Effectiveness of exercise interventions on physical function in community-dwelling frail older people: an umbrella review of systematic reviews Physical activity and functional limitations in older adults: a systematic review related to Canada's Physical Activity Guidelines Effects of Feldenkrais exercises on balance, mobility, balance confidence, and gait performance in community-dwelling adults age 65 and older. Risk Factors Associated with Falls in Older Adults with Dementia: A Systematic Review. The effect of multidimensional exercises on balance, mobility, and fall risk in community-dwelling older adults. Onset of mobility disability among community-dwelling old men and women. The role of tiredness in daily activities. Which impairments are most associated with high mobility performance in older adults? Implications for a rehabilitation prescription. Early Mobilization in the Intensive Care Unit: A Systematic Review Translating weight loss and physical activity programs into the community to preserve mobility in older, obese adults in poor cardiovascular health. Mobility Limitations and Cognitive Deficits as Predictors of Institutionalization among Community-Dwelling Older People Increased trunk extension endurance is associated with meaningful improvement in balance among older adults with mobility problems. Exercise for fall risk reduction in community-dwelling older adults: a systematic review. Validity of an exercise test based on habitual gait speed in mobility-limited older adults. Exercise Mode Moderates the Relationship Between Mobility and Basal Ganglia Volume in Healthy Older Adults. Community environmental factors are associated with disability in older adults with functional limitations: the MOST study. Are changes in leg power responsible for clinically meaningful improvements in mobility in older adults? Effect of Structured Physical Activity on Respiratory Outcomes in Sedentary Elderly Adults with Mobility Limitations. Effectiveness of manual therapies: the UK evidence report Effects of T'ai Chi training on function and quality of life indicators in older adults with osteoarthritis. Use of Stance Time Variability for Predicting Mobility Disability in Community-Dwelling Older Persons: A Prospective Study Effects of long-term resistive training on mobility and strength in older adults with diabetes. Reducing the fear of falling among community-dwelling elderly adults through cognitive-behavioural strategies and intense Tai Chi exercise: a randomized controlled trial. Mobility Is a Key Predictor of Change in Well-Being Among Older Adults Who Experience Falls: Evidence From the Vancouver Falls Prevention Clinic Cohort. Exercise leads to faster postural reflexes, improved balance and mobility, and fewer falls in older persons with chronic stroke. Increased velocity exercise specific to task training versus the National Institute on Aging's strength training program: changes in limb power and mobility. Measuring life-space mobility in community-dwelling older adults. Sit-to-stand as home exercise for mobility-limited adults over 80 years of age--GrandStand System may keep you standing? Performance-Based Versus Patient-Reported Physical Function: What Are the Underlying Predictors? Are the EQ-5D-3L and the ICECAP-O responsive among older adults with impaired mobility? Evidence from the Vancouver Falls Prevention Cohort Study A Population-Based Survey of Factors Relating to the Prevalence of Falls in Older People Optimizing Medication Adherence in Older Patients: A Systematic Review. Community services' involvement in the discharge of older adults from hospital into the community Yoga Is as Good as Stretching-Strengthening Exercises in Improving Functional Fitness Outcomes: Results From a Randomized Controlled Trial. Long-term effects of three multicomponent exercise interventions on physical performance and fall-related psychological outcomes in community-dwelling older adults: a randomized controlled trial. Effect of structured physical activity on prevention of major mobility disability in older adults: the LIFE study randomized clinical trial. A Randomized Trial to Measure the Impact of a Community-Based Cognitive Training Intervention on Balance and Gait in Cognitively Intact Black Older Adults The longitudinal impact of cognitive speed of processing training on driving mobility.
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 The purpose was to conduct systematic review s of the relationship between physical activity of healthy community-dwelling older ( > 65 years ) adults and outcomes of  functional limitations , disability , or loss of independence .  Methods Prospect i ve cohort studies with an outcome related to functional independence or to cognitive function  were search ed , as well as exercise training interventions that reported a functional outcome . Electronic data base search strategies were used to identify citations which were screened ( title and abstract ) for inclusion . Included articles were review ed to complete st and ardized data extraction tables , and assess study quality . An established system of assessing the level and grade of evidence for recommendations was employed . Results Sixty-six studies met inclusion criteria for the relationship between physical activity and functional independence , and 34 were included with a cognitive function outcome . Greater physical activity of an aerobic nature ( categorized by a variety of methods ) was associated with higher functional status ( expressed by a host of outcome measures ) in older age . For functional independence , moderate ( and high ) levels of physical activity appeared effective in conferring a reduced risk ( odds ratio ~0.5 ) of functional limitations or disability . Limitation in higher level performance outcomes was reduced ( odds ratio ~0.5 ) with vigorous ( or high ) activity with an apparent dose-response of moderate through to high activity . Exercise training interventions ( including aerobic and resistance ) of older adults showed improvement in physiological and functional measures , and suggestion of longer-term reduction in incidence of mobility disability . A relatively high level of physical activity was related to better cognitive function and reduced risk of developing dementia ; however , there were mixed results of the effects of exercise interventions on cognitive function indices . Conclusions There is a consistency of findings across studies and a range of outcome measures related to functional independence ; regular aerobic activity and short-term exercise programmes confer a reduced risk of functional limitations and disability in older age . Although a precise characterization of a minimal or effective physical activity dose to maintain functional independence is difficult , it appears moderate to higher levels of activity are effective and there may be a threshold of at least moderate activity for significant outcomes BACKGROUND Falls and fall-related injuries are a major public health concern , a financial challenge for health care providers , and critical issues for older adults . Poor balance and limited mobility are major risk factors for falls . OBJECTIVE The purpose of this study was to examine effects of Feldenkrais exercises in improving balance , mobility , and balance confidence in older adults . METHODS Participants ( N = 47 , mean age 75.6 ) were r and omly assigned to a Feldenkrais group ( FG , n = 25 ) or to a control group ( CG , n = 22 ) . The FG group attended a 5-week Feldenkrais program , 60 minutes three times per week , while the CG group was a waitlist control . The outcome measures were balance ( t and em stance ) , mobility ( Timed Up and Go ) , gait characteristics ( GAITRite Walkway System ) , balance confidence ( Balance Confidence Scale ; ABC ) , and fear of falling ( Falls Efficacy Scale ) . Pre- and post-tests were conducted . RESULTS After completion of the program , balance ( p = 0.030 ) and mobility ( p = 0.042 ) increased while fear of falling ( p = 0.042 ) decreased significantly for the FG group . No other significant changes were observed . However , participants of the FG group showed improvements in balance confidence ( p = 0.054 ) and mobility while performing concurrently a cognitive task ( p = 0.067 ) . CONCLUSIONS These results indicate that Feldenkrais exercises are an effective way to improve balance and mobility , and thus offer an alternative method to help offset age-related declines in mobility and reduce the risk of falling among community-dwelling older adults . A long-term follow-up study of balance and mobility is warranted . Further research is needed to identify whether Feldenkrais exercises may impact cognitive processes Purpose : People with dementia fall more often than cognitively healthy older adults , but their risk factors are not well understood . A review is needed to determine a fall risk profile for this population . The objective was to critically evaluate the literature and identify the factors associated with fall risk in older adults with dementia . Methods : Articles published between January 1988 and October 2014 in EMBASE , PubMed , PsycINFO , and CINAHL were search ed . Inclusion criteria were participants aged 55 years or older with dementia or cognitive impairment , prospect i ve cohort design , detailed fall definition , falls as the primary outcome , and multi-variable regression analysis . Two authors independently review ed and extracted data on study characteristics , quality assessment , and outcomes . Adjusted risk estimates were extracted from the articles . Results : A total of 17 studies met the inclusion criteria . Risk factors were categorized into demographic , balance , gait , vision , functional status , medications , psychosocial , severity of dementia , and other . Risk factors varied with living setting and were not consistent across all studies within a setting . Conclusion : Falls in older adults with dementia are associated with multiple intrinsic and extrinsic risk factors , some shared with older adults in general and others unique to the disease . Risk factors vary between community- and institution-dwelling sample s of adults with dementia or cognitive impairment BACKGROUND AND PURPOSE This prospect i ve clinical investigation examined the effects of a multidimensional exercise program on balance , mobility , and risk for falls in community-dwelling older adults with a history of falling . Factors used to predict adherence and a successful response to exercise were identified . SUBJECTS A total of 105 community-dwelling older adults ( > or = 65 years of age ) with a history of two or more falls in the previous 6 months ( no neurologic diagnosis ) participated . They were classified into ( 1 ) a control group of fallers ( n = 21 ) , ( 2 ) a fully adherent exercise group ( n = 52 ) , and ( 3 ) a partially adherent exercise group ( n = 32 ) . METHODS Following evaluation , each patient received an individualized exercise program addressing the impairments and functional disabilities identified during the assessment . The control group received no intervention . Changes in performance on five clinical tests of balance and mobility and fall risk were compared among groups . RESULTS Both exercise groups scored better than the control group on all measures of balance and mobility . Although both exercise groups showed a reduction in fall risk compared with the control group , the greatest reduction was found in the fully adherent exercise group . Factors associated with successful response to exercise included degree of adherence to exercise program and pretest score on the Tinetti Mobility Assessment . CONCLUSION AND DISCUSSION Exercise can improve balance and mobility function and reduce the likelihood for falls among community-dwelling older adults with a history of falling . The amount of exercise needed to achieve these results , however , could not be determined from this study BACKGROUND in the primary prevention of disability among older adults it might be useful to identify individuals at high risk for functional decline before it occurs . OBJECTIVE to examine whether  tiredness in daily activities  is an independent determinant of onset of mobility disability at 1 1/2-year follow-up among non-disabled older men and women . DESIGN a prospect i ve study with 1 1/2-year follow-up . SETTING 34 communities in four counties in Denmark . SUBJECTS 1396 older non-disabled adults ( 74 - 75 and 80 years old ) living in 17 of the participating communities . METHODS question naire surveys at baseline and at 1 1/2-year follow-up . Tiredness in daily activities  was measured by questions about tiredness in six mobility activities . Onset of mobility disability was measured as onset of need for help in one to six mobility activities . RESULTS men and women who felt tired in their daily activities at baseline had a higher risk of onset of mobility disability at 1 1/2-year follow-up , when adjusted by the covariates . In addition , low social participation , poor psychological function , and physical inactivity were independent risk factors of onset of mobility disability among men , and home help , low sense of coherence and physical inactivity were independent risk factors of onset of mobility disability among women . CONCLUSION older people who complain about tiredness are at higher risk of becoming disabled than others . This highlights the need for alertness and management of this early sign of functional decline in a preventive perspective OBJECTIVE To test which rehabilitative impairments are associated with higher mobility performance among community-dwelling , mobility-limited older adults . DESIGN Cross-sectional analysis of baseline data from participants within a r and omized controlled trial . SETTING Outpatient rehabilitation research center . PARTICIPANTS Community-dwelling older adults ( N=138 ; mean age , 75.4 y ) with mobility limitations as defined by the Short Physical Performance Battery ( SPPB ) . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Balance measured via the Berg Balance Scale , leg strength , leg velocity , submaximal aerobic capacity , body mass index ( BMI ) , and mobility performance as measured by the SPPB . RESULTS Each of the 5 physiologic attributes ( unipedal balance , leg strength , leg velocity , submaximal aerobic capacity , BMI ) was categorized into tertiles by using lower values as reference for impairment status . Within an adjusted model , measures associated with higher SPPB performance ( > 9 ) included a BBS score greater than or equal to 54 ( odds ratio [OR]=4.54 ; 95 % confidence interval [ CI ] , 1.11 - 18.60 ) , leg strength greater than or equal to 21.5 N/kg ( OR=30.35 ; 95 % CI , 5.48 - 168.09 ) , leg velocity .0101 to .0129 m.s(-1).kg(-1 ) ( OR=5.31 ; 95 % CI , 1.25 - 22.57 ) , and leg velocity greater than or equal to .0130 m.s(-1).kg(-1 ) ( OR=22.86 ; 95 % CI , 3.88 - 134.75 ) . CONCLUSIONS Our investigation highlights the importance of rehabilitative impairments in leg strength , leg velocity , and balance as being associated with mobility status as measured by the SPPB . In our sample of participants within an exercise trial , submaximal aerobic capacity and BMI status were not associated with mobility performance . These findings suggest that the augmentation of not only leg strength and balance but also leg velocity may be important in the rehabilitative care of mobility-limited older adults Purpose : The purpose of this review is to evaluate the literature related to mobilization of the critically ill patient with an emphasis on functional outcomes and patient safety . Methods : We search ed the electronic data bases of PubMed , CINAHL , Medline ( Ovid ) , and The Cochrane Library for a period spanning 2000‐2011 . Articles used in this review included r and omized and nonr and omized clinical trials , prospect i ve and retrospective analyses , and case series in peer review ed journals . Sackett 's Levels of Evidence were used to classify the current literature to evaluate the strength of the outcomes reported . Results : Fifteen studies met inclusion criteria and were review ed . According to Sackett 's Levels of Evidence , 9 studies were level 4 evidence , one study was level 3 , 4 studies were level 2 , and one study was level one evidence . Ten studies pertained to patient safety/feasibility and 10 studies pertained to functional outcomes with 5 fitting into both categories . Conclusion : A search of the scientific literature revealed a limited number of studies that examined the mobilization of critically ill patients in the intensive care unit . However , literature that does exist supports early mobilization and physical therapy as a safe and effective intervention that can have a significant impact on functional outcomes BACKGROUND Limitations in mobility are common among older adults with cardiovascular and cardiometabolic disorders and have profound effects on health and well-being . With the growing population of older adults in the United States , effective and scalable public health approaches are needed to address this problem . Our goal was to determine the effects of a physical activity and weight loss intervention on 18-month change in mobility among overweight or obese older adults in poor cardiovascular health . METHODS The study design was a translational , r and omized controlled trial of physical activity ( PA ) and weight loss ( WL ) on mobility in overweight or obese older adults with cardiovascular disease ( CVD ) or at risk for CVD . The study was conducted within the community infrastructure of Cooperative Extension Centers . Participants were r and omized to 1 of 3 interventions : PA , WL + PA , or a successful aging ( SA ) education control arm . The primary outcome was time to complete a 400-m walk in seconds ( 400MWT ) . RESULTS A significant treatment effect ( P = .002 ) and follow-up testing revealed that the WL + PA group improved their 400MWT ( adjusted mean [ SE ] , 323.3 [ 3.7 ] seconds ) compared with both PA ( 336.3 [ 3.9 ] seconds ; P = .02 ) and SA ( 341.3 [ 3.9 ] seconds ; P < .001 ) . Participants with poorer mobility at baseline benefited the most ( P < .001 ) . CONCLUSION Existing community infrastructures can be effective in delivering lifestyle interventions to enhance mobility in older adults in poor cardiovascular health with deficits in mobility ; attention should be given to intervening on both weight and sedentary behavior since weight loss is critical to long-term improvement in mobility . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00119795 Purpose : Mobility limitations and cognitive disorders have often been observed as risks for institutionalization . However , their combined effects on risk of institutionalization among initially community-dwelling older people have been less well reported . Design : A prospect i ve cohort study with 10-year surveillance on institutionalization . Subjects : Study population ( n = 476 ) consisted of 75- and 80-year-old people who were community-dwelling , had not been diagnosed with dementia , and participated in tests on walking speed and cognitive capacity at a research centre . Measures : Cognitive capacity was measured with three vali date d psychometric tests that were from the Wechsler Adult Intelligence Scale , Wechsler Memory Scale and Schaie- Thurstone Adult Mental Abilities Test .  Mobility  was measured with walking speed over a 10-m distance . Exclusive distribution based study groups were formed with cut-offs at the lowest third as follows : no limitation , solely mobility limitation , solely cognitive deficits , and combined mobility limitation and cognitive deficits . Cox proportional hazards model was used to determine the relative risks of institutionalization for the study groups . Results : Eleven percent of the participants were institutionalized during the 10-year surveillance . The risk for institutionalization was 4.9 times greater ( 95 % confidence interval : 2.1–11.2 ) for those who had co-existing mobility limitations and cognitive deficits than for those with no limitations . Conclusions : The findings show that the accumulation of limitations in physical and cognitive performance substantially decreases the possibility for a person remaining at home . This might be due to a decreased reserve capacity and ineffective compensatory strategies . Therefore , interventions targeted to improve even one limitation , or prevent accumulation of these risk factors , could significantly reduce the risk of institutionalization OBJECTIVE To determine whether trunk extension endurance changes with training are associated with clinical ly meaningful improvements in balance among mobility-limited older adults . DESIGN Longitudinal data from a r and omized controlled trial . SETTING Outpatient rehabilitation research center . PARTICIPANTS Community-dwelling older adults ( N=64 ; mean age , 75.9y ) with mobility limitations as defined by a score of 4 to 10 on the Short Physical Performance Battery . INTERVENTIONS Sixteen weeks of progressive resistance training . MAIN OUTCOME MEASURES Outcomes were the Berg Balance Scale ( BBS ) and the Unipedal Stance Time ( UST ) . Predictors included leg strength , leg power , trunk extension endurance , and the product of heart rate and blood pressure ( RPP ) at the final stage of an exercise tolerance test . We performed an analysis of data from participants who completed 16 weeks of training by using binary outcomes defined by a clinical ly meaningful change ( CMC ) from baseline to completion of the intervention ( BBS=4 units ; UST=5s ) . The association of predictor variables with balance outcomes was examined separately and together in multivariate adjusted logistic regression models . RESULTS Trunk extension endurance in seconds ( 1.04 [ 1.00 - 1.09 ] ) was independently associated with CMC on the BBS . Trunk extension endurance ( 1.02 [ 1.00 - 1.03 ] ) was independently associated with CMC on the UST . Other physical attributes were not associated with meaningful change in balance . CONCLUSIONS Improvements in trunk extension endurance were independently associated with CMCs in balance in older adults . Leg strength , leg power , and RPP were not associated with CMC in balance . Poor trunk extension endurance may be a rehabilitative impairment worthy of further study as a modifiable factor linked to balance among older adults PURPOSE To evaluate the influence of exercise on falls and fall risk reduction  in community-dwelling older adults and to present an up date d synthesis of outcome measures for the assessment of fall risk in community-dwelling older adults . METHOD A systematic review was performed , considering English- language articles published from 2000 to 2006 and accessible through MEDLINE , CINAHL , PEDro , EMBASE , and /or AMED . Included were r and omized controlled clinical trials ( RCTs ) that used an exercise or physical activity intervention and involved participants over age 50 . Screening and method ological quality for internal validity were conducted by two independent review ers . RESULTS The search retrieved 156 abstract s ; 22 articles met the internal validity criteria . Both individualized and group exercise programmes were found to be effective in reducing falls and fall risk . The optimal type , frequency , and dose of exercise to achieve a positive effect have not been determined . A variety of outcome measures have been used to measure fall risk , especially for balance . CONCLUSIONS Falls and fall risk can be reduced with exercise interventions in the community-dwelling elderly , although the most effective exercise variables are unknown . Future studies in population s with comorbidities known to increase fall risk will help determine optimal , condition-specific fall-prevention programmes . Poor balance is a key risk factor for falls ; therefore , the best measure of this variable should be selected when evaluating patients at risk of falling OBJECTIVE To evaluate whether a customized exercise tolerance testing ( ETT ) protocol based on an individual 's habitual gait speed ( HGS ) on level ground would be a valid mode of exercise testing older adults . Although ETT provides a useful means to risk-stratify adults , age-related declines in gait speed paradoxically limit the utility of st and ard ETT protocol s for evaluating older adults . A customized ETT protocol may be a useful alternative to these st and ard methods , and this study hypothesized that this alternative approach would be valid . DESIGN We performed a cross-sectional analysis of baseline data from a r and omized controlled trial of older adults with observed mobility problems . Screening was performed using a treadmill-based ETT protocol customized for each individual 's HGS . We determined the content validity by assessing the results of the ETTs , and we evaluated the construct validity of treadmill time in relation to the Physical Activity Scale for the Elderly ( PASE ) and the Late Life Function and Disability Instrument ( LLFDI ) . SETTING Outpatient rehabilitation center . PARTICIPANTS Community-dwelling , mobility-limited older adults ( N=141 ) . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Cardiac instability , ETT duration , peak heart rate , peak systolic blood pressure , PASE , and LLFDI . RESULTS Acute cardiac instability was identified in 4 of the participants who underwent ETT . The remaining participants ( n=137 , 68 % female ; mean age , 75.3 y ) were included in the subsequent analyses . Mean exercise duration was 9.39 minutes , with no significant differences in duration s being observed after evaluating among tertiles by HGS status . Mean peak heart rate and mean peak systolic blood pressure were 126.6 beats/min and 175.0 mmHg , respectively . Within separate multivariate models ,  ETT duration in each of the 3 gait speed groups was significantly associated ( P<.05 ) with PASE and LLFDI . CONCLUSIONS Mobility-limited older adults can complete this customized ETT protocol , allowing for the identification of acute cardiac instability and the achievement of optimal exercise parameters OBJECTIVES To examine whether 12 months of aerobic training ( AT ) moderated the relationship between change in mobility and change in basal ganglia volume than balance and toning ( BAT ) exercises in older adults . DESIGN Secondary analysis of a r and omized controlled trial . SETTING Champaign-Urbana , Illinois . PARTICIPANTS Community-dwelling older adults ( N=101 ; mean age 66.4 ) . INTERVENTION Twelve-month exercise trial with two groups : AT and BAT . MEASUREMENTS Mobility was assessed using the Timed Up and Go test . Basal ganglia ( putamen , cau date nucleus , pallidum ) was segmented from T1-weighted magnetic resonance images using the Oxford Centre for Functional Magnetic Resonance Imaging of the Brain Software Library Integrated Registration and Segmentation Tool . Measurements were obtained at baseline and trial completion . Hierarchical multiple regression was conducted to examine whether exercise mode moderates the relationship between change in mobility and change in basal ganglia volume over 12 months . Age , sex , and education were included as covariates . RESULTS Exercise significantly moderated the relationship between change in mobility and change in left putamen volume . Specifically , for the AT group , volume of the left putamen did not change , regardless of change in mobility . Similarly , in the BAT group , those who improved their mobility most over 12 months had no change in left putamen volume , although left putamen volume of those who declined in mobility levels decreased significantly . CONCLUSION The primary finding that older adults who engaged in 12 months of BAT training and improved mobility exhibited maintenance of brain volume in an important region responsible for motor control provides compelling evidence that such exercises can contribute to the promotion of functional independence and healthy aging BACKGROUND There is limited evidence supporting the hypothesized environment-disability link . The objectives of this study were to ( a ) identify the prevalence of community mobility barriers and transportation facilitators and ( b ) examine whether barriers and facilitators were associated with disability among older adults with functional limitations . METHODS Four hundred and thirty-five participants aged 65 + years old with functional limitations were recruited from the Multicenter Osteoarthritis Study , a prospect i ve study of community-dwelling adults with or at risk of developing symptomatic knee osteoarthritis . Presence of community barriers and facilitators was ascertained by the Home and Community Environment survey . Two domains of disability , ( a ) daily activity limitation ( DAL ) and ( b ) daily activity frequency ( DAF ) , were assessed with the Late-Life Disability Instrument . Covariates included age , gender , education , race , comorbidity , body mass index , knee pain , and functional limitation . Multivariable logistic regression was used to examine adjusted associations of community factors with presence of DAL and DAF . RESULTS Approximately one third of the participants lived in a community with high mobility barriers and low transportation facilitators .  High mobility barriers was associated with greater odds of DAL ( odds ratio [ OR ] = 2.0 , 95 % confidence interval [ CI ] 1.2 - 3.1 ) after adjusting for covariates , and high transportation facilitators was associated with lower odds of DAL ( OR = 0.5 , 95 % CI 0.3 - 0.8 ) but not with DAF in adjusted models . CONCLUSION People with functional limitations who live in communities that were more restrictive felt more limited in doing daily activities but did not perform these daily activities any less frequently OBJECTIVES From among physiological attributes commonly targeted in rehabilitation , to identify those in which changes led to clinical ly meaningful differences ( CMDs ) in mobility outcomes . DESIGN Secondary analysis of data collected for a r and omized controlled trial of exercise using binary outcomes defined by recording a large CMD ( Short Physical Performance Battery (SPPB)=1 unit ; gait speed (GS)=0.1 m/s ) . Iterative models were performed to evaluate possible confounding between physiological variables and relevant covariates . SETTING Outpatient rehabilitation centers . PARTICIPANTS Community-dwelling mobility-limited older adults ( n=116 ) participating in a 16-week r and omized controlled trial of two modes of exercise .  MEASUREMENTS Physiological measures included leg power , leg strength , balance as measured according to the Performance-Oriented Mobility Assessment ( POMA ) , and rate pressure product at the maximal stage of an exercise tolerance test . Outcomes included GS and SPPB . Leg power and leg strength were measured using computerized pneumatic strength training equipment and recorded in Watts and Newtons , respectively . RESULTS Participants were 68 % female , had a mean age of 75.2 , a mean of 5.5 chronic conditions , and a baseline mean SPPB score of 8.7 . After controlling for age , site , group assignment , and baseline outcome values , leg power was the only attribute in which changes were significantly associated with a large CMD in SPPB ( odds ratio (OR)=1.48 , 95 % confidence interval (CI)=1.09 - 2.02 ) and GS ( OR=1.31 , 95 % CI=1.01 - 1.70 ) . CONCLUSION Improvements in leg power , independent of strength , appear to make an important contribution to clinical ly meaningful improvements in SPPB and GS OBJECTIVES To evaluate the effect of structured physical activity on respiratory outcomes in community-dwelling elderly adults with mobility limitations . DESIGN Multicenter , r and omized trial of physical activity vs health education , with respiratory variables prespecified as tertiary outcomes over an intervention period of 24 - 42 months . Physical activity included walking ( goal of 150 min/week ) and strength , flexibility , and balance training . Health education included workshops on topics relevant to older adults and upper extremity stretching exercises . SETTING Lifestyle Interventions and Independence in Elders ( LIFE ) Study . PARTICIPANTS Community-dwelling persons aged 70 - 89 with Short Physical Performance Battery scores less than 10 ( N = 1,635 ) . MEASUREMENTS Dyspnea severity ( defined as moderate to severe according to a Borg index > 2 immediately after a 400-m walk ) , forced expiratory volume in 1 second ( FEV1 ) ( < lower limit of normal ( LLN ) defined low breathing capacity ) , and maximal inspiratory pressure ( MIP ) ( < LLN defined respiratory muscle weakness ) were assessed at baseline and 6 , 18 , and 30 months . Hospitalization for exacerbation of obstructive airways disease ( EOAD ) and pneumonia was also ascertained over the 42-month follow-up period . RESULTS The r and omized groups were similar in baseline demographics , including mean age ( 79 ) and sex ( 67 % female ) . The effect of physical activity on dyspnea severity , FEV1 , and MIP was no different from that of health education but was associated with higher likelihood of respiratory hospitalization , significantly for EOAD ( hazard ratio ( HR ) = 2.34 , 95 % confidence interval ( CI ) = 1.19 - 4.61 , P = .01 ) and marginally for pneumonia ( HR = 1.54 , 95 % CI = 0.98 - 2.42 , P = .06 ) . CONCLUSION In older persons with mobility limitations , physical activity was associated with higher likelihood of respiratory hospitalization than health education , but differences in dyspnea severity , FEV1 , and MIP did not accompany this effect-indicating that higher hospital use could be attributable to greater participant contact Background The purpose of this report is to provide a succinct but comprehensive summary of the scientific evidence regarding the effectiveness of manual treatment for the management of a variety of musculoskeletal and non-musculoskeletal conditions . Methods The conclusions are based on the results of systematic review s of r and omized clinical trials ( RCTs ) , widely accepted and primarily UK and United States evidence -based clinical guidelines , plus the results of all RCTs not yet included in the first three categories . The strength/ quality of the evidence regarding effectiveness was based on an adapted version of the grading system developed by the US Preventive Services Task Force and a study risk of bias assessment tool for the recent RCTs . Results By September 2009 , 26 categories of conditions were located containing RCT evidence for the use of manual therapy :  13 musculoskeletal conditions , four types of chronic headache and nine non-musculoskeletal conditions . We identified 49 recent relevant systematic review s and 16 evidence -based clinical guidelines plus an additional 46 RCTs not yet included in systematic review s and guidelines .Additionally , brief references are made to other effective non-pharmacological , non-invasive physical treatments . Conclusions Spinal manipulation/mobilization is effective in adults for : acute , subacute , and chronic low back pain ; migraine and cervicogenic headache ; cervicogenic dizziness ;  manipulation/mobilization is effective for several extremity joint conditions ; and thoracic manipulation/mobilization is effective for acute/subacute neck pain . The evidence is inconclusive for cervical manipulation/mobilization alone for neck pain of any duration , and for manipulation/mobilization for mid back pain , sciatica , tension-type headache , coccydynia , temporom and ibular joint disorders , fibromyalgia , premenstrual syndrome , and pneumonia in older adults . Spinal manipulation is not effective for asthma and dysmenorrhea when compared to sham manipulation , or for Stage 1 hypertension when added to an antihypertensive diet . In children , the evidence is inconclusive regarding the effectiveness for otitis media and enuresis , and it is not effective for infantile colic and asthma when compared to sham manipulation . Massage is effective in adults for  chronic low back pain and chronic neck pain . The evidence is inconclusive for knee osteoarthritis , fibromyalgia , myofascial pain syndrome , migraine headache , and premenstrual syndrome . In children , the evidence is inconclusive for asthma and infantile colic OBJECTIVE To determine the effects of T'ai Chi training on arthritis self-efficacy , quality of life indicators , and lower extremity functional mobility in older adults with osteoarthritis . DESIGN A prospect i ve , r and omized , controlled clinical trial . Intervention length was 12 weeks , with outcomes measured before and after intervention using blinded testers . Group ( T'ai Chi vs Control ) x time ( 2 x 2 ) mixed factorial ANOVA . SETTING Allied Health Sciences Center at Springfield College , Springfield , MA PARTICIPANTS : A total of 33 community-dwelling participants ( mean age 68 ) diagnosed with lower extremity osteoarthritis and having no prior T'ai Chi training longer than 2 weeks . INTERVENTION T'ai Chi training included two 1-hour T'ai Chi classes per week for 12 weeks . MEASUREMENTS Arthritis self-efficacy ( Arthritis Self-Efficacy Scale ) , quality of life indicators ( Arthritis Impact Measurement Scale ) , functional outcomes ( one-leg st and ing balance , 50-foot walking speed , time to rise from a chair ) . RESULTS T'ai Chi participants experienced significant ( P < .05 ) improvements in self-efficacy for arthritis symptoms , total arthritis self-efficacy , level of tension , and satisfaction with general health status . CONCLUSIONS A moderate T'ai Chi intervention can enhance arthritis self-efficacy , quality of life , and functional mobility among older adults with osteoarthritis . T'ai Chi training is a safe and effective complementary therapy in the medical management of lower extremity osteoarthritis Background and Purpose : Mobility disability is a serious and frequent adverse health outcome associated with aging . Early identification of individuals at risk for mobility disability is important if interventions to prevent disability are to be instituted . The objectives of this prospect i ve study were to ( 1 ) determine the magnitude of stance time variability ( STV ) that discriminates individuals who currently have mobility disability ( prevalent mobility disability ) and ( 2 ) determine the magnitude of STV that predicts a new onset of mobility disability at 1 year ( incident mobility disability ) . Methods : A total of 552 community-dwelling older adults were evaluated as part of the Cardiovascular Health Study , a longitudinal cohort study . Stance time , in milliseconds , was determined from 2 passes on a 4-m computerized walkway at self-selected walking speed , and STV was defined as the st and ard deviation from approximately 12 individual steps . Mobility disability was defined as self-reported difficulty walking a one-half mile . Receiver operating characteristic ( ROC ) curves were plotted to determine an optimal cutoff value for STV for prevalent and incident mobility disability , and the area under the receiver operating characteristic curve ( AUC ) was computed . Results : The optimal cutoff score for STV ( maximizing sensitivity and specificity ) for prevalent mobility disability was 0.037 seconds ( sensitivity = 65 % , specificity = 65 % , AUC = 0.70 ) and for incident 1-year mobility disability was 0.034 seconds ( sensitivity = 61 % , specificity = 60 % , AUC = 0.65 ) . The use of likelihood ratios demonstrated a gradient of risk across values of STV , with mobility risk increasing as values of STV increased . Discussion and Conclusion : Values of STV may be useful in identifying older adults with mobility disability and at risk for future disability . We recommend the more conservative estimate for identifying risk , STV = 0.034 seconds , which maximizes the sensitivity and minimizes false negatives . The relatively modest values on the validity indices could possibly be improved by increasing the reliability of the measurement of STV . Clinicians should interpret the cutoff values liberally and use STV in conjunction with other measures until further work is completed to vali date STV as an indicator of mobility disability BACKGROUND Strength training has been shown to be beneficial in older adults . However , very little data exist on the effects of strength training in older diabetics . METHODS 31 community-dwelling older adults with diabetes ( mean age = 66.1 years ) were r and omly assigned to either an exercise ( EX ) or control ( CO ) group . The EX group trained the plantar flexors , knee extensors , knee flexors , hip extensors , and hip flexors muscle groups at 50 % , 60 % , and 70 % of 1-repetition maximum , 2.6 days a week , for 24 months . Mobility tests included the timed up and go , 50-foot walk , and walking up and down 8 stairs . Strength and mobility for both groups were evaluated at 6-month intervals . RESULTS There was a group and time effect as the EX group increased 31.4 % ( p < .001 ) in strength for all muscle groups after the first 6 months of training , and the strength gains were retained for the duration of the training intervention . There was also a group and time effect for mobility as performance increased 8.6 % and 9.8 % ( p = .032 and p = 0.031 ) for the first 6 and 12 months , respectively , but decreased to 4.6 % above baseline at the end of the intervention . There were essentially no changes from baseline strength or mobility values for the CO group . CONCLUSION In conclusion , these data suggest that a moderate-intensity resistive-training program can improve mobility and strength for the duration of a 24-month intervention in older adults with diabetes , thus potentially reducing the rate of mobility loss during aging AIM To examine the effectiveness of cognitive-behavioural strategies with/without intense Tai Chi exercise in reducing fear of falling among community-dwelling elderly adults . Background . Fear of falling is a major health problem among community-dwelling older persons . The prevalence of this fear ranges from 29 % to 77 % , indicating the importance of developing effective strategies to reduce fear of falling among elderly adults . METHODS Data were collected from January to December 2007 . A r and omized controlled trial with three groups ( control , cognitive-behavioural and cognitive-behavioural with Tai Chi ) . Participants were assessed at baseline for  demographic data , falls-related history , and fear of falling . Data on these variables plus falls , mobility , social support behaviour and satisfaction , and quality of life were also collected at 2 and 5 months after interventions . RESULTS Participants in the three groups differed significantly in both measures of fear of falling ( F = 20·89 , P < 0·001 ; F = 6·09 , P < 0·001 ) and mobility ( F = 30·33 , P < 0·001 ) , social support behaviour and satisfaction ( F = 3·32 , P < 0·05 and F = 6·35 , P < 0·001 , respectively ) , and quality of life ( F = 16·66 , P < 0·001 ) . In addition , participants who received the cognitive-behavioural intervention with Tai Chi had significantly lower fear of falling scores ( P < 0·001 ) and higher mobility ( P < 0·001 ) , social support satisfaction ( P < 0·01 ) and quality of life ( P < 0·001 ) than the cognitive-behavioural alone and control groups at 5 months . The three groups did not differ significantly in falls . CONCLUSION The results of this trial suggest that the cognitive-behavioural intervention with Tai Chi exercise helped community-dwelling elderly adults to enhance their mobility , to manage their fear of falling and to increase their quality of life OBJECTIVE To determine the factors that predict change in well-being over time in older men and women presenting to the falls prevention clinic . DESIGN Prospect i ve cohort study . SETTING Falls prevention clinic . PARTICIPANTS Community-dwelling older adults who were referred to the clinic after sustaining a fall ( between N=244 and N=255 , depending on the analysis ) . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES The ICEpop CAPability measure for Older people , a measure of well-being or quality of life , was administered at baseline , 6 months , and 12 months . We constructed linear mixed models to determine whether baseline predictor variables were related to baseline well-being and /or changes in well-being over time . In addition , we included interactions with sex to investigate the difference between men and women . Baseline predictors included 2 measures of mobility -- Short Performance Physical Battery and timed Up and Go test-- and a measure of global cognitive function -- Montreal Cognitive Assessment .  RESULTS All 3 predictors were associated with well-being at baseline ( P<.05 ) . Furthermore , both the Short Performance Physical Battery and the timed Up and Go test interacted with sex ( P<.05 ) to predict changes in well-being over time . Follow-up analyses suggested that better mobility was protective against decline in well-being in men but was generally unrelated to changes in well-being in women . CONCLUSIONS We found that 2 valid and reliable measures of mobility interacted with sex to predict changes in well-being over time . This is a critical research area to develop in order to appropriately tailor future intervention strategies targeting well-being in older fallers , a population at high risk of functional decline OBJECTIVES To determine the effect of two different community-based group exercise programs on functional balance , mobility , postural reflexes , and falls in older adults with chronic stroke . DESIGN A r and omized , clinical trial . SETTING Community center . PARTICIPANTS Sixty-one community-dwelling older adults with chronic stroke . INTERVENTION Participants were r and omly assigned to an agility ( n=30 ) or stretching/weight-shifting ( n=31 ) exercise group . Both groups exercised three times a week for 10 weeks . MEASUREMENTS Participants were assessed before , immediately after , and 1 month after the intervention for Berg Balance , Timed Up and Go , step reaction time , Activities-specific Balance Confidence , and Nottingham Health Profile . Testing of st and ing postural reflexes and induced falls evoked by a translating platform was also performed . In addition , falls in the community were tracked for 1 year from the start of the interventions . RESULTS Although exercise led to improvements in all clinical outcome measures for both groups , the agility group demonstrated greater improvement in step reaction time and paretic rectus femoris postural reflex onset latency than the stretching/weight-shifting group . In addition , the agility group experienced fewer induced falls on the platform . CONCLUSION Group exercise programs that include agility or stretching/weight shifting exercises improve postural reflexes , functional balance , and mobility and may lead to a reduction of falls in older adults with stroke BACKGROUND This study was design ed to evaluate the benefits of InVEST ( Increased Velocity Specific to Task ) training on limb power and mobility among mobility-limited older adults . METHODS We conducted a single blinded , r and omized controlled trial among 138 mobility-limited community-dwelling older adults , evaluating two 16-week supervised exercise programs . The intervention group participated in InVEST training , and the control group participated in the National Institute on Aging 's ( NIA ) strength training program . Primary outcomes were changes in limb power per kilogram and mobility performance as measured by the Short Physical Performance Battery ( SPPB ) . RESULTS After 16 weeks , InVEST produced significantly greater improvements in limb power than NIA ( p=.02 ) . There was no significant difference in strength improvements . Both groups had significant changes in SPPB of greater than 1 unit . Self-reported function was also significantly improved in both groups . Differences between groups were not statistically different . In a post hoc analysis when participants were categorized by the manifestation of baseline leg velocity impairments ( N=68 ) , InVEST training produced effect size differences in SPPB that were clinical ly meaningful ( SPPB Group x Time difference 0.73 units , p=.05 ) . CONCLUSIONS Among mobility-limited older adults , both NIA and InVEST produce robust changes in observed physical performance and self-reported function . These improvements were not meaningfully different by statistical or clinical criteria . Compared with NIA , InVEST training produced greater improvements in limb power and equivalent improvements in strength . Observed differences between NIA and InVEST based upon baseline leg impairment status are informative for futures studies OBJECTIVES To evaluate the validity and reliability of a st and ardized approach for assessing life-space mobility ( the University of Alabama at Birmingham Study of Aging Life-Space Assessment ( LSA ) ) and its ability to detect changes in life-space over time in community-dwelling older adults . DESIGN Prospect i ve , observational cohort study . SETTING Five counties ( three rural and two urban ) in central Alabama . PARTICIPANTS Community-dwelling Medicare beneficiaries ( N=306 ; 46 % male , 43 % African American ) who completed in-home baseline interviews and 2-week and 6-month telephone follow-up interviews . MEASUREMENTS The LSA assessed the range , independence , and frequency of movement over the 4 weeks preceding assessment s. Correlations between the baseline LSA and measures of physical and mental health ( physical performance , activities of daily living , instrumental activities of daily living , a global measure of health ( the short form-12 question survey ) , the Geriatric Depression Scale , and comorbidities ) established validity . Follow-up LSA scores established short-term test-retest reliability and the ability of the LSA to detect change . RESULTS For all LSA scoring methods , baseline and 2-week follow-up LSA correlations were greater than 0.86 ( 95 % confidence interval=0.82 - 0.97 ) . Highest correlations with measures of physical performance and function were noted for the LSA scoring method considering all attributes of mobility . The LSA showed both increases and decreases at 6 months . DISCUSSION Life-space correlated with observed physical performance and self-reported function . It was stable over a 2-week period yet showed changes at 6 months PURPOSE To compare the effects of functional home exercise of repeated sit-to-st and s with low-intensity progressive resistance training , on performance measures in mobility-limited adults over 80 years of age . SETTING Participants ' homes . DESIGN Community-dwelling older adults > or = 80 years of age were invited to participate in a r and omised controlled clinical trial . Baseline and outcome measures were : comfortable gait velocity , 30-s chair-st and test , 15-s step test , Berg Balance Scale , Modified Falls Efficacy Scale and the Late-Life Function and Disability Instrument-function component . Participants r and omised to the intervention group performed repeated sit-to-st and s using a Gr and St and System ; a biofeedback device that recorded and displayed the number of repetitions performed . Participants r and omised to the control group performed knee extensions using ankle cuff weights . Both groups performed the exercises daily for 6 weeks . RESULTS Sixty-six older adults took part . The intervention group had a statistically significant improvement in Berg Balance Scale mean score , 1.67 + /- 2.64 points , P = 0.001 ( control group 0.73 + /- 3.63 points , P = 0.258 ) , indicating an improvement in balance over the 6-week exercise period . There was no statistically significant effect of either intervention on the other outcome measures . CONCLUSIONS In a highly variable population of older adults with mobility limitations , low-intensity functional home exercise of repeated sit-to-st and s using the Gr and St and System improved Berg Balance Scale score while low-intensity progressive resistance training did not . While statistically significant , the improvement in Berg Balance Scale score was modest raising the issue of what extent of change in score is clinical ly significant in this population Background Functional limitations have been operationally defined for studies of rehabilitation science through measures of physical performance and patient-reported function . Although conceived as representing similar concepts , differences between these 2 modes of measuring physical functioning have not been adequately characterized scientifically . Objective The purpose of this study was to compare the Short Physical Performance Battery ( SPPB ) with the function component of the Late-Life Function and Disability Instrument ( LLFDI ) with respect to their association with physiologic factors and other psychosocial and health factors potentially influencing rehabilitative care . Design This study was a cross-sectional analysis of baseline data from a sample of community-dwelling older adults ( N=137 ) with mobility limitations enrolled in a r and omized controlled trial of exercise . Methods A performance-based measure of function ( the SPPB ) and a self-report measure of function ( the LLFDI ) served as functional outcomes . Physiologic factors included measures of leg strength , leg velocity , and exercise tolerance test ( ETT ) duration , which served as a surrogate measure of aerobic capacity . Psychosocial and health factors included age , sex , height , body mass index , number of chronic conditions , depression , and falls efficacy . Results Separate multivariable regression models predicting SPPB and LLFDI scores described 33 % and 42 % of the variance in each outcome ( R2 ) , respectively . Leg velocity and ETT duration were positively associated with both performance-based and patient-reported functional measures . Leg strength and age were positively associated with SPPB scores , whereas number of chronic conditions , sex , and falls efficacy were associated with the LLFDI scores . Limitations This study included older adults with mobility limitations and may not generalize to other population s. Conclusions Performance-based and patient-reported measures of physical function appear to assess different aspects of an older person 's functioning . The SPPB was associated with age and physiologic factors , whereas patient-reported function measured by the LLFDI was associated with these factors as well as with psychosocial and health factors Purpose Preference-based generic measures are gaining increased use in mobility research to assess health-related quality of life and wellbeing . Hence , we examined the responsiveness of these two measures among individuals at risk of mobility impairment among adults aged ≥70 years . Methods We conducted a 12-month prospect i ve cohort study of community-dwelling older adults ( n = 288 to n = 341 depending on analysis ) who were seen at the Vancouver Falls Prevention Clinic who had a history of at least one fall in the previous 12 months . We compared the responsiveness of the EuroQol-5 Domain-3 Level ( EQ-5D-3L ) and the index of capability for older adults ( ICECAP-O ) by examining changes in these measures over time ( i.e. , over 6 and 12 months ) and by examining whether their changes varied as a function of having experienced 2 or more falls over 6 and 12 months . Results Only the ICECAP-O showed a significant change over time from baseline through 12 months ; however , neither measure showed change that exceeded the st and ard error of the mean . Both measures were responsive to falls that occurred during the first 6 months of the study ( p < .05 ) . These effects appeared to be amplified among individuals identified as having mild cognitive impairment ( MCI ) at baseline ( p < .01 ) . Additionally , the EQ-5D-3L was responsive among fallers who did not have MCI as well as individuals with MCI who did not fall ( p < .05 ) . Conclusion This study provides initial evidence suggesting that the EQ-5D-3L is generally more responsive , particularly during the first 6 months of falls tracking among older adults at risk of future mobility impairment Background : Research on older people ’s perception regarding their quality of life and services and supports needed to maintain their independence was identified as a priority for the South Australian Department of Health in 2000–2001 . This population survey was conducted to examine issues that older persons considered important in the areas of housing , transport , finances and information provision . Objective : The aim of this article is to present the characteristics of community-dwelling older adults who reported falling in the previous 12 months . Method : A r and om representative sample of community-dwelling adults , living in South Australia , and aged 65 years and over were selected based on a sample from the electronic white pages telephone directory . Overall , 2,619 interviews were conducted ( 70.5 % response rate ) using Computer-Assisted Telephone Interviewing technology . Results : Approximately 30 % of older adults had experienced a fall in the previous 12 months . The characteristics of people who had fallen included those in the older age groups , with fair or poor general health , whose health had worsened in the last 12 months , with lower socioeconomic status , those born in an English-speaking country , needing assistance at home , and with a home in need of repair . Of the respondents who had experienced a fall in the previous 12 months , 71.8 % did not consider that they were at risk of having another fall . Conclusion : There is a wide range of characteristics associated with community-dwelling older adults over the age of 65 who report falling in the previous 12 months . Perceptions of the risk of falling also vary . All factors need to be considered when targeting interventions to reduce the risk of both initial and multiple falls OBJECTIVE : To review the literature on strategies to optimize medication adherence in community-dwelling older adults and to make recommendations for clinical practice . METHODS : A systematic literature search was conducted using the MEDLINE , CINAHL , PsycINFO , International Pharmaceutical Abstract s , and EMBASE data bases for r and omized controlled trials examining strategies to optimize medication adherence in patients aged 65 or older prescribed long-term medication regimens . Additional studies were found by examining the reference lists of systematic review s and selected papers . 34 papers reporting on 33 studies met the eligibility criteria and were included in this review . RESULTS : Improvement in adherence was mixed across the studies examining educational interventions , with only 12 of the 28 studies showing improvement in adherence ; most were delivered by pharmacists . Effect sizes for the statistically significant educational interventions ranged from Cohen 's d = 0.14 to 4.93 . Four of the 5 interventions using memory aids and cues , some in conjunction with newer technologies , improved adherence . Effect sizes for the statistically significant interventions using memory aids and cues ranged from Cohen 's d = 0.26 to 2.72 . CONCLUSION : The evidence from this review does not clearly support one single intervention to optimize medication adherence in older patients . Future studies should explore suggestive strategies , such as tailored interventions involving ongoing contact , and should endeavor to correct method ologic weaknesses found in the literature Background Community services are playing an increasing role in supporting older adults who are discharged from hospital with ongoing non-acute care needs . However , there is a paucity of information regarding how community services are involved in the discharge process of older individuals from hospital into the community . Methods Twenty-nine data bases were search ed from 1980 to 2012 ( inclusive ) for relevant primary published research , of any study design , as well as relevant unpublished work ( e.g. clinical guidelines ) which investigated community services ' involvement in the discharge of older individuals from hospital into the community . Data analysis and quality appraisal ( using McMaster critical appraisal tools ) were undertaken predominately by the lead author . Data was synthesis ed qualitatively . Results Twelve papers were eligible for inclusion ( five r and omised controlled trials , four before and after studies and three controlled trials ) , involving a total of 8440 older adults ( > 65 years ) . These papers reported on a range of interventions . During data synthesis , descriptors were assigned to four emergent discharge methods :  Virtual Interface Model , In-reach Interface Model , Out-reach Interface Model and  Independent Interface Model . In each model , the findings were mixed in terms of health care and patient and carer outcomes . Conclusions It is plausible that each model identified in this systematic review has a role to play in successfully discharging different cohorts of older adults from hospital . Further research is required to identify appropriate population groups for various discharge models and to select suitable outcome measures to determine the effectiveness of these models , considering all stakeholders ' involved BACKGROUND Despite yoga 's popularity , few clinical trials have employed rigorous methodology to systematic ally explore its functional benefits compared with more established forms of exercise . The objective of this study was to compare the functional benefits of yoga with the conventional stretching-strengthening exercises recommended for adults . METHODS Sedentary healthy adults ( N = 118 ; M age = 62.0 ) participated in an 8-week ( three times a week for 1 hour ) r and omized controlled trial , which consisted of a Hatha yoga group ( n = 61 ) and a stretching-strengthening exercise group ( n = 57 ) . St and ardized functional fitness tests assessing balance , strength , flexibility , and mobility were administered at baseline and postintervention . RESULTS A repeated measures multivariate analysis of variance showed a significant time effect for measures of balance [ F(3,18 ) = 4.88 , p < .01 , partial η(2 ) = .45 ] , strength [ F(2,19 ) = 15.37 , p < .001 , partial η(2 ) = .62 ] , flexibility [ F(4,17 ) = 8.86 , p < .001 , partial η(2 ) = .68 ] , and mobility [ F(2,19 ) = 8.54 , p < .002 , partial η(2 ) = .47 ] . Both groups showed significant improvements on measures of balance ( left-right leg and four square step ) ; strength ( chair st and s and arm curls ) ; flexibility ( back scratch and sit- and -reach ) ; and mobility ( gait speed and 8-feet up and go ) , with partial η(2 ) ranging from .05 to .47 . CONCLUSIONS These data suggest that regular yoga practice is just as effective as stretching-strengthening exercises in improving functional fitness . To our knowledge , this is the first study to examine functional benefits of yoga in comparison with stretching-strengthening exercises in sedentary , healthy , community-dwelling older adults . These findings have clinical implication s as yoga is a more amenable form of exercise than strengthening exercises as it requires minimal equipment and can be adapted for individuals with lower levels of functioning or disabilities OBJECTIVES To determine the long-term effects of three strength and balance exercise interventions on physical performance , fall-related psychological outcomes , and falls in older people . DESIGN A single-blinded , four-group , r and omized controlled trial . SETTING Community , Germany . PARTICIPANTS Community-dwelling adults aged 70 to 90 who had fallen in the past 6 months or reported fear of falling . INTERVENTION After baseline assessment , 280 participants were r and omly assigned to the control group ( CG ; no intervention ; n = 80 ) or one of three strength and balance exercise interventions ( the strength and balance group ( SBG ; strength and balance only ; n = 63 ) , the fitness group ( FG ; strength and balance plus endurance training ; n = 64 ) , or the multifaceted group ( MG ; strength and balance plus fall risk education ; n = 73 ) . The interventions consisted of 32 one-hour group sessions in 16 weeks . MEASUREMENTS Data on physical performance , fall-related psychological outcomes , and falls were collected for 24 months . RESULTS Mixed-effects regression analyses showed improved short- and long-term ( 12 and 24 months , respectively ) physical performance for the SBG and FG , particularly regarding mobility , balance , and walking speed ( P < .05 ) . The improvements in physical performance outcomes were most prominent in the FG . Fall-related psychological outcomes , number of falls , and injurious falls were not significantly different from in the control group . CONCLUSION Training focusing on strength , balance , and endurance can enhance physical performance for up to 24 months in community-dwelling older adults . These findings did not translate to improved fall-related psychological outcomes or reduced incidence of falls . This demonstrates the need for a different approach ( e.g. , regarding intervention dose and components ) to gain intervention benefits in the multiple domains that contribute to independence and well-being in older adults IMPORTANCE In older adults reduced mobility is common and is an independent risk factor for morbidity , hospitalization , disability , and mortality . Limited evidence suggests that physical activity may help prevent mobility disability ; however , there are no definitive clinical trials examining whether physical activity prevents or delays mobility disability . OBJECTIVE To test the hypothesis that a long-term structured physical activity program is more effective than a health education program ( also referred to as a successful aging program ) in reducing the risk of major mobility disability . DESIGN , SETTING , AND PARTICIPANTS The Lifestyle Interventions and Independence for Elders ( LIFE ) study was a multicenter , r and omized trial that enrolled participants between February 2010 and December 2011 , who participated for an average of 2.6 years . Follow-up ended in December 2013 . Outcome assessors were blinded to the intervention assignment . Participants were recruited from urban , suburban , and rural communities at 8 centers throughout the United States . We r and omized a volunteer sample of 1635 sedentary men and women aged 70 to 89 years who had physical limitations , defined as a score on the Short Physical Performance Battery of 9 or below , but were able to walk 400 m. INTERVENTIONS Participants were r and omized to a structured , moderate-intensity physical activity program ( n = 818 ) conducted in a center ( twice/wk ) and at home ( 3 - 4 times/wk ) that included aerobic , resistance , and flexibility training activities or to a health education program ( n = 817 ) consisting of workshops on topics relevant to older adults and upper extremity stretching exercises . MAIN OUTCOMES AND MEASURES The primary outcome was major mobility disability objective ly defined by loss of ability to walk 400 m. RESULTS Incident major mobility disability occurred in 30.1 % ( 246 participants ) of the physical activity group and 35.5 % ( 290 participants ) of the health education group ( hazard ratio [ HR ] , 0.82 [ 95 % CI , 0.69 - 0.98 ] , P = .03).Persistent mobility disability was experienced by 120 participants ( 14.7 % ) in the physical activity group and 162 participants ( 19.8 % ) in the health education group ( HR , 0.72 [ 95 % CI , 0.57 - 0.91 ] ; P = .006 ) . Serious adverse events were reported by 404 participants ( 49.4 % ) in the physical activity group and 373 participants ( 45.7 % ) in the health education group ( risk ratio , 1.08 [ 95 % CI , 0.98 - 1.20 ] ) . CONCLUSIONS AND RELEVANCE A structured , moderate-intensity physical activity program compared with a health education program reduced major mobility disability over 2.6 years among older adults at risk for disability . These findings suggest mobility benefit from such a program in vulnerable older adults . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01072500 Introduction . Fall prevention is important for maintaining mobility and independence into old age . Approaches for reducing falls include exercise , tai chi , and home modifications ; however , causes of falling are multifactorial and include not just physical but cognitive factors . Cognitive decline occurs with age , but older adults with the greatest declines in executive function experience more falls . The purpose of this study was twofold : to demonstrate the feasibility of a community-based cognitive training program for cognitively intact Black older adults and to analyze its impact on gait and balance in this population . Method . This pilot study used a pretest/posttest r and omized trial design with assignment to an intervention or control group . Participants assigned to the intervention completed a computer-based cognitive training class that met 2 days a week for 60 min over 10 weeks . Classes were held at senior/community centers . Primary outcomes included balance as measured by the Berg Balance Scale ( BBS ) , 10-meter gait speed , and 10-meter gait speed under visuospatial dual-task condition . All measures were assessed at baseline and immediately post-intervention . Results . Participants were community-dwelling Black adults with a mean age of 72.5 and history of falls ( N = 45 ) . Compared to controls , intervention participants experienced statistically significant improvements in BBS and gait speed . Mean performance on distracted gait speed also improved more for intervention participants compared to controls . Conclusion . Findings from this pilot r and omized trial demonstrate the feasibility of a community-based cognitive training intervention . They provide initial evidence that cognitive training may be an efficacious approach toward improving balance and gait in older adults known to have a history of falls PURPOSE To examine how cognitive speed of processing training affects driving mobility across a 3-year period among older drivers . DESIGN AND METHODS Older drivers with poor Useful Field of View ( UFOV ) test performance ( indicating greater risk for subsequent at-fault crashes and mobility declines ) were r and omly assigned to either a speed of processing training or a social and computer contact control group . Driving mobility of these 2 groups was compared with a group of older adults who did not score poorly on the UFOV test ( reference group ) across a 3-year period . RESULTS Older drivers with poor UFOV test scores  who did not receive training experienced greater mobility declines as evidence d by decreased driving exposure and space and increased driving difficulty at 3 years . Those at risk for mobility decline who received training did not differ across the 3-year period from older adults in the reference group with regard to driving exposure , space , and most aspects of driving difficulty . IMPLICATION S Cognitive speed of processing training can not only improve cognitive performance but also protect against mobility declines among older drivers . Scientifically proven cognitive training regimens have the potential to enhance the everyday lives of older adults
Commonly measured constructs of mobility included walking , climbing stairs , and lower extremity function .
There was heterogeneity in ways of defining and measuring mobility limitation in older adults living in the community .
Mobility is critical in maintaining independence in older adults .
This study aims to systematic ally review the scientific literature to identify measures of mobility limitation for community-dwelling older adults .