but earning very little ( less than R500 per month ) and often single or widowed ( n = 23 ; 54.8 % ) . Barriers to physical activity identified included physical complaints , e.g. , low-energy levels ; psychological complaints , e.g. , stress levels ; family responsibility , e.g. , being primary caregivers ; the physical environment , e.g. , adverse weather conditions ; social environment , e.g. , domestic abuse and crime ; and workplace , e.g. , being in a sedentary job . Facilitators of physical activity included support and encouragement from friends and family , religious practice s during worship and community environment , e.g. , having access to parks and sport fields . The study is of benefit as it highlights personal and environmental factors that need to be considered when developing or implementing a home-based walking programme in PLWHA The objective of this study is to describe the rationale , design and selected baseline results of a 2-year r and omized-controlled trial ( RCT ) on the effects of physical activity counseling in community-living older people . After a four-phase screening and data - collection process targeting all independently living people in the city center of Jyväskylä , Finl and , six hundred and thirty-two 75 - 81-year-old cognitively intact , sedentary persons who were able to move independently outdoors at least minimally and willing to take part in the RCT were r and omized into intervention and control groups . At baseline , over half of the subjects exercised less than two to three times a month and two-thirds were willing to increase their physical activity level . The desire to increase physical activity was more common ( 86 % ) among subjects with mobility limitation compared with those without ( 60 % , P=0.004 ) . The intervention group received an individualized face-to-face counseling session , followed by phone contacts every 3 months throughout the intervention . The study outcomes include physical activity level , mobility limitation , functional impairments , disability , mood , quality of life , use of services , institutionalization and mortality . The screening and recruitment process was feasible and succeeded well , and showed that unmet physical activity needs are common in older people Background : Physical activity has been effective in enhancing quality of life ( QOL ) of older adults over relatively short periods of time . However , little is known about the longterm effects of physical activity and even less about the possible mediators of this relationship . Purpose : We examined the mediating effects of psychological variables on the relationship between  physical activity  and global QOL ( satisfaction with life ) in older adults over a 4-year period . Methods : Participants ( N = 174 , M age = 66.7 years ) completed a battery of psychosocial measures at 1 and 5 years following enrollment in a 6-month r and omized controlled exercise trial .  Results : Panel analysis conducted within a covariance modeling framework indicated that physical activity was related to self-efficacy , physical self-esteem , and positive affect at 1 year , and in turn , greater levels of self-efficacy and positive affect were associated with higher levels of QOL . Analyses indicated that changes in physical activity over the 4-year period were related to increases in physical self-esteem and positive affect , but only positive affect directly influenced improvements in QOL . Conclusions : The findings lend support to the position that physical activity effects on QOL are in part mediated by intermediate psychological outcomes and that physical activity can have long-term effects on well-being OBJECTIVE To assess the patterns and determinants of physical activity  among Saudi adult males living in Riyadh . METHODS Self-administered question naires were filled out by 1333 r and omly selected Saudi males 19 years and older , during the Fall of 1996 . RESULTS Over 53 % of Saudi males were totally physically inactive , and another 27.5 % were irregularly active . Only 19 % of the entire sample were active on a regular basis . A curvilinear relationship was found between age and inactivity , with the middle age group the least active .  Physical activity  was lower among those who were married , work in the private sectors , working 2 shifts , less educated , or who had only one day off during the week . Time constraint seems to be the major contributing factor to inactivity , while maintaining health and losing weight were the most important reason for being physically active among Saudi males . CONCLUSION The proportion of Saudi males who are at risk for inactivity is very high . Indeed , it is exceedingly higher than those who are at risk for hypertension , hypercholesterolemia , obesity , or cigarette smoking . Public policies are needed to encourage active living and discourage sedentary habits . Health care providers have an important role in promoting physical activity among the population BACKGROUND Self-management is recommended for patients with chronic conditions , but its use with cancer survivors is underexplored . Optimal strategies for achieving lifestyle changes in cancer survivors are not known . OBJECTIVE We aim ed to determine feasibility , acceptability and preliminary efficacy of self-management-based nutrition and physical activity interventions for cancer survivors . DESIGN , SETTING AND PARTICIPANTS Adult survivors ( n = 25 ) during ( Group 1 , n = 11 ) or post ( Group 2 , n = 14)-curative chemotherapy for solid tumours , most ( n = 20 , 80 % ) with breast cancer , were recruited prospect ively from a single clinical centre . INTERVENTION The Flinders Living Well Self-Management Program , a generic self-management care planning programme , was utilized to establish patient-led nutrition and exercise goals within a tailored 12-week intervention . Fortnightly progress review s occurred with assessment s at baseline , 6 and 12 weeks . RESULTS Most participants ( 84 % ) found the intervention acceptable/very acceptable . Both groups showed a trend towards significant improvement in the self-management capability ' knowledge about changing risk factors ' ( P = 0.047 ) ; Group 2 showed a trend towards significantly improved ' psychological impacts ' ( P = 0.007 ) . Goal ratings improved for both groups ( P = 0.001 ) . Quality of life improved for both groups for emotional functioning ( P = 0.03 ) . Physical functioning improved for Group 2 ( P = 0.05 ) ; however , most symptom domains worsened for Group 1 , as expected given their treatment stage . DISCUSSION AND CONCLUSIONS Self-management interventions are feasible for this population . In particular , building self-management capacity during the active phase of patients ' cancer treatment provides health and psychosocial benefits . Larger r and omized controlled trials are required to further determine efficacy . Further translational research is also needed to determine acceptability , feasibility , enablers and barriers for clinicians embedding this approach into routine cancer survivorship care BACKGROUND More evidence is needed on the potential role of ' booster ' interventions in the maintenance of increases in physical activity levels after a brief intervention in relatively sedentary population s. OBJECTIVES To determine whether objective ly measured physical activity , 6 months after a brief intervention , is increased in those receiving physical activity ' booster ' consultations  delivered in a motivational interviewing ( MI ) style , either face to face or by telephone . DESIGN Three-arm , parallel-group , pragmatic , superiority r and omised controlled trial with nested qualitative research fidelity and geographical information systems and health economic sub studies . Treatment allocation was carried out using a web-based simple r and omisation procedure with equal allocation probabilities . Principal investigators and study statisticians were blinded to treatment allocation until after the final analysis only . SETTING Deprived areas of Sheffield , UK . PARTICIPANTS Previously sedentary people , aged 40 - 64 years , living in deprived areas of Sheffield , UK , who had increased their physical activity levels after receiving a brief intervention . INTERVENTIONS Participants were r and omised to the control group ( no further intervention ) or to two sessions of MI , either face to face ( ' full booster ' ) or by telephone ( ' mini booster ' ) . Sessions were delivered 1 and 2 months post-r and omisation . MAIN OUTCOME MEASURES The primary outcome was total energy expenditure ( TEE ) per day in kcal from 7-day accelerometry , measured using an Actiheart device ( CamNtech Ltd , Cambridge , UK ) . Independent evaluation of practitioner competence was carried out using the Motivational Interviewing Treatment Integrity assessment . An estimate of the per-participant intervention costs , re source use data collected by question naire and health-related quality of life data were analysed to produce a range of economic models from a short-term NHS perspective . An additional series of models were developed that used TEE values to estimate the long-term cost-effectiveness . RESULTS In total , 282 people were r and omised ( control = 96 ; mini booster = 92 , full booster = 94 ) of whom 160 had a minimum of 4 out of 7 days ' accelerometry data at 3 months ( control = 61 , mini booster = 47 , full booster = 52 ) . The mean difference in TEE per day between baseline and 3 months favoured the control arm over the combined booster arm but this was not statistically significant ( -39 kcal , 95 % confidence interval -173 to 95 , p = 0.57 ) . The autonomy-enabled MI communication style was generally acceptable , although some participants wanted a more paternalistic approach and most expressed enthusiasm for monitoring and feedback components of the intervention and research . Full boosters were more popular than mini boosters . Practitioners achieved and maintained a consistent level of MI competence . Walking distance to the nearest municipal green space or leisure facilities was not associated with physical activity levels . Two alternative modelling approaches both suggested that neither intervention was likely to be cost-effective . CONCLUSIONS Although some individuals do find a community-based , brief MI ' booster ' intervention supportive , the low levels of recruitment and retention and the lack of impact on objective ly measured physical activity levels in those with adequate outcome data suggest that it is unlikely to represent a clinical ly effective or cost-effective intervention for the maintenance of recently acquired physical activity increases in deprived middle-aged urban population s. Future research with middle-aged and relatively deprived population s should explore interventions to promote physical activity that require less proactive engagement from individuals , including environmental interventions . STUDY REGISTRATION Current Controlled Trials IS RCT N56495859 , Clinical Trials.gov NCT00836459 . FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol . 18 , No. 13 . See the NIHR Journals Library website for further project information OBJECTIVES To examine joint associations of physical activity and adiposity measures ( body mass index ( BMI ) , waist circumference , percentage body fat ) with incident mobility limitation . DESIGN Prospect i ve observational cohort study . SETTING Memphis , Tennessee and Pittsburgh , Pennsylvania . PARTICIPANTS Two thous and nine hundred and eighty-two black and white men and women aged 70 to 79 participating in the Health , Aging and Body Composition ( Health ABC ) study . MEASUREMENTS Mobility limitation was defined as reported difficulty walking one-quarter of a mile or climbing 10 steps during two consecutive semiannual assessment s over 6.5 years . Three measures of adiposity were included in this study : BMI , total percentage body fat , and waist circumference . Physical activity  was assessed using a modified leisure-time physical activity question naire . RESULTS Forty-six percent of the cohort developed mobility limitation .  White and black men with a high BMI ( > or = 30 kg/m(2 ) ) , high total percentage body fat ( > 31.3 % ) , or high waist circumference ( > or = 102 cm ) had an approximately 60 % , 40 % , and 40 % , respectively , higher risk of incident mobility limitation than those with low adiposity . In women , high adiposity was also associated with a significantly higher mobility limitation risk than in those with low adiposity . Low physical activity ( lowest quartile ) was associated with a 70 % higher risk of mobility limitation in all groups . Persons with high adiposity and low physical activity were at particularly high risk of mobility limitation .  People with high adiposity who were physically active had an equally high risk of mobility limitation as inactive people with low adiposity . CONCLUSION High adiposity and low self-reported physical activity predicted the onset of mobility limitation in well-functioning older persons . Preventing weight gain in old age and promoting physical activity in obese and non-obese older persons may therefore be effective strategies to prevent mobility loss and future disability Abstract Background Despite the well‐known health benefits of physical activity , it is a great challenge to stay physically active for frail – older adults with mobility limitations . The aim of this study was to test the ( cost‐ ) effectiveness of a patient‐centred physical therapy strategy ( Coach2Move ) in which individualized treatment ( motivational interviewing , physical examination , individualized goal setting , coaching and advice on self management , and physical training ) is combined to increase physical activity level and physical fitness and , thereby , to decrease the level of frailty . Methods A r and omized controlled trial was performed in 13 physical therapy practice s with measurements at 3 and 6 months . Eligible patients were aged 70 years or over and had mobility problems ( i.e. difficulties with walking , moving , getting up and changing position from bed or chair to st and ing , or stair climbing ) . The primary outcome was physical activity ( total and moderate intensity ) in minutes per day . Secondary outcomes were as follows : frailty , walking speed and distance , mobility , and quality of life . Data were analysed using linear mixed models for repeated measurements . Healthcare costs and quality ‐adjusted life years ( QALYs ) were computed and combined using net monetary benefit ( NMB ) for different willingness to pay thresholds . Data on costs , QALYs , and NMBs were analysed using linear mixed models . Results One hundred and thirty patients participated in this study . At 6 months , the between‐group difference was significant for moderate‐intensity physical activity in favour of the Coach2Move group [ mean difference : 17.9 min per day ; 95 % confidence interval ( CI ) 4.0 to 34.9 ; P = 0.012 ] . The between‐group difference for total physical activity was 14.1 min per day ( 95 % CI −6.6 to 34.9 ; P = 0.182 ) . Frailty decreased more in the Coach2Move group compared with usual care [ mean difference : −0.03 ( 95 % CI : −0.06 to −0.00 ; P = 0.027 ) ] . Compared with usual treatment , the Coach2Move strategy result ed in cost savings ( € 849.8 ; 95 % CI : 1607 to 90 ; P = 0.028 ) , an improvement in QALYs , ( 0.02 ; 95 % CI : 0.00 to 0.03 ; P = 0.03 ) , and a higher NMB at every willingness to pay threshold . Conclusions Older adults with mobility problems are able to safely increase physical activity in their own environment and reduce frailty . This study emphasizes both the potential cost‐effectiveness of a patient‐centred approach in the frail elderly and the importance of physical activity promotion in older adults with mobility limitations BACKGROUND Effective new strategies that complement primary care are needed to reduce disability risks and improve self-management of chronic illness in frail older people living in the community . OBJECTIVE To evaluate the impact of a 1-year , senior center-based chronic illness self-management and disability prevention program on health , functioning , and healthcare utilization in frail older adults . DESIGN A r and omized controlled trial . SETTING A large senior center located in a northeast Seattle suburb . The trial was conducted in collaboration with primary care providers of two large managed care organizations . PARTICIPANTS A total of 201 chronically ill older adults seniors aged 70 and older recruited through medical practice s. INTERVENTION A targeted , multi-component disability prevention and disease self-management program led by a geriatric nurse practitioner ( GNP ) . MEASUREMENTS Self-reported Physical function , physical performance tests , health care utilization , and health behaviors . RESULTS Each of 101 intervention participants met with the GNP from 1 to 8 times ( median = 3 ) during the study year . The intervention group showed less decline in function , as measured by disability days and lower scores on the Health Assessment Question naire . Other measures of function , including the SF-36 and a battery of physical performance tests , did not change with the intervention . The number of hospitalized participants increased by 69 % among the controls and decreased by 38 % in the intervention group ( P = .083 ) . The total number of inpatient hospital days during the study year was significantly less in the intervention group compared with controls ( total days = 33 vs 116 , P = .049 ) . The intervention led to significantly higher levels of physical activity and senior center participation and significant reductions in the use of psychoactive medications . CONCLUSIONS This project provides evidence that a community-based collaboration with primary care providers can improve function and reduce inpatient utilization in chronically ill older adults . Linking organized medical care with complementary community-based interventions may be a promising direction for research and practice OBJECTIVES to determine whether a repetitive activities of daily living ( ADL ) activity programme improves health status , life satisfaction and mobility for older people living in residential care . DESIGN cluster r and omised controlled trial . SETTING five low-level dependency residential care homes in Auckl and , New Zeal and . PARTICIPANTS one hundred and forty-nine older residents ( mean age 84.7 years ) . INTERVENTION trained research staff worked with residents in intervention wards to set a goal and complete a functional assessment for each resident . They then design ed an individualised activity programme based on ADL and worked with residential care home staff to implement the programme into daily activities of residents . MEASUREMENTS mobility : timed-up- and -go ( TUG ) ; life satisfaction : late life satisfaction index ( LSI-Z ) ; and health status : SF-36 were assessed at baseline , 3- and 6-months follow-up . RESULTS in the intervention group the SF-36 total physical component summary ( PCS ) score improved at 3 months in comparison with the control group . There was no difference between groups on mobility measures at any time , nor any measures at 6-months follow-up . Significant contamination is likely to have affected the 6-month follow-up measures . CONCLUSIONS a repetitive ADL exercise programme may improve health status in the short term in a group of frail older people living in residential care . Further research is needed to establish sustainability of change Introduction The health benefits of regular cardiovascular exercise are well-known . Such exercise , however , has traditionally been defined as vigorous physical activity , such as jogging , swimming , or aerobic dance . Exercise of moderate intensity also promotes health , and many U.S. adults may be experiencing the health benefits of exercise through lifestyle activities of moderate intensity , such as yard work , housework , or walking for transportation . Until recently , public health surveillance systems have not included assessment s of this type of physical activity , focusing on exercise of vigorous intensity . We used an enhanced surveillance tool to describe the prevalence and amount of both moderate-intensity and vigorous-intensity physical activity among U.S. adults . Methods We analyzed data from the 2001 Behavioral Risk Factor Surveillance System , a state-based , r and om-digit  – dialed telephone survey administered to U.S. adults aged 18 years and older ( n = 82,834 men and 120,286 women ) .  Physical activity behavior was assessed using questions design ed to quantify the frequency of participation in moderate- or vigorous-intensity physical activities performed during leisure time or for household chores and transportation . Results Overall , 45 % of adults ( 48 % of men and 43 % of women ) were active at recommended levels during nonworking hours ( at least 30 minutes five or more days per week in moderate-intensity activities , equivalent to brisk walking , or at least 20 minutes three or more days per week in vigorous activities , equivalent to running , heavy yard work , or aerobic dance ) . Less than 16 % of adults ( 15 % of men and 17 % of women ) reported no moderate or vigorous activity in a usual week . Conclusion Integrating surveillance of lifestyle activities into national systems is possible , and doing so may provide a more accurate representation of the prevalence of recommended levels of physical activity . These results , however , suggest that the majority of U.S. adults are not active at levels associated with the promotion and maintenance of health OBJECTIVES The development of falls prevention strategies is an essential health concern in elderly people . However , a global consensus does not exist for elderly subjects who live independently in the community . The aim of the study was to evaluate the benefit of an exercises program . MATERIAL S AND METHODS A control group ( 153 subjects ) and an " Intervention " group ( 150 subjects ) were tested before and after a 1-year prospect i ve study . The " Intervention " group performed ten training sessions of physical activity , based on balance , muscular activity and coordination . We compared the incidence of falls , and the performances in several tests between the two groups . RESULTS The clinical features were similar between the two groups : mean age 71 years , 83 % of females , subjects who were independent for activities of daily living . However , all subjects presented risk for factors for falls : 38 % were not able to maintain the unipodal position more than five seconds , 29 % had already fallen during the previous year . For the " Intervention " group , the comparison of the performances before and after the physical activity program showed significant increases ( p < 0.001 ) for all the tests , and specifically for the unipodal position and for the exercises performed with eyes closed . After one year follow-up , the incidence rate of falls was lower in the " Intervention " group compared with the control group , but the difference was not significant ( p = 0.32 ) . However , falls occurred significantly latter in the " Intervention " group ( p = 0.02 ) . CONCLUSION Ten training sessions of physical activity allowed to improve the performance of elderly people in several tests . This result suggests that a fall prevention program based on collective and regular exercises , may be efficient for elderly subjects who still have an active and independent way of live Abstract Objective : To describe the mental health of a community sample of carers of elderly people with dementia , depression , or physical disability and to compare that with the mental health of other adults living in the household and of those living alone . Design : Assessment of psychiatric morbidity and physical disability with st and ardised question naire in r and omly selected enumeration districts ; subjects were interviewed at home . Setting : London Borough of Islington . Subjects : 700 people aged > /=65 and other coresidents . Main outcome measure : Depression measured with st and ardised interview . Results : The prevalence of depression was not significantly higher in carers overall ( 15 % ) than in coresidents ( 11 % ) . Being a woman carer was a significant predictor of psychiatric illness . Depression was more common in the carers of people with a psychiatric disorder than in coresidents ( 24 % v 11 % , P<0.05 ) and in those living alone ( 19 % ) . Depression was most common ( 47 % ) in women carers of people with dementia . Conclusion : The increase in psychiatric morbidity reported in carers of people with psychiatric disorders may reflect the lack of a confiding relationship . Key messages Key messages Although in clinical practice carers seem psychologically vulnerable , studies of representative community sample s provide little evidence to support this This study shows that being a carer of an older person is not in itself a risk factor for psychiatric illness or for important psychological symptoms Carers of older people with psychiatric disorders ( particularly women carers of people with dementia ) have an increased risk of depression Increased psychiatric morbidity in carers of people with psychiatric ( rather than physical ) illness may be mediated by the lack of a confiding Background Regular physical activity ( PA ) is a key contributor to healthy ageing . However , despite known health benefits , only one third of older adults in Germany reach the PA levels recommended for persons aged 65 years and above by the World Health Organization . The aim of the current study is to evaluate the effectiveness of two web-based interventions for the initiation and maintenance of regular PA ( i.e. , intervention groups 1 and 2 ) compared to a delayed intervention control group of older adults aged 65 to 75 years . Methods / Design Study participants will be r and omly assigned to one of three study arms in five communities in the Bremen-Oldenburg metropolitan region : a ) Participants in the first arm will receive access to a web-based intervention for 10 weeks allowing them to track their weekly PA ( subjective self-monitoring , intervention group 1 ) ; b ) participants in the second arm will receive access to the web-based intervention for 10 weeks and , in addition , track PA using Fitbit Zips ( objective self-monitoring , intervention group 2 ) ; c ) participants in the delayed intervention control group will receive access to the intervention implemented in the first study arm after completion of the 12-week follow-up in the other two groups within each community . In addition , weekly group meetings in the communities will be offered to study participants in the intervention groups providing the opportunity to address questions related to the use of the website and to practice PA in groups ( e.g. , neighborhood walks , strength and balance exercises ) . To evaluate short-term effects of the intervention on physical and psychological health , PA , physical fitness , and cognitive and psychological variables will be assessed at baseline and 12-week follow-up . Discussion This study will provide answers regarding acceptance and effectiveness of web-based interventions promoting uptake and maintenance of regular PA in persons aged 65–75 years . Study findings will contribute to a growing body of evidence in Germany concerning the role of community-based interventions for the promotion of PA and healthy ageing in older adults . Trial registration German Clinical Trials Register DRKS00010052 ( Date of registration 07–11 - 2016 ) Exercise and diet are the cornerstones of management of non-insulin-dependent diabetes mellitus ( NIDDM ) . Many older people have difficulty in exercising , missing benefits on glycaemic control , weight , cardiac disease and mood . We report the outcomes of a 6 month structured exercise and support programme based on a health promotion model , on physical activity , glycaemic control and parameters of cardiovascular risk in non-exercisers , compared with st and ard outpatient clinic education . A total of 26 non-exercising patients were r and omised to an intervention or control group ( ten men , 16 women ; mean age ( + /- S.D. ) 60 + /- 8 years ) . Programme participation was not associated with any significant increase in activity . Glycated hemoglobin ( HbAtc ) levels tended to stabilise in the intervention group during the 6 month programme and to deteriorate in the control group ( P = 0.03 ) ; by 12 months HbA1C levels deteriorated to a similar level in both . Programme participation did not cause significant change in anthropometric or metabolic parameters . Examining the cohort as a whole , increased activity over 6 months was associated with improvements in weight , body mass index ( BMI ) , body fat and fasting insulin . Activity increases over 12 months were associated with improvements in weight and BMI . These changes could not be attributed to changes in energy intake or dietary composition . We conclude that while exercise can benefit older people with NIDDM , a programme based on a model of health promotion was not effective in increasing physical activity In July the Department of Health ( DH ) in Engl and published a toolkit of re sources to promote more effective services to reduce the burden of  falls and fractures in older people . Unfortunately , there is plenty of evidence that the present provision of falls services is suboptimal . The toolkit is part of a ‘ Prevention Package ’ aim ed primarily at commissioners of care , in an attempt to achieve a more consistent and integrated approach to a range of prevention issues in older people [ 1 ] . Falls are a major international public health challenge because of the myriad effects on older individuals : direct physical and psychological injury ; fear of falling and activity limitation ; reduced social participation and quality of life ; increased dependence [ 2–5 ] ; and because of the economic impact on health and social care providers [ 6 , 7 ] . Studies from various countries have shown that about one third of people aged above 65 years fall each year . In UK primary care population s , the rate rises with age to over 60 % of nonagenarians , and is generally higher in women [ 8 ] and in socio-economically deprived population s [ 9 ] . Fragility fractures are the commonest significant injury , 300,000 annually in the UK including upwards of 70,000 hip fractures . Many falls go unreported , but nevertheless they account for 40 % of UK ambulance call-outs , with the variable proportion being conveyed to hospital accounting for one in ten Emergency Department ( ED ) attendances of the over 75s [ 6 ] , a third of whom are admitted , thus comprising about 14 % of emergency admissions . Identifying all falls related activity is challenging but recent estimates suggest that it accounts for between 10 % and 25 % of all local health and social care spending on older people [ 10 ] . Care of fragility fractures is particularly expensive , total health and social care costs in the UK being around £ 2 billion , most of which relates to hip fractures [ 11 ] . Current population and incidence projections suggest that by 2020 , this figure will rise by 50 % . Early in the development of geriatric medicine , falls were identified as a ‘ geriatric giant’—adverse in their own right but also a non-specific indicator of functional decompensation . Building on clarification of falls risk factors [ 12 ] , r and omised controlled trials demonstrated the effectiveness of risk factor based multi-factorial interventions [ 13 , 14 ] . This led to the notion of ‘ falls prevention services ’ . Based on international consensus about what constituted best clinical practice [ 15 ] , broadly similar policies have been developed by the responsible government departments of the four UK nations , and in Irel and [ 16 ] . The National Service Framework for Older People in Engl and ( NSF , 2001 ) [ 17 ] required health services and their local council partners to develop integrated services by April 2005 , incorporating case finding , assessment and referral systems and specialist falls and fragility fracture services . The NSF was launched without earmarked implementation funding , but there was plenty of activity , some enabled and directed by various government initiatives , encouraging community engagement . An independent postal question naire survey to health and social care agencies about their falls services in 2004 [ 18 ] reported most having made plans for an integrated service but implementation was patchy and focused on widely differing priorities . Only 30 % included systems for identifying high risk individuals and only 13 % of falls prevention programmes included exercise classes , the most effective prevention strategy [ 19 ] whilst interventions with little or no evidence base were promoted [ 20 ] . Implementation of these policies across Engl and , Wales and Northern Irel and has been monitored in a series of government funded national audits run by the Royal College of Physicians of London ( RCP ) . The first of these confirmed major gaps at the organisational level , particularly in case finding and referrals for secondary prevention [ 21 ] . A subsequent patient level clinical care audit of fragility fracture patients showed that most returning home from the Emergency Department were not offered a falls risk assessment and only one third were on appropriate treatment for osteoporosis 3 months later [ 22 ] . Despite intense interest among clinicians in the UK and appointment of many geriatricians with a focus on falls , syncope and orthogeriatrics , a repeat organisational audit showed that by 2008 there had been little improvement in service structure , capacity or processes [ 23 ] . Meanwhile the picture was clouded by the negative results of a DH funded systematic review with meta-analyses [ 24 ] . This suggested that the variable outcomes of clinical trials might be associated with the way that the multifactorial approach was organised . There are now several negative outcome trials employing the strategy of nurse led case finding linked to interventions intended to be provided by a range of unconnected professions acting on referral [ 25 ] . In clinical practice , it is likely that there is even more differential effectiveness depending on case finding and referral practice s and context ual differences in service delivery . Research evidence is still lacking on how to achieve much that the NSF aspired to , but there is sufficient evidence and examples of successful implementation to do much better than most are currently doing . So how will the latest government action help ? A key step is to clarify priorities and to put available re sources into the activities likely to make The purpose of this paper is to present key points of an intervention programme ( Agita São Paulo Program ) to promote physical activity in a developing country . Agita is a multi-level , community-wide intervention design ed to increase knowledge about the benefits and the level of physical activity in a mega- population of 34 million inhabitants of São Paulo State , Brazil . The main message was taken from the Centers for Disease Control/American College of Sports Medicine ( CDC/ACSM ) recommendation that : ' everyone should accumulate at least 30 minutes of physical activity , on most days of the weeks , of moderate intensity , in one single or in multiple sessions ' . Activities were encouraged in three setting s : home , transport and leisure time . Focus groups were students from elementary schools through to college , white and blue collar workers , and elderly people . Innovative aspects included : ( 1 ) a research centre leading the process , ( 2 ) scientific and institutional partnerships ( over 160 groups ) , ( 3 ) a feasible approach -- the ' one-step-ahead ' model , ( 4 ) empowerment , ( 5 ) inclusion , ( 6 ) non-paid media , ( 7 ) social marketing , and ( 8) culture-linked . Data were obtained from 645 r and om , home-based question naires over four years -- stratified by sex , age , education and socio-economic level . These data show that the Agita message reached 55.7 % of the population , and among these , 23.1 % knew the main message . Recall of Agita and knowledge of its purpose were well distributed among different socioeconomic levels , being known by 67 % of the most educated . The prevalence of people reaching the recommendation was 54.8 % ( men 48.7 % , women 61 % ) ; and risk of being sedentary was quite smaller among those who knew the Agita message ( 7.1 % ) compared with those who did not know ( 13.1 % ) . In conclusion , based upon the Agita São Paulo experience , it appears that a multi-level , community-wide intervention to promote physical activity may obtain good results if the model contains the items listed above BACKGROUND Efforts to achieve population -wide increases in walking and similar moderate-intensity physical activities potentially can be enhanced through relevant applications of state-of-the-art interactive communication technologies . Yet few systematic efforts to evaluate the efficacy of h and -held computers and similar devices for enhancing physical activity levels have occurred . The purpose of this first-generation study was to evaluate the efficacy of a h and -held computer ( i.e. , personal digital assistant [ PDA ] ) for increasing moderate intensity or more vigorous ( MOD+ ) physical activity levels over 8 weeks in mid-life and older adults relative to a st and ard information control arm . DESIGN R and omized , controlled 8-week experiment . Data were collected in 2005 and analyzed in 2006 - 2007 . SETTING / PARTICIPANTS Community-based study of 37 healthy , initially underactive adults aged 50 years and older who were r and omized and completed the 8-week study ( intervention=19 , control=18 ) . INTERVENTION Participants received an instructional session and a PDA programmed to monitor their physical activity levels twice per day and provide daily and weekly individualized feedback , goal setting , and support . Controls received st and ard , age-appropriate written physical activity educational material s. MAIN OUTCOME MEASURE Physical activity was assessed via the Community Healthy Activities Model Program for Seniors ( CHAMPS ) question naire at baseline and 8 weeks . RESULTS Relative to controls , intervention participants reported significantly greater 8-week mean estimated caloric expenditure levels and minutes per week in MOD+ activity ( p<0.04 ) . Satisfaction with the PDA was reasonably high in this largely PDA-naive sample . CONCLUSIONS Results from this first-generation study indicate that h and -held computers may be effective tools for increasing initial physical activity levels among underactive adults INTRODUCTION Older adults with a high number of chronic conditions and who live in environments that do not promote physical activity have great difficulty initiating and adhering to exercise programs . Novel lifestyle activity interventions that can effectively increase physical activity may address disparities in health in these population s. This study evaluates the effects of the Baltimore Experience Corps program , a community-based volunteer program , on walking activity in older adults . METHODS The Baltimore Experience Corps Trial is a sex-stratified RCT that recruited participants from 2006 to 2009 . Older adult participants aged ≥60 years ( n=123 ) were from a nested objective physical activity trial within the larger Baltimore Experience Corps Trial . Participants r and omized to the intervention group were placed as volunteers within the Baltimore public school system for 2 years . The primary study outcome was objective ly measured total amount of walking activity measured in steps/day . Differences between intervention and control groups were measured at 12 and 24 months using linear mixed effects models . Data were analyzed in 2014 . RESULTS At 24 months , women , but not men , in the intervention group showed an increased amount of walking activity , averaging 1,500.3 ( 95 % CI=77.6 , 2,922.9 ) greater steps/day compared with the control group . Women in the control group showed a decline of 1,191.6 ( 95 % CI=-2243.7 , -139.5 ) steps/day at 24 months compared to baseline . CONCLUSIONS A community-based volunteer intervention  increased walking activity  among older women , who were at elevated risk for both inactivity and adverse health outcomes . TRIAL REGISTRATION This study is registered at www . clinical trials.gov NCT00380562 BACKGROUND Recent r and omized controlled trials indicated that exercise training for elderly significantly increased their physical fitness . However , very few studies have examined changes in physical activity after exercise training . The purpose of this study was to investigate whether six-month exercise training for older adults can increase and maintain their physical activity in daily life . METHODS Sixty-two men and women aged 60 to 81 years ( mean age 67.1 years ) , living in communities , were r and omly allocated into an exercise group ( n = 32 ) or a control group ( n = 33 ) . The intervention started in April 1998 and lasted for 25 weeks . The exercise regimen consisted of endurance training and resistance exercises in a two-hour class conducted at least twice a week . The subjects completed a physical activity diary at each pre-intervention ( March 1998 ) , post-intervention ( September 1998 ) and follow-up ( April 1999 ) measurement of physical activity . Physical activity , expressed as total daily energy expenditure , was calculated by multiplying the amount of time spent in each activity and the corresponding METs . RESULTS Total daily energy expenditure significantly increased from 40.8 kcal/kg/day to 43.5 kcal/kg/day in the exercise group ( p = 0.03 ) , but did not change in the control group . At the follow-up measurement , the mean total daily energy expenditure in the exercise group remained significantly higher , by 1.7 kcal/kg/day , than that at the pre-intervention ( p = 0.05 ) . CONCLUSIONS This r and omized controlled trial indicated that exercise training for elderly was effective in increasing physical activity in daily life Objectives : This umbrella review aim ed to determine the effectiveness of exercise interventions , alone or in combination with other interventions , in improving physical function in community-dwelling older people identified as pre-frail or frail . Introduction : Exercise is said to have a positive impact on muscle mass and strength which improves physical function and hence is beneficial for the treatment of frailty . Several systematic review s discuss the effects of exercise interventions on physical function parameters , such as strength , mobility , gait , balance and physical performance , and indicate that multi-component exercise , including resistance , aerobic , balance and flexibility training , appears to be the best way in which to improve physical function parameters in frail older people . However , there is still uncertainty as to which exercise characteristics ( type , frequency , intensity , duration and combinations ) are the most effective and sustainable over the long-term . Inclusion criteria : Participants were adults , 60 years or over , living in the community and identified as pre-frail or frail . Quantitative systematic review s , with or without meta- analysis that examined the effectiveness of exercise interventions of any form , duration , frequency and intensity , alone or in combination with other interventions design ed to alter physical function parameters in frail older people , were considered . The quantitative outcome measures were physical function , including muscular strength , gait , balance , mobility and physical performance . Methods : An iterative search strategy for ten bibliometric data bases and gray literature was developed . Critical appraisal of seven systematic review s was conducted independently by two review ers using a st and ard Joanna Briggs Institute tool . Data was extracted independently by two review ers using a st and ard Joanna Briggs Institute data extraction tool and summarized using a narrative synthesis approach . Results : Seven systematic review s were included in this umbrella review , with a total of 58 relevant r and omized controlled trials and 6927 participants . Five systematic review s examined the effects of exercise only , while two systematic review s reported on exercise in combination with a nutritional approach , including protein supplementations , as well as fruit and dairy products . The average  exercise frequency was 2–3 times per week ( mean 3.0 ± 1.5 times per week ; range 1–7 weekly ) for 10–90 minutes per session ( mean of 52.0 ± 16.5 mins ) and a total duration of 5–72 weeks with the majority lasting a minimum of 2.5 months ( mean 22.7 ± 17.7 weeks ) . Multi-component exercise interventions can currently be recommended for pre-frail and frail older adults to improve muscular strength , gait speed , balance and physical performance , including resistance , aerobic , balance and flexibility tasks . Resistance training alone also appeared to be beneficial , in particular for improving muscular strength , gait speed and physical performance . Other types of exercise were not sufficiently studied and their effectiveness is yet to be established . Conclusions : Interventions for pre-frail and frail older adults should include multi-component exercises , including in particular resistance training , as well as aerobic , balance and flexibility tasks . Future research should adopt a consistent definition of frailty and investigate the effects of other types of exercise alone or in combination with nutritional interventions so that more specific recommendations can be made Background Along with reduced levels of physical activity , older Australian 's mean energy consumption has increased . Now over 60 % of older Australians are considered overweight or obese . This study aims to confirm if a low-cost , accessible physical activity and nutrition program can improve levels of physical activity and diet of insufficiently active 60 - 70 year-olds . Methods / Design This 12-month home-based r and omised controlled trial ( RCT ) will consist of a nutrition and physical activity intervention for insufficiently active people aged 60 to 70 years from low to medium socio-economic areas . Six-hundred participants will be recruited from the Australian Federal Electoral Role and r and omly assigned to the intervention ( n = 300 ) and control ( n = 300 ) groups . The study is based on the Social Cognitive Theory and Precede-Proceed Model , incorporating voluntary cooperation and self-efficacy . The intervention includes a specially design ed booklet that provides participants with information and encourages dietary and physical activity goal setting . The booklet will be supported by an exercise chart , calendar , bi-monthly newsletters , resistance b and s and pedometers , along with phone and email contact . Data will be collected over three time points : pre-intervention , immediately post-intervention and 6-months post- study . Discussion This trial will provide valuable information for community-based strategies to improve older adults ' physical activity and dietary intake . The project will provide guidelines for appropriate sample recruitment , and the development , implementation and evaluation of a minimal intervention program , as well as information on minimising barriers to participation in similar programs . Trial Registration Australian and New Zeal and Clinical Trials Registry QUESTION Are ambulant patients who are admitted for inpatient rehabilitation for a lower limb orthopaedic condition active enough to meet current physical activity guidelines ? DESIGN Prospect i ve observational study . PARTICIPANTS Adults admitted for inpatient rehabilitation for a lower limb orthopaedic condition who were cognitively alert and able to walk independently or with assistance . OUTCOME MEASURES Participants wore an activity monitor for three full days .  Daily time spent in moderate intensity physical activity  was used to determine whether the levels of physical activity recommended in clinical guidelines were achieved . RESULTS Fifty-four participants with a mean age of 74 years ( SD 11 ) took a median of 398 ( IQR 140 to 993 ) steps per day and spent a median of 8 ( IQR 3 to 16 ) minutes walking per day . No participant completed a 10-minute bout of moderate intensity physical activity during the monitoring period . One participant accumulated 30 minutes of moderate intensity physical activity and nine participants accumulated 15 minutes of moderate intensity physical activity in a day . Physical activity was associated with shorter length of stay ( r=-0.43 ) and higher functional status on discharge ( r=0.39 ) . CONCLUSIONS Adults with lower limb orthopaedic conditions in inpatient rehabilitation are relatively inactive and do not meet current physical activity guidelines for older adults . Results of this study indicate that strategies to increase physical activity are required OBJECTIVE During hospitalization older people often experience functional decline which impacts on their future independence . The objective of this study was to evaluate a multifaceted transitional care intervention including home-based exercise strategies for at-risk older people on functional status , independence in activities of daily living ( ADLs ) and walking ability . METHODS A r and omized controlled trial was undertaken in a metropolitan hospital in Australia with 128 patients ( 64 intervention , 64 control ) aged over 65 years with an acute medical admission and at least one risk factor for hospital readmission . The intervention group received an individually tailored programme for exercise and follow-up care which was commenced in hospital and included regular visits in hospital by a physiotherapist and a registered nurse , a home visit following discharge and regular telephone follow-up for 24 weeks following discharge . The programme was design ed to improve health-promoting behaviours , strength , stability , endurance and mobility . Data were collected at baseline , then 4 , 12 and 24 weeks following discharge using the Index of ADL , Instrumental Activities of Daily Living ( IADL ) and the Walking Impairment Question naire ( WIQ ; modified ) . RESULTS Significant improvements were found in the intervention group in IADL scores ( P < 0.001 ) , ADL scores ( P < 0.001 ) and WIQ scale scores ( P < 0.001 ) in comparison to the control group . The greatest improvements were found in the first 4 weeks following discharge . CONCLUSIONS Early introduction of a transitional model of care incorporating a tailored exercise programme and regular telephone follow-up for hospitalized at-risk older adults can improve independence and functional ability Many older adults with hearing impairment continue to have substantial communication difficulties after being fitted with hearing aids , and many do not choose to wear hearing aids . Two group communication education programs aim ed at such older people are described . The ‘ Keep on Talking ’ program has a health promotion focus , and is aim ed at maintaining communication for older adults living in the community . An experimental group ( n=120 ) attended the program , and a control group ( n = 130 ) received a  communication assessment but no intervention . Significant improvements were found in the experimental participants in terms of knowledge about communication changes with age and about strategies to maintain communication skills . At the follow-up evaluation at 1 year , 45 % of the experimental group , compared to 10 % of the control group , had acted to improve their communication skills . The ‘ Active Communication Education ’ program focuses on the development of problem-solving strategies to improve communication in everyday life situations . Preliminary outcomes have been assessed on a small scale ( n=14 ) to date . It is concluded that communication programs represent an important adjunct to , or supplement for , the traditional approach that focuses on hearing aid fitting Background Regular physical activity is an important goal for elders with chronic health conditions . Context This report describes Physical Activity for a Lifetime of Success ( PALS ) , an attempt to translate a motivational support program for physical activity , Active Choices , for use by a group of diverse , low-income , community-dwelling elders with diabetes . Methods PALS linked physical activity assessment and brief counseling by primary care providers with a structured referral to a community-based motivational telephone support program delivered by older adult volunteers . People with diabetes aged 65 years or older who were receiving care at two community clinics were r and omized to receive either immediate or delayed intervention . The main intended outcome measure was physical activity level ; the secondary outcome measure was mean hemoglobin A1c . Consequences One-third of those offered referral to the PALS program in the clinic setting declined . Another 44 % subsequently declined enrollment or were unreachable by the support center . Only 14 ( 21 % ) of those offered referral enrolled in the program . Among these 14 , the percentage who were sufficiently active was higher at follow-up than at enrollment , though not significantly so . Using an intent-to-treat analysis , which included all r and omized clinic patients , we found no significant change in mean hemoglobin A1c for the intervention group compared with controls . Interpretation A community-based referral and support program to increase physical activity  among elderly , ethnically diverse , low-income people with diabetes , many of whom are not English-speaking , may be thwarted by unforeseen barriers . Those who enroll and participate in the PALS program appear to increase their level of physical activity Objective To evaluate the efficacy of a home-based exercise programme added to usual medical care for the treatment of depression . Design Prospect i ve , two group parallel , r and omised controlled study . Setting Community-based . Patients 200 adults aged 50 years or older deemed to be currently suffering from a clinical depressive illness and under the care of a general practitioner . Interventions Participants were r and omly allocated to either usual medical care alone ( control ) or usual medical care plus physical activity ( intervention ) . The intervention consisted of a 12-week home-based programme to promote physical activity at a level that meets recently published guidelines for exercise in people aged 65 years or over . Main outcome measurements Severity of depression was measured with the structured interview guide for the Montgomery-Asberg Depression Rating Scale ( SIGMA ) , and depression status was assessed with the Structured Clinical Interview for DSM-IV Axis I Disorders ( SCID-I ) . Results Remission of depressive illness was similar in both the usual care ( 59 % ) and exercise groups ( 63 % ; OR = 1.18 , 95 % CI 0.61 to 2.30 ) at the end of the 12-week intervention , and again at the 52-week follow-up ( 67 % vs 68 % ) ( OR=1.07 , 95 % CI 0.56 to 2.02 ) . There was no change in objective measures of fitness over the 12-week intervention among the exercise group . Conclusions This home-based physical activity intervention failed to enhance fitness and did not ameliorate depressive symptoms in older adults , possibly due to a lack of ongoing supervision to ensure compliance and optimal engagement OBJECTIVES The theory of planned behavior proposes that physical activity is the result of intentions ; however little is known about whether the relation between intentions and behavior differs between vigorous , moderate physical activity , and walking . For university students , vigorous physical activity is oftentimes enacted as a goal -directed behavior ; whereas walking is oftentimes a means to achieving a goal other than physical activity ( e.g. , transportation ) . DESIGN The study was a one-week prospect i ve study . METHODS Undergraduate students ( N=164 ) reported intentions for walking , moderate physical activity , and vigorous physical activity and self-reported these behaviors one week later . RESULTS Hierarchical linear modeling revealed that intentions were more strongly related to vigorous physical activity than to moderate physical activity or walking . CONCLUSIONS Intention-enhancing interventions may effectively promote vigorous physical activity , but other motivational processes may be more appropriate to target in interventions of walking and moderate physical activity Objectives : To determine the effects of gymnastics on the health related quality of life ( HRQoL ) and functional status of independently living people , aged 65 to 80 years .  Gymnastics formed part of the More Exercise for Seniors ( MBvO in Dutch ) programme , a group based exercise programme for older adults in the Netherl and s. It has been widely implemented since 1980 . Design : R and omised controlled trial with pretest and post-test measurements . Intervention : The exercise programme given by experienced instructors lasted 10 weeks and was given weekly ( MBvO1 ; n = 125 , six groups ) or twice weekly ( MBvO2 ; n = 68 , six groups ) . The control group ( n = 193 ) was offered a health education programme . Setting : Community dwelling of older people , with a comparatively low level of fitness as assessed with the Groningen Fitness test for the Elderly . Results : No significant effects were found on the HRQoL ( Vitality Plus Scale , TAAQoL , and R AND -36 ) and the functional status ( Physical Performance Test and the Groningen Activity Restriction Scale ) . The MBvO2 group , with a low level of physical activity at baseline , showed the only improvement found on the Vitality Plus Scale ( F = 4.53 ; p = 0.01 ) . Conclusions : MBvO gymnastics once a week did not provide benefits in HRQoL and functional status after 10 weeks . However , participants with a low level of physical activity may benefit from MBvO gymnastics if they participate twice a week . To improve the health of the general public , sedentary older adults should be recruited and encouraged to combine MBvO with the health enhancing physical activity guidelines BACKGROUND Although many Japanese older adults spend more than an hour each day walking for exercise , the intensity is often lower than the minimum level associated with various health benefits . The purpose of this study was to evaluate the efficacy of a lifestyle physical activity intervention on improving quantity and quality of daily physical activity ( DPA ) as well as cardiorespiratory endurance in community-dwelling older women . METHODS 68 women ( 60 - 78 yr of age ) were r and omly assigned to either a lifestyle physical activity intervention group ( LIFE ) or control group . During the 12-wk intervention , feedback based on accelerometer DPA data ( number of daily steps ( STEPS ) and time spent performing daily moderate intensity physical activity ( MPA ) was provided to each participant in LIFE every two weeks . Cardiorespiratory endurance was evaluated using the 12-Minute Walk Test ( 12-MW ) . RESULTS Following the 12-wk intervention , significant group interactions were observed for STEPS , MPA , and cardiorespiratory endurance . LIFE increased STEPS by 16 % , MPA by 53 % , and the distance walked during the 12-MW by 10 % . CONCLUSIONS Promotion of DPA using accelerometers can significantly improve quantity and quality of daily physical activity as well as cardiorespiratory endurance in older women Background Few studies have investigated both the self-perceived and measured environment with objective ly determined physical activity in older adults . Accordingly , the aim of this study was to examine measured and perceived environmental associations with physical activity of older adults residing across different neighborhood types . Methods One-hundred and forty-eight older individuals , mean age 64.3 ± 8.4 , were r and omly recruited from one of four neighborhoods that were pre-determined as either having high- or low walkable characteristics . Individual residences were geocoded and 200 m network buffers established . Both objective environment audit , and self-perceived environmental measures  were collected , in conjunction with accelerometer derived physical activity behavior . Using both perceived and objective environment data , analysis consisted of a macro-level comparison of physical activity levels across neighborhood , and a micro-level analysis of individual environmental predictors of physical activity levels . Results Individuals residing in high-walkable neighborhoods on average engaged in 11 min of moderate to vigorous physical activity per day more than individuals residing in low-walkable neighborhoods . Both measured access to non-residential destinations ( b = .11 , p < .001 ) and self-perceived access to non-residential uses ( b = 2.89 , p = .031 ) were significant predictors of time spent in moderate to vigorous physical activity . Other environmental variables significantly predicting components of physical activity behavior included presence of measured neighborhood crime signage ( b = .4785 , p = .031 ) , measured street safety ( b = 26.8 , p = .006 ) , and perceived neighborhood satisfaction ( b = .5.8 , p = .003 ) . Conclusions Older adult residents who live in high-walkable neighborhoods , who have easy and close access to nonresidential destinations , have lower social dysfunction pertinent to crime , and generally perceive the neighborhood to a higher overall satisfaction are likely to engage in higher levels of physical activity behavior . Efforts aim ed at promoting more walkable neighborhoods could influence activity levels in older adults Background Systematic review s have identified a range of brief interventions which increase physical activity in previously sedentary people . There is an absence of evidence about whether follow up beyond three months can maintain long term physical activity . This study assesses whether it is worth providing motivational interviews , three months after giving initial advice , to those who have become more active . Methods / Design Study c and i date s ( n = 1500 ) will initially be given an interactive DVD and receive two telephone follow ups at monthly intervals checking on receipt and use of the DVD . Only those that have increased their physical activity after three months ( n = 600 ) will be r and omised into the study . These participants will receive either a " mini booster " ( n = 200 ) , " full booster " ( n = 200 ) or no booster ( n = 200 ) . The " mini booster " consists of two telephone calls one month apart to discuss physical activity and maintenance strategies . The " full booster " consists of a face-to-face meeting with the facilitator at the same intervals . The purpose of these booster sessions is to help the individual maintain their increase in physical activity . Differences in physical activity , quality of life and costs associated with the booster interventions , will be measured three and nine months from r and omisation . The research will be conducted in 20 of the most deprived neighbourhoods in Sheffield , which have large , ethnically diverse population s , high levels of economic deprivation , low levels of physical activity , poorer health and shorter life expectancy . Participants will be recruited through general practice s and community groups , as well as by postal invitation , to ensure the participation of minority ethnic groups and those with lower levels of literacy . Sheffield City Council and Primary Care Trust fund a range of facilities and activities to promote physical activity and variations in access to these between neighbourhoods will make it possible to examine whether the effectiveness of the intervention is modified by access to community facilities . A one-year integrated feasibility study will confirm that recruitment targets are achievable based on a 10 % sample . Discussion The choice of study population , study interventions , brief intervention preceding the study , and outcome measure are discussed . Trial Registration Current Controlled Trials : IS RCT N56495859 ; Clinical Trials.gov : NCT00836459 BACKGROUND Using peer volunteers as delivery agents may improve translation of evidence -based physical activity promotion programs for older adults . This study examined whether tailored support from older peer volunteers could improve initiation and long-term maintenance of physical activity behavior . METHODS Participants were r and omized to 2 16-week , group-based  programs : ( 1 ) peer-delivered , theory-based support for physical activity behavior change ; or ( 2 ) an intervention typically available in community setting s ( basic education , gym membership , and pedometer for self-monitoring ) , attention-matched with health education .  Moderate-to-vigorous physical activity ( MVPA ) was assessed via daily self-report logs at baseline , at the end of the intervention ( 16 weeks ) , and at follow-up ( 18 months ) , with accelerometry validation ( RT3 ) in a r and om sub sample . RESULTS Seven peer volunteers and 81 sedentary adults were recruited .  Retention at the end of the trial was 85 % and follow-up at 18 months was 61 % . Using intent-to-treat analyses , at 16 weeks , both groups had similar significant improvements in MVPA . At 18 months , the group supplemented with peer support had significantly more MVPA . CONCLUSIONS Trained peer volunteers may enhance long-term maintenance of physical activity gains from a community-based intervention . This approach has great potential to be adapted and delivered inexpensively in community setting Background : Underst and ing factors that influence the amount of time people with stroke spend sitting and being active is important to inform the development of targeted interventions . Objective : To explore the physical , cognitive , and psychosocial factors associated with daily sitting time and physical activity in people with stroke . Method : Secondary analysis of an observational study ( n = 50 , mean age 67.2 ± 11.6 years , 33 men ) of adults at least 6 months post-stroke . Activity monitor data were collected via a 7-day , continuous wear ( 24 hours/day ) protocol  . Sitting time [ total , and prolonged ( time in bouts of ≥ 30 minutes ) ]  was measured with an activPAL3 activity monitor . A hip-worn Actigraph GT3X+ accelerometer was used to measure moderate-to-vigorous-intensity physical activity ( MVPA ) time . Univariate analyses examined relationships of stroke severity ( National Institutes of Health Stroke Scale ) , physical [ walking speed , Stroke Impact Scale ( SIS ) physical domain score ] , cognitive ( Montreal Cognitive Assessment ) , and psychosocial factors ( living arrangement , SIS emotional domain score ) with sitting time , prolonged sitting time , and MVPA . Results : Self-reported physical function and walking speed were negatively associated with total sitting time  ( r = − 0.354 , P = 0.022 and r = − 0.361 , P = 0.011 , respectively )  and prolonged sitting time  ( r = − 0.5 , P = 0.001 and − 0.45 , P = 0.001 , respectively ) , and positively associated with MVPA ( r = 0.469 , P = 0.002 and 0.431 , P = 0.003 , respectively ) . Conclusions : Physical factors , such as walking ability , may influence sitting and activity time in people with stroke , yet much of the variance in daily sitting time remains unexplained . Large prospect i ve studies are required to underst and the drivers of activity and sitting time Background Regular physical activity may improve different aspects of wellbeing in older people , such as quality of life , vitality and depression . However , there is little experimental evidence to support this assumption . Therefore , we examined the effect of different training protocol s on quality of life , vitality and depression of older adults living in long-term care facilities . Methods Subjects ( n = 173 , aged 64 to 94 years , living in long-term care facilities ) , were r and omized to six months of three different moderate-intensity group exercise training protocol s , or to an ' educational ' control condition . Exercise consisted of two 45–60-minute training sessions per week of 1 ) resistance training ; 2 ) all-round , functional training ; or 3 ) a combination of both . Perceived health , the Geriatric Depression Scale ( GDS ) , the Vitality Plus Scale ( VPS ) and the Dementia Quality of Life question naire ( DQoL ) were administered at baseline and after six months . Results In the combined training group a small but significant decline was seen in perceived health , DQoL and VPS score compared to the control group . Conclusions We conclude that neither strength training nor all-round , functional training of moderate intensity is effective in improving quality of life , vitality or depression of older people living in long-term care facilities Background : Adherence to self-care recommendations is associated with improved patient outcomes and improved quality of life for people living with heart failure .  The Home-Heart-Walk ( HHW ) is an intervention to promote physical activity adapting the elements of a six minute walk test , a reliable and valid measure . This adaptation was design ed to support self-monitoring of physical functioning and promote the self-care of people with heart failure . The primary outcome of the Home-Heart-Walk was perceived physical functioning and the secondary outcomes were six-minute walk test distance , health related quality of life , self-care behaviour , self-efficacy and physical activity level . Methods : A multicentre r and omized controlled trial . Participants ( N=132 ) were recruited from three academic hospitals in Sydney , Australia . Participants were r and omized to either the  Home-Heart-Walk group or the control group . Perceived physical functioning , health related quality of life , self-care behaviour , exercise self-efficacy and physical activity level were measured at baseline and at three- and six-month follow-up . Results : After adjusting for baseline scores , there were no statistically significant between-group differences in perceived physical functioning , six-minute walk test distance , health related quality of life and exercise self-efficacy at follow-up . The intervention group had improvement in self-care behaviour ( F(1,129 ) = 4.75 , p = 0.031 ) and physical activity level ( U = 1713 , z = −2.12 , p = 0.034 ) at the six-month follow-up compared with the control group . Conclusion : The Home-Heart-Walk did not improve the perceived physical functioning of the intervention group . Although the feasibility and acceptability of this strategy to support self-monitoring and improve self-care behaviour was demonstrated , self-reported adherence was unreliable ; newer technologies may offer better assessment of adherence Background Ageing is associated with a decrease in physical activity . This decrease particularly occurs during specific transitional life stages . Especially during adolescence and young adulthood a steep decrease in physical activity is observed . Inactive people are often not aware of their inactivity . Providing feedback on the actual physical activity level by an activity monitor can increase awareness and may in combination with an individually tailored physical activity advice stimulate a physically active lifestyle . Methods In a r and omized controlled trial the effectiveness of providing an activity monitor in combination with a personal physical activity advice through the Internet will be examined . Outcome measures are level of physical activity , determinants of physical activity , quality of life , empowerment , aerobic fitness and body composition .  Participants are relatively inactive adolescents and young adults who are measured at baseline , after 3 months intervention and 5 months after the end of the intervention . In addition , facilitating and hindering factors for implementation of the intervention will be investigated . Discussion The use of a personal activity monitor in combination with web-based assisted individually tailored health promotion offers a good opportunity to work interactively with large groups of adolescents and young adults and provide them with advice based on their actual activity level . It has great potential to motivate people to change their behaviour and to our knowledge has not been evaluated before BACKGROUND Nutritional status is associated with physical functioning in older people . Protein-energy malnutrition can limit functional performance . OBJECTIVES This study examined the effectiveness of a " need-based intervention " on improving the physical functioning of older adults living in nursing homes . DESIGN A 24-week r and omized , double-blind , controlled trial . SETTING S A privately managed geriatric nursing home in Taiwan . PARTICIPANTS Ninety-two persons who were ≥65 years old , ≤25 kg/m(2 ) , > 1 month residence , non-bed-ridden , without acute infection , and able to self-feed or receive oral feeding . METHODS Qualified participants were stratified by gender and then r and omly assigned to either the control group ( n=45 ) or the intervention group ( n=47 ) . Each participant in the intervention group would receive a 50 g/day soy-protein-based nutritional supplement when he/she was rated as undernourished , defined as Mini Nutritional Assessment score ≤24 and body mass index ≤24 kg/m(2 ) . The supplement contained 9.5 g protein , 250 kcal energy , and all essential micronutrients . The supplementation would be suspended if either one of the two " at risk " conditions was not met at the next measurement ( every 4 weeks ) . H and grip strength and Barthel Index were measured at baseline , mid-point ( week 12 ) , and end-point ( week 24 ) of the trial . Results were analyzed with Student 's t-test and by the Generalized Estimating Equations controlled for nutritional status . RESULTS The intervention significantly improved ( a ) h and grip strength of the older adults at weeks 12 and 24 , and ( b ) the overall Barthel Index at week 24 ( all p<0.05 ) according to the Generalized Estimating Equations . CONCLUSIONS " Need-based intervention " can be an effective and useful strategy for improving the physical functioning of older adults living in nursing homes , without adverse effects . The results probably are the indirect results of the improved nutritional status . The study highlights the importance of routine screening and timely intervention in geriatric care . The applicability of this need-based strategy to community-living older adults is an important issue and should be evaluated . We can probably reap a greater benefit by eliminating the risk of malnutrition at the emerging stage Little is known about the effectiveness of school-based health promotion on physical activity inequalities among children from low-income areas . This study compared the two-year change in physical activity among 10 - 11 year-old children attending schools with and without health promotion programs by activity level , body weight status , and socioeconomic background s to assess whether health promotion programs reduce or exacerbate health inequalities . This was a quasi-experimental trial of a Comprehensive School Health ( CSH ) program implemented in schools located in socioeconomically disadvantaged neighbourhoods in Edmonton , Alberta , Canada . In the spring of 2009 and 2011 , pedometer ( 7 full days ) and demographic data were collected from cross-sectional sample s of grade five children from 10 intervention and 20 comparison schools . Socioeconomic status was determined from parent self-report . Low-active , active , and high-active children were defined according to step-count tertiles . Multilevel linear regression methods adjusted for potential confounders were used to assess the relative inequity in physical activity and were compared between groups and over-time . In 2009 , a greater proportion of students in the intervention schools were overweight ( 38 % vs. 31 % p = 0.03 ) and were less active ( 10,827 vs. 12,265 steps/day p < 0.001 ) . Two years later , the relative difference in step-counts between intervention and comparison schools reduced from -15.5 % to 0 % among low-active students , from -13.4 % to 0 % among active students , and from -15.1 % to -2.7 % among high-active students . The relative difference between intervention and comparison schools reduced from -11.1 % to -1.6 % among normal weight students , from -16.8 % to -1.4 % among overweight students , and was balanced across socioeconomic subgroups . These findings demonstrate that CSH programs implemented in socioeconomically disadvantaged neighbourhoods reduced inequalities in physical activity . Investments in school-based health promotion are a viable , promising , and important approach to improve physical activity and prevent childhood obesity , and may also reduce inequalities in health A r and omised controlled trial was used to evaluate a theory-based health promotion intervention . The intervention , a healthy living booklet , was design ed to promote healthy eating and physical activity amongst people aged over 65 years attending hospital out-patient clinics . The booklet employed persuasive arguments targeting the most proximal cognitive antecedents of behaviour specified by the theory of planned behaviour , as well as goal setting prompts . Participants ( N = 252 , average age=82 ) were r and omly allocated to a control ( patient satisfaction question naire ) or intervention ( healthy living booklet ) group .  Cognitions and behaviour were measured pre-intervention and at a two week follow up . The intervention group made significantly higher gains in perceived behavioural control , intention and behaviour for both target behaviours , suggesting that the intervention was successful . Sixty three of those invited to set goals to eat more healthily ( e.g. , " to eat five portions of fruit and vegetables a day " ) did so , and 67 % of those who set such goals reported 100 % success in acting on them . By contrast , only 34 % of intervention participants set an activity goal ( e.g. , " a five minute walk everyday " ) , and only 51 % reported 100 % success in enacting these goals . Results suggest that the observed behavioural effects of the healthy eating booklet could be attributed to goal setting as well as changes in perceived behavioural control and intention Background The high number of adult males engaging in low levels of physical activity and poor dietary practice s , and the health risks posed by these behaviors , necessitate broad-reaching intervention strategies . Information technology (IT)-based ( Web and mobile phone ) interventions can be accessed by large numbers of people , yet there are few reported IT-based interventions targeting males ’ physical activity and dietary practice s. Objective This study examines the effectiveness of a 9-month IT-based intervention ( ManUp ) to improve the physical activity , dietary behaviors , and health literacy in middle-aged males compared to a print-based intervention . Methods Participants , recruited offline ( eg , newspaper ads ) , were r and omized into either an IT-based or print-based intervention arm on a 2:1 basis in favor of the fully automated IT-based arm . Participants were adult males aged 35 - 54 years living in 2 regional cities in Queensl and , Australia , who could access the Internet , owned a mobile phone , and were able to increase their activity level .  The intervention , ManUp , was based on social cognitive and self-regulation theories and specifically design ed to target males . Educational material s were provided and self-monitoring of physical activity and nutrition behaviors was promoted . Intervention content was the same in both intervention arms ; only the delivery mode differed . Content could be accessed throughout the 9-month study period . Participants ’ physical activity , dietary behaviors , and health literacy were measured using online surveys at baseline , 3 months , and 9 months . Results A total of 301 participants completed baseline assessment s , 205 in the IT-based arm and 96 in the print-based arm . A total of 124 participants completed all 3 assessment s. There were no significant between-group differences in physical activity and dietary behaviors ( P≥.05 ) . Participants reported an increased number of minutes and sessions of physical activity at 3 months ( exp(β)=1.45 , 95 % CI 1.09 - 1.95 ; exp(β)=1.61 , 95 % CI 1.17 - 2.22 ) and 9 months ( exp(β)=1.55 , 95 % CI 1.14 - 2.10 ; exp(β)=1.51 , 95 % CI 1.15 - 2.00 ) . Overall dietary behaviors improved at 3 months ( exp(β)=1.07 , 95 % CI 1.03 - 1.11 ) and 9 months ( exp(β)=1.10 , 95 % CI 1.05 - 1.13 ) . The proportion of participants in both groups eating higher-fiber bread and low-fat milk  increased at 3 months ( exp(β)=2.25 , 95 % CI 1.29 - 3.92 ; exp(β)=1.65 , 95 % CI 1.07 - 2.55 ) . Participants in the IT-based arm were less likely to report that 30 minutes of physical activity per day improves health ( exp(β)=0.48 , 95 % CI 0.26 - 0.90 ) and more likely to report that vigorous intensity physical activity 3 times per week is essential ( exp(β)=1.70 , 95 % CI 1.02 - 2.82 ) . The average number of log-ins to the IT platform at 3 and 9 months was 6.99 ( SE 0.86 ) and 9.22 ( SE 1.47 ) , respectively . The average number of self-monitoring entries at 3 and 9 months was 16.69 ( SE 2.38 ) and 22.51 ( SE 3.79 ) , respectively . Conclusions The ManUp intervention was effective in improving physical activity and dietary behaviors in middle-aged males with no significant differences between IT- and print-based delivery modes . Trial Registration Australian New Zeal and Clinical Trials Registry : ACTRN12611000081910 ; https://www.anzctr.org.au/Trial/ Registration /Trial Review .aspx?ACTRN=12611000081910 ( Archived by WebCite at http://www.webcitation.org/6QHIWad63 ) BACKGROUND walking is the most popular form of exercise in older people but the impact of walking on falls is unclear . This study investigated the impact of a 48-week walking programme on  falls in older people . METHODS three hundred and eighty-six physically inactive people aged 65 + years living in the community were r and omised into an intervention or control group . The intervention group received a self-paced , 48-week walking programme that involved three mailed printed manuals and telephone coaching . Coinciding with the walking programme manual control group participants received health information unrelated to falls . Monthly falls calendars were used to monitor falls ( primary outcome ) over 48 weeks . Secondary outcomes were self-reported quality of life , falls efficacy , exercise and walking levels . Mobility , leg strength and choice stepping reaction time were measured in a sub- sample ( n = 178 ) of participants . RESULTS there was no difference in fall rates between the intervention and control groups in the follow-up period ( IRR = 0.88 , 95 % CI : 0.60 - 1.29 ) . By the end of the study , intervention group participants spent significantly more time  exercising in general , and specifically walking for exercise  ( median 1.69 versus 0.75 h/week , P < 0.001 ) . CONCLUSION our finding that a walking programme is ineffective in preventing falls supports previous research and questions the suitability of recommending walking as a fall prevention strategy for older people . Walking , however , increases physical activity levels in previously inactive older people AIM This paper reports a study to determine the factors affecting community-dwelling older Chinese people 's  health-promoting behaviour in the domains of physical activity , healthy dietary practice s and stress management , and to identify any barriers to these behaviours . BACKGROUND Previous studies have identified factors affecting different types of health-promoting behaviours , including perceived self-efficacy , perceived benefits and five individual characteristics ( age , sex , marital status , education and perceived health ) of older non-Chinese people . However , few studies have simultaneously taken these factors into account in examining community-dwelling Chinese older people 's health-promoting behaviour . METHOD Individual face-to-face interviews were completed in 2002 - 2003 with a convenience sample of 896 community-dwelling older Chinese people in Hong Kong aged between the ages of 60 and 98 ( years mean 76 ) . Participants had no apparent communication and cognition impairments . A structured interview schedule was used to collect the data . RESULTS Multiple regression analysis showed that perceived self-efficacy , perceived benefits and sex together explained 38.4 % of health-promoting behaviour among community-dwelling older Chinese people in Hong Kong . Fatigue during and after physical activity , enjoyment of unhealthy foods and inadequate family and peer support were the most frequently reported barriers to health-promoting behaviour . CONCLUSION When developing health promotion programmes to motivate community-dwelling older Chinese clients to participate in health-promoting behaviour and to minimize barriers , community nurses should include some activities to increase both the perceived self-efficacy and perceived benefits of health-promoting behaviour . Future studies should include more critical factors based on theories , empirical evidence and knowledge of culture with sample s that are r and om and from more diverse community setting Background Pulmonary rehabilitation programs often fail to substantially enhance long-term physical activity in patients with chronic obstructive pulmonary disease ( COPD ) . The reasons for successful physical activity changes in patients with COPD are not well understood . The need to better underst and the determinants of physical activity in patients with COPD and effective rehabilitation strategies to improve physical activity is evident . Methods / design The STAR study ( Stay Active after Rehabilitation ) investigates , in a r and omized controlled trial , the additional effect of a pedometer-based behavior-change intervention during inpatient pulmonary rehabilitation on objective ly measured physical activity 6 weeks and 6 months post rehabilitation . The intervention uses the behavior-change techniques ( 1 ) instruction on how , where and when to perform the behavior , ( 2 ) prompt goal setting for physical activity , ( 3 ) prompt self-monitoring of behavior , and ( 4 ) feedback on behavior . The primary outcome of physical activity will be measured using a physical activity monitor ( Actigraph wGT3X-BT )  for a period of 7 days , firstly 2 weeks before rehabilitation begins ( t0 ) as well as 6 weeks and 6 months after rehabilitation ( t3 , t4 ) . Additionally , to predict physical activity progression after rehabilitation , a complex personal diagnostics battery , including question naires as well as functional assessment s , is to be carried out at the start and end of rehabilitation ( t1 , t2 ) . This battery is based on the foundational ideas of the Physical Activity-Related health Competence model . Five hundred and two patients with COPD , aged 18 years or older and admitted for an approved pulmonary rehabilitation , will be enrolled in the STAR study . Discussion The STAR study is design ed as a r and omized controlled trial to gain a better underst and ing of the personal determinants of physical activity in patients with COPD and to evaluate a pedometer-based physical activity-change intervention in the context of inpatient pulmonary rehabilitation . The results enable the future identification of patients with COPD who will find it difficult to engage in long-term physical activity after rehabilitation . Based on this , intervention strategies to promote physical activity in the content of pulmonary rehabilitation can be optimized . Trial registration Clinical trials.gov , ID : NCT02966561 . Registered retrospectively after the start of the recruitment in June 2016 on 22 November 2016 . All protocol modifications will be registered in the trial registry BACKGROUND there is inadequate evidence to support currently formulated NHS strategies to achieve health promotion and preventative care in older people through broad-based screening and assessment in primary care . The most extensively evaluated delivery instrument for this purpose is Health Risk Appraisal ( HRA ) . This article describes a trial using HRA to evaluate the effect on health behaviour and preventative-care uptake in older people in NHS primary care . METHODS a r and omised controlled trial was undertaken in three London primary care group practice s. Functionally independent community-dwelling patients older than 65 years ( n = 2,503 ) received a self-administered Health Risk Appraisal for Older Persons ( HRA-O ) question naire leading to computer-generated individualised written feedback to participants and general practitioners ( GPs ) , integrated into practice information-technology ( IT ) systems . All primary care staff received training in preventative health in older people . The main outcome measures were self-reported health behaviour and preventative care uptake at 1-year follow-up . RESULTS of 2,503 individuals r and omised , 2,006 respondents ( 80.1 % ) ( intervention , n = 940 , control n = 1,066 ) were available for analysis . Intervention group respondents reported slightly higher pneumococcal vaccination uptake and equivocal improvement in physical activity levels compared with controls . No significant differences were observed for any other categories of health behaviour or preventative care measures at 1-year follow-up . CONCLUSIONS HRA-O implemented in this way result ed in minimal improvement of health behaviour or uptake of preventative care measures in older people . Supplementary reinforcement involving contact by health professionals with patients over and above routine clinical encounters may be a prerequisite to the effectiveness of IT-based delivery systems for health promotion in older people There is a need to identify evidence d-based obesity treatments that are effective in maintaining lost weight . Weight loss results in reductions in energy expenditure , including spontaneous physical activity ( SPA ) which is defined as energy expenditure result ing primarily from unstructured mobility-related activities that occur during daily life . To date , there is little research , especially r and omized , controlled trials , testing strategies that can be adopted and sustained to prevent declines in SPA that occur with weight loss . Self-monitoring is a successful behavioral strategy to facilitate behavior change , so a provocative question is whether monitoring SPA-related energy expenditure would override these reductions in SPA , and slow weight regain . This study is a r and omized trial in older , obese men and women design ed to test the hypothesis that adding a self-regulatory intervention ( SRI ) , focused around self-monitoring of SPA , to a weight loss intervention will result in less weight and fat mass regain following weight loss than a comparable intervention that lacks this self-regulatory behavioral strategy . Participants ( n=72 ) are r and omized to a 5-month weight loss intervention with or without the addition of a behavioral component that includes an innovative approach to promoting increased SPA . Both groups then transition to self-selected diet and exercise behavior for a 5-month follow-up . Throughout the 10-month period , the SRI group is provided with an intervention design ed to promote a SPA level that is equal to or greater than each individual 's baseline SPA level , allowing us to isolate the effects of the SPA self-regulatory intervention component on weight and fat mass regain Abstract Background : Many people with mild disability after stroke are physically inactive despite the risk of recurrent stroke . A self-management program may be one strategy to increase physical activity in stroke survivors . Objectives : To investigate the feasibility of a self-management program , and determine whether self-management can increase daily physical activity levels and self-efficacy for exercise , decrease cardiovascular risk , and improve walking ability , participation , and quality of life in people with mild disability after stroke . Method : A Phase I , single-group , pre-post intervention study was carried out with twenty stroke survivors who had mild disability and were discharged directly home from acute stroke units . A self-management program was delivered via five home-based sessions over 3 months , incorporating : education , goal setting , barrier identification , self-monitoring , and feedback .  Feasibility of the intervention was determined by examining adherence , duration , usefulness , and safety . Clinical outcomes were amount of physical activity ( duration of moderate physical activity in min/day and counts of physical activity in steps/day ) , self-efficacy , cardiovascular risk , walking ability , participation , and quality of life . Results : The intervention was feasible with 96 % of sessions being delivered , each taking less than an hour ( 41 min , SD 12 ) . Participants perceived the self-management program to be useful and there were few adverse events . At 3 months , participants completed 27 min/day ( 95 % CI 4–49 ) more moderate physical activity than at baseline and 16 min/day ( 95 % CI −10 to 42 ) at 6 months . Conclusion : Self-management appears to be feasible and has the potential to increase physical activity in people with mild disability after stroke . A Phase II r and omized trial is warranted Background Chile is currently undergoing a period of rapid demographic transition which has led to an increase in the proportion of older people in the population ; the proportion aged 60 years and over , for example , increased from 8 % of the population in 1980 to 12 % in 2005 . In an effort to promote healthy ageing and preserve function , the government of Chile has formulated a package of actions into the Programme of Complementary Feeding for the Older Population ( PACAM ) which has been providing a nutritional supplement to older people since 1998 . PACAM distributes micronutrient fortified foods to individuals aged 70 years and over registered at Primary Health Centres and enrolled in the programme . The recommended serving size ( 50 g/day ) of these supplements provides 50 % of daily micronutrient requirements and 20 % of daily energy requirements of older people . No information is currently available on the cost-effectiveness of the supplementation programme . Aim The aim of the CENEX cluster r and omised controlled trial is to evaluate the cost-effectiveness of an ongoing nutrition supplementation programme , and a specially design ed physical exercise intervention for older people of low to medium socio-economic status living in Santiago , Chile . Methods The study has been conceptualised as a public health programme effectiveness study and has been design ed as a 24-month factorial cluster-r and omised controlled trial conducted among 2800 individuals aged 65.0–67.9 years at baseline attending 28 health centres in Santiago . The main outcomes are incidence of pneumonia , walking capacity and change in body mass index over 24 months of intervention . Costing data ( user and provider ) , collected at all levels , will enable the determination of the cost-effectiveness of the two interventions individually and in combination . The study is supported by the Ministry of Health in Chile , which is keen to exp and and improve its national programme of nutrition for older people based on sound science-base and evidence for cost-effectiveness . Trial registration IS RCT Background The fastest growing age group globally is older adults , and preventing the need for long-term nursing care in this group is important for social and financial reasons . A population approach to diet and physical activity through the use of social services can play an important role in prevention . This study examined the effectiveness of a social health program for community-dwelling older adults aim ed at introducing and promoting physical activity in the home at each individual ’s pace , helping participants maintain good dietary habits by keeping self-check sheets , and determining whether long-st and ing unhealthy or less-than-ideal physical and dietary habits can be changed . Method This cluster r and omized trial conducted at 6 community centers in an urban community involved 92 community-dwelling older adults aged 65–90 years . The intervention group ( 3 community centers ; n = 57 ) participated in the social health program “ Sumida TAKE10 ! ” which is an educational program incorporating the “ TAKE10 ! ® for Older Adults ” program , once every 2 weeks for 3 months . The control group ( 3 community centers ; n=35 ) was subsequently provided with the same program as a crossover intervention group . The main outcome measures were changes in food intake frequency , food frequency score ( FFS ) , dietary variety score ( DVS ) , and frequency of walking and exercise . The secondary outcome measures were changes in self-rated health , appetite , and the Tokyo Metropolitan Institute of Gerontology ( TMIG ) Index of Competence score . Results Compared to baseline , post-intervention food intake frequency for 6 of 10 food groups ( meat , fish/shellfish , eggs , potatoes , fruits , and seaweed ) , FFS , and DVS were significantly increased in the intervention group , and interaction effects of FFS and DVS were seen between the two groups . No significant differences were observed between baseline and post-intervention in the control group . Frequency of walking and exercise remained unchanged in both groups , and no significant difference in improvement rate was seen between the groups . Self-rated health was significantly increased in the intervention group . Appetite and TMIG Index of Competence score were unchanged in both groups . Conclusions The social health program result ed in improved dietary habits , as measured by food intake frequency , FFS , and DVS , and may improve self-rated health among community-dwelling older adults . Trial registration Physical activity during pregnancy has been associated with significant health benefits ; however , most women in the United States do not meet the current guidelines . This systematic review evaluates evidence for interventions to improve physical activity during pregnancy in order to identify best practice s and inform future research . Electronic data bases ( PubMed , CINAHL , SportD ISCUS , Embase , ERIC , Psych Info , and ISI Web of Science ) were search ed in July 2011 for peer- review ed journal articles . Studies were included if they were English- language r and omized control trials that measured the efficacy of an intervention targeted at pregnant women and were design ed to change physical activity as a primary or secondary outcome . Out of 777 studies identified through the systematic search , 9 interventions were selected for inclusion by multiple review ers . Data were abstract ed using an abstract ion form modeled after the “ Guide to Community Preventive Services . ” Of the 9 interventions included in the review , 3 reported statistically significant positive results for physical activity . Although the interventions included a variety of strategies and techniques , none were uniquely associated with positive outcomes . Overall , this review suggests that little is known about the efficacy of interventions for physical activity during pregnancy . This study provides several recommendations for future research and intervention design Background Although the benefits of physical activity ( PA ) on to prevent and manage non-communicable diseases are well known , strategies to help increase the levels of PA among different population s are limited . Exercise-referral schemes have emerged as one effective approach to promote PA ; however , there is uncertainty about the feasibility and effectiveness of these schemes in setting s outside high-income countries . This study will examine the effectiveness of a scheme to refer hypertensive patients identified in Primary Health Care facilities ( PHCU ) of the Mexican social security institution to a group PA program offered in the same institution . Methods and design We will describe the methods of a cluster r and omized trial study design ed to evaluate the effectiveness of an exercise referral scheme to increasing physical activity in hypertensive patients compared to a non-referral scheme .  Four PHCU were selected for the study ; the PHCU will take part as the unit of r and omization and sedentary hypertensive patients as the unit of assessment . 2 PHCU of control group ( GC ) will provide information to hypertensive patients about physical activity benefits and ways to increase it safely . 2 PHCU of intervention group ( IG ) will refer patients to sports facilities at the same institution , to follow a group-based PA program developed to increase the PA levels with a design ed based on the Transtheoretical Model and Social Cognitive Theory . To evaluate the effects of the intervention as well as short-term maintenance of the intervention ’s effects ,  PA  will be assessed at baseline , at 24 and 32 weeks of follow-up . The main outcome will be the difference before and after intervention in the percentage of participants meeting recommended levels of PA  between and within intervention and control groups . PA will be measured through self-report and with objective measure by accelerometer . Discussion This study will allow us to evaluate a multidisciplinary effort to link the primary care and community-based areas of the same health care system . Our findings will provide important information about the feasibility and effectiveness of an exercise-referral scheme and will be useful for decision-making about the implementation of strategies for increasing PA among hypertensive and other clinical population s in Mexico and Latin America . Trial registration Clinical trials.gov Identifier : NCT01910935 . Date of registration : 07/05/2013 OBJECTIVES We assessed the impact of existing best- practice physical activity programs for older adults on physical activity participation and health-related outcomes . METHODS We used a multisite , r and omized trial with 544 older adults ( mean age 66 years ) and measures at baseline , 5 , and 10 months to test the impact of a multiple-component physical activity program compared with results for a control group that did not participate in such a program . RESULTS For adults who participated in a multiple-component physical activity program , we found statistically significant benefits at 5 and 10 months with regard to self-efficacy for exercise adherence over time ( P < .001 ) , adherence in the face of barriers ( P = .01 ) , increased upper- and lower-body strength ( P = .02 , P = .01 ) , and exercise participation ( P = .01 ) . CONCLUSIONS Best- practice community-based physical activity programs can measurably improve aspects of functioning that are risk factors for disability among older adults . US public policy should encourage these inexpensive health promotion programs PURPOSE Whilst the health benefits associated with regular physical activity are well known , little objective evidence exists regarding the activity profiles of adults with mild and moderate learning disabilities . The aims of the present study were to establish 7 day physical activity profiles for 24 adults with mild and moderate learning disabilities and to compare them with the general population and current Department of Health recommendations for physical activity . METHOD A descriptive study was used , based on interviews with 24 adults with learning disabilities ( mean age 34 years ) triangulated by daytime and residential care workers . Participants volunteered from two residential homes and one social education centre ( SEC ) in a city in the North of Engl and . RESULTS The physical activity profiles show that the participants led sedentary lifestyles that were more exaggerated than those of the general population . Twenty-two participants ( 93 % ) performed significantly less than the minimum daily levels of physical activity recommended by the Department of Health . CONCLUSIONS Few adults with learning disabilities can choose to walk to work , go for a run or visit the local swimming pool without adequate support . This study suggests that there may not be enough moderate or vigorous physical activity choices available in day and residential care setting s to empower adults with mild and moderate learning disabilities to meet the minimum recommendations of the Department of Health . Hence some people with learning disabilities have no alternatives to a sedentary lifestyle and the health risks associated with physical inactivity Background Research and practice partnerships have the potential to enhance the translation of research findings into practice . Purpose This paper describes such a partnership in the development of Walk Kansas ( WK ) and highlights individual and organizational level outcomes . Method Phase 1 examined : ( a ) the reach of WK , ( b ) physical activity changes , and ( c ) maintenance of physical activity changes 6 months after the program was completed . Phase 2 explored WK adoption and sustainability over 5 years . Results WK attracted a large number of participants who were more likely to be female , more active , and older than the adult population within the counties where they resided . Inactive or insufficiently active participants at baseline experienced significant increases in both moderate ( p < 0.001 ) and vigorous ( p < 0.001 ) physical activity . A r and om selection of participants who were assessed 6 months post-program did not demonstrate a significant decrease in moderate or vigorous activity between program completion and 6-month follow-up . The number of counties adopting the program increased across years , peaking at 97 in 2006 and demonstrated the sustainability of the WK over 5 years . Conclusions WK is effective , has a broad reach , and enables participants to maintain increased activity . It also shows promise for broad adoption and sustainability Background Healthful dietary patterns , including eating fruits and vegetables ( F&V ) and avoiding obesity , may decrease the risk of cancer and other chronic diseases . In addition to promoting health for the general population , a cancer diagnosis may provide a “ teachable moment , ” facilitating the adoption of more healthful eating habits and leading to lower risk of chronic disease and better overall health . Purpose This study was design ed to test the effectiveness of two health communication interventions in increasing F&V consumption and physical activity in a sample of older adults ( average age of 66 years ) , including both colorectal cancer ( CRC ) survivors and noncolorectal cancer-affected ( N-CRC ) individuals . Methods CRC survivors and N-CRC individuals were recruited from a population -based case – control study and r and omly assigned to four conditions using a 2 × 2 design . We tested two different methods of communicating and promoting health behavior change alone or in combination : tailored print communication ( TPC ) and brief telephone-based motivational interviewing ( TMI ) . Results A significant increase in F&V consumption was found for the combined intervention group in the entire sample ( p < 0.05 ) . When stratified by cancer survivor status , the effect was concentrated in the N-CRC subset ( p < 0.01 ) versus CRC survivors . The combined intervention was also found to be most cost-effective for the N-CRC group , with TPC  more cost-effective than TMI . For physical activity , none of the interventions produced statistically significant improvements . Conclusions This study indicates that combining tailoring and motivational interviewing may be an effective and cost-effective method for promoting dietary behavior change among older healthy adults . More research is needed to identify the optimal dose and timing for intervention strategies to promote dietary and physical activity change among both CRC survivors and the general population Background Many older adults are both highly sedentary ( that is , spend considerable amounts of time sitting ) and physically inactive ( that is , do little physical activity ) . This protocol describes an exploratory trial of a theory-based behaviour change intervention in the form of a booklet outlining simple activities ( ‘ tips ’ ) design ed both to reduce sedentary behaviour and to increase physical activity in older adults . The intervention is based on the ‘ habit formation ’ model , which proposes that consistent repetition leads to behaviour becoming automatic , sustaining activity gains over time . Methods The intervention is being developed iteratively , in line with Medical Research Council complex intervention guidelines . Selection of activity tips was informed by semi-structured interviews and focus groups with older adults , and input from a multidisciplinary expert panel . An ongoing preliminary field test of acceptability among 25 older adults will inform further refinement . An exploratory r and omized controlled trial will be conducted within a primary care setting , comparing the tips booklet with a control fact sheet . Retired , inactive and sedentary adults ( n = 120 ) aged 60 to 74 years , with no physical impairments precluding light physical activity , will be recruited from general practice s in north London , UK . The primary outcomes are recruitment and attrition rates . Secondary outcomes are changes in behaviour , habit , health and wellbeing over 12 weeks . Discussion Data will be used to inform study procedures for a future , larger-scale definitive r and omized controlled trial . Trial registration Current Controlled Trials IS RCT N47901994 Despite the benefits associated with a physically active lifestyle , many older adults are insufficiently active to achieve health gain , and also exhibit decreased activity levels with age . Insufficient physical activity in this population is associated with increased morbidity , mortality and dem and on health care services and expenditure . There is a clear need for effective intervention to encourage physical activity in older adults . The aim of this paper is to describe the development and participant evaluation of a r and omized controlled trial of TeleWalk , a telephone-based motivational counseling intervention to encourage physical activity in adults aged 65 years and older . Participants ( N = 186 , mean age 74 + /- 6 years ) were recruited through their General Practitioner ( primary care physician ) and r and omized to either receive eight telephone counseling sessions and related printed material s over 3 months ( intervention group ) or participate in outcome assessment s only ( control group ) . Intervention group participants were mailed an anonymous evaluation question naire on intervention completion . A high response rate was achieved ( 70 % ) . All respondents ( 100 % ) agreed or strongly agreed that a good overall level of service and support was provided , and that the counselor was underst and ing and supportive . Nearly all respondents agreed or strongly agreed that the service was professional , the counselor advice was helpful and motivating and the information provided was relevant ( 97 , 95 and 89 % , respectively ) . Most ( 87 % ) agreed or strongly agreed that the telephone calls encouraged them to be physically active . Among the participants who received printed material , most agreed or strongly agreed that these encouraged them to become or remain active . Findings from this evaluation can be used to inform such interventions and ensure their relevance to community-dwelling older adults Increasing evidence suggests that physical activity can prevent some aspects of mental illness in older people such as depression , dementia and Alzheimer ’s disease . Additionally , limited research has shown that engagement in structured exercise can improve aspects of psychological well-being such as mood and self-perceptions in older adults . However , the relationship between incidental daily activity such as walking or time spent sedentary , with psychological well-being has not been investigated . The Better Ageing Project provided an opportunity to assess well-being and quality of life using st and ardised question naires with 176 adults aged 70 and over .  Accelerometry was used to objective ly assess daily energy expended in physical activity at different levels of intensity . In addition , an assessment of the impact of the 12-month Better Ageing structured group exercise programme was assessed through question naires and interviews . Total daily physical activity energy expenditure ( joules/day ) and amount of time spent in activity of at least moderate intensity were weakly related ( r = 0.20–0.28 ) to quality of life , subjective well-being and physical self-perceptions . Time spent sedentary ( min/day ) was weakly and negatively related to several mental health indicators . The quantitative data showed only minor psychological benefits of the exercise intervention . In contrast , interviews with 27 research participants and 4 exercise leaders suggested that important improvements in perceived function and social benefits had been experienced In this 12-month trial st and ard exercise training was compared with a group-mediated cognitive-behavioral ( GMCB ) intervention with respect to effects on long-term adherence and change in physical function of older adults who were either at risk for or had cardiovascular disease . Participants ( 147 older men and women ) were r and omized to the 2 treatments . Outcomes included self-reportedphysical activity , fitness , and self-efficacy . The GMCB treatment produced greater improvements on all outcomes than did st and ard exercise therapy . Regardless of treatment assignment , men had more favorable change on the study outcomes than did women . Analysis of a self-regulatory process measure in the GMCB group revealed that change in barriers efficacy was related to change in physical activity and fitness . Results suggest that teaching older adults to integrate physical activity into their lives via GMCB leads to better long-term outcomes than st and ardized exercise therapy Physical activity is associated with health and reduced mortality risk , yet only15 % ofU.S. adults achieve adequate activity . This study is an experimental repeated measures nested design r and omizing two similar rural communities to investigate the effectiveness of the Heart and Soul Physical Activity Program ( HSPAP ) ( Peterson , 2002 ) in promoting physical activity in midlife women ( n = 42 ) aged 35 to 65 years . The HSPAP , an innovative church-based health promotion intervention , is conceptualized in social support and design ed to increase physical activity , energy expenditure ( EE ) , and cardiorespiratory fitness ( VO2 max ) , measured over time . A significant interaction ( p < .001 ) was found for EE in one HSPAP group increasing their EE by 1,010 kcals/week . HSPAP participants increased their VO2 max level by 75 % ( p < .001 ) and 10 % ; comparison groups stayed the same or declined 16 % . Study results provide preliminary support for the HSPAP intervention as an effective treatment to improve physical activity levels in sedentary , rural , midlife women BACKGROUND Little is known about the prevalence of falls and the related risk factors in the general population of community-living older people in Germany . OBJECTIVES To assess the prevalence and related predictors of different types of falls  in a sample of community-dwelling 65 years and older people in Germany living in a metropolitan area . Study design and setting prospect i ve cohort study in 622 community dwelling people aged > or = 65 years . RESULTS A total of 107 persons ( 17.2 % ) reported falling at least once ( occasional fallers ) , while 36 ( 5.7 % ) experienced two or more falls ( recurrent fallers ) in the last 6 months . Main predictors for all fallers were age ( OR 1.8 ; 95 % CI 1.1 - 3.0 ) , being female ( OR 1.7 ; 95 % CI 1.1 - 2.2 ) , living alone ( OR 1.9 ; 95 % CI 1.2 - 2.9 ) , poor health status ( OR 3.3 ; 95 % CI 2.1 - 5.3 ) , varifocals ( OR 1.7 ; 95 % CI 1.0 - 3.1 ) , disturbance of memory ( OR 1.7 ; 95 % CI 1.0 - 3.0 ) , depression ( OR 4.8 ; 95 % CI 2.5 - 9.2 ) , sleep disturbances ( OR 2.7 ; 95 % CI 1.7 - 4.3 ) , incontinence ( OR 2.1 ; 95 % CI 1.3 - 4.9 ) , dizziness ( OR 3.0 ; 95 % CI 1.9 - 5.0 ) , 3 medical conditions or more ( OR 3.3 ; 95 % CI 2.1 - 5.1 ) , lower physical functioning and mobility . Two of the strongest predictors were reported falls ( OR 4.9 ; 95 % CI 3.1 - 7.7 ) and recurrent falls ( OR 10.0 ; 95 % CI 5.0 - 20.0 ) in the last 6 months . CONCLUSION Older adults living at home should be screened for falls in history and problems in gait and mobility in any anamnesis to identify those who are at risk for falls People with ID have an increased risk for unhealthy diets , physical inactivity and weight disturbances . The aim of the current study was to investigate the effectiveness of a novel and complex intervention to improve diet and physical activity , targeting both caregivers and residents , in community residences for people with ID . A three component intervention based on Social Cognitive Theory was developed , including : ( 1 ) appointment of a health ambassador in each community residence attending network meetings , ( 2 ) a study circle for caregivers , and ( 3 ) a health course for the residents . The intervention lasted for 12 - 16 months and allowed for some local tailoring . A cluster r and omised controlled trial , r and omised at residence level , was conducted to evaluate the effects of the intervention . Thirty community residences for people with mild or moderate ID in Stockholm County , Sweden , were included . A total of 130 participants , 74 women and 56 men aged 20 - 66 years , entered , and 129 participants completed the study . The primary outcome was physical activity , measured by pedometry . Secondary outcomes were BMI , waist circumference , dietary quality measured by digital photography , satisfaction with life assessed with a scale , and work routines assessed with a question naire . Outcomes were related to intervention fidelity . A positive intervention effect was found on physical activity , with an average increase of 1608 steps/day among participants in the intervention group ( P=0.045 ) . The effect size was 0.29 ( Cohen 's d ) . The type of residence was found to be an effect moderator . A positive intervention effect was found as well on work routines , with an average increase of 7.1 percentage points on a self- assessment scale among residences in the intervention group ( P=0.016 ) . No significant effects were found on BMI , waist circumference , dietary quality , or satisfaction with life . In conclusion , this innovative intervention was effective in improving physical activity and work routines . It is likely that even greater effects could be achieved by improvements in implementation strategies , leading to higher fidelity Sedentary behavior among older adults increases risk for chronic diseases . Physicians in a primary care setting can play an important role in promoting physical activity adoption among their older patients . The Physically Active for Life ( PAL ) project was a r and omized , controlled trial comparing the efficacy of brief physician-delivered physical activity counseling to usual care on self-reported physical activity levels . The physical activity counseling was based on the Transtheoretical Model of Change and social learning theory . Twenty-four community-based primary care medical practice s were recruited into the study ; 12 were r and omized to the Intervention condition and 12 to the Control condition . Physicians in the Intervention practice s received training in the delivery of brief physical activity counseling . Subjects in the Intervention practice s ( n=181 ) received brief activity counseling matched to their stage of motivational readiness for physical activity , a patient manual , a follow-up appointment with their physician to discuss activity counseling , and newsletter mailings . Subjects in the Control practice s ( n=174 ) received st and ard care .  Measures of motivational readiness for physical activity and the Physical Activity Scale for the Elderly ( PASE ) were administered to subjects in both conditions at baseline , 6 weeks following their initial appointment , and at 8 months . Results showed that at the 6-week follow-up , subjects in the Intervention condition were more likely to be in more advanced stages of motivational readiness for physical activity than subjects in the Control condition . This effect was not maintained at the 8 month follow-up and the intervention did not produce significant changes in PASE scores . Results suggest that more intensive , sustained interventions may be necessary to promote the adoption of physical activity among sedentary , middle-aged , and older adults in primary care medical practice BACKGROUND The continued prevalence of sedentary behavior in older adults underscores the need for physical activity promotion . Physician-delivered activity counseling may be an important avenue of promoting physical activity for these individuals . The Physically Active for Life ( PAL ) project was a r and omized study of the effects of brief physician counseling plus follow-up on physical activity behaviors in older adults . METHOD Twelve practice s were r and omized to the intervention group and 12 to st and ard care . Physicians in the intervention group participated in a 1-hour training session and received support material s for exercise counseling . Pre- assessment and post- assessment of self-reported exercise counseling behaviors and confidence in providing exercise counseling were obtained from physicians in the study . Patient evaluations of the exercise counseling and support material s were also obtained . RESULTS Results showed that physicians favorably endorsed the training and the support material s , and reported adherence to delivery of the intervention protocol . Comparisons between the two groups showed significant improvements in confidence for intervention-group physicians , but no significant changes in physician reports of exercise counseling provided to all patients . Patients reported satisfaction with the exercise counseling and support material s. CONCLUSIONS Physicians and patients indicated the PAL project offered an acceptable and feasible approach to promote physical activity in older adults BACKGROUND There is increasing interest in the health-promoting potential of physical activity in older adults . The objective of this study was to estimate the likely costs , health benefits and consequences for the National Health Service which might result from a publicly funded programme of regular exercise made available to a population of 10,000 people over the age of 65 . METHODS Risk education data from observational studies were used to calculate the possible impact of a community-based programme of activity on hospital admissions and deaths from coronary heart disease , stroke , diabetes , femoral neck fractures and mental disorders . The avoided costs of health care and net cost per life-year saved were estimated . RESULTS Providing twice-weekly exercise classes for 10,000 participants would cost approximately 854,700 pounds per year , but would prevent 76 deaths and 230 in-patient episodes , avoiding annual health care costs of approximately 601,000 pounds . Assuming the mean expectation of life after 65 to be ten years , the programme would cost about 330 pounds per life-year saved . Under a range of more extreme assumptions , the cost per life-year saved would vary from 100 pounds to 1500 pounds . CONCLUSIONS A publicly funded programme of regular moderate exercise for over-65-year-olds could achieve important health benefits at relatively low cost . The estimates provided by this analysis should now be tested in a rigorous r and omized trial , and health commissioners should begin to think of purchasing exercise programmes alongside other health-promoting measures Objectives : We have a limited underst and ing of the epidemiological association between objective ly measured physical activity and  depression among older adults . Therefore , the purpose of this study was to examine the association between accelerometer-assessed physical activity and depression symptoms among a nationally representative sample of US older adults . Methods : Data from the 2005–2006 National Health and Nutrition Examination Survey was used . 708 older adults ( 65 + years ) wore an ActiGraph 7164 accelerometer for at least 4 days , and completed data on the study covariates along with depression , as assessed by the Patient Health Question naire-9 . Results : After controlling for age , gender , race-ethnicity , body mass index , marital status , education , comorbidity index , and physical functioning , for every 60-minute increase in light-intensity physical activity , participants were 20 % ( OR = 0.80 ; 95 % CI : 0.67–0.95 ; p = 0.01 ) less likely to be depressed . Moderate-to-vigorous physical activity was also inversely associated with depression ( OR = 0.78 ; 95 % CI : 0.64–0.94 ; p = 0.01 ) . Conclusion : These findings suggest that promoting physical activity , even light-intensity physical activity , may have positive mental health effects  among older adults . Future prospect i ve and experimental studies are warranted Purpose : The purpose of this study was to investigate the impact of using a pedometer on time spent walking , in sedentary and overweight adults with type 2 diabetes participating in a coaching intervention . It was hypothesized that participants using a pedometer would spend more time walking than would nonpedometer participants . Method : A sample of 57 men and women with a mean age of 62 years participated in a r and omized controlled trial in a community setting . Participants were allocated to either a pedometer and coaching ( intervention ) group or a coaching-only ( control ) group . Coaching for both groups involved education , goal setting , and supportive/motivational strategies to increase  time spent walking .  The duration of the study was 6 months , with blood pressure , glycosylated hemoglobin , anthropometric , and fitness measurements assessed at baseline and at 3-month intervals . Results : A repeated- measures analysis of variance indicated that the coaching-only group spent significantly more time walking than did the pedometer group . However , when an analysis of covariance with all the other variables as covariates was performed , group membership had no influence on time spent walking . Significant reductions in waist circumference and weight were achieved for both groups from baseline to 6 months . Cardiovascular fitness also increased significantly for both groups . Conclusion : The study demonstrated that previously sedentary older adults with type 2 diabetes , supported with a coaching intervention , were able to achieve the physical activity targets known to be beneficial to health . However , using a pedometer added no further benefit . Further research on the impact of specific coaching strategies in diabetes management is warranted Self-reported rates of participation in sport vary by country . In the UK , about 40 % of men and women aged 16 years or older participate in at least one sport every week . Although few data exist to assess trends for participation in sport , there is little evidence of change in the past decade among adults . Large cohort studies suggest that such participation in sport is associated with a 20 - 40 % reduction in all-cause mortality compared with non-participation . R and omised trials and crossover clinical studies suggest that playing sport is associated with specific health benefits . Some sports have relatively high injury risk although neuromuscular training programmes can prevent various lower extremity injuries . Clinicians can influence a large number of patients through brief interventions that promote physical activity , and encouragement toward participation in sport for some physically inactive patients qualifies as evidence -based therapy . Exercise might also be considered as a fifth vital sign and should be recorded in patients ' electronic medical records and routine histories OBJECTIVE Physical inactivity is common among older population s and American Indians . Our objective was to compare two methods for increasing physical activity and walking among American Indian elders . METHODS We conducted a two arm r and omized trial to increase physical  activity in 125 American Indians aged 50 - 74 years at the Seattle Indian Health Board in 2005 . Participants were r and omized into either an activity monitoring ( N=63 ) or activity monitoring with a pedometer ( N=62 ) arm over a six-week period . Outcomes included self-reported physical activity and well-being , and the 6-min walk test . RESULTS There were no group differences in self-reported physical activities and well-being . The 6-min walk test yielded no between-group differences . All participants increased the frequency of leisure walking ( p<0.01 ) , frequency of all exercise-related activities ( p<0.01 ) , frequency of moderate-intensity exercise activities ( p<0.01 ) , and improved weekly caloric expenditure for all exercise activities ( p<0.05 ) by the end of the trial . CONCLUSIONS Pedometers did not confer enhanced performance on the physical activity outcomes beyond those achieved through self-monitoring . Physical activity can be promoted among at-risk groups in a brief , inexpensive manner in primary care . Exercise prescription and culturally relevant enhancement strategies may optimize physical activity outcomes for elder American Indians Purpose . Determine the proportion of adults aware of Canada 's Physical Activity Guide to Healthy Active Living ( Guide ) and its specific recommendations ( objective 1 ) ; whether key demographic factors ( objective 2a ) and physical activity behavior ( objective 2b ) are associated with awareness and specific familiarity with the Guide ; and if changes in awareness and specific recommendations with the Guide occurred over a 1-year period ( objective 3a and 3b ) . Design . R and om selection with computer-assisted telephone interviewing . Setting . Edmonton , Alberta , Canada . Subjects . A total of 2803 adults 18 years or older completed interviews from 4831 telephone contacts ( response rate , 58.0 % ) , and after 1 year , 1423 individuals ( 55 % ) completed interviews . Measures . Demographic , physical activity , Guide awareness . Analysis . Chi-square , analysis of variance . Results . At baseline , 27.3 % were aware of the Guide , and 15.6 % were familiar with the Guide 's specific recommendations . Younger individuals ( p = .01 ) , women ( p < .001 ) , and those with a higher education ( p < .001 ) were more likely to be generally aware of the Guide , and women were also more specifically aware ( p = .01 ) . Physical activity levels were positively associated with the general ( p < .001 ) and specific ( p < .001 ) awareness of the Guide . Changes in general familiarity and specific recommendations over 1 year were observed . Conclusions . The majority of those surveyed were not familiar with the Guide . Men , individuals with a lower education , and older individuals may need to be specifically targeted . ( Am J Health Promot 2011;25[5]:294 - 297 . Abstract Objective : To evaluate the impact of a programme of integrated social and medical care among frail elderly people living in the community . Design : R and omised study with 1 year follow up . Setting : Town in northern Italy ( Rovereto ) . Subjects : 200 older people already receiving conventional community care services . Intervention : R and om allocation to an intervention group receiving integrated social and medical care and case management or to a control group receiving conventional care . Main outcome measures : Admission to an institution , use and costs of health services , variations in functional status . Results : Survival analysis showed that admission to hospital or nursing home in the intervention group occurred later and was less common than in controls ( hazard ratio 0.69 ; 95 % confidence interval 0.53 to 0.91 ) . Health services were used to the same extent , but control subjects received more frequent home visits by general practitioners . In the intervention group the estimated financial savings were in the order of £ 1125 ( $ 1800 ) per year of follow up . The intervention group had improved physical function ( activities of daily living score improved by 5.1 % v 13.0 % loss in controls ; P<0.001 ) . Decline of cognitive status ( measured by the short portable mental status question naire ) was also reduced ( 3.8 % v 9.4 % ; P<0.05 ) . Conclusion : Integrated social and medical care with case management programmes may provide a cost effective approach to reduce admission to institutions and functional decline in older people living in the community . Key messages Responsibility for management of care of elderly people living in the community is poorly defined Integration of medical and social services together with care management programmes would improve such care in the community In a comparison of this option with a traditional and fragmented model of community care the integrated care approach reduced admission to institutions and functional decline in frail elderly people living in the community and also reduced Background . Physical activity can positively influence health for older adults . Primary care is a good setting for physical activity promotion . Objective . To assess the feasibility of a pedometer-based walking programme in combination with physical activity consultations . Methods . Design : Two-arm ( intervention/control ) 12-week r and omized controlled trial with a 12-week follow-up for the intervention group . Setting : One general practice in Glasgow , UK . Participants : Participants were aged ≥65 years . The intervention group received two 30-minute physical activity consultations from a trained practice nurse , a pedometer and a walking programme . The control group continued as normal for 12 weeks and then received the intervention . Both groups were followed up at 12 and 24 weeks . Outcome measures : Step counts were measured by sealed pedometers and an activPALTM monitor . Psychosocial variables were assessed and focus groups conducted . Results . The response rate was 66 % ( 187/284 ) , and 90 % of those r and omized ( 37/41 ) completed the study . Qualitative data suggested that the pedometer and nurse were helpful to the intervention . Step counts ( activPAL ) showed a significant increase from baseline to week 12 for the intervention group , while the control group showed no change . Between weeks 12 and 24 , step counts were maintained in the intervention group , and increased for the control group after receiving the intervention . The intervention was associated with improved quality of life and reduced sedentary time . Conclusions . It is feasible to recruit and retain older adults from primary care and help them increase walking . A larger trial is necessary to confirm findings and consider cost-effectiveness Background As the population ages , older adults are seeking meaningful , and impactful , post-retirement roles . As a society , improving the health of people throughout longer lives is a major public health goal . This paper presents the design and rationale for an effectiveness trial of Experience Corps ™ , an intervention created to address both these needs . This trial evaluates ( 1 ) whether  senior volunteer roles within Experience Corps ™ beneficially impact children 's academic achievement and classroom behavior in public elementary schools and ( 2 ) impact on the health of volunteers . Methods Dual evaluations of ( 1 ) an intention-to-treat trial r and omizing eligible adults 60 and older to volunteer service in Experience Corps ™ , or to a control arm of usual volunteering opportunities  , and ( 2 ) a comparison of eligible public elementary schools receiving Experience Corps ™  to matched , eligible control schools  in a 1:1 control : intervention school ratio . Outcomes For older adults , the primary outcome is decreased disability in mobility and Instrumental Activities of Daily Living ( IADL ) . Secondary outcomes are decreased frailty , falls , and memory loss ; slowed loss of strength , balance , walking speed , cortical plasticity , and executive function ; objective performance of IADLs ; and increased social and psychological engagement . For children , primary outcomes are improved reading achievement and classroom behavior in Kindergarten through the 3rd grade ; secondary outcomes are improvements in school climate , teacher morale and retention , and teacher perceptions of older adults . Summary This trial incorporates principles and practice s of community-based participatory research and evaluates the dual benefit of a single intervention , versus usual opportunities , for two generations : older adults and children Background High levels of physical inactivity are linked to several chronic diseases including coronary heart disease , type-2 diabetes , obesity , some cancers and poor mental health . Encouraging people to be more active has proven difficult . One way to incorporate physical activity into the daily routine is through the journey to and from work . Although behaviour change techniques ( BCTs ) are considered valuable in promoting behaviour change , there is very little in the published literature about the views and experiences of those encouraged to use them . Methods The Walk to Work study was a feasibility study incorporating an exploratory cluster r and omised controlled trial . The 10-week intervention involved training workplace-based Walk to Work promoters ( volunteers or nominated by participating employers ) to encourage colleagues to increase walking during their daily commute . The intervention used nine specific BCTs : Intention formation , barrier identification , specific goal setting , instruction , general encouragement , self-monitoring of behaviour social support , review of behavioural goals and relapse prevention . Digitally recorded interviews were undertaken with 22 employees , eight of whom were Walk to Work promoters to underst and their views and experiences of using these techniques . The Framework method of data management and constant comparison were used to analyse the data and identify key themes . Results For each individual BCT , there appeared to be people who found it useful in helping them to increase walking to work and others who did not . Following training , the Walk to Work promoters varied in the extent to which they were able to fulfil their role : additional support and encouragement during the 10-week intervention may be required for the promoters to maintain motivation . Wider context ual ( economic climate , unprecedented wet weather ) and organisational ( workload , car parking facilities ) issues were identified that influenced the delivery of , and response to , the intervention . Conclusions Walk to work interventions employing BCTs should include sufficient techniques to enable participants to choose a ‘ package ’ to suit their needs . Additional support at organisational level should also be encouraged , and consideration given to wider context ual factors that impinge on the delivery of , and response to , the intervention . Trial registration IS RCT N72882329 OBJECTIVE to investigate and compare the predictive values of four physical performance measures for the onset of functional dependence in older Japanese people living at home . DESIGN a population -based prospect i ve cohort study . SETTING Nangai village , Akita Prefecture , Japan . METHODS out of the population aged 65 years and older living in Nangai ( n = 940 ) in 1992 , we measured h and grip-strength , one-leg st and ing , and usual and maximum walking speeds  in 736 subjects who were independent in the five basic activities of daily living . Their functional status was assessed each year for the subsequent 6 years . The outcome event was the onset of functional dependence , defined as a new disability in one or more of the five basic activities of daily living , or death of a subject who had shown no disability at the previous follow-up . RESULTS even after controlling for age , sex and a number of chronic conditions , lower scores on each baseline performance measure showed increased risk for the onset of functional dependence . Maximum walking speed  was most sensitive in predicting future dependence for those aged 65 - 74 years , while usual walking speed was most sensitive for people aged > or = 75 years . CONCLUSION  walking speed  was the best physical performance measure for predicting the onset of functional dependence in a Japanese rural older population Background Older adults receiving inpatient rehabilitation have low activity levels and poor mobility outcomes . Increased physical activity may improve mobility . The objective of this Phase II study was to evaluate the feasibility of a r and omized controlled trial ( RCT ) of enhanced physical activity in older adults receiving rehabilitation . Methods Patients admitted to aged care rehabilitation with reduced mobility were r and omized to receive usual care or usual care plus additional physical activity  , which was delivered by a physiotherapist or physiotherapy assistant . The feasibility and safety of the proposed RCT protocol was evaluated . The primary clinical outcome was mobility , which was assessed on hospital admission and discharge by an assessor blinded to group assignment . To determine the most appropriate measure of mobility , three measures were trialled ; the Timed Up and Go , the Elderly Mobility Scale and the de Morton Mobility Index . Results The protocol was feasible . Thirty-four percent of people admitted to the ward were recruited , with 47 participants r and omised to a control ( n = 25 ) or intervention group ( n = 22 ) . The rates of adverse events ( death , falls and readmission to an acute service ) did not differ between the groups . Usual care therapists remained blind to group allocation , with no change in usual practice . Physical activity targets were met on weekdays but not weekends and the intervention was acceptable to participants . The de Morton Mobility Index was the most appropriate measure of mobility . Conclusions The proposed RCT of enhanced physical activity in older adults receiving rehabilitation was feasible . A larger multi-centre RCT to establish whether this intervention is cost effective and improves mobility is warranted . Trial registration The trial was registered with the ANZTCR ( ACTRN12608000427370 ) OBJECTIVE Physical activity is integral to the management of type 2 diabetes . Unfortunately , the majority of adults with type 2 diabetes do not regularly engage in physical activity . The purpose of this study was to assess  physical activity behavior  and its correlates ( i.e. , physical activity knowledge , barriers , and performance and outcome expectations ) in older adults with type 2 diabetes . RESEARCH DESIGN AND METHODS A subgroup of 260 adults with type 2 diabetes was identified from a larger stratified r and om sample of adults aged > or = 55 years . Participants completed an interviewer-administered survey design ed from focus group findings and social learning theory . RESULTS The majority of the respondents ( 54.6 % ) reported 0 min of weekly physical activity . This was especially true of older female respondents . Performance expectation scores were lower among respondents who were in the oldest age-group , namely , white women . Physical activity knowledge varied by age-group , and barriers to physical activity were prevalent in all groups . The following are significant correlates of reported weekly physical activity : younger age , more education , fewer motivational barriers , and greater perceived health and performance expectations . CONCLUSIONS Given the importance of physical activity to diabetes management , the low prevalence of physical activity found in this and other studies should raise concerns among clinicians . Future research to identify predictors of physical activity is needed to guide clinicians in the promotion of physical activity Background : Attempts to study the translation of evidence -based physical activity interventions in community setting s are scarce . Purpose : This project was an investigation of whether 13 diverse local lead agencies could effectively implement a choice-based , telephone-assisted physical activity promotion program for older adults based on intervention models proven efficacious in research setting s. Methods : At baseline , participants developed their own physical activity programs through an individualized planning session based on preference , health status , readiness to change , and available community re sources . Thereafter , participants received regular telephone calls over a 1-year period from a trained staff member or volunteer support buddy . Additional program components consisted of health education workshops , newsletters , and group-based physical activities .  Self-report data on caloric expenditure due to all and moderate or greater intensity physical activities were collected from 447 participants ( M age = 68 ± 8.6 years ) . Results : A significant increase ( p ≤ .0001 ) from baseline to midintervention and intervention endpoint was observed for total weekly caloric expenditure ( Mdn change = 644–707 kcal/week ) and moderate or greater weekly caloric expenditure ( Mdn change = 149–265 kcal/week ) , as well as for weekly physical activity duration and frequency . These changes were observed in participants across all sites . Conclusions : The increases in weekly caloric expenditure were commensurate with findings from several previous r and omized clinical trials . The utilization of community agency staff and volunteers receiving basic training to implement essential program components proved feasible . Very favorable levels of program satisfaction expressed by community staff , volunteer support buddies , and participants , combined with the significant increases in physical activity , warrant further dissemination of the intervention model Objectives : To evaluate the effect of individually tailored programs on perceived autonomy in institutionalized physically disabled older people and to describe participants ’ activity wishes and content of the programs . Method : This blinded r and omized trial with follow up included a total of nine nursing homes and 50 nursing home residents who were r and omized into either a control group or an intervention group .  Perceived autonomy was measured at baseline ( T1 ) , after 12 weeks ( T2 ) of intervention and after 24 weeks ( T3 ) Wishes for daily activities was identified at T1 . Weekly reports of individual programs were drawn up . Results : Both groups perceived autonomy as average at baseline and increased their mean score at T2 to high or close to high . At T3 , both groups scored average but exceeded the level of T1 . Activity wishes and the content of the programs indicate incoherence . Discussion : Although the correspondence between the individual wishes for activities and the concrete content of the programs was not obvious , results indicate potential for enabling the perception of autonomy among physically disabled older nursing home residents . The clinical consequences may suggest a focus on existing traditions , methods , and tools in the nursing home practice OBJECTIVES To assess the effectiveness of a community-based falls- and -fracture nurse coordinator and multifactorial intervention in reducing  falls in older people . DESIGN R and omized , controlled trial . SETTING Screening for previous falls in family practice followed by community-based intervention . PARTICIPANTS Three hundred twelve community-living people aged 75 and older who had fallen in the previous year . INTERVENTION Home-based nurse assessment of falls- and -fracture risk factors and home hazards , referral to appropriate community interventions , and strength and balance exercise program . Control group received usual care and social visits . MEASUREMENTS Primary outcome was rate of falls over 12 months . Secondary outcomes were muscle strength and balance , falls efficacy , activities of daily living , self-reported physical activity level , and quality of life ( Medical Outcomes Study 36-item Short Form Question naire ) . RESULTS Of the 3,434 older adults screened for falls , 312 ( 9 % ) from 19 family practice s were enrolled and r and omized . The average age was 81+/-5 , and 69 % ( 215/312 ) were women . The incidence rate ratio for falls for the intervention group compared with the control group was 0.96 ( 95 % confidence interval=0.70 - 1.34 ) . There were no significant differences in secondary outcomes between the two groups . CONCLUSION This nurse-led intervention was not effective in reducing  falls in older people who had fallen previously . Implementation and adherence to the fall-prevention measures was dependent on referral to other health professionals working in their usual clinical practice . This may have limited the effectiveness of the interventions Aim : To investigate the effects of inhaler device technique education on improving inhaler technique in older people with asthma . Methods : In a r and omised controlled trial , device technique education was provided to a sample of 123 adults aged > 55 years who had a doctor diagnosis of asthma . The active education group received one-on-one technique coaching , including observation , verbal instruction and physical demonstration at baseline . The passive group received a device-specific instruction pamphlet only . Inhaler technique , including the critical steps for each device type , was assessed and scored according to Australian National Asthma Council ( NAC ) guidelines . Device technique was scored objective ly at baseline and again at 3 and 12 months post education . Results : The majority of participants demonstrated poor technique at baseline . Only 11 ( 21 % ) of the active intervention group and 7 ( 16 % ) of the passive group demonstrated 100 % correct technique . By 3 months 26 ( 48 % ) of the active group achieved adequate technique . Improvement in technique was observed in the active group at 3 months ( P<0.001 ) and remained significant at 12 months ( P<0.001 ) . No statistically significant improvement was observed in the passive group . Conclusion : The provision of active device technique education improves device technique in older adults . Passive education alone fails to achieve any improvement in device technique Background : Unhealthy diet and lack of physical activity increase rural midlife and older women 's risk of chronic diseases and premature death , and they are behind urban residents in meeting Healthy People 2010 objectives . Objectives : The objective of this study was to compare a tailored intervention based on the Health Promotion Model with a generic intervention to increase physical activity  and  healthy eating  among rural women . Methods : In a r and omized-by-site , community-based , controlled , clinical trial , Wellness for Women , 225 women aged 50 to 69 years were recruited in two similar rural areas . Over 12 months , women received by mail either 18 generic newsletters or 18 newsletters computer tailored on Health Promotion Model behavior-specific cognitions ( benefits , barriers , self-efficacy , and interpersonal support ) , activity , and eating . Outcomes at 6 and 12 months included behavioral markers and biomarkers of physical activity and eating . Data were analyzed by repeated- measures analysis of variance and chi-square tests ( & agr ; < .05 ) . Results : Both groups significantly increased stretching and strengthening exercise and fruit and vegetable servings and decreased percentage of calories from fat , whereas only the tailored group increased moderate or greater intensity activity and decreased percentage of calories from saturated fat from baseline to 6 months . Both groups increased stretching and strengthening exercise , whereas only the tailored group increased moderate or greater intensity activity and fruit and vegetable servings and decreased percentage of calories from fat from baseline to 12 months . Both groups had several changes in biomarkers over the study . A higher proportion of women receiving tailored newsletters met Healthy People 2010 criteria for moderate or greater intensity activity , fruit and vegetable servings , and percentage of calories from fat at 12 months . Discussion : Mailed computer-tailored and generic print newsletters facilitated the adoption of change in both activity and eating over 6 months . Tailored newsletters were more efficacious in facilitating change over 12 months Colorectal cancer screening forms part of Scotl and 's cancer reduction strategy . Screened participants , who had undergone colonoscopy and had adenoma(s ) removed , were invited to participate in the bowel health to better health ( BHBH ) programme . BHBH tested the hypothesis that a minimal contact lifestyle intervention could prove effective in promoting changes in diet and activity . Baseline and follow-up question naires on lifestyle and psycho-social measures were undertaken in adults r and omised to BHBH or a comparison group ( CG ) . The 3-month intervention comprised personalised lifestyle advice , goal - setting and social support to promote increases in physical activity , fibre , fruit and vegetables .  Response rate to BHBH was 51 % . BHBH participants ( n 32 ) increased their intake of fibre ( DINE FFQ scores 30 ( sd 11)-41 ( sd 13 ) ) significantly ( P < 0.001 ) more than the CG ( n 30 ; 31 ( sd 8)-30 ( sd 11 ) . No significant differences between the groups were detected for changes in fruits , vegetables and moderate activity . At baseline , only one participant from each study arm , met the target recommendations for fibre , fruit and vegetable intakes and physical activity . At follow up a significant number of BHBH participants , 15 ( 47 % ) compared to 4 ( 13 % ) of the CG were achieving all three lifestyle recommendations ( chi2 ( 1 , n 62 ) = 8.196 , P = 0.006 ) . If sustained , the positive behaviour change achieved through this intervention has the potential to impact on the progression of chronic disease risk including CVD In order to promote health in people of 65 years and older , TNO Prevention and Health developed , evaluated , and implemented " Healthy & Vital " ( also known as " Ageing Well and Healthily " ) . Healthy & Vital consists of six sessions of health education and low-intensity exercises . This paper reports on the theoretical basis of the intervention , the methods and results of a R and omised Controlled Trial ( n = 50 ) , and a Community Intervention Trial ( in 8 municipalities , n = 448 ) . A brief report is given of the implementation study . Healthy & Vital had a number of positive physiological effects , such as a decrease in blood pressure ( effect size -0.55 ) , the Body Mass Index ( effect 0.62 ) , and the level of blood glucose ( 1.00 ) , especially in women and in elderly people who are less active physically . Participants ' underst and ing of health and illness increased significantly ( effect 0.78 ) . Due to ceiling effects only a few effects on subjective general health were found , and they disappeared after 6 months . A positive effect on feelings of loneliness remained even after 6 months ( p < 0.1 ) . The most important effect of Healthy & Vital was the increase in physical activity , especially in the least active elderly ( p < 0.001 ) . Twenty-five per cent of the participants continued activities with More Exercise for Seniors , 28 % were still considering this , and 19 % continued at home with the exercises they had learnt . Currently , Healthy & Vital is being implemented nationally by the Local Policy for the Elderly Knowledge Centre ( www.lokoud.nl ) BACKGROUND Greater hippocampal volume is observed in healthy older adults after short-term structured exercise . Whether long-term exposure to real-world physical activity ( PA ) programs has similar effects for sedentary older adults with impaired mobility and comorbid conditions is not known . HYPOTHESIS A long-term moderate intensity regimen of PA is related to larger volume of the hippocampus in older adults at risk for mobility disability . We further explore whether these associations are modified by factors known to be related to dementia . METHODS Twenty-six sedentary adults at risk for mobility disability participated in a 24-month r and omized intervention program of physical activity ( PA , N = 10 , age : 74.9 years , 7 women ) or health education ( HE , N = 16 , age : 76.8 years , 14 women ) . Volumes of total hippocampus , dentate gyrus , and cornu ammonis were measured at baseline and at 24-month follow-up using 7-Tesla magnetic resonance imaging . Between-group volumetric differences at 24 months were adjusted for sessions attended and baseline volumes . The contribution of each dementia-related factor was tested separately for education , APOE , diabetes , cardiovascular diseases , white matter hyperintensities , and brain atrophy . RESULTS Between-group differences were significant for left hippocampus , left cornu ammonis , and right hippocampus . Adjustment for regional baseline volume attenuated the associations to statistically nonsignificant for right hippocampus and left conru ammonis ; associations for left hippocampus were robust for all adjustments . Results were similar after adjustment for dementia-related factors . CONCLUSIONS In this group of sedentary older adults there was a hippocampal response to a long-term program of moderate-intensity PA . Future studies should examine whether hippocampal response could explain the beneficial effects of PA on cognition for vulnerable older adults OBJECTIVES To assess the long-term effectiveness of a telephone counseling intervention on physical activity and health-related quality of life in low-active older adults recruited through their primary care physician . DESIGN R and omized , controlled trial . SETTING Three primary care practice s from different socioeconomic regions of Auckl and , New Zeal and . PARTICIPANTS One hundred and eighty-six low-active adults ( aged 65 ) recruited from their primary care physicians ' patient data bases . INTERVENTION Eight telephone counseling sessions over 12 weeks based on increasing physical activity .  Control patients received usual care . MEASUREMENTS Change in physical activity ( as measured using the Auckl and Heart Study Physical Activity Question naire ) and quality of life ( as measured using the Short Form-36 Health Survey ( SF-36 ) ) over a 12-month period . RESULTS Moderate leisure physical activity increased by 86.8 min/wk more in the intervention group than in the control group ( P=.007 ) . More participants in the intervention group reached 2.5 hours of moderate or vigorous leisure physical activity per week after 12 months ( 42 % vs 23 % , odds ratio=2.9 , 95 % confidence interval=1.33 - 6.32 , P=.007 ) . No differences on SF-36 measures were observed between the groups at 12 months . CONCLUSION Telephone-based physical activity counseling is effective at increasing physical activity over 12 months in previously low-active older adults BACKGROUND Disability in basic activities of daily living ( ADLs ) implies a loss of independence and increases the risk for hospitalization , nursing home admission , and death . Little is known about ways by which ADL disability can be prevented or reversed . The authors evaluated the efficacy of the Health Enhancement Program in preventing and reducing ADL disability in community-dwelling older adults . METHODS The authors analyzed data from a 12-month , r and omized , single-blinded , controlled trial of a  disability prevention , chronic disease self-management program involving 201 adults aged 70 years and older that was conducted from February 1995 to June 1996 at a senior center in western Washington state .  Activities of daily living disability incidence , improvement , and worsening were assessed using intention-to-treat methods . RESULTS The cumulative incidence of ADL disability among those who were not ADL disabled at baseline ( n = 56 in the intervention group , n = 57 in the control group ) was modestly lower in the intervention group than in the control group at 12 months ( 14.3 % vs 21.3 % , p = .466 ) . Cumulative improvement in ADL function among those who reported any ADL disability at baseline ( n = 41 in the intervention group , n = 43 in the control group ) was greater in the intervention group at 12 months ( 80.5 % vs 46.5 % , p = .026 ) . The likelihood for ADL improvement was greater in the intervention group compared with controls at 12 months ( adjusted hazard ratio , 1.84 ; 95 % confidence interval , 1.05 to 3.22 ; p = .020 ) . Cumulative worsening of ADL function was slightly lower in the intervention group at 12 months ( 18.6 % vs 26.5 % , p = .237 ) . Intervention participants tended to be at lower risk for ADL worsening ( adjusted hazard ratio , 0.71 ; 95 % confidence interval , 0.38 to 1.30 ; p = .266 ) compared with control participants . CONCLUSION The Health Enhancement Program intervention led to improved ADL functioning  in those who were disabled initially and thereby offers a promising strategy for limiting or reversing functional decline in disabled elderly persons Fruit and vegetable ( FV ) intake , which is often low in older people , may be associated with improved muscle strength and physical function . However , there is a shortage of intervention trial evidence to support this . The current study examined the effect of increased FV consumption on measures of muscle strength and physical function among healthy , free-living older adults . A r and omized controlled intervention study was undertaken . Eighty-three participants aged 65–85 years , habitually consuming ≤2 portions of FV/day , were r and omised to continue their normal diet ( ≤2 portions/day ) , or to consume ≥5 portions of FV/day for 16 weeks . FV were delivered to all participants each week , free of charge . Compliance was monitored at baseline , 6 , 12 and 16 weeks by diet history and by measuring biomarkers of micronutrient status  . Grip strength was measured by a h and -held dynamometer , while lower-extremity physical function was assessed by performance-based measures . Eighty-two participants completed the intervention . The 5 portions/day group showed greater change in daily FV consumption compared to the 2 portions/day group ( P < 0.001 ) . This was reflected in significant increases in biomarkers of micronutrient status . No significant differences were evident in change in physical function between the two groups . However , there was a trend towards a greater change in grip strength in the 5 portions/day compared to the 2 portions/day group ( mean change at 16 weeks ± SD , 2.04 ± 5.16 and 0.11 ± 3.26 kg , respectively , P = 0.06 ) . Increased FV consumption may modestly increase grip strength but has no effect on physical function in healthy older adults OBJECTIVE To assess whether the " 10,000 Steps Ghent " intervention had any effect on self-reported sitting time . METHODS A multi- strategy community-based intervention was implemented in 2005 to promote physical activity ( PA ) to adults living in Ghent , Belgium . In 2005 , 648 r and omly selected participants ( aged 25 to 75 ) from the intervention community Ghent and 592 from a comparison community , completed the International Physical Activity Question naire ( IPAQ ) and a pedometer log .  Of these , 440 intervention participants and 426 comparison participants completed the follow-up measurements in 2006 . RESULTS A decrease of 12 min in total daily sitting time was found in the intervention community , compared with an increase of 18 min/day in the comparison community ( F=9.5 , p=0.002 ) . The effect was seen for both weekday ( p=0.044 ) and weekend day ( p<0.001 ) sitting times . In the intervention community , total daily sitting time decreased more in the participants who increased their step counts ( -18 min/day ; t=2.5 ; p=0.012 ) , than in those who did not ( no change ; t=0.8 , ns ) . CONCLUSIONS After 1 year of intervention , total , weekday , and weekend day sitting times were reduced in the intervention community , while sitting time increased in the comparison community Abstract A national objective as outlined in Healthy People 2000 is to increase to 50 % the proportion of primary care providers who routinely counsel clients about use of physical activity as a means to promote health . Results of this r and om national survey suggest that adult nurse practitioners are meeting the Healthy People 2000 objective by routinely counseling clients about physical activity Introduction Physical activity participation is low among blacks , and strategies are needed to successfully create immediate and sustained behavior change related to physical activity . Churches can play an important role in health promotion efforts among blacks because of their central role in spiritual guidance , communication , social support , and networking . This pilot study evaluated the feasibility and acceptability of implementing a physical activity program for sedentary black adults in churches . Methods We used a preintervention/postintervention single-group design to evaluate the effect of a 3-month faith-based physical activity intervention on  daily walking and moderate- and vigorous-intensity physical activity  among sedentary blacks . Eighty-seven black adults participated in eight group sessions that included discussion of physical activity-related topics , an instructor-led physical activity session , and weekly incentives to promote physical activity . We used a question naire to assess moderate and vigorous physical activity in minutes per week at baseline and after 3 months . Walking was assessed weekly in steps per day by using a pedometer . Results Participants ( mean age , 52 yrs ; mean body mass index , 35 kg/m2 ) reported 27 ± 54 and 10 ± 25 minutes per week in moderate-intensity and vigorous-intensity physical activity , respectively , and walked 4822 ± 2351 steps per day at baseline . After 12 weeks , moderate- and vigorous-intensity physical activity increased by 67 ± 78 and 44 ± 66 minutes per week , respectively ( P ≤ .01 ) , and daily walking increased by 1373 ± 728 steps per day ( P < .001 ) . Conclusion These data suggest that a faith-based physical activity intervention may be an appropriate strategy for increasing physical activity among sedentary black adults . Future research will determine the impact of this program in a r and omized , controlled design Background Depression is associated with physical inactivity , which may mediate the relationship between depression and a range of chronic physical health conditions . However , few interventions have combined a psychological intervention for depression with behaviour change techniques , such as behavioural activation ( BA ) , to promote increased physical activity . Methods To determine procedural and clinical uncertainties to inform a definitive r and omised controlled trial ( RCT ) , a pilot parallel-group RCT was undertaken within two Improving Access to Psychological Therapies ( IAPT ) services in South West Engl and . We aim ed to recruit 80 adults with depression and r and omise them to a supported , written self-help programme based on either BA or BA plus physical activity promotion ( BAcPAc ) . Data were collected at baseline and 4 months post-r and omisation to evaluate trial retention , intervention uptake and variance in outcomes to inform a sample size calculation . Qualitative data were collected from participants and psychological wellbeing practitioners ( PWPs ) to assess the acceptability and feasibility of the trial methods and the intervention . Routine data were collected to evaluate re source use and cost . Results Sixty people with depression were recruited , and a 73 % follow-up rate was achieved . Accelerometer physical activity data were collected for 64 % of those followed . Twenty participants ( 33 % ) attended at least one treatment appointment . Interview data were analysed for 15 participants and 9 study PWPs . The study highlighted the challenges of conducting an RCT within existing IAPT services with high staff turnover and absences , participant scheduling issues , PWP and participant preferences for cognitive focussed treatment , and deviations from BA delivery protocol s. The BAcPAc intervention was generally acceptable to patients and PWPs . Conclusions Although recruitment procedures and data collection were challenging , participants generally engaged with the BAcPAc self-help booklets and reported willingness to increase their physical activity . A number of feasibility issues were identified , in particular the under-use of BA as a treatment for depression , the difficulty that PWPs had in adapting their existing procedures for study purpose s and the instability of the IAPT PWP workforce . These problems would need to be better understood and resolved before proceeding to a full-scale RCT .Trial registration IS RCT N74390532 . Registered on 26 March 2013 OBJECTIVES to describe changes in physical functioning after fall-related injuries to the limbs in independently living older people . DESIGN prospect i ve cohort study , including a pre-injury assessment and post-injury assessment s at 8 weeks and 5 and 12 months . SETTING the study is part of the larger , population -based prospect i ve and longitudinal Groningen Longitudinal Aging Study on the determinants of health-related quality of life of people aged 57 and over , who are living independently in the north of the Netherl and s. SUBJECTS 171 patients who sustained injuries at various sites on the limbs and who had completed all four assessment s ( 66 % of the eligible population ) . Patients were grouped according to injury site . OUTCOME MEASURE self-reported grade s of difficulties with performing basic and instrumental activities of daily living as measured by the Groningen Activity Restriction Scale . RESULTS 1 year after the injury , pre-injury ( mean ) levels of functioning were not regained in any of the groups studied . However , only those with fractures of the wrist or hip experienced a substantial decrease in ability to perform basic and instrumental activities of daily living between baseline and the final assessment . Furthermore , of the 44 subjects with wrist fractures , seven ( 15.9 % ) needed help with at least one relevant activity at baseline and 18 ( 40.9 % ) at 12 months . Of the 34 subjects with hip fractures , four ( 11.8 % ) needed help with at least one activity at baseline and 18 ( 52.9 % ) at 12 months . Practically no changes were found in any of the groups after 5 months post-injury . CONCLUSIONS not only hip fractures , but also wrist fractures may reduce older people 's chances of remaining independent . Prospect s of further recovery are minimal 5 - 6 months after the injury Background : Both urban and rural adults are likely to be inactive , but rural adults have less access to exercise classes or facilities to increase physical activity . Objectives : To evaluate whether a telephone-only motivational interviewing ( MI ) intervention would increase daily physical activity of rural adults . Methods : This r and omized controlled trial enrolled 86 physically inactive adults living in rural communities ( mean age = 58 years , range = 30 - 81 years ) who stated that they were ready to increase physical activity during the next 6 months . Participants were assigned r and omly to  MI intervention ( n = 43 ) or  control ( n = 43 ) groups . The MI group participants received a pedometer and monthly MI telephone calls over 6 months from a counselor . Control group participants received an equal number of telephone calls without MI content .  Physical activity was measured by self-report using the Community Healthy Activities Model Program For Seniors Physical Activity Question naire for Older Adults . Data were collected by mailed surveys and analyzed using analysis of variance . Results : Seventy-two participants completed the study ( 35 in the intervention group and 37 in the control group ) . The telephone-only MI intervention increased self-efficacy for exercise ( p = .019 ) but did not increase levels of physical activity ( p = .572 ) compared with controls . Discussion : The intervention increased self-efficacy for exercise but did not increase physical activity , possibly due to seasonal effects , the control condition , or the length of the MI intervention . Even so , future studies are warranted because telephone-only MI has potential as a practical , relatively inexpensive method to provide health counseling to rural adults in a broad geographic area . This study produced an effect size on physical activity that will be useful to guide future studies Background Physical activity ( PA ) for older adults has well-documented physical and cognitive benefits , but most seniors do not meet recommended guidelines for PA , and interventions are lacking . Objectives This study evaluated the efficacy of a 12-week Internet intervention to help sedentary older adults over 55 years of age adopt and maintain an exercise regimen . Methods A total of 368 sedentary men and women ( M=60.3 ; SD 4.9 ) were recruited , screened , and assessed online . They were r and omized into treatment and control groups and assessed at pretest , at 12 weeks , and at 6 months . After treatment group participants rated their fitness level , activity goals , and barriers to exercise , the Internet intervention program helped them select exercise activities in the areas of endurance , flexibility , strengthening , and balance enhancement . They returned to the program weekly for automated video and text support and education , with the option to change or increase their exercise plan . The program also included ongoing problem solving to overcome user-identified barriers to exercise . Results The multivariate model indicated significant treatment effects at posttest ( P=.001 ; large effect size ) and at 6 months ( P=.001 ; medium effect size ) . At posttest , intervention participation showed significant improvement on 13 of 14 outcome measures compared to the control participants . At 6 months , treatment participants maintained large gains compared to the control participants on all 14 outcome measures . Conclusions These results suggest that an online PA program has the potential to positively impact the physical activity of sedentary older adult participants . More research is needed to replicate the study results , which were based on self-report measures . Research is also needed on intervention effects with older population OBJECTIVE To evaluate three strategies for promoting physical activity ( PA ) in a primary care setting . METHOD Data were collected between 2002 and 2004 from 136 patients attending two general practice s in Brisbane , Australia . Inactive patients ( 50 - 70 years ) were r and omly allocated to one of three hierarchical intervention groups : the general practitioner ( GP ) group received ' brief ' advice ; the GP+ES group also received behavior change advice from an exercise scientist ( ES ) ; and the GP+ES+P group also received a pedometer .  Self-reported PA and its determinants were measured at baseline and weeks 12 and 24 . Cardio-respiratory variables were measured at baseline and week 12 . RESULTS Overall , mean PA time increased by 84 and 128 min/week at weeks 12 and 24 ( p<.01 ) with no significant group differences . Small improvements in blood pressure and post-exercise heart rate were observed . At week 24 , the GP+ES+P group were more likely to report meeting PA guidelines than the GP group ( OR=2.39 95 % CI : 1.01 , 5.64 ) . CONCLUSION PA levels can be increased in mid- to older-age adults , either by brief advice from motivated GPs alone , or from collaboration between GPs and ESs . The most intense intervention ( GP+ES+P ) showed the most promising results Background Older adults who have received inpatient rehabilitation often have significant mobility disability at discharge . Physical activity levels in rehabilitation are also low . It is hypothesized that providing increased physical activity to older people receiving hospital-based rehabilitation  will lead to better mobility outcomes at discharge . Methods / Design A single blind , parallel-group , multisite r and omized controlled trial with blinded assessment of outcome and intention-to-treat analysis . The cost effectiveness of the intervention will also be examined . Older people ( age > 60 years ) undergoing inpatient rehabilitation to improve mobility will be recruited from geriatric rehabilitation units at two Australian hospitals . A computer-generated blocked stratified r and omization sequence will be used to assign 198 participants in a 1:1 ratio to either an ‘ enhanced physical activity ’ ( intervention ) group or a ‘ usual care plus ’ ( control ) group for the duration of their inpatient stay . Participants will receive usual care and either spend time each week performing additional physical activities such as st and ing or walking ( intervention group ) or performing an equal amount of social activities that have minimal impact on mobility such as card and board games ( control group ) . Self-selected gait speed will be measured using a 6-meter walk test at discharge ( primary outcome ) and 6 months follow-up ( secondary outcome ) . The study is powered to detect a 0.1 m/sec increase in self-selected gait speed in the intervention group at discharge . Additional measures of mobility ( Timed Up and Go , De Morton Mobility Index ) , function ( Functional Independence Measure ) and quality of life will be obtained as secondary outcomes at discharge and tertiary outcomes at 6 months follow-up . The trial commenced recruitment on 28 January 2014 . Discussion This study will evaluate the efficacy and cost effectiveness of increasing physical activity in older people during inpatient rehabilitation . These results will assist in the development of evidence d-based rehabilitation programs for this population .Trial registration Australian New Zeal and Clinical Trials Registry ACTRN12613000884707 ( Date of registration 08 August 2013 ) ; Clinical Trials.gov Identifier NCT01910740 ( Date of registration 22 July 2013 ) PURPOSE We wanted to assess the effectiveness of a home-based physical activity program , the Depression in Late Life Intervention Trial of Exercise ( DeLLITE ) , in improving function , quality of life , and mood in older people with depressive symptoms . METHODS We undertook a r and omized controlled trial involving 193 people aged 75 years and older with depressive symptoms at enrollment who were recruited from primary health care practice s in Auckl and , New Zeal and . Participants received either an individualized physical activity program or social visits to control for the contact time of the activity intervention delivered over 6 months . Primary outcome measures were function , a short physical performance battery comprising balance and mobility , and the Nottingham Extended Activities of Daily Living scale . Secondary outcome measures were quality of life , the Medical Outcomes Study 36-item short form , mood , Geriatric Depression Scale ( GDS-15 ) , physical activity , Auckl and Heart Study Physical Activity Question naire , and self-report of falls . Repeated measures analyses tested the differential impact on outcomes over 12 months ’ follow-up . RESULTS The mean age of the participants was 81 years , and 59 % were women . All participants scored in the at – risk category on the depression screen , 53 % had a Diagnostic and Statistical Manual of Mental Disorders or International Classification of Diseases , Tenth Revision diagnosis of major depression or scored more than 4 on the GDS-15 at baseline , indicating moderate or severe depression . Almost all participants , 187 ( 97 % ) , completed the trial . Overall there were no differences in the impact of the 2 interventions on outcomes . Mood and mental health related quality of life improved for both groups . CONCLUSION The DeLLITE activity program improved mood and quality of life for older people with depressive symptoms as much as the effect of social visits . Future social and activity interventions should be tested against a true usual care control
The heterogeneity in reported effects was reduced in higher quality studies , when physical activity was self-directed with some professional guidance and when there was on-going professional support .
Our review suggests that physical activity interventions have a moderate effect on self reported physical activity and cardio-respiratory fitness , but not on achieving a predetermined level of physical activity .
Due to the clinical and statistical heterogeneity of the studies , only limited conclusions can be drawn about the effectiveness of individual components of the interventions .
BACKGROUND Little is known about the effectiveness of strategies to enable people to achieve an increase in their physical activity .
OBJECTIVES To assess the effects of interventions for promoting physical activity in adults aged 16 years and older , not living in an institution .